Xu H, Rossi M, Campbell K L, Sencion G L, Ärnlöv J, Cederholm T, Sjögren P, Risérus U, Lindholm B, Carrero J J
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Centre for Kidney Disease Research, Princess Alexandra Hospital, Brisbane, Australia; Division of Diabetes and Nutritional Sciences, King's College, London, United Kingdom.
Nutr Metab Cardiovasc Dis. 2016 Jul;26(7):597-602. doi: 10.1016/j.numecd.2016.02.016. Epub 2016 Mar 8.
The elevated cardiovascular (CVD) risk observed in chronic kidney disease (CKD) may be partially alleviated through diet. While protein intake may link to CVD events in this patient population, dietary fiber has shown cardioprotective associations. Nutrients are not consumed in isolation; we hypothesize that CVD events in CKD may be associated with dietary patterns aligned with an excess of dietary protein relative to fiber.
Prospective cohort study from the Uppsala Longitudinal Study of Adult Men. Included were 390 elderly men aged 70-71 years with CKD and without clinical history of CVD. Protein and fiber intake, as well as its ratio, were calculated from 7-day dietary records. Cardiovascular events were registered prospectively during a median follow-up of 9.1 (inter-quartile range, 4.5-10.7) years. The median dietary intake of protein and fiber was 66.7 (60.7-71.1) and 16.6 (14.5-19.1) g/day respectively and the protein-to-fiber intake ratio was 4.0 (3.5-4.7). Protein-to-fiber intake ratio was directly associated with serum C-reactive protein levels. During follow-up, 164 first-time CVD events occurred (incidence rate 54.5/1000 per year). Protein-fiber intake ratio was an independent risk factor for CVD events [adjusted hazard ratio, HR per standard deviation increase (95% confidence interval, CI) 1.33 (1.08, 1.64)]. Although in opposing directions, dietary protein [1.18 (0.97, 1.44)], dietary fiber alone [0.81 (0.64, 1.02)], were not significantly associated with CVD events.
An excess of dietary protein relative to fiber intake was associated with the incidence of cardiovascular events in a homogeneous population of older men with CKD.
慢性肾脏病（CKD）患者心血管疾病（CVD）风险升高，饮食调整或许能部分降低该风险。蛋白质摄入可能与这类患者的CVD事件相关，而膳食纤维已显示出对心脏的保护作用。营养素并非孤立摄入；我们推测，CKD患者的CVD事件可能与蛋白质摄入量相对于膳食纤维过量的饮食模式有关。
来自乌普萨拉成年男性纵向研究的前瞻性队列研究。纳入390名年龄在70 - 71岁、患有CKD且无CVD临床病史的老年男性。根据7天饮食记录计算蛋白质和纤维摄入量及其比例。在中位随访9.1年（四分位间距4.5 - 10.7年）期间前瞻性记录心血管事件。蛋白质和纤维的中位饮食摄入量分别为66.7（60.7 - 71.1）克/天和16.6（14.5 - 19.1）克/天，蛋白质与纤维摄入量之比为4.0（3.5 - 4.7）。蛋白质与纤维摄入量之比与血清C反应蛋白水平直接相关。随访期间，发生164例首次CVD事件（发病率54.5/1000人年）。蛋白质 - 纤维摄入量之比是CVD事件的独立危险因素[调整后风险比，每标准差增加的HR（95%置信区间，CI）为1.33（1.08，1.64）]。尽管方向相反，但饮食蛋白质[1.18（0.97，1.44）]、单独的膳食纤维[0.81（0.64，1.02）]与CVD事件无显著关联。
在患有CKD的老年男性同质人群中，相对于纤维摄入量而言，过量的饮食蛋白质与心血管事件的发生率相关。
