Greater red meat consumption is associated with an increased risk of end-stage renal disease (ESRD), new finding suggest.

Individuals in the highest quartile of red meat intake have a 40% increased risk of ESRD compared with those in the lowest quartile, researchers led by Woon-Puay Koh, MBBS, PhD, of Duke-NUS Medical School and Saw Swee Hock School of Public Health at the National University of Singapore reported online ahead of print in the Journal of the American Society of Nephrology. Consumption of poultry, fish, eggs, or dairy products was not associated with ESRD risk.

In addition, the investigators found that substituting 1 serving of red meat with poultry or fish resulted in a 62.4% and 48.6% reduction in ESRD risk, respectively. Replacing 1 serving of red meat with soy and legumes or eggs was associated with a 50.4% and 44.9% reduction in ESRD risk, respectively.

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We embarked on our study to see what advice should be given to CKD patients or to the general population worried about their kidney health regarding types or sources of protein intake,” Dr Koh said in a press release from the American Society of Nephrology. “Our findings suggest that these individuals can still maintain protein intake but consider switching to plant-based sources; however, if they still choose to eat meat, fish/shellfish and poultry are better alternatives to red meat.”

Dr Koh and colleagues studied 60,198 Chinese adults who participated in the prospective Singapore Chinese Health Study. ESRD developed in 951 individuals over a mean follow-up of 15.5 years. The mean age at ESRD diagnosis was 69.3 years.

Individuals in the highest quartile of red meat intake were slightly younger than those in the lowest quartile (55.7 vs. 56.5 years) and less likely to be physically active (31% vs. 39% reporting at least 30 minutes of moderate activity, vigorous activity, or strenuous sports per week). At baseline, individuals in the highest quartile had a lower prevalence of self-reported hypertension than those in the lowest quartile (22% vs. 24%), but a higher prevalence of self-reported diabetes (9% vs. 7%).

Endogenous acid production resulting from red meat consumption is among the possible explanations for the observed association between red meat consumption and ESRD risk, according to the researchers. They cited studies showing that high dietary acid load was associated with an increased incidence of ESRD in a population-based US cohort of adults with chronic kidney disease and that red meat generally yields greater acid production than other animal-sourced protein.

The strengths of the study include its prospective design, large sample size, and long-term and complete follow-up of outcomes, the investigators noted. In addition, dietary intake was assessed using a validated food frequency questionnaire developed specifically for the study population. Limitations include the observational nature of the study, the use of participant self-report, and a single assessment of diet, which could lead to misclassification bias to due measurement error, the investigators stated.

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