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Association of Higher Intake of Plant-Based Foods and Protein With Slower Kidney Function Decline in Women With HIV
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Nov 1 2023
The present study examined the association between intake of FV [fruits/vegetables] and risk of eGFR decline among women receiving ART among a large geographically diverse cohort of women with HIV in the United States. We found that repeated higher intake of FVs was associated with a slower rate of decline in eGFR, suggesting lower dietary acid load diet because of a daily higher intake of FVs may be associated with slowing decline in kidney function.
Results:
We found a dose-response relationship for the association of FV intake and eGFR decline, with lesser annual decline in eGFR in the middle and highest tertiles of FV intake. An increase of 5 servings of FV intake per day was associated with a lower annual eGFR decline (-1.18 [-1.43, -0.94]). On average, 39% of the association between higher FV intake and slower eGFR decline was explained by decreased levels of inflammation.
Conclusions:
Plant-rich diet was associated with slower decline in kidney function. Inflammation is a potential path through which diet may affect kidney function. The findings support an emerging body of literature on the potential benefits of plant-rich diets for prevention of chronic kidney disease.
We found that higher protein intake was associated with a slower decline in kidney function. Although previous studies suggest that high protein intake may promote kidney damage by chronically increasing glomerular pressure and hyperfiltration,36-38 growing evidence show that the more important determinant of the effect of dietary protein on CKD progression is the quality of the protein ingested (ie, whether it induces acid production [like most animal protein] or base production [like most fruit and vegetable protein]) rather than the quantity of the protein ingested.3,15,18,39,40 This study did not evaluate the association between the quality of the ingested protein and decline in kidney function, which may explain this unexpected finding.
We found that higher protein intake was associated with a slower decline in kidney function. Although previous studies suggest that high protein intake may promote kidney damage by chronically increasing glomerular pressure and hyperfiltration,36-38 growing evidence show that the more important determinant of the effect of dietary protein on CKD progression is the quality of the protein ingested (ie, whether it induces acid production [like most animal protein] or base production [like most fruit and vegetable protein]) rather than the quantity of the protein ingested.3,15,18,39,40 This study did not evaluate the association between the quality of the ingested protein and decline in kidney function, which may explain this unexpected finding.
The findings from this study show an association between higher intake of fruits and vegetables and slower decline in kidney function, supporting an emerging body of literature on the potential benefits of plant-rich diets for primary CKD prevention. This result suggests that inflammation is a potential path through which diet may affect kidney function. This is the first study in a population living with HIV that has examined the association of diet-dependent acid load characterized by higher intake of fruits and vegetables with kidney function, a population in whom comorbid kidney diseases become increasingly common with age. Our results suggest that the alkali-based diet in people with HIV receiving antiretroviral therapy slows decline of kidney function despite potential nephrotoxic effects of ART. Findings from our study, if confirmed in clinical trials, may have application for both population-wide and high-risk approaches to CKD prevention and management in various settings.
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