Vegetarian Diet Was Associated With a Lower Risk of Chronic Kidney Disease in Diabetic Patients

Abstract

IntroductionDiabetes mellitus (DM) is a pathological hyperglycemic state related to the dysregulation of insulin. Chronic kidney disease (CKD) is a common chronic complication in diabetic patients. A vegetarian diet could be one of the preventive strategies for the occurrence of CKD in patients with diabetes mellitus. However, it is still unknown whether a vegetarian diet lowers the occurrence of CKD in DM patients.Research Design and MethodsThis retrospective study was conducted at Taipei Tzu Chi Hospital from 5 September 2005 to 31 December 2016. Subjects with an HbA1c level > 6.5% or previous history of diabetes mellitus elder than 40 years were grouped based on self-reported dietary habits (vegetarians, lacto-ovo vegetarians and omnivores) in the structured questionnaire. Structural equation modeling (SEM) was applied to estimate the direct and indirect effects of variables on the occurrence of chronic kidney disease.ResultsAmong these 2,797 subjects, the participants were grouped into dietary habits as vegans (n = 207), lacto-ovo vegetarians (n = 941) and omnivores (n = 1,649). The incidence of overall CKD was higher in the omnivore group [36.6% vs 30.4% (vegans) and 28.5% (lacto-ovo vegetarian), p < 0.001]. In the SEM model, after adjusting for age and sex, the lacto-ovo vegetarian [OR: 0.68, 95% confidence interval (CI): 0.57–0.82] and vegan groups (OR 0.68, 95% CI: 0.49–0.94) were both associated with a lower risk of CKD occurrence than the omnivore group. The vegan diet and lacto-ovo diet lowered the risk related to a high BMI (OR: 0.45, p < 0.001, OR: 0.58, p < 0.001) and hyperuricemia (OR: 0.53, p < 0.001; OR: 0.55, p < 0.001) for the occurrence of CKD.ConclusionVegetarian dietary habits were associated with a lower occurrence of CKD in DM patients.

Vegan Diet Is Associated with a Lower Risk of Chronic Kidney Disease in Patients with Hyperuricemia

“…Similar to our study, Szeto et al found that vegetarians had lower uric acid concentrations than omnivores [ 12 ]. In addition, few studies have reported that lacto-ovo vegetarians have lower risks of hyperuricemia or gout [ 11 , 15 ]. Unlike our previous study [ 15 ], a lacto-ovo vegetarian diet was not significantly linked to lower ORs for very high serum uric acid levels and CKD in patients with hyperuricemia.…”

“…All subjects completed structured dietary questionnaires [ 15 , 16 , 17 ] and underwent a comprehensive health examination. The dietary questionnaire on dietary practices in terms of type and duration as well as a quantitative food frequency questionnaire has been validated in previous studies [ 16 , 17 ].…”

“…Obesity in this Taiwanese adult population was defined as a BMI of >27 kg/m 2 (based on the criteria by Taiwan’s Ministry of Health and Welfare) [ 18 ]. The subjects were grouped according to their self-reported dietary habits as vegans (only consumed plant-based foods), lacto-ovo vegetarians (ate eggs and/or dairy products but no other animal products), and omnivores (ate both plant- and animal-based foods) [ 15 , 16 ]. Height, weight, and blood pressure were measured by using an electronic meter (SECA GM-1000, Seoul, Republic of Korea) and an automatic blood pressure machine (Welch Allyn 53000, New York, NY, USA), respectively.…”

“…The eGFR was calculated by using the equation from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) [ 19 ]. We evaluated urine protein semi-quantitatively with a dipstick test (AX-4030, Arkray Inc., Tokyo, Japan), as we described previously [ 15 ]. Proteinuria was classified into 6 ordinal categories: absent (<10 mg/dL), trace (10 to 30 mg/dL), 1+ (30 mg/dL), 2+ (100 mg/dL), 3+ (300 mg/dL), or 4+ (1000 mg/dL).…”

The effect of vegetarian diet on chronic kidney disease (CKD) progression – systematic review

“…Considering the patients with diagnosed T2DM there is an even lower risk of CKD occurrence (OR: 0.68, 95% (CI): 0.57-0.82) for the lactoovo vegetarians and (OR 0.68, 95% CI: 0.49-0.94) for the vegan group (30). Moreover the control group tend to have more frequent incidence of proteinuria (27.7 vs 21.7% comparing to vegans and 20.5% in lacto-ovo vegetarian group, p < 0.001) (30) There is a signi cant difference between the lacto-ovo-vegetarian diet (VD) and Mediterranean diet (MD) with the mean difference of 4.2 mL/min/1.73 m² (p < 0.001) There is an 3.4 mL/min/1.73 m² increase between the initial and nal eGFR in a VD group. (Table 3).…”