Dietary protein score and carbohydrate quality index with the risk of chronic kidney disease: Findings from a prospective cohort study

Abstract

Background/AimThis study aimed to examine the associations between dietary protein score and carbohydrate quality index (CQI) and the risk of chronic kidney disease (CKD) in Iranian adults.MethodsThis population-based cohort study was performed within the Tehran Lipid and Glucose Study framework on 6,044 subjects aged ≥18 years old, who were followed up for a mean of 7.7 years. Dietary protein score and CQI were determined using a food frequency questionnaire. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2. A multivariate Cox proportional hazard regression model was used to estimate the risk of CKD across tertiles of protein score and CQI.ResultsThe mean (standard deviation) of age and body mass index of participants were 37.9 (12.8) years and 26.8 (4.7) kg/m2, respectively. During the 7.7 ± 2.7 years of follow-up, 1,216 cases (20.1%) of CKD were ascertained. In the final adjusted model, individuals in the highest tertile of protein score had decreased risk of CKD (HR: 0.85, 95% CI: 0.74–0.98, Ptrend = 0.033). Also, there is a significant association between total carbohydrate score (HR: 0.85, 95% CI: 0.73–0.99, Ptrend = 0.016), the ratio of whole grain/total grains (HR: 0.81, 95% CI: 0.70–0.94, Ptrend = 0.004), and glycemic index (HR: 1.30, 95% CI: 1.12–1.51, Ptrend < 0.001) and risk of CKD. However, no significant association was found between total protein intakes, plant-to-animal ratio, and solid carbohydrate/total carbohydrate with the risk of CKD.ConclusionOur results revealed a diet with a high protein score and high quality of carbohydrates, characterized by higher intakes of plant proteins, low glycaemic index (GI) carbohydrates, whole grain, fibers, and lower intakes of animal proteins, can be related to reduced CKD risk.

Sugar types, genetic predictors of the gut microbiome, and the risk of chronic kidney disease: a prospective cohort study

“…Few large observational studies have examined the associations of carbohydrate types and sources with the risk of CKD, and none have focused on specific sugar types in detail. 6,8 The findings of our study suggested that the intake of specific types of sugars may have diverging associations with CKD risk. We found that the consumption of free sugar was positively associated with incident CKD; whereas regarding non-free sugar intake, there was an inverse association.…”

“…Emerging nutritional epidemiological studies have explored the potential role of dietary carbohydrates in CKD risk and have increasingly suggested that the current focus on carbohydrate quantity should shift toward carbohydrate types or sources to obtain a greater benefit for CKD prevention. [6][7][8] As important forms of carbohydrates, free sugars (all monosaccharides and disaccharides added to foods by the manufac-turer, cook, or consumer, plus sugars naturally present in honey, syrups, and unsweetened fruit juices) and non-free sugars (all sugars excluded from the definition of free sugars, mostly naturally occurring in fruit, vegetables, and dairy products) have garnered increasing attention from various public health organizations that advocate for limiting free sugars for additional health benefits. 9,10 A large body of evidence has linked the intake of sugar-sweetened beverages (SSBs), the major source of free sugars, with a greater risk of CKD.…”

Macronutrients quality indices and risk of metabolic syndrome and its components in Iranian adults

“…Finally, with the sum of the scores of these two items, people get a score between 0 and 20, which is the higher score indicating a higher relative consumption of protein or higher PAR. For this purpose, the index components are also reported separately [ 16 ].…”

“…Recently, a novel protein score has been introduced to assess the quality and quantity of dietary protein intake, which combines both total protein and the plant-to-animal ratio (PAR) [ 15 ]. Although some studies may have shown the possible role of protein score in predicting the risk of chronic diseases [ 16 ], no study has yet examined the association between the dietary protein score and the risk of MetS.…”

“…Recently, the CHO quality index (CQI) as a scoring system that incorporates four attributes of CHO quality, namely dietary fiber, glycemic index (GI), whole grain/total grain ratio, and solid/total CHO (SCHO/TCHO) has been introduced to determine the quality and quantity of CHO in the diet [ 21 ]. Previous research has yielded interesting and valuable results and reported the possible relationship of a diet with high CQI with the reduced risk of chronic diseases, such as obesity [ 22 , 23 ], CVD [ 24 , 25 ], and chronic kidney disease (CKD) [ 16 ]. However, evidence on the possible association of CQI with the risk of MetS is limited to some cross-sectional studies that showed conflicting results [ 26 , 27 ].…”