Plant-based diets, insulin sensitivity and inflammation in elderly men with chronic kidney disease
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ORIGINAL ARTICLE
Plant‑based diets, insulin sensitivity and inflammation in elderly men with chronic kidney disease Ailema González‑Ortiz1,2 · Hong Xu3 · Carla M. Avesani4 · Bengt Lindholm4 · Tommy Cederholm5,6 · Ulf Risérus5 · Johan Ärnlöv7,8 · Angeles Espinosa‑Cuevas2 · Juan Jesús Carrero1 Received: 8 April 2020 / Accepted: 27 May 2020 © The Author(s) 2020
Abstract Background In persons with CKD, adherence to plant-based diets is associated with lower risk of CKD progression and death, but underlying mechanisms are poorly characterized. We here explore associations between adherence to plant-based diets and measures of insulin sensitivity and inflammation in men with CKD stages 3–5. Methods Cross-sectional study including 418 men free from diabetes, aged 70–71 years and with cystatin-C estimated glomerular filtration rate (eGFR) 1.71 mmol/L or treatment with lipid-lowering medications. Smoking status was self-reported and defined as current smoking versus nonsmoking. Physical activity was self-reported and classified as sedentary and moderate vs regular and athletic [30]. Hypertension was defined as 24-h SBP ≥130 mmHg, 24-h DBP ≥80 mm Hg, or use of antihypertensive medications [31]. CVD comorbid history was obtained by linkage to the Swedish Patient Register (ICD-9 codes 390–459, ICD-10 codes I00-I99).
Statistical analysis Values are expressed as mean and standard deviation (SD) for continuous variables with normal distribution, median (interquartile range, IQR) for non-normal distribution variables and percentage of total for categorical. We report baseline characteristics of the sample according to quintiles (Q) of plant based diet score and evaluate P for linear trends across these groups. We used linear regression models to evaluate the association between PBDi (as a continuous variable, per score unit increase) and study outcomes. Because of skewed data distribution, eGFR, CRP, M and M/I were log-transformed before entering in the regression. Selection of covariates was done on the basis of biological consideration as confounders in the association of interest. Three stepwise models were investigated; In model 1, we considered multivariable adjustment for age and eGFR; In model 2, we further adjusted for total energy intake, lifestyle factors (physical activity, smoking and alcohol intake), BMI and comorbidities (CVD history and hypertension); in model 3, we further adjusted for the use of antihypertensive medication and lipid lowering agents.Finally, we investigated the relationship between PBDi and study outcomes graphically by the use of restricted cubic spline graphs with four degrees of freedom. Data are expressed as regression coefficients and 95% confidence interval (95% CIs). All statistical analysis
Journal of Nephrology
were performed using STATA software (version 15.1; Stata Corp, College Station, TX).
Results Baseline characteristics After applying inclusion and exclusion criteria, the cohort consisted of 418 men free from diabetes, aged 70–71 years and with CKD stages
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