Vegetarian Compared with Meat Dietary Protein Source and Phosphorus Homeostasis in Chronic Kidney Disease

Moe, Sharon M.; Zidehsarai, Miriam P.; Chambers, Mary; Jackman, Lisa; Radcliffe, J. S.; Trevino, Laurie L.; Donahue, S.; Asplin, John R.

doi:10.2215/cjn.05040610

Cited by 483 publications

(384 citation statements)

References 33 publications

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“…Similar findings have been reported elsewhere, with improvement in metabolic acidosis and phosphorus metabolism as possible mechanisms of action (41)(42)(43).…”

Section: Discussionsupporting

confidence: 90%

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

Khatri¹,

Moon

Scarmeas

et al. 2014

Clinical Journal of the American Society of Nephrology

116

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Background and objectives Various dietary strategies have been investigated to slow kidney function decline. However, it is unknown whether a Mediterranean diet, which has been associated with improved cardiovascular risk, is associated with change in kidney function.Design, setting, participants, & measurements This study used the Northern Manhattan Study, a prospective, multiethnic, observational cohort of participants who were stroke free at baseline. Data were collected between 1993 and 2008. Serum creatinine measurements were taken a mean 6.9 years apart. A baseline dietary questionnaire was extrapolated into a previously used 9-point scoring system (MeDi). The primary outcome was incident eGFR,60 ml/min per 1.73 m 2 using the Modification of Diet in Renal Disease formula. A secondary outcome was the upper quartile of annualized eGFR decline ($2.5 ml/min per 1.73 m 2 per year). Conditional logistic regression models adjusted for demographics and baseline vascular risk factors.Results Mean baseline age was 64 years, with 59% women and 65% Hispanics (N=900); mean baseline eGFR was 83.1 ml/min per 1.73 m 2 . Incident eGFR,60 ml/min per 1.73 m 2 developed in 14% . In adjusted models, every 1-point increase in the MeDi score, indicating increasing adherence to a Mediterranean diet, was associated with decreased odds of incident eGFR,60 ml/min per 1.73 m 2 (odds ratio, 0.83; 95% confidence interval, 0.71 to 0.96) and decreased odds of being in the upper quartile of eGFR decline (odds ratio, 0.88; 95% confidence interval, 0.79 to 0.98).Conclusions A Mediterranean diet was associated with a reduced incidence of eGFR,60 ml/min per 1.73 m 2 and upper quartile of eGFR decline in a multiethnic cohort.

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“…Similar findings have been reported elsewhere, with improvement in metabolic acidosis and phosphorus metabolism as possible mechanisms of action (41)(42)(43).…”

Section: Discussionsupporting

confidence: 90%

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

Khatri¹,

Moon

Scarmeas

et al. 2014

Clinical Journal of the American Society of Nephrology

116

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“…Nevertheless, in our study, patients showed a reduction of urinary P about 40% greater with VLpD compared with LpD, and the intense and fast reduction of P intake obtained with only 1 week of VLpD was sufficient to reduce FGF23 levels, which is contrary to what has been showed in healthy subjects (12,38-41) and CKD patients using phosphate binders (29,31). Moreover, the vegetarian diet allows a minor absorption of dietary phosphate because of a reduced bioavailability of phosphate contained in vegetables compared with meat and a reduced intestinal absorption, which was recently showed in the work by Moe et al (42) in a crossover trial of nine patients with moderate CKD.…”

Section: Discussioncontrasting

confidence: 58%

Acute Effects of Very-Low-Protein Diet on FGF23 Levels

Iorio¹,

Micco²,

Torraca³

et al. 2012

Clinical Journal of the American Society of Nephrology

104

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SummaryBackground and objectives High levels of fibroblast growth factor 23 are associated with mortality, CKD progression, and calcification in CKD patients. The aim of this pilot study is to assess whether a very-low-protein diet (0.3 g/kg per day) with a consequent low intake of phosphorus would reduce fibroblast growth factor 23 compared with a low-protein diet (0.6 g/kg per day) in CKD patients not yet on dialysis.Design, setting, participants, & measurements A prospective, randomized, controlled crossover study was performed in which 32 patients were randomized into two groups. Group A (16 patients) received a very-lowprotein diet (0.3 g/kg body wt per day) supplemented with ketoanalogues during the first week and a lowprotein diet during the second week, and group B (16 patients) received a low-protein diet during the first week and a very-low-protein diet during the second week. Fibroblast growth factor 23, seric, and urinary phosphate levels were measured at baseline and the end of each study period.Results After only 1 week of the very-low-protein diet, reductions in fibroblast growth factor 23 levels (33.5%), serum phosphate (12%), and urinary phosphate (34%) with the very-low-protein diet compared with the lowprotein diet were observed. Serum and urinary phosphate levels and protein intake were significant determinants of fibroblast growth factor 23 (95% confidence interval=1.04-1.19, 1.12-1.37, and 1.51-2.23, respectively).Conclusions A very-low-protein diet supplemented with ketoanalogues reduced fibroblast growth factor 23 levels in CKD patients not yet on dialysis.

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“…Blocking dietary phosphate absorption with phosphate binders may decrease FGF23 levels in patients with CKD (9)(10)(11), but the effects of reducing dietary phosphate intake have been less well studied and yielded inconsistent results (12)(13)(14). Additional limitations of the existing literature on FGF23 reduction in CKD include lack of information on the longerterm effectiveness of dietary interventions, sparse data on the efficacy of strategies based on outpatient dietary counseling that are feasible in usual clinical practice, and uncertainty about the effect of combining outpatient dietary counseling with phosphate binders.…”

Section: Introductionmentioning

confidence: 99%

Effects of Dietary Phosphate Restriction and Phosphate Binders on FGF23 Levels in CKD

Isakova

Barchi-Chung

Enfield

et al. 2013

Clinical Journal of the American Society of Nephrology

136

100

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SummaryBackground Elevated levels of fibroblast growth factor 23 (FGF23) are associated with increased risk of adverse outcomes in patients with CKD. Reducing dietary phosphate intake or absorption may decrease FGF23 levels, but data on the combined effects of dietary phosphate restriction and phosphate binders in CKD are limited.Design, setting, participants, & measurements In this 232 factorial, single-blinded, placebo-controlled, 3-month study, conducted between July 2009 and March 2012, 39 patients with CKD stages 3 or 4 and normal serum phosphate levels were randomly assigned to one of four groups: ad libitum diet plus lanthanum carbonate (LC) placebo (n=10), 900-mg phosphate diet plus LC placebo (n=10), ad libitum diet plus LC (n=11), or 900-mg phosphate diet plus LC (n=8). The dose of LC was 1000 mg three times daily with meals. Dietary restriction was accomplished with outpatient counseling. The primary end point was change in FGF23 levels from baseline.Results Compared with ad libitum diet, the 900-mg phosphate diet did not significantly reduce FGF23 levels (diet 3 time interaction, P=0.05). Compared with placebo, LC alone also did not significantly reduce FGF23 levels (LC 3 time interaction, P=0.21). However, the dual intervention significantly decreased FGF23 levels throughout the study period (diet 3 LC 3 time interaction, P=0.02), resulting in a 35% (95% confidence interval, 8%-62%) reduction by study end. ConclusionThe combination of LC plus counseling for a phosphate-restricted diet decreased FGF23 levels in patients with CKD stages 324 and normal serum phosphate levels.

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Vegetarian Compared with Meat Dietary Protein Source and Phosphorus Homeostasis in Chronic Kidney Disease

Cited by 483 publications

References 33 publications

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

Acute Effects of Very-Low-Protein Diet on FGF23 Levels

Effects of Dietary Phosphate Restriction and Phosphate Binders on FGF23 Levels in CKD

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