Impact of early-life diet on long-term renal health

Abstract

In the last years, great advances have been made in the effort to understand how nutritional influences can affect long-term renal health. Evidence has accumulated that maternal nutrition before and during pregnancy and lactation as well as early postnatal nutrition is of special significance. In this review, we summarize epidemiologic and experimental data on the renal effects of perinatal exposure to energy restriction, low-protein diet, high-fat diet, high-fructose diet, and high- and low-salt diet as well as micronutrient deficiencies. Interestingly, different modifications during early-life diet may end up with similar sequelae for the offspring. On the other hand, molecular pathways can be influenced in opposite directions by different dietary interventions during early life. Importantly, postnatal nutrition significantly modifies the phenotype induced by maternal diet. Sequelae of altered macro- or micronutrient intakes include altered nephron count, blood pressure dysregulation, altered sodium handling, endothelial dysfunction, inflammation, mitochondrial dysfunction, and oxidative stress. In addition, renal prostaglandin metabolism as well as renal AMPK, mTOR, and PPAR signaling can be affected and the renin-angiotensin-aldosterone system may be dysregulated. Lately, the influence of early-life diet on gut microbiota leading to altered short chain fatty acid profiles has been discussed in the etiology of arterial hypertension. Against this background, the preventive and therapeutic potential of perinatal nutritional interventions regarding kidney disease is an emerging field of research. Especially individuals at risk (e.g., newborns from mothers who suffered from malnutrition during gestation) could disproportionately benefit from well-targeted dietary interventions.

Early life factors in relation to albuminuria and estimated glomerular filtration rate based on cystatin C and creatinine in adults from a Swedish population-based cohort study

“…These findings highlight the importance of postnatal risk factors, e.g. over-nutrition [ 44 ], for the long-term kidney outcomes. Surprisingly, subjects born with low birth weight and the higher BMI gained during the first 20 years of life (the mismatch phenotype), did not have lower eGFR compared to the reference group.…”

A Scoping Review of Life-Course Psychosocial Stress and Kidney Function

“…Specifically, regarding kidney development, nephrogenesis culmination between gestational weeks 34 and 36, together with nephron maturation in the early postnatal period, are critical windows of susceptibility [ 9 ]. Several studies demonstrated that low birth weight (<2500 g), prematurity and delayed intrauterine growth are associated with CKD in adulthood, secondary to elevated blood pressure, microalbuminuria presence and reduced estimate glomerular filtration rate [ 50 , 51 ], because low birth weight correlates linearly with nephron number in children and adults [ 12 , 52 ].…”

Educational Review: The Impact of Perinatal Oxidative Stress on the Developing Kidney

“…After birth, there is a critical window in which the nutritional and postnatal environmental exposures can influence nephrogenesis. Growth trajectories and neonatal nutrition are known to contribute to the developmental programming of nephron endowment, insulin resistance and cardiovascular and renal disease in later life (153)(154)(155).…”

“…Accelerated postnatal growth in preterm infants, whether small or appropriate for gestational age, contributes to the precocious development of the metabolic syndrome with insulin resistance in early childhood, which is further confounded by excessive adiposity ( 155 , 156 ). This, in turn, contributes to the early progression of CKD, especially in those born preterm with low nephron endowment ( 157 – 159 ).…”

“…The early neonatal nutritional prescription is of paramount influence on kidney development and will be a major determinant of cardiovascular and renal health for the entire life course. The macronutrient and micronutrient (vitamin and mineral supplements) distributions require close review and planning ( 155 , 157 ). The adverse long-term effects of perinatal exposure to excessive carbohydrate energy, low protein diet, high fat diet, high fructose diet, high and low salt diets, as well as micronutrient deficiencies have been documented in human and laboratory studies ( 155 , 157 ).…”