特等奖论文获得者 党子涵：哥伦比亚大学教育学院在读博士
植物性饮食与慢性肾脏疾病：系统综述和荟萃分析
党子涵1邹丰蔚2
1哥伦比亚大学教育学院；博士候选人；
2美国蒙特菲奥雷医院-爱因斯坦心血管中心；医学博士
通信作者：党子涵，邮箱: zd2172@tc.columbia.edu
【背景】慢性肾脏病（CKD）是一种无法治愈的渐进性疾病，严重增加了全球健康负担，影响着全球超过10%的人口。近年来，越来越多的证据表明植物性饮食（PBD）对肾功能有着积极影响。然而，目前还缺乏全面评估PBD与CKD之间关系的荟萃分析研究。本荟萃分析是该领域中首次评估这种关系的研究之一。
【方法】在PubMed和Embase数据库中，筛选出与PBD与CKD的发病率、进展和死亡率相关的研究，检索日期截止到2023年8月3日。统计方法采用随机效应模型估计比值比（OR）和95%置信区间（CI）。
【结果】本研究共纳入了107582名参与者，年龄分布在18岁到71岁之间，参与者的加权平均随访时间为12.5年。结果显示，在83169名参与者中，采用PBD可显著降低罹患CKD的风险[OR=0.77，95% CI (0.69~0.85)，P< 0.0001]。亚组分析结果显示，与 Q1/T1相比，较高的PBD五分位数（Q2-Q5）[OR=0.95，95% CI （0.91~1.00）]与三分位数（T2-T3）[OR=0.59，95% CI (0.38~0.79)]同样显示降低CKD的发病风险。调整PBD患者的 CKD相关合并症（调整模型 M1、M2 和 M3），结果同样显著[OR=0.85,95% CI (0.76~0.93）]。
【结论】采用 PBD 并增加植物性蛋白质的摄入量可显著降低慢性肾脏病的发病率。此外，PBD 还能延缓慢性肾脏病患者的病情发展，降低死亡率
【关键词】植物性饮食;素食;纯素；植物蛋白;慢性肾脏病;慢性肾功能不全;慢性肾功能减退
Plant-based Diet and Chronic Kidney Disease: A Systematic Review and Meta-analysis
Zihan Dang, PHD candidate1 Fengwei Zou, MD2
1Teachers College, Columbia University, New York, 10027
2 Department of Cardiology, Montefiore-Einstein Center For Heart & Vascular Care, Albert Einstein College of Medicine, Bronx, NY, USA, 10467
Correspondence Author:Zihan Dang，Email:zd2172@tc.columbia.edu
Background: Chronic kidney disease (CKD) is a progressive condition without cure, and significantly contributes to the global health burden, affecting more than 10% of the world's population. Recently, there is increasing evidence of the positive impact of plant-based diets (PBD)on kidney function. However, there is a lack of meta-analytical studies comprehensively examining the relationship between PBD and CKD. This meta-analysis is one of the first in the field to evaluate this association.
Methods:A systematic review of PubMed and Embase was conducted from inception to August 3, 2023 to select studies that evaluated the the association between adopting a PBD and the incidence, progression, and mortality of CKD. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effects model.
Results:A total of 107,582 participants were included in this study, with age ranging from 18 to 71 years. These participants were followed up for a weighted average of 12.5 years. Adopting PBD is associated with significantly reduce risk of developing CKD [OR=0.77, 95% CI (0.69, 0.85), P< 0.0001] across 83,169 participants. Similar results were observed in subgroup analyses that examined higher quintiles (Q2-Q5) and tertiles (T2-T3) of PBD vs Q1/T1, with overall effect measures of 0.95 (95% CI: 0.91 to 1.00) and 0.59 (95% CI: 0.38 to 0.79), respectively. When adjusting for CKD-related comorbidities in patients following PBD (adjusted models M1, M2, and M3), significant findings were also observed, with an overall effect OR of 0.85 (95% CI: 0.76 to 0.93).
Conclusion: Adopting PBD and increasing plant-based protein consumption is associated with significant reduction of CKD incidence in the general population from pooled meta-analysis. PBD is also associated with decreased progression and mortality in individuals with CKD.
Key Words: plant-based diet, vegetarian, vegan, plant protein, chronic kidney disease, chronic renal insufficiency, chronic kidney insufficiency