Association of Plant-Based Protein Intake with Cognitive Function in Adults with CKD

Abstract

Background Patients with chronic kidney disease (CKD) have accelerated cardiovascular and cognitive aging when compared to the non-CKD population. This cognitive decline contributes to excessive rates of physical and functional decline, reduced quality of life, and mortality in the CKD population. Mediterranean diets, a plant-forward diet, have been associated with positive cognitive performance in the general non-CKD population and with some beneficial outcomes in CKD. However, it is still unclear whether plant-based diets are associated with cognitive decline in patients with CKD. Methods Using the National Health and Nutrition Examination Survey (NHANES) 2011-2012 and 2013-14 data, we conducted a secondary analysis evaluating the relationship of plant-based and unprocessed plant protein with cognitive outcomes measures in eligible participants aged 60 years and older. All data was extracted from the available NHANES demographic, questionnaire, examination, and laboratory data. CKD was calculated and defined in participants as urine albumin to creatinine ratio ≥30mg/g and/or estimated glomerular filtration rate (eGFR) <60 mL/min). In incremental models, we adjusted for total energy intake, age, sex, race/ethnicity, body mass index (BMI), total energy intake, diabetes, hypertension, education, smoking, and alcohol. Results Higher plant-based protein above median dietary intakes were significantly associated with higher executive function scores in participants with CKD (p<0.05). For all subjects and in those with CKD, plant-based protein was significantly associated (p<0.05) with higher composite cognitive scores in nearly all statistical models. Higher unprocessed plant protein was significantly associated (p<0.05) with higher composite cognitive scores in all categorical models. Conclusions Higher plant protein intake was a significant predictor of certain individual and composite cognitive score measures within the general and in the CKD population. Future interventional trials are needed to determine if increasing plant-based protein intake improves measures of cognition in patients with CKD.