Meat intake and risk of mortality and graft failure in kidney transplant recipients

M. Yusof Said*, Angelica Rodriguez-Niño, Adrian Post, Joëlle Schutten, Lyanne Kieneker, António Gomes Neto, Marco van Londen, Maryse Osté, Karin J Borgonjen-van den Berg, Ilja M. Nolte, Else Berg ,van den, Pim de Blaauw, Jennifer van der Krogt, Rebecca Fokkema, Gerjan Navis, Benito Yard, Stephan Bakker

*Corresponding author for this work

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Background: It is unknown whether meat intake is beneficial for long-term patient and graft survival in kidney transplant recipients (KTR).

Objectives: We first investigated the association of the previously described meat intake biomarkers 1-methylhistidine and 3-methylbistidine with intake of white and red meat as estimated from a validated food frequency questionnaire (FFQ). Second, we investigated the association of the meat intake biomarkers with longterm outcomes in KTR.

Methods: We measured 24-h urinary excretion of 1-methylhistidine and 3-methylhistidine by validated assays in a cohort of 678 clinically stable KTR. Cross-sectional associations were assessed by linear regression. We used Cox regression analyses to prospectively study associations of log`-transformed biomarkers with mortality and graft failure.

Results: Urinary 1-methylhistidine and 3-methylhistidine excretion values were median: 282; interquartile range (IQR): 132-598 mu mol/24 h and median: 231; IQR: 175-306 mu mol/24 h, respectively. Urinary 1-methylhistidine was associated with white meat intake (standardized beta (st beta): 0.20; 95% CI: 0.12, 0.28; P < 0.001], whereas urinary 3-methylhistidine was associated with red meat intake (st beta: 0.30; 95% CI: 0.23, 0.38; P < 0.001). During median follow-up for 5.4 (IQR: 4.9-6.1) y, 145 (21%) died and 83 (12%) developed graft failure. Urinary 3-methylhistidine was inversely associated with mortality independently of potential confounders (HR per doubling: 0.55; 95% CI:; P < 0.001). Both urinary 1-methylhistidine and urinary 3-methylhistidine were inversely associated with graft failure independent of potential confounders (HR per doubling: 0.84; 95% CI: 0.73. 0.96; P = 0.01; and 0.59; 95% CI: 0.41, 0.85; P = 0.004, respectively).

Conclusions: High urinary 3-methylhistidine, reflecting higher red meat intake, is independently associated with lower risk of mortality. High urinary concentrations of both 1- and 3-methylhistidine, of which the former reflects higher white meat intake, are independently associated with lower risk of graft failure in KTR. Future intervention studies are warranted to study the effect of high meat intake on mortality and graft failure in KTR. using these biomarkers.

Original languageEnglish
Article numbernqab185
Pages (from-to)1505-1517
Number of pages13
JournalAmerican Journal of Clinical Nutrition
Issue number4
Early online date5-Jun-2021
Publication statusPublished - Oct-2021


  • kidney transplantation
  • animal protein intake
  • red meat
  • white meat
  • mortality
  • graft failure
  • long-term survival
  • 1-methylhistidine
  • 3-methylhistidine

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