Potential Role of Vegetarianism on Nutritional and Cardiovascular Status in Taiwanese Dialysis Patients: A Case-Control Study

Abstract

Background & ObjectivesCardiovascular disease remains the most common cause of death for patients on chronic dialysis. End stage renal disease patients undergoing dialysis imposed to reduce phosphorus intake, which likely contributes to development of vegetarian diet behaviors. Vegetarian diets are often lower in protein content, in contradiction to the recommendation that a high protein diet is followed by patients undergoing dialysis. The purpose of the study was to investigate the effects of a vegetarian diet on the nutritional and cardiovascular status of dialysis patients.Design, Setting, Participants, MeasurementsA study of 21 vegetarian dialysis patients and 42 age- and sex-matched non-vegetarian dialysis patients selected as controls was conducted in the Kaohsiung Veterans General Hospital. Brachial-ankle pulse wave velocity and biochemistry data including total homocysteine levels, serum lipid profiles, high-sensitivity C-reactive protein, vitamin D levels, albumin, and normalized protein catabolic rate were measured.ResultsCompared with the non-vegetarian control group, vegetarian subjects had lower body weight, body mass index, serum phosphate, blood urea nitrogen, serum creatinine, vitamin D, uric acid, albumin, and normalized protein catabolic rate (p < 0.05). The vegetarian group showed higher brachial-ankle pulse wave velocity than the non-vegetarian group (1926.95 ± 456.45 and 1684.82 ± 309.55 cm/sec, respectively, p < 0.05). After adjustment for age, albumin, pre-dialysis systolic blood pressure, and duration of dialysis, vegetarian diet remained an independent risk factor for brachial-ankle pulse wave velocity.ConclusionsThe present study revealed that patients on dialysis who follow vegetarian diets may experience subclinical protein malnutrition and vitamin D deficiency that could offset the beneficial cardiovascular effects of vegetarianism.

Systematic review and meta-analysis of the associations of vegan and vegetarian diets with inflammatory biomarkers

“…Main characteristics of the included 21 studies are summarized in Table 1 . Studies were conducted across 3 continents, most studies were conducted in Asia (12 studies 19 , 22 – 27 , 29 , 32 , 35 , 36 ), followed by Europe (6 studies 18 , 20 , 21 , 28 , 30 , 37 ) and South America (3 studies 17 , 33 , 34 ). All studies, with exception of one prospective study 29 , used a cross-sectional design.…”

Dietary Approaches in the Management of Diabetic Patients with Kidney Disease

“…While various markers of overnutrition, such as increased body mass index or high serum cholesterol levels, have shown deleterious effects upon cardiovascular disease and death in the general population, multiple observational studies have paradoxically shown survival benefit in dialysis patients [ 46 , 47 ]. Notably, in a Taiwanese study of 21 vegetarian dialysis patients and 42 age- and sex-matched non-vegetarian dialysis patients selected as controls, those who followed vegetarian diets demonstrated markers of subclinical protein malnutrition and vitamin D deficiency [ 48 ]. Indeed, monitored liberalization of protein intake is needed to ensure adequate dietary intake and prevention of PEW in diabetic ESRD patients receiving dialysis [ 49 ].…”

Managing protein‐energy wasting in hemodialysis patients: A comparison of animal‐ and plant‐based protein foods

“…For example, the impact of red meat on inflammation may be influenced by bowel function, iron and phosphorus status, presence and control of anemia, diabetes and hypertension, portion size and cut of meat, preparation and cooking method, and meal pairings. Epidemiological data in this area are limited, but in a cross‐sectional analysis of HD patients in Taiwan, high‐sensitivity C‐reactive protein concentrations did not differ between vegetarians and nonvegetarians …”

“…4 Inflammation pro- Epidemiological data in this area are limited, but in a cross-sectional analysis of HD patients in Taiwan, high-sensitivity C-reactive protein concentrations did not differ between vegetarians and nonvegetarians. 42 Although metabolic derangements are important dietary determinants of appetite and intake, other dietary factors may contribute to HD patients' impaired dietary intakes. One of the key factors determining dietary intake is pleasure.…”