Hsu Bang-Gee, Tong Li-Xia, Liou Hung-Hsiang, Wang Chih-Hsien, Lin Yu-Li
Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97010, Taiwan.
School of Medicine, Tzu Chi University, Hualien 97010, Taiwan.
Nutrients. 2025 Aug 15;17(16):2649. doi: 10.3390/nu17162649.
: Increasing evidence indicates that a vegetarian diet may provide renal protection and improve metabolic health in patients with chronic kidney disease (CKD). However, transitioning from an omnivorous to a vegetarian diet can be challenging. A more practical alternative could be to increase the consumption of plant protein. In this cross-sectional study, we investigated the association between increased plant protein intake and adherence to a low-protein diet (LPD) and the effect on biochemical parameters, body composition, and muscle strength in patients with non-dialysis CKD stages 3-5. : The daily dietary intake of 377 patients, aged 68.5 ± 12.1 years, was evaluated using a quantitative food frequency questionnaire. Plant protein intake percentage was calculated as (daily plant protein intake/total protein intake) × 100%, and the potential renal acid load (PRAL) was estimated. A LPD was defined as a diet with a daily protein intake of <0.8 g/kg of body weight. Anthropometric measurements, body composition, and handgrip strength were assessed in a subgroup comprising 260 patients. The lean tissue index (LTI) and fat tissue index (FTI) were calculated by dividing lean mass and fat mass (kg) by the height in m, respectively. : Of the included 377 patients, 69.5% adhered to the LPD. Further, a 10% increase in plant protein intake was associated with a 20% increase in the likelihood of LPD adherence (OR, 1.20, 95% CI, 1.06 to 1.37), lower PRAL (β = -1.10 per 10% increase, 95% CI, -1.63 to -0.57), and higher serum bicarbonate levels (β = 0.24, 95% CI, 0.02 to 0.45). Analysis of the 260-patient subgroup revealed that a 10% increase in plant protein intake was associated with lower body mass index (β = -0.82, 95% CI, -1.05 to -0.59), FTI (β = -0.71, 95% CI, -1.01 to -0.40), waist circumference (β = -2.11, 95% CI, -2.80 to -1.41), hip circumference (β = -1.25, 95% CI, -1.75 to -0.75), waist-to-hip ratio (β = -0.91, 95% CI, -1.44 to -0.38), and waist-to-height ratio (β = -1.25, 95% CI, -1.71 to -0.80). There was no significant association between increased plant protein intake and LTI and handgrip strength. : Increased intake of plant protein can reduce dietary acid load, alleviate metabolic acidosis, and potentially improve adiposity parameters without compromising lean mass and handgrip strength.
越来越多的证据表明，素食饮食可能为慢性肾脏病（CKD）患者提供肾脏保护并改善代谢健康。然而，从杂食饮食转变为素食饮食可能具有挑战性。一个更实际的替代方法可能是增加植物蛋白的摄入量。在这项横断面研究中，我们调查了植物蛋白摄入量增加与坚持低蛋白饮食（LPD）之间的关联，以及对非透析CKD 3 - 5期患者生化参数、身体成分和肌肉力量的影响。
使用定量食物频率问卷评估了377名年龄为68.5±12.1岁患者的每日饮食摄入量。植物蛋白摄入百分比计算为（每日植物蛋白摄入量/总蛋白摄入量）×100%，并估算潜在肾酸负荷（PRAL）。LPD定义为每日蛋白质摄入量<0.8 g/kg体重的饮食。在由260名患者组成的亚组中评估了人体测量、身体成分和握力。瘦组织指数（LTI）和脂肪组织指数（FTI）分别通过将瘦体重和脂肪量（kg）除以身高（m）来计算。
在纳入的377名患者中，69.5%坚持LPD。此外，植物蛋白摄入量增加10%与LPD坚持可能性增加20%相关（OR，1.20，95%CI，1.06至1.37），PRAL降低（每增加10%，β = -1.10，95%CI，-1.63至-0.57），血清碳酸氢盐水平升高（β = 0.24，95%CI，0.02至0.45）。对260名患者亚组的分析显示，植物蛋白摄入量增加10%与较低的体重指数（β = -0.82，95%CI，-1.05至-0.59）、FTI（β = -0.71，95%CI，-1.01至-0.40）、腰围（β = -2.11，95%CI，-2.80至-1.41）、臀围（β = -1.25，95%CI，-1.75至-0.75）、腰臀比（β = -0.91，95%CI，-1.44至-0.38）和腰高比（β = -1.25，95%CI，-1.71至-0.80）相关。植物蛋白摄入量增加与LTI和握力之间无显著关联。
增加植物蛋白摄入量可降低饮食酸负荷，减轻代谢性酸中毒，并可能改善肥胖参数，而不会损害瘦体重和握力。
