Omnivorous low-protein diet for CKD shows superior essential amino acid, nutrient levels
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Compared with vegan and lacto-ovo low-protein diets for those with chronic kidney disease, an omnivorous low-protein diet is less likely to be deficient in essential amino acids and nutrients, findings in the Journal of Renal Nutrition show.
Further, researchers recommend vegan and lacto-ovo low-protein diets (LPD) are carefully planned for patients with CKD to include necessary amounts of amino acids and nutrients, which can sometimes be achieved through supplements.
“Although the potential health and environmental benefits of plant-based diets have been discussed in a number of publications, the question of whether lacto-ovo vegetarian diets, and particularly vegan LPDs, are likely to be nutritionally adequate has not been well examined. Moreover, there are few studies of whether omnivorous, lacto-ovo vegetarian, or vegetarian diets provide adequate amounts of all essential nutrients, especially when the protein content of the diets is restricted,” Dina A. Tallman, PhD, RD, from the department of nutrition and food science at Wayne State University in Detroit, and colleagues wrote. They added, “The purpose of the present study was to examine whether the omnivorous, lacto-ovo vegetarian, and vegan LPDs that are likely to be prescribed for CKD patients are prone to be deficient in any essential macronutrients or micronutrients.”
Using current renal dietary guidelines from the Nutrition Care Manual of the Academy of Nutrition and Dietetics in the U.S., a registered dietitian created three theoretical 3-day menus to model omnivorous, lacto-ovo vegetarian and vegan LPDs at seven different levels of protein consumption (0.5-1.2 grams/kilograms body weight/day [g/kg/day]). All meal plans included at least 50% of high biological value protein for the omnivorous and lacto-ovo vegetarian diets.
Further, researchers also conducted a substitution analysis to determine if a different combination of less commonly eaten plant proteins and grains would significantly change the essential amino acids profile.
Ultimately, all three diets failed to meet the recommended dietary allowances (RDA) for the following essential amino acids: histidine, leucine, lysine and threonine. While the omnivorous LPD achieved the RDA and estimated average requirement at levels 0.6 g protein/kg/day or greater, the lacto-ovo and vegan diets were below the RDA for lysine at 0.6 g protein/kg/day and 0.8 g protein/kg/day, respectively.
Tallman and colleagues wrote, “The findings from this study indicate that for a 70-kg person, LPDs ranging from 0.5 [g protein/kg/day to] 0.8 g protein/kg/day, which are commonly prescribed for CKD patients in the United States, and which provided 30 kcals/kg/[day], were deficient in certain essential nutrients.” Therefore, supplements may need to be prescribed.
However, because supplements are not always available in the U.S., researchers recommended diets and prescribed protein intake must be carefully planned.
“For example, for both vegan and lacto-ovo vegetarian diets containing less than 0.8 g protein/kg/[day], it is recommended that efforts be made to ensure that the diets include adequate amounts of lysine- and methionine-rich foods,” Tallman and colleagues wrote. They added, “CKD patients prescribed LPDs should also have their intake of calcium and magnesium monitored. Additionally, to preclude the possibility of deficiency in vitamins or trace elements, offering nutritional supplements, most importantly vitamin B6, folate, zinc, calcitriol and calcium, should be considered for all CKD patients prescribed diets providing 0.8 g protein/kg/day or less. Unless further research provides evidence to the contrary, all advanced CKD and chronic dialysis patients should receive supplements of vitamin B6 (pyridoxine hydrochloric acid).”
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