Low Protein Intake in the Population: Low Risk of Kidney Function Decline but High Risk of Mortality

Cirillo, Massimo; Cavallo, Pierpaolo; Bilancio, Giancarlo; Lombardi, Cinzia; Vagnarelli, Oscar Terradura; Laurenzi, Martino

doi:10.1053/j.jrn.2017.11.004

Cited by 14 publications

(20 citation statements)

References 31 publications

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“…In our study, we observed that a protein intake of less than 0.8 g/kg/day was associated with an increased risk of mortality in subjects with or without albuminuria (Table 3). Our findings were in line with previous reports 29,30 . Moreover, the increase in mortality risk remained significant after adjustment for relevant risk factors and diet quality (HEI‐2010 total score; Table 3).…”

Section: Discussionsupporting

confidence: 92%

Effect of low‐protein intake on all‐cause mortality in subjects with an estimated glomerular filtration rate higher than 60 mL/min/1.73 m²with or without albuminuria

Lee¹,

Liu

Wang

2020

Int J Clin Pract

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Background We aimed to investigate the effect of a low‐protein intake on all‐cause mortality in subjects with an estimated glomerular filtration rate (eGFR) ≧60 mL/min/1.73 m2 with or without albuminuria using data from the National Health and Nutrition Examination Survey (NHANES). Methods We analysed participants in the NHANES from 2003 to 2010. We excluded participants with an eGFR less than 60 mL/min/1.73 m2 from the analyses. Low‐protein intake was defined as a protein intake of less than 0.8 g/kg/day. The Healthy Eating Index 2010 was used to assess diet quality. The vital status of all participants in the NHANES was determined by linking to the National Death Index through the end of 2011. The hazard ratios (HRs) for the association of low‐protein intake and mortality were determined using weighted Cox proportional hazards regression models. Results A total of 7730 participants were included in the analyses. After a median follow up of 4.7 years, 462 participants died. A low‐protein intake was associated with a higher risk of mortality (HRs 1.394, 95% CI 1.121‐1.734, P = .004) with adjustment for diet quality and relevant risk factors. The higher risk of mortality associated with a low‐protein intake was consistent in subjects with or without albuminuria (P interaction .280). Conclusion A protein intake of less than 0.8 g/kg/day was associated with a higher risk of mortality in subjects with an eGFR ≧60 mL/min/1.73 m2, irrespective of whether they had albuminuria.

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Section: Discussionsupporting

confidence: 92%

Effect of low‐protein intake on all‐cause mortality in subjects with an estimated glomerular filtration rate higher than 60 mL/min/1.73 m²with or without albuminuria

Lee¹,

Liu

Wang

2020

Int J Clin Pract

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“…One article that combined mortality and ischaemic heart disease as the outcome was also excluded 38. Another paper that had considered urine urea nitrogen as a surrogate index of protein intake and reported the hazard ratio for mortality across categories of overnight urine urea nitrogen was excluded 39. One article that had considered total dietary patterns40 and three with insufficient data414243 were also excluded.…”

Section: Resultsmentioning

confidence: 99%

“… 38 Another paper that had considered urine urea nitrogen as a surrogate index of protein intake and reported the hazard ratio for mortality across categories of overnight urine urea nitrogen was excluded. 39 One article that had considered total dietary patterns 40 and three with insufficient data 41 42 43 were also excluded. In one study, the type of protein intake was assessed rather than amount in relation to mortality and was therefore excluded.…”

Section: Resultsmentioning

confidence: 99%

Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies

Naghshi

Sadeghi

Willett

et al. 2020

BMJ

199

134

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ObjectiveTo examine and quantify the potential dose-response relation between intake of total, animal, and plant protein and the risk of mortality from all causes, cardiovascular disease, and cancer.DesignSystematic review and meta-analysis of prospective cohort studies.Data sourcesPubMed, Scopus, and ISI Web of Science until December 2019, and references of retrieved relevant articles.Study selectionProspective cohort studies that reported the risk estimates for all cause, cardiovascular, and cancer mortality in adults aged 18 or older.Data synthesisRandom effects models were used to calculate pooled effect sizes and 95% confidence intervals for the highest versus lowest categories of protein intake and to incorporate variation between studies. Linear and non-linear dose-response analyses were done to evaluate the dose-response relations between protein intake and mortality.Results32 prospective cohort studies were included in the systematic review and 31 in the meta-analysis. During the follow-up period of 3.5 to 32 years, 113 039 deaths (16 429‬ from cardiovascular disease and 22 303‬ from cancer) occurred among 715 128 participants. Intake of total protein was associated with a lower risk of all cause mortality (pooled effect size 0.94, 95% confidence interval 0.89 to 0.99, I2=58.4%, P<0.001). Intake of plant protein was significantly associated with a lower risk of all cause mortality (pooled effect size 0.92, 95% confidence interval 0.87 to 0.97, I2=57.5%, P=0.003) and cardiovascular disease mortality (pooled hazard ratio 0.88, 95% confidence interval 0.80 to 0.96, I2=63.7%, P=0.001), but not with cancer mortality. Intake of total and animal protein was not significantly associated with risk of cardiovascular disease and cancer mortality. A dose-response analysis showed a significant inverse dose-response association between intake of plant protein and all cause mortality (P=0.05 for non-linearity). An additional 3% energy from plant proteins a day was associated with a 5% lower risk of death from all causes.ConclusionsHigher intake of total protein was associated with a lower risk of all cause mortality, and intake of plant protein was associated with a lower risk of all cause and cardiovascular disease mortality. Replacement of foods high in animal protein with plant protein sources could be associated with longevity.

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“…Three epidemiologic studies reported longitudinal data on the association of protein intake with changes in kidney function over time: The Nurses’ Health study, the Prevention of Renal and Vascular End-stage Disease (PREVEND) study, and the Gubbio Study [11,12,13]. The design of all these three studies consisted of two exams: The first exam for baseline assessment of protein intake and kidney function and the second exam for the assessment of kidney function change over baseline after long-term follow-up.…”

Section: Epidemiologic Studies On Dietary Protein and Kidney Functionmentioning

confidence: 99%

Dietary Protein, Kidney Function and Mortality: Review of the Evidence from Epidemiological Studies

Bilancio

Cavallo

Cirillo³

2019

Nutrients

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The World Health Organization recommends a minimum requirement of 0.8 g/day protein/kg ideal weight. Low protein diets are used against kidney failure progression. Efficacy and safety of these diets are uncertain. This paper reviews epidemiological studies about associations of protein intake with kidney function decline and mortality. Three studies investigated these associations; two reported data on mortality. Protein intake averaged >60 g/day and 1.2 g/day/kg ideal weight. An association of baseline protein intake with long-term kidney function decline was absent in the general population and/or persons with normal kidney function but was significantly positive in persons with below-normal kidney function. Independent of kidney function and other confounders, a J-curve relationship was found between baseline protein intake and mortality due to ≈35% mortality excess for non-cardiovascular disease in the lowest quintile of protein intake, a quintile where protein intake averaged <0.8 g/day/kg ideal weight. Altogether, epidemiological evidence suggests that, in patients with reduced kidney function, protein intakes of ≈0.8 g/d/kg ideal weight could limit kidney function decline without adding non-renal risks. Long-term lower protein intake could increase mortality. In most patients, an intake of ≈0.8 g/day/kg would represent a substantial reduction of habitual intake considering that average intake is largely higher.

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Low Protein Intake in the Population: Low Risk of Kidney Function Decline but High Risk of Mortality

Cited by 14 publications

References 31 publications

Effect of low‐protein intake on all‐cause mortality in subjects with an estimated glomerular filtration rate higher than 60 mL/min/1.73 m²with or without albuminuria

Effect of low‐protein intake on all‐cause mortality in subjects with an estimated glomerular filtration rate higher than 60 mL/min/1.73 m²with or without albuminuria

Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies

Dietary Protein, Kidney Function and Mortality: Review of the Evidence from Epidemiological Studies

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Low Protein Intake in the Population: Low Risk of Kidney Function Decline but High Risk of Mortality

Cited by 14 publications

References 31 publications

Effect of low‐protein intake on all‐cause mortality in subjects with an estimated glomerular filtration rate higher than 60 mL/min/1.73 m2with or without albuminuria

Effect of low‐protein intake on all‐cause mortality in subjects with an estimated glomerular filtration rate higher than 60 mL/min/1.73 m2with or without albuminuria

Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies

Dietary Protein, Kidney Function and Mortality: Review of the Evidence from Epidemiological Studies

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Product

Resources

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Effect of low‐protein intake on all‐cause mortality in subjects with an estimated glomerular filtration rate higher than 60 mL/min/1.73 m²with or without albuminuria

Effect of low‐protein intake on all‐cause mortality in subjects with an estimated glomerular filtration rate higher than 60 mL/min/1.73 m²with or without albuminuria