Plain language summary
Consumption of a plant-based diet in individuals with chronic kidney disease (CKD) is associated with lower risk of disease progression and death, however how this occurs is not fully understood. This cross-sectional study of 418 men with CKD aimed to determine whether a plant-based diet is associated with inflammation and the ability to adequately maintain blood-sugar balance. The results showed that individuals who had a higher intake of plant-based foods were associated with lower levels of inflammation and an increased ability to balance blood sugar levels, which was inversed when lower amounts of plant-based foods were consumed. It was concluded that plant-based diets may have a role in lowering the risk of disease progression and death in individuals with CKD. However, an adequately designed study needs to be performed to investigate If this is due to the reduction in inflammation and increased ability to balance blood-sugars observed in the trial. This study could be used by health care professionals to recommend increased consumption of plant-based foods to individuals with CKD to improve disease outcomes.
Abstract
BACKGROUND In persons with CKD, adherence to plant-based diets is associated with lower risk of CKD progression and death, but underlying mechanisms are poorly characterized. We here explore associations between adherence to plant-based diets and measures of insulin sensitivity and inflammation in men with CKD stages 3-5. METHODS Cross-sectional study including 418 men free from diabetes, aged 70-71 years and with cystatin-C estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 and not receiving kidney-specific dietetic advice. Information from 7-day food records was used to evaluate the adherence to a plant-based diet index (PBDi), which scores positively the intake of plant-foods and negatively animal-foods. Insulin sensitivity and glucose disposal rate were assessed with the gold-standard hyperinsulinemic euglycemic glucose clamp technique. Inflammation was evaluated by serum concentrations of C-reactive protein (CRP) and interleukin (IL)-6. Associations were explored through linear regression and restricted cubic splines. RESULTS The majority of men had CKD stage 3a. Hypertension and cardiovascular disease were the most common comorbidities. The median PBDi was 38 (range 14-55). Across higher quintiles of PBDi (i.e. higher adherence), participants were less often smokers, consumed less alcohol, had lower BMI and higher eGFR (P for trend <0.05 for all). Across higher PBDi quintiles, patients exhibited higher insulin sensitivity and lower inflammation (P for trend <0.05). After adjustment for eGFR, lifestyle factors, BMI, comorbidities and energy intake, a higher PBDi score remained associated with higher glucose disposal rate and insulin sensitivity as well as with lower levels of IL-6 and CRP. CONCLUSION In elderly men with non-dialysis CKD stages 3-5, adherence to a plant-based diet was associated with higher insulin sensitivity and lower inflammation, supporting a possible role of plant-based diets in the prevention of metabolic complications of CKD.
Methodological quality
Jadad score
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Allocation concealment
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