Hung Shang-Li, Lin Ting-Yun, Hung Szu-Chun
School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
Division of Nephrology, Taipei Tzu Chi Hospital, New Taipei City, Taiwan.
J Am Nutr Assoc. 2025 Sep-Oct;44(7):651-660. doi: 10.1080/27697061.2025.2488366. Epub 2025 Apr 25.
The confluence of cardiovascular-kidney-metabolic (CKM) risk factors and chronic kidney disease (CKD) elevates the risk for adverse cardiovascular and kidney outcomes. Mounting evidence has emerged on the benefits of plant-based diets for CKD management. However, whether the benefits are mediated by improved CKM health are unclear. In addition, there remain concerns about the risk of malnutrition and hyperkalemia associated with plant-based diets. The objective of this study was to assess the relationship between adherence to healthy plant-based diets and CKM syndrome, nutritional status, and serum potassium levels in patients with nondialysis CKD stages 3-5.
A total of 147 patients (median age 66 years) with CKD (median eGFR 23.1 mL/min/1.73 m) were included. Responses to a food frequency questionnaire developed for the Asian population with CKD were used to calculate a healthy plant-based diet score (HPDS), which reflects higher consumption of plant foods and reduced intake of animal products and sugar. CKM risk factors included overweight/obesity, central obesity, high blood pressure, high triglycerides, and high blood glucose. Nutritional status was assessed using serum albumin and dietary energy and protein intake.
In logistic regression analyses, a higher HPDS was significantly associated with lower odds of all CKM risk factors and malnutrition. After adjusting for age, sex, comorbidities, lifestyle factors, and medications, a higher HPDS remained significantly linked to lower odds of overweight/obesity and central obesity, as well as higher odds of having a normal serum albumin level (≥ 3.8 g/dL), dietary protein intake (≥ 0.6 g/kg/day), and dietary energy intake (≥ 25 g/kg/day). No significant association was observed between HPDS and hyperkalemia.
In patients with moderate to advanced CKD, healthy plant-based diets were associated with a lower risk of CKM syndrome. Adherence to a healthy plant-based diet was more likely to achieve a better nutritional status and was not associated with risk of hyperkalemia.
心血管-肾脏-代谢（CKM）危险因素与慢性肾脏病（CKD）并存会增加不良心血管和肾脏结局的风险。越来越多的证据表明植物性饮食对CKD管理有益。然而，这些益处是否通过改善CKM健康状况来介导尚不清楚。此外，人们仍担心植物性饮食与营养不良和高钾血症风险有关。本研究的目的是评估非透析CKD 3-5期患者坚持健康植物性饮食与CKM综合征、营养状况和血清钾水平之间的关系。
共纳入147例CKD患者（中位年龄66岁）（中位估算肾小球滤过率[eGFR]为23.1 mL/min/1.73 m²）。对为亚洲CKD人群开发的食物频率问卷的回答用于计算健康植物性饮食评分（HPDS），该评分反映了植物性食物的较高摄入量以及动物性产品和糖的摄入量减少。CKM危险因素包括超重/肥胖、中心性肥胖、高血压、高甘油三酯和高血糖。使用血清白蛋白以及饮食能量和蛋白质摄入量评估营养状况。
在逻辑回归分析中，较高的HPDS与所有CKM危险因素和营养不良的较低几率显著相关。在调整年龄、性别、合并症、生活方式因素和药物治疗后，较高的HPDS仍与超重/肥胖和中心性肥胖的较低几率以及血清白蛋白水平正常（≥3.8 g/dL）、饮食蛋白质摄入量（≥0.6 g/kg/天）和饮食能量摄入量（≥25 kcal/kg/天）的较高几率显著相关。未观察到HPDS与高钾血症之间存在显著关联。
在中重度CKD患者中，健康的植物性饮食与较低的CKM综合征风险相关。坚持健康的植物性饮食更有可能实现更好的营养状况，并且与高钾血症风险无关。
