Plant Protein Intake is Associated With Fibroblast Growth Factor 23 and Serum Bicarbonate Levels in Patients With Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort Study

Julia J. Scialla, Lawrence J. Appel, Myles Wolf, Wei Yang, Xiaoming Zhang, Stephen M. Sozio, Edgar R. Miller, Lydia A. Bazzano, Magdalena Cuevas, Melanie J. Glenn, Eva Lustigova, Radhakrishna R. Kallem, Anna C. Porter, Raymond R. Townsend, Matthew R. Weir, Cheryl A M Anderson

Research output: Contribution to journalArticle

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Abstract

Background: Protein from plant, as opposed to animal, sources may be preferred in chronic kidney disease (CKD) because of the lower bioavailability of phosphate and lower nonvolatile acid load. Study Design: Observational cross-sectional study. Setting and Participants: A total of 2,938 participants with CKD and information on their dietary intake at the baseline visit in the Chronic Renal Insufficiency Cohort Study. Predictors: Percentage of total protein intake from plant sources (percent plant protein) was determined by scoring individual food items using the National Cancer Institute Diet History Questionnaire (DHQ). Outcomes: Metabolic parameters, including serum phosphate, bicarbonate (HCO3), potassium, and albumin, plasma fibroblast growth factor 23 (FGF-23), and parathyroid hormone (PTH), and hemoglobin levels. Measurements: We modeled the association between percent plant protein and metabolic parameters using linear regression. Models were adjusted for age, sex, race, diabetes status, body mass index, estimated glomerular filtration rate, income, smoking status, total energy intake, total protein intake, 24-hour urinary sodium concentration, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and use of diuretics. Results: Higher percent plant protein was associated with lower FGF-23 (P = .05) and higher HCO3 (P = .01) levels, but not with serum phosphate or parathyroid hormone concentrations (P = .9 and P = .5, respectively). Higher percent plant protein was not associated with higher serum potassium (P = .2), lower serum albumin (P = .2), or lower hemoglobin (P = .3) levels. The associations of percent plant protein with FGF-23 and HCO3 levels did not differ by diabetes status, sex, race, CKD stage (2/3 vs. 4/5), or total protein intake (≤0.8 g/kg/day vs. >0.8 g/kg/day; P-interaction >.10 for each). Limitations: This is a cross-sectional study; determination of percent plant protein using the Diet History Questionnaire has not been validated. Conclusions: Consumption of a higher percentage of protein from plant sources may lower FGF-23 and raise HCO3 levels in patients with CKD.

Original languageEnglish
JournalJournal of Renal Nutrition
Volume22
Issue number4
DOIs
StatePublished - Jul 1 2012

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Plant Proteins
Bicarbonates
Chronic Renal Insufficiency
Cohort Studies
Serum
Phosphates
Parathyroid Hormone
Serum Albumin
Cross-Sectional Studies
Diet
fibroblast growth factor 23
National Cancer Institute (U.S.)
Angiotensin Receptor Antagonists
Energy Intake
Glomerular Filtration Rate
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Biological Availability
Observational Studies
Linear Models

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Nephrology

Cite this

Plant Protein Intake is Associated With Fibroblast Growth Factor 23 and Serum Bicarbonate Levels in Patients With Chronic Kidney Disease : The Chronic Renal Insufficiency Cohort Study. / Scialla, Julia J.; Appel, Lawrence J.; Wolf, Myles; Yang, Wei; Zhang, Xiaoming; Sozio, Stephen M.; Miller, Edgar R.; Bazzano, Lydia A.; Cuevas, Magdalena; Glenn, Melanie J.; Lustigova, Eva; Kallem, Radhakrishna R.; Porter, Anna C.; Townsend, Raymond R.; Weir, Matthew R.; Anderson, Cheryl A M.

In: Journal of Renal Nutrition, Vol. 22, No. 4, 01.07.2012.

Research output: Contribution to journalArticle

Scialla, JJ, Appel, LJ, Wolf, M, Yang, W, Zhang, X, Sozio, SM, Miller, ER, Bazzano, LA, Cuevas, M, Glenn, MJ, Lustigova, E, Kallem, RR, Porter, AC, Townsend, RR, Weir, MR & Anderson, CAM 2012, 'Plant Protein Intake is Associated With Fibroblast Growth Factor 23 and Serum Bicarbonate Levels in Patients With Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort Study', Journal of Renal Nutrition, vol. 22, no. 4. https://doi.org/10.1053/j.jrn.2012.01.026
Scialla, Julia J. ; Appel, Lawrence J. ; Wolf, Myles ; Yang, Wei ; Zhang, Xiaoming ; Sozio, Stephen M. ; Miller, Edgar R. ; Bazzano, Lydia A. ; Cuevas, Magdalena ; Glenn, Melanie J. ; Lustigova, Eva ; Kallem, Radhakrishna R. ; Porter, Anna C. ; Townsend, Raymond R. ; Weir, Matthew R. ; Anderson, Cheryl A M. / Plant Protein Intake is Associated With Fibroblast Growth Factor 23 and Serum Bicarbonate Levels in Patients With Chronic Kidney Disease : The Chronic Renal Insufficiency Cohort Study. In: Journal of Renal Nutrition. 2012 ; Vol. 22, No. 4.
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abstract = "Background: Protein from plant, as opposed to animal, sources may be preferred in chronic kidney disease (CKD) because of the lower bioavailability of phosphate and lower nonvolatile acid load. Study Design: Observational cross-sectional study. Setting and Participants: A total of 2,938 participants with CKD and information on their dietary intake at the baseline visit in the Chronic Renal Insufficiency Cohort Study. Predictors: Percentage of total protein intake from plant sources (percent plant protein) was determined by scoring individual food items using the National Cancer Institute Diet History Questionnaire (DHQ). Outcomes: Metabolic parameters, including serum phosphate, bicarbonate (HCO3), potassium, and albumin, plasma fibroblast growth factor 23 (FGF-23), and parathyroid hormone (PTH), and hemoglobin levels. Measurements: We modeled the association between percent plant protein and metabolic parameters using linear regression. Models were adjusted for age, sex, race, diabetes status, body mass index, estimated glomerular filtration rate, income, smoking status, total energy intake, total protein intake, 24-hour urinary sodium concentration, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and use of diuretics. Results: Higher percent plant protein was associated with lower FGF-23 (P = .05) and higher HCO3 (P = .01) levels, but not with serum phosphate or parathyroid hormone concentrations (P = .9 and P = .5, respectively). Higher percent plant protein was not associated with higher serum potassium (P = .2), lower serum albumin (P = .2), or lower hemoglobin (P = .3) levels. The associations of percent plant protein with FGF-23 and HCO3 levels did not differ by diabetes status, sex, race, CKD stage (2/3 vs. 4/5), or total protein intake (≤0.8 g/kg/day vs. >0.8 g/kg/day; P-interaction >.10 for each). Limitations: This is a cross-sectional study; determination of percent plant protein using the Diet History Questionnaire has not been validated. Conclusions: Consumption of a higher percentage of protein from plant sources may lower FGF-23 and raise HCO3 levels in patients with CKD.",
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T1 - Plant Protein Intake is Associated With Fibroblast Growth Factor 23 and Serum Bicarbonate Levels in Patients With Chronic Kidney Disease

T2 - The Chronic Renal Insufficiency Cohort Study

AU - Scialla, Julia J.

AU - Appel, Lawrence J.

AU - Wolf, Myles

AU - Yang, Wei

AU - Zhang, Xiaoming

AU - Sozio, Stephen M.

AU - Miller, Edgar R.

AU - Bazzano, Lydia A.

AU - Cuevas, Magdalena

AU - Glenn, Melanie J.

AU - Lustigova, Eva

AU - Kallem, Radhakrishna R.

AU - Porter, Anna C.

AU - Townsend, Raymond R.

AU - Weir, Matthew R.

AU - Anderson, Cheryl A M

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N2 - Background: Protein from plant, as opposed to animal, sources may be preferred in chronic kidney disease (CKD) because of the lower bioavailability of phosphate and lower nonvolatile acid load. Study Design: Observational cross-sectional study. Setting and Participants: A total of 2,938 participants with CKD and information on their dietary intake at the baseline visit in the Chronic Renal Insufficiency Cohort Study. Predictors: Percentage of total protein intake from plant sources (percent plant protein) was determined by scoring individual food items using the National Cancer Institute Diet History Questionnaire (DHQ). Outcomes: Metabolic parameters, including serum phosphate, bicarbonate (HCO3), potassium, and albumin, plasma fibroblast growth factor 23 (FGF-23), and parathyroid hormone (PTH), and hemoglobin levels. Measurements: We modeled the association between percent plant protein and metabolic parameters using linear regression. Models were adjusted for age, sex, race, diabetes status, body mass index, estimated glomerular filtration rate, income, smoking status, total energy intake, total protein intake, 24-hour urinary sodium concentration, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and use of diuretics. Results: Higher percent plant protein was associated with lower FGF-23 (P = .05) and higher HCO3 (P = .01) levels, but not with serum phosphate or parathyroid hormone concentrations (P = .9 and P = .5, respectively). Higher percent plant protein was not associated with higher serum potassium (P = .2), lower serum albumin (P = .2), or lower hemoglobin (P = .3) levels. The associations of percent plant protein with FGF-23 and HCO3 levels did not differ by diabetes status, sex, race, CKD stage (2/3 vs. 4/5), or total protein intake (≤0.8 g/kg/day vs. >0.8 g/kg/day; P-interaction >.10 for each). Limitations: This is a cross-sectional study; determination of percent plant protein using the Diet History Questionnaire has not been validated. Conclusions: Consumption of a higher percentage of protein from plant sources may lower FGF-23 and raise HCO3 levels in patients with CKD.

AB - Background: Protein from plant, as opposed to animal, sources may be preferred in chronic kidney disease (CKD) because of the lower bioavailability of phosphate and lower nonvolatile acid load. Study Design: Observational cross-sectional study. Setting and Participants: A total of 2,938 participants with CKD and information on their dietary intake at the baseline visit in the Chronic Renal Insufficiency Cohort Study. Predictors: Percentage of total protein intake from plant sources (percent plant protein) was determined by scoring individual food items using the National Cancer Institute Diet History Questionnaire (DHQ). Outcomes: Metabolic parameters, including serum phosphate, bicarbonate (HCO3), potassium, and albumin, plasma fibroblast growth factor 23 (FGF-23), and parathyroid hormone (PTH), and hemoglobin levels. Measurements: We modeled the association between percent plant protein and metabolic parameters using linear regression. Models were adjusted for age, sex, race, diabetes status, body mass index, estimated glomerular filtration rate, income, smoking status, total energy intake, total protein intake, 24-hour urinary sodium concentration, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and use of diuretics. Results: Higher percent plant protein was associated with lower FGF-23 (P = .05) and higher HCO3 (P = .01) levels, but not with serum phosphate or parathyroid hormone concentrations (P = .9 and P = .5, respectively). Higher percent plant protein was not associated with higher serum potassium (P = .2), lower serum albumin (P = .2), or lower hemoglobin (P = .3) levels. The associations of percent plant protein with FGF-23 and HCO3 levels did not differ by diabetes status, sex, race, CKD stage (2/3 vs. 4/5), or total protein intake (≤0.8 g/kg/day vs. >0.8 g/kg/day; P-interaction >.10 for each). Limitations: This is a cross-sectional study; determination of percent plant protein using the Diet History Questionnaire has not been validated. Conclusions: Consumption of a higher percentage of protein from plant sources may lower FGF-23 and raise HCO3 levels in patients with CKD.

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