Dietary butyric acid intake, kidney function, and survival: The National Health and Nutrition Examination Surveys, 2005–2018

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-03-25 DOI:10.1016/j.clnesp.2025.03.011

Wei Tang , Zhengyi Long , Yang Xiao , Jingyun Du , Chenyuan Tang , JunXiang Chen , Can Hou

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引用次数: 0

Abstract

Background

Although preclinical data support the hypothesis that butyric acid supplementation improves kidney health, the clinical significance of dietary butyric acid intake in patients with chronic kidney disease (CKD) remains unconfirmed in large-sample studies. This study aimed to investigate the association between dietary butyric acid intake and all-cause mortality in the United States population, stratified by kidney function.

Methods

We examined the relationship between dietary butyric acid intake, assessed through a 24-h dietary recall, and all-cause mortality among 23,008 consecutive adult participants from the National Health and Nutrition Examination Surveys (NHANES, 2005–2018), categorized by impaired versus normal kidney function (estimated glomerular filtration rate <60 vs ≥ 60 mL/min/1.72 m²), using multivariable Cox models. We also employed a restricted cubic spline based on Cox regression models to elucidate the nonlinear relationship between dietary butyric acid intake and mortality in patients.

Result

In participants with impaired kidney function, high dietary butyric acid intake was associated with lower mortality, while lower intake levels (reference) showed no such association: adjusted HRs (aHRs) were 0.67 (95 % CI: 0.45, 1.00), 0.65 (95 % CI: 0.45, 0.94), and 0.58 (95 % CI: 0.38, 0.89) for intake levels of the square root of butyric acid 0.25–0.45, 0.45–0.75, and >0.75 g/day, respectively. However, in participants with normal kidney function, no association between butyric acid levels and mortality was observed. Additionally, we identified an L-shaped association between the levels of the square root of dietary butyric acid intake and all-cause mortality in the CKD population, reaching a plateau at 0.52 g/day (butyric acid intake of approximately 0.27 g/day).

Conclusion

This study revealed a nonlinear association between high dietary butyric acid intake and reduced all-cause mortality in patients with chronic kidney disease. A plateau occurs after 0.27 g/day, and for individuals with CKD whose butyric acid intake is below approximately 0.27 g/day, increasing a butyrate-rich diet or supplementing with butyric acid preparations may help prevent progression to renal failure and associated adverse outcomes in CKD patients, thereby reducing mortality. Therefore, it can be considered a new therapeutic strategy for the treatment of chronic kidney disease.

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膳食丁酸摄入量、肾功能和存活率：2005-2018 年全国健康与营养调查。

背景：尽管临床前数据支持补充丁酸可以改善肾脏健康的假设，但在大样本研究中，慢性肾脏疾病（CKD）患者饮食中丁酸摄入的临床意义仍未得到证实。本研究旨在调查美国人群中按肾功能分层的膳食丁酸摄入量与全因死亡率之间的关系。方法：我们使用多变量Cox模型，通过24小时饮食回忆来评估膳食丁酸摄入量与全国健康与营养调查（NHANES, 2005-2018）中23,008名连续成人参与者的全因死亡率之间的关系，这些参与者按肾功能受损与正常（估计肾小球滤过率2）分类。我们还采用基于Cox回归模型的限制三次样条来阐明膳食丁酸摄入量与患者死亡率之间的非线性关系。结果：在肾功能受损的参与者中，高膳食丁酸摄入量（>0.75 g/天）与较低的死亡率相关，而较低的摄入水平（参考，≤0.25 g/天）没有这种关联：调整后的hr （aHRs）分别为0.72 (95% CI: 0.49, 1.08), 0.69 （95% CI: 0.47, 1.00）和0.65 (95% CI: 0.43, 0.98)，丁酸的平方根摄入量为0.25-0.45,0.45-0.75和>0.75 g/天。然而，在肾功能正常的参与者中，没有观察到丁酸水平与死亡率之间的关联。此外，我们确定了CKD人群中膳食丁酸摄入量的平方根水平与全因死亡率之间的l形相关性，在0.52 g/天（丁酸摄入量约为0.27 g/天）时达到平台期。结论：本研究揭示了高膳食丁酸摄入量与降低慢性肾病患者全因死亡率之间的非线性关联。0.27 g/天后出现平台期，对于丁酸摄入量低于约0.27 g/天的CKD患者，增加富含丁酸盐的饮食或补充丁酸制剂可能有助于预防CKD患者肾功能衰竭进展和相关不良后果，从而降低死亡率。因此，它可以被认为是治疗慢性肾脏疾病的一种新的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.