蛋白质摄入量对肾功能正常或轻度肾功能不全女性肾功能下降的影响。

The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency.

作者信息

Knight Eric L, Stampfer Meir J, Hankinson Susan E, Spiegelman Donna, Curhan Gary C

机构信息

Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

出版信息

Ann Intern Med. 2003 Mar 18;138(6):460-7. doi: 10.7326/0003-4819-138-6-200303180-00009.

DOI:10.7326/0003-4819-138-6-200303180-00009

PMID:12639078

Abstract

BACKGROUND

In individuals with moderate to severe renal insufficiency, low protein intake may slow renal function decline. However, the long-term impact of protein intake on renal function in persons with normal renal function or mild renal insufficiency is unknown.

OBJECTIVE

To determine whether protein intake influences the rate of renal function change in women over an 11-year period.

DESIGN

Prospective cohort study.

SETTING

Nurses' Health Study.

PARTICIPANTS

1624 women enrolled in the Nurses' Health Study who were 42 to 68 years of age in 1989 and gave blood samples in 1989 and 2000. Ninety-eight percent of women were white, and 1% were African American.

MEASUREMENTS

Protein intake was measured in 1990 and 1994 by using a semi-quantitative food-frequency questionnaire. Creatinine concentration was used to estimate glomerular filtration rate (GFR) and creatinine clearance.

RESULTS

In multivariate linear regression analyses, high protein intake was not significantly associated with change in estimated GFR in women with normal renal function (defined as an estimated GFR > or = 80 mL/min per 1.73 m2). Change in estimated GFR in this subgroup over the 11-year period was 0.25 mL/min per 1.73 m2 (95% CI, -0.78 to 1.28 mL/min per 1.73 m2) per 10-g increase in protein intake; the change in estimated GFR was 1.14 mL/min per 1.73 m2 (CI, -3.63 to 5.92 mL/min per 1.73 m2) after measurement-error adjustment for protein intake. In women with mild renal insufficiency (defined as an estimated GFR > 55 mL/min per 1.73 m2 but <80 mL/min per 1.73 m2), protein intake was significantly associated with a change in estimated GFR of -1.69 mL/min per 1.73 m2 (CI, -2.93 to -0.45 mL/min per 1.73 m2) per 10-g increase in protein intake. After measurement-error adjustment, the change in estimated GFR was -7.72 mL/min per 1.73 m2 (CI, -15.52 to 0.08 mL/min per 1.73 m2) per 10-g increase in protein intake, an association of borderline statistical significance. High intake of nondairy animal protein in women with mild renal insufficiency was associated with a significantly greater change in estimated GFR (-1.21 mL/min per 1.73 m2 [CI, -2.34 to -0.33 mL/min per 1.73 m2] per 10-g increase in nondairy animal protein intake).

CONCLUSIONS

High protein intake was not associated with renal function decline in women with normal renal function. However, high total protein intake, particularly high intake of nondairy animal protein, may accelerate renal function decline in women with mild renal insufficiency.

摘要

背景

在中重度肾功能不全患者中，低蛋白摄入可能会减缓肾功能衰退。然而，蛋白质摄入量对肾功能正常或轻度肾功能不全者肾功能的长期影响尚不清楚。

目的

确定蛋白质摄入量是否会在11年期间影响女性的肾功能变化率。

设计

前瞻性队列研究。

地点

护士健康研究。

参与者

1989年参加护士健康研究的1624名女性，年龄在42至68岁之间，并于1989年和2000年提供了血样。98%的女性为白人，1%为非裔美国人。

测量

1990年和1994年使用半定量食物频率问卷测量蛋白质摄入量。使用肌酐浓度来估计肾小球滤过率（GFR）和肌酐清除率。

结果

在多变量线性回归分析中，高蛋白摄入与肾功能正常女性（定义为估计GFR≥80 mL/（min·1.73 m²））的估计GFR变化无显著关联。在该亚组中，蛋白质摄入量每增加10克，11年期间估计GFR的变化为0.25 mL/（min·1.73 m²）（95%CI，-0.78至1.28 mL/（min·1.73 m²））；在对蛋白质摄入量进行测量误差调整后，估计GFR的变化为1.14 mL/（min·1.73 m²）（CI，-3.63至5.92 mL/（min·1.73 m²））。在轻度肾功能不全女性（定义为估计GFR>55 mL/（min·1.73 m²）但<80 mL/（min·1.73 m²））中，蛋白质摄入量与估计GFR每增加10克变化-1.69 mL/（min·1.73 m²）（CI，-2.93至-0.45 mL/（min·1.73 m²））显著相关。在对测量误差进行调整后，蛋白质摄入量每增加10克，估计GFR的变化为-7.72 mL/（min·1.73 m²）（CI，-15.52至0.08 mL/（min·1.73 m²）），该关联具有临界统计学意义。轻度肾功能不全女性中，非乳类动物蛋白的高摄入量与估计GFR的显著更大变化相关（非乳类动物蛋白摄入量每增加10克，估计GFR变化-1.21 mL/（min·1.73 m²）[CI，-2.34至-0.33 mL/（min·1.73 m²）]）。