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      Associations of meat, fish and seafood consumption with kidney function in middle-aged to older Chinese: a cross-sectional study based on the Guangzhou Biobank Cohort Study

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          Abstract

          Objective

          To examine the associations of red meat, poultry, fish and seafood and processed meat consumption with kidney function in middle-aged to older Chinese.

          Design

          A cross-sectional study based on the Guangzhou Biobank Cohort Study.

          Setting

          Community-based sample.

          Participants

          9768 participants (2743 men and 7025 women) aged 50+ years.

          Primary and secondary outcome measures

          Primary outcome was estimated glomerular filtration rate (eGFR) derived from the Chinese-specific equation based on the Modification of Diet in Renal Disease (MDRD) equation (c-aGFR). eGFR derived from the original isotope-dilution mass spectrometry-traceable MDRD study equation, and prevalent chronic kidney disease (CKD) defined as c-aGFR<60 mL/min/1.73 m 2 were considered the secondary outcomes.

          Results

          After adjusting for sex, age, body mass index, education, occupation, family income, smoking status, alcohol use, physical activity, daily energy intake, self-rated health and chronic disease history (diabetes, hypertension and dyslipidaemia), compared with processed meat consumption of 0–1 portion/week, those who consumed ≥3 portions/week had lower c-aGFR (β=−2.74 mL/min/1.73 m 2, 95% CI=−4.28 to −1.20) and higher risk of prevalent CKD (OR=1.40, 95% CI=1.09 to 1.80, p<0.0125). Regarding fish and seafood consumption, the associations varied by diabetes (p for interaction=0.02). Fish and seafood consumption of ≥11 portions/week, versus 0–3 portions/week, was non-significantly associated with higher c-aGFR (β=3.62 mL/min/1.73 m 2, 95% CI=−0.06 to 7.30) in participants with diabetes, but was associated with lower c-aGFR in normoglycaemic participants (β=−1.51 mL/min/1.73 m 2, 95% CI=−2.81 to −0.20). No significant associations of red meat or poultry consumption with c-aGFR nor prevalent CKD were found. Similar results were found for meat, fish and seafood consumption with eGFR.

          Conclusions

          Higher processed meat, fish and seafood consumption was associated with lower kidney function in normoglycaemic participants. However, the associations in participants with diabetes warrant further investigation.

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          Most cited references40

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          Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

          Summary Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. Funding Bill & Melinda Gates Foundation.
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            Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis

            Intestinal microbiota metabolism of choline/phosphatidylcholine produces trimethylamine (TMA), which is further metabolized to a proatherogenic species, trimethylamine-N-oxide (TMAO). Herein we demonstrate that intestinal microbiota metabolism of dietary L-carnitine, a trimethylamine abundant in red meat, also produces TMAO and accelerates atherosclerosis. Omnivorous subjects are shown to produce significantly more TMAO than vegans/vegetarians following ingestion of L-carnitine through a microbiota-dependent mechanism. Specific bacterial taxa in human feces are shown to associate with both plasma TMAO and dietary status. Plasma L-carnitine levels in subjects undergoing cardiac evaluation (n = 2,595) predict increased risks for both prevalent cardiovascular disease (CVD) and incident major adverse cardiac events (MI, stroke or death), but only among subjects with concurrently high TMAO levels. Chronic dietary L-carnitine supplementation in mice significantly altered cecal microbial composition, markedly enhanced synthesis of TMA/TMAO, and increased atherosclerosis, but not following suppression of intestinal microbiota. Dietary supplementation of TMAO, or either carnitine or choline in mice with intact intestinal microbiota, significantly reduced reverse cholesterol transport in vivo. Intestinal microbiota may thus participate in the well-established link between increased red meat consumption and CVD risk.
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              Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate.

              Glomerular filtration rate (GFR) estimates facilitate detection of chronic kidney disease but require calibration of the serum creatinine assay to the laboratory that developed the equation. The 4-variable equation from the Modification of Diet in Renal Disease (MDRD) Study has been reexpressed for use with a standardized assay. To describe the performance of the revised 4-variable MDRD Study equation and compare it with the performance of the 6-variable MDRD Study and Cockcroft-Gault equations. Comparison of estimated and measured GFR. 15 clinical centers participating in a randomized, controlled trial. 1628 patients with chronic kidney disease participating in the MDRD Study. Serum creatinine levels were calibrated to an assay traceable to isotope-dilution mass spectrometry. Glomerular filtration rate was measured as urinary clearance of 125I-iothalamate. Mean measured GFR was 39.8 mL/min per 1.73 m2 (SD, 21.2). Accuracy and precision of the revised 4-variable equation were similar to those of the original 6-variable equation and better than in the Cockcroft-Gault equation, even when the latter was corrected for bias, with 90%, 91%, 60%, and 83% of estimates within 30% of measured GFR, respectively. Differences between measured and estimated GFR were greater for all equations when the estimated GFR was 60 mL/min per 1.73 m2 or greater. The MDRD Study included few patients with a GFR greater than 90 mL/min per 1.73 m2. Equations were not compared in a separate study sample. The 4-variable MDRD Study equation provides reasonably accurate GFR estimates in patients with chronic kidney disease and a measured GFR of less than 90 mL/min per 1.73 m2. By using the reexpressed MDRD Study equation with the standardized serum creatinine assay, clinical laboratories can report more accurate GFR estimates.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2023
                6 October 2023
                : 13
                : 10
                : e073738
                Affiliations
                [1 ]departmentSchool of Public Health , Ringgold_26469Sun Yat-sen University , Guangzhou, Guangdong, China
                [2 ]departmentMolecular Epidemiology Research Centre , Guangzhou Twelfth People’s Hospital , Guangzhou, Guangdong, China
                [3 ]departmentSchool of Public Health , The University of Hong Kong , Hong Kong, Hong Kong
                [4 ]departmentInstitute of Applied Health Research , University of Birmingham , Birmingham, UK
                Author notes
                [Correspondence to ] Professor Lin Xu; xulin27@ 123456mail.sysu.edu.cn

                TYL and WSZ are joint first authors.

                Author information
                http://orcid.org/0000-0002-0537-922X
                Article
                bmjopen-2023-073738
                10.1136/bmjopen-2023-073738
                10565302
                37802614
                2881559f-df7b-4fe8-b475-91ef443e78ca
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 16 March 2023
                : 21 September 2023
                Funding
                Funded by: University of Birmingham, UK;
                Award ID: N/A
                Funded by: Guangzhou Science and Technology Bureau, Guangzhou, China;
                Award ID: 2002Z2-E2051
                Award ID: 2012J5100041
                Award ID: 2013J4100031
                Award ID: 201704030132
                Funded by: Natural Science Foundation of China;
                Award ID: 81941019
                Funded by: the Health Medical Research Fund in Hong Kong;
                Award ID: HMRF/13143241
                Funded by: Guangzhou Public Health Bureau;
                Award ID: 201102A211004011
                Funded by: Natural Science Foundation of Guangdong;
                Award ID: 2015A030313891
                Award ID: 2018A030313140
                Funded by: The University of Hong Kong Foundation for Educational Development and Research;
                Award ID: C20400.28505200
                Award ID: SN/1f/HKUF-DC
                Categories
                Epidemiology
                1506
                1692
                Original research
                Custom metadata
                unlocked

                Medicine
                epidemiologic studies,nephrology,nutrition & dietetics
                Medicine
                epidemiologic studies, nephrology, nutrition & dietetics

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