Dietary Plant Protein and Mortality Among Patients Receiving Maintenance Hemodialysis: A Cohort Study
Although greater dietary intake of protein has been associated with beneficial health effects among patients receiving maintenance hemodialysis (MHD), the effects of plant protein intake are less certain. We studied the association of the proportion of protein intake derived from plant sources with...
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Veröffentlicht in: | American journal of kidney diseases 2021-11, Vol.78 (5), p.649-657.e1 |
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creator | He, Yanhuan Lu, Yongxin Yang, Shenglin Li, Yumin Yang, Yaya Chen, Junzhi Huang, Yan Lin, Zizhen Li, Youbao Kong, Yaozhong Zhao, Yanhong Wan, Qijun Wang, Qi Huang, Sheng Liu, Yan Liu, Aiqun Liu, Fanna Hou, Fan Fan Qin, Xianhui Liang, Min |
description | Although greater dietary intake of protein has been associated with beneficial health effects among patients receiving maintenance hemodialysis (MHD), the effects of plant protein intake are less certain. We studied the association of the proportion of protein intake derived from plant sources with the risk of mortality among patients receiving MHD and explored factors that may modify these associations.
Prospective observational cohort study.
1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015.
The proportion of plant protein intake to total protein intake.
All-cause mortality and cardiovascular disease (CVD) mortality.
Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes.
The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. During a median follow-up period of 28.0 months, 249 deaths occurred, with 146 of these deaths resulting from CVD. Overall, there was a U-shaped association between plant protein intake proportion and the risk of all-cause mortality, with an inflection point at 45%. Among patients with a plant protein intake proportion |
doi_str_mv | 10.1053/j.ajkd.2021.03.023 |
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fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2535110553</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0272638621006314</els_id><sourcerecordid>2535110553</sourcerecordid><originalsourceid>FETCH-LOGICAL-c422t-3685574dd3f905c123c58544f7a3699b0c56449f0800b2ab8976020b88e80c4b3</originalsourceid><addsrcrecordid>eNp9kEtrGzEUhUVISdy0fyCLomU2M70jjWRN6ca4DxcSavpYC410J5U7M0okOeB_XxmnXXZ14fKdA-cj5LqBugHB3-5qs_vtagasqYHXwPgZWTSC8Uoqrs7JAtiSVZIreUleprQDgI5LeUEueQsFE3JB8IPHbOKBbkczZ7qNIaOfqZkdvQsxm9HnA11NYb6nW5M9zjnRb2jRP_nyujN-zjib2SLd4BScN-Mh-fSOrug6_CoF9Hveu8Mr8mIwY8LXz_eK_Pz08cd6U91-_fxlvbqtbMtYrrhUQixb5_jQgbAN41Yo0bbD0nDZdT1YIdu2G0AB9Mz0qltKYNArhQps2_MrcnPqfYjhcY8p68kni2PZhmGfNBNcNMWd4AVlJ9TGkFLEQT9EPxUTugF91Kt3-qhXH_Vq4LroLaE3z_37fkL3L_LXZwHenwAsK588Rp1skWbR-Yg2axf8__r_ALUyioY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2535110553</pqid></control><display><type>article</type><title>Dietary Plant Protein and Mortality Among Patients Receiving Maintenance Hemodialysis: A Cohort Study</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>He, Yanhuan ; Lu, Yongxin ; Yang, Shenglin ; Li, Yumin ; Yang, Yaya ; Chen, Junzhi ; Huang, Yan ; Lin, Zizhen ; Li, Youbao ; Kong, Yaozhong ; Zhao, Yanhong ; Wan, Qijun ; Wang, Qi ; Huang, Sheng ; Liu, Yan ; Liu, Aiqun ; Liu, Fanna ; Hou, Fan Fan ; Qin, Xianhui ; Liang, Min</creator><creatorcontrib>He, Yanhuan ; Lu, Yongxin ; Yang, Shenglin ; Li, Yumin ; Yang, Yaya ; Chen, Junzhi ; Huang, Yan ; Lin, Zizhen ; Li, Youbao ; Kong, Yaozhong ; Zhao, Yanhong ; Wan, Qijun ; Wang, Qi ; Huang, Sheng ; Liu, Yan ; Liu, Aiqun ; Liu, Fanna ; Hou, Fan Fan ; Qin, Xianhui ; Liang, Min</creatorcontrib><description>Although greater dietary intake of protein has been associated with beneficial health effects among patients receiving maintenance hemodialysis (MHD), the effects of plant protein intake are less certain. We studied the association of the proportion of protein intake derived from plant sources with the risk of mortality among patients receiving MHD and explored factors that may modify these associations.
Prospective observational cohort study.
1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015.
The proportion of plant protein intake to total protein intake.
All-cause mortality and cardiovascular disease (CVD) mortality.
Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes.
The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. During a median follow-up period of 28.0 months, 249 deaths occurred, with 146 of these deaths resulting from CVD. Overall, there was a U-shaped association between plant protein intake proportion and the risk of all-cause mortality, with an inflection point at 45%. Among patients with a plant protein intake proportion<45%, there was a 17% lower rate of mortality with each 5% greater plant protein intake proportion (HR, 0.83 [95% CI, 0.73-0.96]). Among patients with plant protein intake proportion≥45%, there was a 9% greater rate of mortality with each 5% greater plant protein intake proportion. A similar U-shaped association was observed for CVD mortality, with an inflection point at 44%.
Observational study, potential unmeasured confounding.
There was a U-shaped association between plant protein intake proportion and the risk of all-cause and cardiovascular mortality in MHD patients. If confirmed, these findings suggest a potential avenue to improve outcomes in this patient population.
[Display omitted]</description><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1053/j.ajkd.2021.03.023</identifier><identifier>PMID: 34052356</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; All-cause mortality ; cardiovascular disease (CVD) ; Cardiovascular Diseases ; Cohort Studies ; cohort study ; CVD mortality ; diet ; dietary protein ; end-stage renal disease (ESRD) ; Humans ; maintenance hemodialysis (MHD) ; Middle Aged ; modifiable risk factor ; Mortality ; nutrition ; plant protein intake proportion ; Plant Proteins, Dietary ; Proportional Hazards Models ; Prospective Studies ; Renal Dialysis ; Risk Factors ; soy</subject><ispartof>American journal of kidney diseases, 2021-11, Vol.78 (5), p.649-657.e1</ispartof><rights>2021 National Kidney Foundation, Inc.</rights><rights>Copyright © 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-3685574dd3f905c123c58544f7a3699b0c56449f0800b2ab8976020b88e80c4b3</citedby><cites>FETCH-LOGICAL-c422t-3685574dd3f905c123c58544f7a3699b0c56449f0800b2ab8976020b88e80c4b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1053/j.ajkd.2021.03.023$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27926,27927,45997</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34052356$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>He, Yanhuan</creatorcontrib><creatorcontrib>Lu, Yongxin</creatorcontrib><creatorcontrib>Yang, Shenglin</creatorcontrib><creatorcontrib>Li, Yumin</creatorcontrib><creatorcontrib>Yang, Yaya</creatorcontrib><creatorcontrib>Chen, Junzhi</creatorcontrib><creatorcontrib>Huang, Yan</creatorcontrib><creatorcontrib>Lin, Zizhen</creatorcontrib><creatorcontrib>Li, Youbao</creatorcontrib><creatorcontrib>Kong, Yaozhong</creatorcontrib><creatorcontrib>Zhao, Yanhong</creatorcontrib><creatorcontrib>Wan, Qijun</creatorcontrib><creatorcontrib>Wang, Qi</creatorcontrib><creatorcontrib>Huang, Sheng</creatorcontrib><creatorcontrib>Liu, Yan</creatorcontrib><creatorcontrib>Liu, Aiqun</creatorcontrib><creatorcontrib>Liu, Fanna</creatorcontrib><creatorcontrib>Hou, Fan Fan</creatorcontrib><creatorcontrib>Qin, Xianhui</creatorcontrib><creatorcontrib>Liang, Min</creatorcontrib><title>Dietary Plant Protein and Mortality Among Patients Receiving Maintenance Hemodialysis: A Cohort Study</title><title>American journal of kidney diseases</title><addtitle>Am J Kidney Dis</addtitle><description>Although greater dietary intake of protein has been associated with beneficial health effects among patients receiving maintenance hemodialysis (MHD), the effects of plant protein intake are less certain. We studied the association of the proportion of protein intake derived from plant sources with the risk of mortality among patients receiving MHD and explored factors that may modify these associations.
Prospective observational cohort study.
1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015.
The proportion of plant protein intake to total protein intake.
All-cause mortality and cardiovascular disease (CVD) mortality.
Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes.
The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. During a median follow-up period of 28.0 months, 249 deaths occurred, with 146 of these deaths resulting from CVD. Overall, there was a U-shaped association between plant protein intake proportion and the risk of all-cause mortality, with an inflection point at 45%. Among patients with a plant protein intake proportion<45%, there was a 17% lower rate of mortality with each 5% greater plant protein intake proportion (HR, 0.83 [95% CI, 0.73-0.96]). Among patients with plant protein intake proportion≥45%, there was a 9% greater rate of mortality with each 5% greater plant protein intake proportion. A similar U-shaped association was observed for CVD mortality, with an inflection point at 44%.
Observational study, potential unmeasured confounding.
There was a U-shaped association between plant protein intake proportion and the risk of all-cause and cardiovascular mortality in MHD patients. If confirmed, these findings suggest a potential avenue to improve outcomes in this patient population.
[Display omitted]</description><subject>Adult</subject><subject>All-cause mortality</subject><subject>cardiovascular disease (CVD)</subject><subject>Cardiovascular Diseases</subject><subject>Cohort Studies</subject><subject>cohort study</subject><subject>CVD mortality</subject><subject>diet</subject><subject>dietary protein</subject><subject>end-stage renal disease (ESRD)</subject><subject>Humans</subject><subject>maintenance hemodialysis (MHD)</subject><subject>Middle Aged</subject><subject>modifiable risk factor</subject><subject>Mortality</subject><subject>nutrition</subject><subject>plant protein intake proportion</subject><subject>Plant Proteins, Dietary</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Renal Dialysis</subject><subject>Risk Factors</subject><subject>soy</subject><issn>0272-6386</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtrGzEUhUVISdy0fyCLomU2M70jjWRN6ca4DxcSavpYC410J5U7M0okOeB_XxmnXXZ14fKdA-cj5LqBugHB3-5qs_vtagasqYHXwPgZWTSC8Uoqrs7JAtiSVZIreUleprQDgI5LeUEueQsFE3JB8IPHbOKBbkczZ7qNIaOfqZkdvQsxm9HnA11NYb6nW5M9zjnRb2jRP_nyujN-zjib2SLd4BScN-Mh-fSOrug6_CoF9Hveu8Mr8mIwY8LXz_eK_Pz08cd6U91-_fxlvbqtbMtYrrhUQixb5_jQgbAN41Yo0bbD0nDZdT1YIdu2G0AB9Mz0qltKYNArhQps2_MrcnPqfYjhcY8p68kni2PZhmGfNBNcNMWd4AVlJ9TGkFLEQT9EPxUTugF91Kt3-qhXH_Vq4LroLaE3z_37fkL3L_LXZwHenwAsK588Rp1skWbR-Yg2axf8__r_ALUyioY</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>He, Yanhuan</creator><creator>Lu, Yongxin</creator><creator>Yang, Shenglin</creator><creator>Li, Yumin</creator><creator>Yang, Yaya</creator><creator>Chen, Junzhi</creator><creator>Huang, Yan</creator><creator>Lin, Zizhen</creator><creator>Li, Youbao</creator><creator>Kong, Yaozhong</creator><creator>Zhao, Yanhong</creator><creator>Wan, Qijun</creator><creator>Wang, Qi</creator><creator>Huang, Sheng</creator><creator>Liu, Yan</creator><creator>Liu, Aiqun</creator><creator>Liu, Fanna</creator><creator>Hou, Fan Fan</creator><creator>Qin, Xianhui</creator><creator>Liang, Min</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202111</creationdate><title>Dietary Plant Protein and Mortality Among Patients Receiving Maintenance Hemodialysis: A Cohort Study</title><author>He, Yanhuan ; Lu, Yongxin ; Yang, Shenglin ; Li, Yumin ; Yang, Yaya ; Chen, Junzhi ; Huang, Yan ; Lin, Zizhen ; Li, Youbao ; Kong, Yaozhong ; Zhao, Yanhong ; Wan, Qijun ; Wang, Qi ; Huang, Sheng ; Liu, Yan ; Liu, Aiqun ; Liu, Fanna ; Hou, Fan Fan ; Qin, Xianhui ; Liang, Min</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-3685574dd3f905c123c58544f7a3699b0c56449f0800b2ab8976020b88e80c4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>All-cause mortality</topic><topic>cardiovascular disease (CVD)</topic><topic>Cardiovascular Diseases</topic><topic>Cohort Studies</topic><topic>cohort study</topic><topic>CVD mortality</topic><topic>diet</topic><topic>dietary protein</topic><topic>end-stage renal disease (ESRD)</topic><topic>Humans</topic><topic>maintenance hemodialysis (MHD)</topic><topic>Middle Aged</topic><topic>modifiable risk factor</topic><topic>Mortality</topic><topic>nutrition</topic><topic>plant protein intake proportion</topic><topic>Plant Proteins, Dietary</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Renal Dialysis</topic><topic>Risk Factors</topic><topic>soy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>He, Yanhuan</creatorcontrib><creatorcontrib>Lu, Yongxin</creatorcontrib><creatorcontrib>Yang, Shenglin</creatorcontrib><creatorcontrib>Li, Yumin</creatorcontrib><creatorcontrib>Yang, Yaya</creatorcontrib><creatorcontrib>Chen, Junzhi</creatorcontrib><creatorcontrib>Huang, Yan</creatorcontrib><creatorcontrib>Lin, Zizhen</creatorcontrib><creatorcontrib>Li, Youbao</creatorcontrib><creatorcontrib>Kong, Yaozhong</creatorcontrib><creatorcontrib>Zhao, Yanhong</creatorcontrib><creatorcontrib>Wan, Qijun</creatorcontrib><creatorcontrib>Wang, Qi</creatorcontrib><creatorcontrib>Huang, Sheng</creatorcontrib><creatorcontrib>Liu, Yan</creatorcontrib><creatorcontrib>Liu, Aiqun</creatorcontrib><creatorcontrib>Liu, Fanna</creatorcontrib><creatorcontrib>Hou, Fan Fan</creatorcontrib><creatorcontrib>Qin, Xianhui</creatorcontrib><creatorcontrib>Liang, Min</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>He, Yanhuan</au><au>Lu, Yongxin</au><au>Yang, Shenglin</au><au>Li, Yumin</au><au>Yang, Yaya</au><au>Chen, Junzhi</au><au>Huang, Yan</au><au>Lin, Zizhen</au><au>Li, Youbao</au><au>Kong, Yaozhong</au><au>Zhao, Yanhong</au><au>Wan, Qijun</au><au>Wang, Qi</au><au>Huang, Sheng</au><au>Liu, Yan</au><au>Liu, Aiqun</au><au>Liu, Fanna</au><au>Hou, Fan Fan</au><au>Qin, Xianhui</au><au>Liang, Min</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dietary Plant Protein and Mortality Among Patients Receiving Maintenance Hemodialysis: A Cohort Study</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>2021-11</date><risdate>2021</risdate><volume>78</volume><issue>5</issue><spage>649</spage><epage>657.e1</epage><pages>649-657.e1</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract>Although greater dietary intake of protein has been associated with beneficial health effects among patients receiving maintenance hemodialysis (MHD), the effects of plant protein intake are less certain. We studied the association of the proportion of protein intake derived from plant sources with the risk of mortality among patients receiving MHD and explored factors that may modify these associations.
Prospective observational cohort study.
1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015.
The proportion of plant protein intake to total protein intake.
All-cause mortality and cardiovascular disease (CVD) mortality.
Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes.
The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. During a median follow-up period of 28.0 months, 249 deaths occurred, with 146 of these deaths resulting from CVD. Overall, there was a U-shaped association between plant protein intake proportion and the risk of all-cause mortality, with an inflection point at 45%. Among patients with a plant protein intake proportion<45%, there was a 17% lower rate of mortality with each 5% greater plant protein intake proportion (HR, 0.83 [95% CI, 0.73-0.96]). Among patients with plant protein intake proportion≥45%, there was a 9% greater rate of mortality with each 5% greater plant protein intake proportion. A similar U-shaped association was observed for CVD mortality, with an inflection point at 44%.
Observational study, potential unmeasured confounding.
There was a U-shaped association between plant protein intake proportion and the risk of all-cause and cardiovascular mortality in MHD patients. If confirmed, these findings suggest a potential avenue to improve outcomes in this patient population.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34052356</pmid><doi>10.1053/j.ajkd.2021.03.023</doi></addata></record> |
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subjects | Adult All-cause mortality cardiovascular disease (CVD) Cardiovascular Diseases Cohort Studies cohort study CVD mortality diet dietary protein end-stage renal disease (ESRD) Humans maintenance hemodialysis (MHD) Middle Aged modifiable risk factor Mortality nutrition plant protein intake proportion Plant Proteins, Dietary Proportional Hazards Models Prospective Studies Renal Dialysis Risk Factors soy |
title | Dietary Plant Protein and Mortality Among Patients Receiving Maintenance Hemodialysis: A Cohort Study |
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