Dietary Protein Sources and Risk for Incident Chronic Kidney Disease: Results From the Atherosclerosis Risk in Communities (ARIC) Study
Open accessAbstract
Objective Dietary protein restriction is recommended for patients with moderate to severe renal insufficiency. Long-term data on the relationship between dietary protein sources and risk for incident kidney disease in individuals with normal kidney function are largely missing. This study aimed to assess the association between dietary protein sources and incident chronic kidney disease (CKD).Design Prospective cohort.Setting Atherosclerosis Risk in Communities study participants from 4 US communities.Subjects A total of 11,952 adults aged 44-66 years in 1987-1989 who were free of diabetes mellitus, cardiovascular disease, and had an estimated glomerular filtration rate (eGFR) ≥ 60 mL/minute/1.73 m 2.Main outcome measure A 66-item food frequency questionnaire was used to assess food intake. CKD stage 3 was defined as a decrease in eGFR of ≥25% from baseline resulting in an eGFR of less than 60 mL/minute/1.73 m 2; CKD-related hospitalization; CKD-related death; or end-stage renal disease. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.Results During a median follow-up of 23 years, there were 2,632 incident CKD cases. Red and processed meat consumption was associated with increased CKD risk (HR Q5 vs. Q1: 1.23, 95% CI: 1.06-1.42, p trend = 0.01). In contrast, higher dietary intake of nuts, legumes, and low-fat dairy products was associated with lower CKD risk (nuts: HR Q5 vs. Q1: 0.81, 95% CI: 0.72-0.92, p trend <0.001; low-fat dairy products: HR Q5 vs. Q1: 0.75, 95% CI: 0.65-0.85, p trend <0.001; legumes: HR Q5 vs. Q1: 0.83, 95% CI: 0.72-0.95, p trend = 0.03).Conclusion There were varied associations of specific dietary protein sources with risk of incident CKD; with red and processed meat being adversely associated with CKD risk; and nuts, low-fat dairy products, and legumes being protective against the development of CKD.
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Protein from red meat consumption may increase the risk of chronic kidney disease; low-fat dairy proteins, fish, and seafood do not have such an effect; proteins from fruits and vegetables might be renal protective.
“Protein from red meat consumption may increase the risk of chronic kidney disease; in contrast, low-fat dairy proteins, fish, and seafood do not have such an effect; proteins from fruits and vegetables actually might be renal protective.”
From Optimal Diet Strategies for Weight Loss and Weight Loss Maintenance (2021) · cites this paper as [55]
The Results and Discussion report higher CKD risk with red and processed meat, lower risk with low-fat dairy and vegetable protein, and no significant increase with fish and seafood. They identify nuts and legumes as protective vegetable-protein sources, but do not establish a protective effect for protein from fruits specifically. The findings are associations in a cohort of middle-aged adults with normal kidney function at baseline. (LLM, conf=0.85)
Experimental — accuracy not yet measuredObservational studies have reported that high consumption of red and processed meat is associated with increased risk of CKD progression and mortality.
“observational studies have reported that high consumption of red and processed meat is associated with increased risk of CKD progression and mortality”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [281]
The Results report that higher red and processed meat intake was associated with increased risk of incident CKD. The Discussion specifies that participants had normal kidney function at baseline, so the study does not establish an association with CKD progression. Although CKD-related death was included in the incident-CKD endpoint (Methods, “Assessment of Incident Kidney Disease”), mortality was not reported as a separate outcome. (LLM, conf=0.90)
Experimental — accuracy not yet measuredObservational studies have reported that fruit and vegetable intake is associated with decline in progression of kidney disease.
“fruit and vegetable intake were associated with decline in progression of kidney disease. 280 -282”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [281]
The Results and Discussion report that higher vegetable-protein intake was associated with lower risk of incident stage 3 CKD. The paper does not report an association for fruit-and-vegetable intake as a combined measure, and its outcome is new CKD rather than slower progression of existing kidney disease. Page numbers are unavailable in our copy. (LLM, conf=0.86)
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References 47 · Cited by 254
- Authors
- Haring, B., Selvin, E., Liang, M., Coresh, J., Grams, M. E., Petruski-Ivleva, N., Steffen, L. M., & Rebholz, C. M.
- Affiliations
- University of Würzburg (DE)
- Johns Hopkins University (US)
- University of Minnesota (US)
- Corresponding author
- Haring, Bernhard
- ORCID
- Venue
- Journal of Renal Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 27
- Issue
- 4
- Pages
- 233-242
- ISSN
- 1051-2276 (ISSN-L)
- PMC
- PMC5476496
- OpenAlex
- W2568083903
- Cited by
- 254
- References
- 47
- Citations by year
- 2026: 16 · 2025: 28 · 2024: 33 · 2023: 35 · 2022: 30 · 2021: 31 · 2020: 37 · 2019: 20 · 2018: 18 · 2017: 5 · 2016: 1
- FWCI
- 20.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Renal Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HHSN268201 100012C, HHSN268201100007I, HHSN268201100007C, HHSN2682 01100008C, HH-SN-268201100006C, HHSN268201100011C, HHSN2682011-00005I, HHSN2682011-00009I, HHSN268201100005C, HHSN268201100005G, HHSN268201100010C, HHSN268201100011I, HHSN26820 1100009C, HHSN2682011-00008I)
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK106414, R01DK089174, K01DK107782)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- chronic kidney disease, dietary protein source, red meat, processed meat, nuts, Fabaceae, low-fat dairy, estimated glomerular filtration rate, end-stage renal disease, dietary risk factors, Atherosclerosis Risk in Communities Study, middle-aged adults, normal kidney function, food frequency questionnaire, prospective cohort follow-up
- MeSH terms
- Adult, Aged, Blood Pressure, Cholesterol, Diabetes Mellitus, Diet, Dietary Carbohydrates, Dietary Fats, Dietary Fiber, Dietary Proteins, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Kidney Failure, Chronic, Male, Middle Aged, Prospective Studies, Risk Factors, Socioeconomic Factors, Triglycerides, Incidence, Atherosclerosis, Renal Insufficiency, Chronic
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