Vegetarian Dietary Patterns and Diet-Related Metabolites Are Associated With Kidney Function in the Adventist Health Study-2 Cohort

Abstract

Objectives

Chronic kidney disease is a significant global health burden. Plant-based diets have shown potential benefits for kidney function, but the specific impacts of vegetarian dietary patterns and underlying metabolic mechanisms remain unclear.

Methods

Serum creatinine was measured in 899 Adventist Health Study-2 cohort participants who were classified as vegan, lacto-ovo-vegetarian, pesco-vegetarian, semivegetarian, or nonvegetarian, and estimated glomerular filtration rate (eGFR) was calculated (<60 or >/ = 60 mL/min/1.73 m²). Untargeted plasma metabolomics using ultra-performance liquid chromatography–mass spectrometry/mass spectrometry was performed on a subset of participants with serum creatinine measurements. Multivariable linear regression models adjusted for confounders assessed associations between eGFR, dietary patterns, and plasma metabolites. The Storey permutation approach was used to adjust for false discovery.

Results

Vegan and pesco-vegetarian dietary patterns were associated with significantly higher eGFR compared to nonvegetarians, with minimal attenuation after adjustment. Metabolomics analysis revealed distinct profiles in relation to creatinine, comparing the 90th to 10th percentiles. Creatinine was positively associated with several lipid and amino acid subclasses, which were lower in participants following vegetarian dietary patterns. Key subclasses included acetylated peptides, histidine metabolism, lysine metabolism, plasmalogens, and notably sphingomyelins for pesco-vegetarians. Individual metabolites within many of the differential subclasses consistently showed opposite directions of associations with vegetarian dietary patterns and creatinine.

Conclusions

Vegan and pesco-vegetarian dietary patterns, relative to nonvegetarian, were associated with higher eGFR, potentially through diet-driven metabolic pathways. Plant-based diets may offer protection against chronic kidney disease by modulating key metabolic pathways.