Abstract
Plant-based low protein diets (LPDs) have gained popularity for managing chronic kidney disease (CKD) patients. The nutritional adequacy of these and other LPDs prescribed for CKD patients have not been carefully examined. This study assessed the nutrient composition of such LPDs and moderately high protein diets (MHPDs) that might be prescribed for patients in the Asia Pacific region with CKD who are not dialyzed or undergoing maintenance dialysis. Conventional diets containing at least 50% animal-based proteins and plant-based diets were also planned with protein prescriptions of 0.5 to 0.8 g/kg/day and MHPDs with protein prescriptions of 1.0 to 1.2 g/kg/day. Plant-based, lacto-, ovo-, and lacto-ovo-vegetarian and vegan LPDs and MHPDs were planned by replacing some or all of the animal proteins from the conventional diet. With 0.5 g protein/kg/day, all diets were below the Recommended Dietary Allowances (RDA) for at least one essential amino acid (EAA). At a protein prescription of 0.6 g/kg/day, only the conventional LPD met the RDA for all EAAs. This deficiency with the plant-based LPDs persisted even with several plant food substitutions. With a protein prescription ≥0.7 g/kg/day, all the plant-based and vegetarian LPDs provided the RDA for all EAA. The plant-based and vegetarian diets also contained relatively greater potassium, phosphorus, and calcium content but lower long-chain n-3 polyunsaturated fatty acids and vitamin B-12 than the conventional diet. Other essential micronutrients were commonly below the RDA even at higher protein intakes. The low contents of some essential micronutrients were found in both animal-based and plant-based diets. Prescription of all LPDs for CKD patients, especially plant-based and vegetarian LPDs, requires careful planning to ensure the adequacy of all nutrients, particularly essential amino acids. Consideration should be given to supplementing all animal-based and plant-based LPDs and MHPDs with multivitamins and certain trace elements.
Highlights
Chronic kidney disease (CKD) is a global health concern
Our food pattern modeling indicated that the Asian plant-based and vegetarian diets providing 0.7 g protein/kg/day or more could meet the Recommended Dietary Allowances (RDA) for all essential amino acid (EAA)
At the protein prescription of 0.6 g/kg/day, only the conventional diet consisting of 50% high biological protein from animal-based foods is able to meet the RDA of all EAAs, while the vegetarian or plant-based low protein diet (LPD) are likely to be deficient in EAAs
Summary
Chronic kidney disease (CKD) is a global health concern. A recent systematic analysis estimates that 9.1% of the worldwide adult population is affected by CKD, and almost a third of people with CKD live in China and India [1]. A number of reports suggest that plant-based foods may be associated with favorable effects on CKD patients with regard to blood pressure, phosphorus burden, acid load, uremic toxins, inflammation, and oxidative stress [8,9,10,11,12,13,14]. These purported benefits have largely not yet been confirmed in randomized prospective controlled clinical trials with clinical outcomes as the key outcome measures
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