Substituting red meat with alternate dietary proteins may reduce kidney disease risk
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While the consumption of greater quantities of red meat was associated with a higher incidence of chronic kidney disease, researchers from Iran suggest that making substitutions with other sources of dietary protein may reduce the risk.
“The role of dietary protein intake in the progression of kidney disease has always been a critical debate,” Parvin Mirmiran, PhD, of the Nutrition and Endocrine Research Center at Shahid Beheshti University of Medical Sciences, and colleagues wrote. “Decline of kidney function was noted with higher intake of animal protein but not plant protein, emphasizing the importance of protein sources rather than the quantity of them regarding adverse health consequences.”
The researchers contended that meat — described here as “a major source of protein in most diets” — has been demonstrated to have negative health outcomes in contrast to the “favorable effects” seen with plant-based proteins (including whole grains, nuts and legumes). They indicated that limited data exist on the impact of substituting these sources of protein for meat on CKD, most notably in developing nations.
To this end, Mirmiran and colleagues administered a food-frequency questionnaire to 4,881 adults without CKD who were participants in the Tehran Lipid and Glucose Study (mean age, 40.1 years; 47% were women).
The relationship between the consumption of total red meat and incident CKD was determined, with estimates calculated as to the impact of substituting one serving of total red meat with one serving of low-fat dairy, nuts, whole grains or legumes. Researchers noted the average intake of red meat was 1.17 servings per day. Adjustments were made for age, sex, smoking, total energy intake, triglycerides, BMI, physical activity, hypertension and diabetes.
After 3-year follow-up, there was a CKD incidence rate of 12.6%, with the researchers finding total red meat intake was associated with a 71% increased risk (odds ratio = 1.73, when comparing those in the highest quartile of consumption to those in the lowest). For processed red meat, they observed a 99% increased CKD risk (OR = 1.99) for participants in the highest compared with those in the lowest quartiles.
Substitution analyses revealed that replacing one serving of total red meat with one serving of low-fat dairy, nuts, whole grains and legumes was associated with a lower risk of incident CKD (17%, 16%, 21% and 19% lower risks, respectively).
In addition, the researchers found substituting one daily serving of unprocessed red meat with whole grains and nuts resulted in a 15% and 13.9% reduction in CKD risk, while replacing one serving of processed red meat with one serving of poultry, fish, low-fat dairy, nuts, whole grains and legumes also led to decreased odds of incident CKD (28%, 39%, 26%, 28%, 30% and 31%, respectively).
According to the researchers, the reduction in CKD risk with greater intake of plant-based foods may be due to the effects on cardiometabolic risk factors, including amelioration of blood lipid profiles, blood pressure, insulin hemostasis, oxidative stress, inflammatory markers and endothelial function.
They also suggested that “plant-based sources of proteins are rich in potassium, magnesium, calcium and vitamin C which were associated with the lower dietary acid load and subsequent improvement in kidney function.”
“Moreover,” they wrote, “dietary intake of poultry, fish, eggs or dairy products protects against onset or progression of CKD, and it might be due to the removal of red meat on the amelioration of fatty acid profile and reduced urinary albumin excretion.”
Perspective
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Brittany Sparks, RDN, CSR
This prospective study is not the first to show a positive relationship between decreased red meat intake and CKD incidence and progression. In a large subgroup analysis from a prospective population-based cohort by Lew and colleagues, they looked at 60,198 subjects for during a 15-year observation period and found similar results. They found that red meat intake was strongly associated with ESRD risk in a dose-dependent manner (Hazard ratio for highest quartile vs. lowest quartile 1.40 (95% CI, 1.15-1.71; P <.001). Substitution analysis from this study found that by replacing one serving of red meat with other protein food sources there was a max relative risk reduction of 62.4% of ESRD (95% CI, 33.1-78.9, P <.01).1
The above studies show that a reduction in red meat intake may offer a beneficial role for those with CKD and possibly help with CKD progression. Incorporation of more plant-based proteins and less red meat intake offer additional benefits aside from what the above two studies have found. Plant-based proteins compared to animal-based proteins provide less absorbable phosphorous, contribute a lower renal acid load, offer dietary fiber, provide more antioxidants and phytochemicals, and may contribute to less uremic toxins by promoting a healthy gut flora. All of these reasons are why as a private-practice renal dietitian I focus my education on the types of proteins being consumed in helping with CKD progression.
Reference:
Lew QLJ, et al. J Am Soc Nephrol. 2017;doi: 10.1681/ASN.2016030248.
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