吃越多紅肉末期腎病風險越高


  【24drs.com】新研究顯示,攝取紅肉與新加坡華人的末期腎病(end-stage renal disease,ESRD)風險增加有關。
  
  杜克-新加坡國立大學醫學研究院的Quan Lan Lew醫師表示,有許多組織機構建議,已有慢性腎病之患者應減少蛋白質攝取,以延緩ESRD病程。
  
  她報告指出,我們發現,多吃紅肉會增加ESRD風險,用其他蛋白質來源取代紅肉的蛋白質將可降低此風險。
  
  Lew醫師在舊金山舉辦的2015年腎臟週(Kidney Week 2015)發表這些研究結果。
  
  研究者使用了1993-1998年間參與新加坡華人健康研究的60,198名研究對象的資料,這是一篇針對具有南中國血統者所進行的大型人口基礎前瞻世代研究,這些研究對象年齡介於45-74歲。
  
  使用有165題的飲食頻率問卷蒐集特定食物攝取量、飲品攝取量、飲食份量等資料;將這些記錄與2012年12月止的新加坡腎臟登記全國資料庫連結發現,在平均15.5年的追蹤期間內,有951例的偶發ESRD。
  
  Lew醫師報告指出,發生ESRD的病患傾向比較年長、比較可能有抽菸史、有高血壓、糖尿病或兩病皆有、體重比較重。
  
  在基本分析模式中,研究者發現 ,校正年齡、性別、方言、教育程度、訪談年份之後,ESRD風險和任何蛋白質攝取量最多的前四分之三之間有顯著關聯。
  
  不過,Lew醫師表示,當他們校正生活型態和慢性病等變項後,減弱了大多數的正相關性,除了紅肉攝取的情況。
  
  事實上,紅肉攝取量前四分之一者的ESRD相對風險,比攝取量最少的後四分之一者高40%;即便將有共病症者排除分析之後,紅肉攝取量高和ESRD風險之間的關係依舊存在。
  
  Lew醫師解釋,在禽肉、魚貝類、蛋、乳製品、豆製品等並沒有發現這種正相關性。
  
  舉例來說,將每份紅肉用禽肉替代,可降低ESRD相對風險達66% (P< .001),用豆製品取代可降低相對風險達54% (P< .001),用魚肉取代可降低相對風險達52% (P= .002),用蛋取代可降低相對風險達52% (P= .009)。
  
  Lew醫師表示,新加坡很少有人經常吃牛肉,在新加坡華人健康研究這項研究中,紅肉主要是豬肉。
  
  她表示,未來的研究方向是要確定吃紅肉對ESRD風險的病理生理機轉,並且探討慢性腎病患者用其他蛋白質來源取代紅肉時,是否可以延緩發展成ESRD的病程。
  
  位於達拉斯Baylor Scott & White Health的首席學術人員,過去30年致力於研究腎臟如何提高或降低酸挑戰的Donald Wesson醫師表示,當腎臟面臨酸挑戰(例如吃動物來源的蛋白質)時,腎臟會提升荷爾蒙值以幫助在短期內排除酸性物質;不過,長期下來,提升的這些荷爾蒙值會惡化腎臟功能。
  
  他解釋,這個想法是,如果患者減少飲食中的蛋白質總量,長期下來將對腎臟的功能有幫助;但是,在1990年代初期進行的腎臟疾病飲食調整這項研究中,降低飲食中的蛋白質總量,並不會延緩腎病病程。
  
  相對的,Wesson醫師報告指出,他自己的研究顯示,蔬果來源的蛋白質對腎臟帶來的是鹼而不會是酸挑戰。他表示,如果你飲食中增加蔬果量,我們發現,它們對腎功能有保護性。
  
  因此,不同於腎臟學界認為蛋白質對腎功能有毒性影響的福音,他們的研究認為,蛋白質的品質才是重點,而不是蛋白質的量;處方應該是人們多吃蔬果作為蛋白質來源,少吃動物性蛋白質。
  
  Wesson醫師表示,他無法推論為什麼新加坡的研究顯示紅肉會影響ESRD風險,而其他動物來源蛋白質不會,但是,他認為,紅肉比其他動物性蛋白質更容易產生酸,因此使紅肉對腎臟特別有毒性。
  
  資料來源:http://www.24drs.com/
  
  Native link:More Red Meat Increases Risk for End-Stage Renal Disease

More Red Meat Increases Risk for End-Stage Renal Disease

By Pam Harrison
Medscape Medical News

There is an association between the consumption of red meat and the risk for end-stage renal disease (ESRD) in people of Chinese origin in the general population of Singapore, new research shows.

"A number of organizations have advocated reducing protein intake in patients with pre-existing chronic kidney disease in order to delay progression to ESRD," said Quan Lan Lew, MD, from the Duke–National University of Singapore Graduate Medical School.

"We found that a high intake of red meat appears to increase ESRD risk, and that replacement of red meat protein with other sources of protein has the potential to reduce this risk," she reported.

Dr Lew presented the study results at the Kidney Week 2015 in San Francisco.

The researchers used data from the 60,198 participants recruited from 1993 to 1998 to the Singapore Chinese Health Study, a large population-based prospective cohort of people of south Chinese descent. Participants were 45 to 74 years of age.

The 165-item food frequency questionnaire was used to collect information on the consumption of specific foods, the number of servings consumed, and the portion sizes consumed.

Record linkage with the nationwide Singapore Renal Registry, up to December 2012, was used to identify 951 cases of incident ESRD during a mean follow-up of 15.5 years.

Patients who developed ESRD tended to be slightly older than those who did not, and were more likely to have smoked at some point, to have hypertension, diabetes, or both, and to be slightly heavier, Dr Lew reported.

In their basic model, the researchers found a significant correlation between ESRD risk and the highest three quartiles of any protein intake after adjustment for age, sex, dialect, educational level, and year of interview.

Red Meat, Not Other Proteins

However, when they adjusted "for variables such as lifestyle and chronic disease, we found that this adjustment attenuated any positive correlation," Dr Lew said, except in the case of red meat intake.

In fact, the relative risk for ESRD was 40% higher in the highest quartile of red meat intake than in the lowest quartile. The association between a high intake of red meat and ESRD risk remained consistent even when participants with underlying comorbidities were excluded from the analysis.

This positive correlation was not seen for poultry, fish or shellfish, eggs, dairy products, or soy and legumes, Dr Lew explained.

Substituting a serving of red meat with a serving of poultry, for example, decreased the relative risk for ESRD by approximately 66% (P< .001), with legumes decreased the relative risk by 54% (P< .001), with fish decreased the relative risk by 52% (P= .002), and with eggs decreased the relative risk by 52% (P= .009).

"Very few people in Singapore eat beef on a regular basis," said Dr Lew, noting that in the Singapore Chinese Health Study, "red meat" referred mainly to pork.

"Future directions will be to determine the pathophysiology of eating red meat on ESRD risk and to see if substituting red meat with other sources of protein in patients with chronic kidney disease might delay progression to ESRD," she said.

Acidification in the Kidney

"When the kidney is challenged with acid — such as by eating an animal-source protein diet — the kidney increases levels of hormones that help it excrete the acid in the short term," said Donald Wesson, MD, chief academic officer at Baylor Scott& White Health in Dallas, who has been studying how the kidney adjusts to either a high or a low acid challenge for the past 30 years.

However, in the long-term, high levels of these hormones worsen kidney function, he told Medscape Medical News.

The thinking has been that if patients simply reduce the total amount of protein in their diet, it will help protect kidney function over the long term, he explained. But lowering the total amount of protein in the diet did not reduce the rate of kidney disease progression in the Modification of Diet in Renal Disease study, which was conducted in the early 1990s.

Our studies suggest that it is the quality, not the quantity, of the protein that is important.

In contrast, Dr Wesson reported that his own research has shown that fruit and vegetable sources of protein offer a base rather than an acid challenge to the kidney. "If you add fruit and vegetables to the diet, we found that they are protective of kidney function," he said.

Thus, contrary to what the "gospel" has been in the kidney community regarding the toxic effects of protein on kidney function, "our studies suggest that it is the quality, not the quantity, of the protein that is important. We say that the prescription should be for people to eat more fruits and vegetables as sources of protein and less animal protein," he said.

Dr Wesson said he is unable to speculate why red meat and not other sources of animal protein affected ESRD risk in the Singapore study. But he did suggest that red meat is particularly high in its acid-producing potential, compared with other sources of animal protein, which would make it especially toxic to the kidney.

The study was funded with the help of non-US government support. Dr Lew and Dr Wesson have disclosed no relevant financial relationships.

Kidney Week 2015: American Society of Nephrology Annual Meeting. AbstractFR-OR109. Presented November6, 2015.

    
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