High Protein Intake Associates with Cardiovascular Events but not with Loss of Renal Function

Halbesma, Nynke; Bakker, Stephan J. L.; Jansen, Desiree; Stolk, Ronald P.; Zeeuw, Dick de; Jong, Paul E. de; Gansevoort, Ronald

doi:10.1681/asn.2008060649

Cited by 79 publications

(73 citation statements)

References 27 publications

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“…The evaluation of the association between protein intake and mortality among healthy individuals is based on seven prospective cohort studies with nine populations included (10–16), four papers quality graded as B (10, 14–16), and three papers quality graded as C (11–13) (see Appendix C, Table C2). Such an association might be expected as a result of a possible association between protein intake and cancer or cardiovascular diseases, as described in the following sections.…”

Section: Resultsmentioning

confidence: 99%

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Health effects of protein intake in healthy adults: a systematic literature review

Pedersen¹,

Kondrup²,

Børsheim³

2013

Food & Nutrition Research

108

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The purpose of this systematic review is to assess the evidence behind the dietary requirement of protein and to assess the health effects of varying protein intake in healthy adults. The literature search covered the years 2000–2011. Prospective cohort, case-control, and intervention studies were included. Out of a total of 5,718 abstracts, 412 full papers were identified as potentially relevant, and after careful scrutiny, 64 papers were quality graded as A (highest), B, or C. The grade of evidence was classified as convincing, probable, suggestive or inconclusive. The evidence is assessed as: probable for an estimated average requirement of 0.66 g good-quality protein/kg body weight (BW)/day based on nitrogen balance studies, suggestive for a relationship between increased all-cause mortality risk and long-term low-carbohydrate–high-protein (LCHP) diets; but inconclusive for a relationship between all-cause mortality risk and protein intake per se; suggestive for an inverse relationship between cardiovascular mortality and vegetable protein intake; inconclusive for relationships between cancer mortality and cancer diseases, respectively, and protein intake; inconclusive for a relationship between cardiovascular diseases and total protein intake; suggestive for an inverse relationship between blood pressure (BP) and vegetable protein; probable to convincing for an inverse relationship between soya protein intake and LDL cholesterol; inconclusive for a relationship between protein intake and bone health, energy intake, BW control, body composition, renal function, and risk of kidney stones, respectively; suggestive for a relationship between increased risk of type 2 diabetes (T2D) and long-term LCHP-high-fat diets; inconclusive for impact of physical training on protein requirement; and suggestive for effect of physical training on whole-body protein retention. In conclusion, the evidence is assessed as probable regarding the estimated requirement based on nitrogen balance studies, and suggestive to inconclusive for protein intake and mortality and morbidity. Vegetable protein intake was associated with decreased risk in many studies. Potentially adverse effects of a protein intake exceeding 20–23 E% remain to be investigated.

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Section: Resultsmentioning

confidence: 99%

“…In the Prevention of Renal and Vascular ENd-stage Disease (PREVEND) study (11), the focus was on mortality, cardiovascular events, and renal outcomes. The protein intake was calculated from two 24-h urinary urea excretions and expressed as protein intake in g/kg ‘ideal’ BW, i.e.…”

Section: Resultsmentioning

confidence: 99%

Health effects of protein intake in healthy adults: a systematic literature review

Pedersen¹,

Kondrup²,

Børsheim³

2013

Food & Nutrition Research

108

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“…9 In a community-based prospective cohort study conducted in 8,461 individuals, protein intake (estimated using 24-hour urinary urea excretion) was not associated with eGFR change over 7 years. 29 Conversely, a large prospective cohort study conducted in 6,213 participants with type 2 diabetes but no CKD showed an inverse association between protein intake and risk for CKD over 5.5 years; that is, lower protein intake was associated with increased risk for CKD. 30 Different from these prior observational studies, which often compared a higher intake of a particular food or nutrient with a lower intake, the present study compared dietary intake with dietary recommendations constructed depending on individuals' own estimated energy requirements that were calculated based on age, sex, and physical activity level (ie, levels of energy expenditure).…”

Section: Discussionmentioning

confidence: 99%

Dietary Guideline Adherence Index and Kidney Measures in the Framingham Heart Study

Jacques

Hwang

et al. 2016

American Journal of Kidney Diseases

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“…The short- and long-term study results showed no benefit, and possible harm, of very-low-protein diet [46]. In the prevention of renal and vascular end-stage disease (PREVEND) community cohort, there was no relationship between dietary protein intake and change in renal function [47]. …”

Section: Factors Affecting Trajectorymentioning

confidence: 99%

Renal Function Trajectory Is More Important than Chronic Kidney Disease Stage for Managing Patients with Chronic Kidney Disease

Rosansky¹

2012

Am J Nephrol

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Management of patients with chronic kidney disease (CKD) emphasizes a current level of function as calculated from the modification of diet in renal disease glomerulofiltration rate equations (eGFR) and proteinuria for staging of CKD. Change in a patient’s eGFR over time (renal function trajectory) is an additional and potentially more important consideration in deciding which patients will progress to the point where they will require renal replacement therapy (RRT). Many patients with CKD 3–5 have stable renal function for years. Proteinuria/albuminuria is a primary determinant of renal trajectory which may be slowed by medications that decrease proteinuria and/or aggressively lower blood pressure. A renal trajectory of >3 ml/min/1.73 m²/year may relate to a need for closer renal follow-up and increased morbidity and mortality. Additional CKD population-based studies need to examine the relationship of renal trajectory to: baseline renal function; acute kidney injury episodes; age, race, sex and primary etiologies of renal disease; blood pressure control and therapies; dietary protein intake; blood glucose control in diabetics and the competitive risk of death versus the requirement for renal replacement therapy. In the elderly CKD 4 population with significant comorbidities and slow decline in renal function, the likelihood of death prior to the need for RRT should be considered before placing AV access for dialysis. Prediction models of renal progression must account for the competitive risk of death as well as stable or improved renal function to be clinically useful.

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High Protein Intake Associates with Cardiovascular Events but not with Loss of Renal Function

Cited by 79 publications

References 27 publications

Health effects of protein intake in healthy adults: a systematic literature review

Health effects of protein intake in healthy adults: a systematic literature review

Dietary Guideline Adherence Index and Kidney Measures in the Framingham Heart Study

Renal Function Trajectory Is More Important than Chronic Kidney Disease Stage for Managing Patients with Chronic Kidney Disease

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