Abstract
In the almost 30 years that have passed since the postulation of the “Developmental Origins of Health and Disease” theory, it has been clearly demonstrated that a mother’s dietary habits during pregnancy have potential consequences for her offspring that go far beyond in utero development. Protein malnutrition during pregnancy, for instance, can cause severe alterations ranging from intrauterine growth retardation to organ damage and increased susceptibility to hypertension, diabetes mellitus, cardiovascular diseases and chronic kidney disease (CKD) later in life both in experimental animals and humans. Conversely, a balanced mild protein restriction in patients affected by CKD has been shown to mitigate the biochemical derangements associated with kidney disease and even slow its progression. The first reports on the management of pregnant CKD women with a moderately protein-restricted plant-based diet appeared in the literature a few years ago. Today, this approach is still being debated, as is the optimal source of protein during gestation in CKD. The aim of this report is to critically review the available literature on the topic, focusing on the similarities and differences between animal and clinical studies.
Highlights
Origins of Health and Disease” theory, it has been clearly demonstrated that a mother’s dietary habits during pregnancy have potential consequences for her offspring that go far beyond in utero development
The most important is whether the effect on maternal kidney function and on intrauterine growth is linked to protein restriction or to different protein sources, or if it is at least partially caused by the avoidance of food additives and preservation agents frequently used in Western countries, as was suggested by two recent case studies [17]
Processed red meat has been associated with the worst outcomes in terms of kidney disease: the generation R study showed that protein intake during the first trimester of pregnancy correlated with renal function in offspring; when assessing the different contributions of protein sources, this association was confirmed for vegetable-derived protein but not for animal-derived protein intake [146]
Summary
“Der Mensch ist was er isst” (Man is what he eats) wrote Feuerbach and his observation is often cited to underline how important food is to maintaining health [1]. The quantity (under- and over-nutrition) and quality of foods we eat, as well as our intake of vitamins and micronutrients, play roles that are only partially understood. Lessons from disasters such as the famine that affected the Dutch during the Second World. Proteinuria, hypertension and cardiovascular and kidney diseases are all reported to increase when food intake is grossly inadequate. Overnutrition in pregnancy is associated, in the short term, with an increase in the hypertensive disorders of pregnancy and, in the long term, almost paradoxically with the same diseases we find in an under-nourished population [6,7,8,9]. Placental stress is likely to be the common pathway determining the long-term effect of these two opposite challenges (Figure 1) [10]
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