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Impact of low-carbohydrate diet on renal function: a meta-analysis of over 1000 individuals from nine randomised controlled trials. Br J Nutr 2016; 116:632-8. [DOI: 10.1017/s0007114516002178] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractWe aimed to clarify the effect of low-carbohydrate diet (LCD) on renal function in overweight and obese individuals without chronic kidney disease (CKD). Literature searches were performed using EMBASE, MEDLINE and Cochrane Library until December 2015. We selected articles that reported human studies from their inception until December 2015 in English using the following searching terms: ‘Low carbohydrate diet’ AND (‘Clinical trial’ OR ‘Clinical study’ OR ‘Clinical investigation’ OR ‘Observational study’ OR ‘Cohort study’). We compared the effects of LCD on renal function, defined as change in estimated glomerular filtration rate (eGFR), assessed in randomised-controlled trials. We calculated the mean change in eGFR and the mean change in standard deviations by eGFR or creatinine clearance, and compared the mean change in eGFR and standard deviations in LCD with those in the control diet using fixed-effects models. We selected nine randomised controlled trials including 1687 participants (861 were fed LCD and 826 were fed the control diet). The mean change in eGFR in the LCD group was −4·7 to 24·0 ml/min per 1·73 m2 and that in the control diet group was −4·1 to 10·8 ml/min per 1·73 m2. The mean change in eGFR in the LCD group was greater than that in the control diet (0·13 ml/min per 1·73 m2; 95 % CI 0·00, 0·26). In the present meta-analysis, we identified that the increase in eGFR was greater in LCD compared with the control diet in overweight and obese individuals without CKD.
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Lifestyle Therapy for Diabetes Mellitus. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Rughooputh MS, Zeng R, Yao Y. Protein Diet Restriction Slows Chronic Kidney Disease Progression in Non-Diabetic and in Type 1 Diabetic Patients, but Not in Type 2 Diabetic Patients: A Meta-Analysis of Randomized Controlled Trials Using Glomerular Filtration Rate as a Surrogate. PLoS One 2015; 10:e0145505. [PMID: 26710078 PMCID: PMC4692386 DOI: 10.1371/journal.pone.0145505] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 12/04/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVE Studies, including various meta-analyses, on the effect of Protein Diet Restriction on Glomerular Filtration Rate (GFR) in Chronic Kidney Disease (CKD) have reported conflicting results. In this paper, we have provided an update on the evidence available on this topic. We have investigated the reasons why the effect has been inconsistent across studies. We have also compared the effect on GFR in various subgroups including type 1 diabetics, type 2 diabetics and non-diabetics. METHOD We searched for Randomized Controlled Trials on this intervention from MEDLINE, EMBASE, and other information sources. The PRISMA guidelines, as well as recommended meta-analysis practices were followed in the selection process, analysis and reporting of our findings. The effect estimate used was the change in mean GFR. Heterogeneity across the considered studies was explored using both subgroup analyses and meta-regression. Quality assessment was done using the Cochrane risk of bias tool and sensitivity analyses. RESULTS 15 randomized controlled trials, including 1965 subjects, were analyzed. The pooled effect size, as assessed using random-effects model, for all the 15 studies was -0.95 ml/min/1.73m2/year (95% CI: -1.79, -0.11), with a significant p value of 0.03. The combined effect estimate for the non-diabetic and type 1 diabetic studies was -1.50 ml/min/1.73m2/year (95% CI: -2.73, -0.26) with p value of 0.02. The effect estimate for the type 2 diabetic group was -0.17 ml/min/1.73m2/year (95% CI: -1.88, 1.55) with p value of 0.85. There was significant heterogeneity across the included studies (I2 = 74%, p value for Q < 0.0001), explained by major variations in the percentage of type 2 diabetic subjects, the number of subjects and overall compliance level to diet prescribed. CONCLUSION Our findings suggest that protein diet restriction slows chronic renal disease progression in non-diabetic and in type 1 diabetic patients, but not in type 2 diabetic patients.
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Affiliation(s)
- Mahesh Shumsher Rughooputh
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (MSR); (RZ); (YY)
| | - Rui Zeng
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (MSR); (RZ); (YY)
| | - Ying Yao
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (MSR); (RZ); (YY)
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Tay J, Thompson CH, Luscombe-Marsh ND, Noakes M, Buckley JD, Wittert GA, Brinkworth GD. Long-Term Effects of a Very Low Carbohydrate Compared With a High Carbohydrate Diet on Renal Function in Individuals With Type 2 Diabetes: A Randomized Trial. Medicine (Baltimore) 2015; 94:e2181. [PMID: 26632754 PMCID: PMC5059023 DOI: 10.1097/md.0000000000002181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare the long-term effects of a very low carbohydrate, high-protein, low saturated fat (LC) diet with a traditional high unrefined carbohydrate, low-fat (HC) diet on markers of renal function in obese adults with type 2 diabetes (T2DM), but without overt kidney disease.One hundred fifteen adults (BMI 34.6 ± 4.3 kg/m, age 58 ± 7 years, HbA1c 7.3 ± 1.1%, 56 ± 12 mmol/mol, serum creatinine (SCr) 69 ± 15 μmol/L, glomerular filtration rate estimated by the Chronic Kidney Disease Epidemiology Collaboration formula (eGFR 94 ± 12 mL/min/1.73 m)) were randomized to consume either an LC (14% energy as carbohydrate [CHO < 50 g/day], 28% protein [PRO], 58% fat [<10% saturated fat]) or an HC (53% CHO, 17% PRO, 30% fat [<10% saturated fat]) energy-matched, weight-loss diet combined with supervised exercise training (60 min, 3 day/wk) for 12 months. Body weight, blood pressure, and renal function assessed by eGFR, estimated creatinine clearance (Cockcroft-Gault, Salazar-Corcoran) and albumin excretion rate (AER), were measured pre- and post-intervention.Both groups achieved similar completion rates (LC 71%, HC 65%) and reductions in weight (mean [95% CI]; -9.3 [-10.6, -8.0] kg) and blood pressure (-6 [-9, -4]/-6[-8, -5] mmHg), P ≥ 0.18. Protein intake calculated from 24 hours urinary urea was higher in the LC than HC group (LC 120.1 ± 38.2 g/day, 1.3 g/kg/day; HC 95.8 ± 27.8 g/day, 1 g/kg/day), P < 0.001 diet effect. Changes in SCr (LC 3 [1, 5], HC 1 [-1, 3] μmol/L) and eGFR (LC -4 [-6, -2], HC -2 [-3, 0] mL/min/1.73 m) did not differ between diets (P = 0.25). AER decreased independent of diet composition (LC --2.4 [-6, 1.2], HC -1.8 [-5.4, 1.8] mg/24 h, P = 0.24); 6 participants (LC 3, HC 3) had moderately elevated AER at baseline (30-300 mg/24 h), which normalized in 4 participants (LC 2, HC 2) after 52 weeks.Compared with a traditional HC weight loss diet, consumption of an LC high protein diet does not adversely affect clinical markers of renal function in obese adults with T2DM and no preexisting kidney disease.
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Affiliation(s)
- Jeannie Tay
- From the Commonwealth Scientific and Industrial Research Organisation (CSIRO)-Food and Nutrition (JT, NDL-M, MN, GDB); Discipline of Medicine, University of Adelaide (JT, CHT, NDL-M, GAW); Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia (JDB); and Agency for Science, Technology and Research (A-STAR), Singapore, Singapore (JT)
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Arimura E, Pulong WP, Marchianti ACN, Nakakuma M, Abe M, Ushikai M, Horiuchi M. Deteriorated glucose metabolism with a high-protein, low-carbohydrate diet in db mice, an animal model of type 2 diabetes, might be caused by insufficient insulin secretion. Eur J Nutr 2015; 56:237-246. [PMID: 26497335 DOI: 10.1007/s00394-015-1075-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/08/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE We previously showed the deleterious effects of increased dietary protein on renal manifestations and glucose metabolism in leptin receptor-deficient (db) mice. Here, we further examined its effects on glucose metabolism, including urinary C-peptide. We also orally administered mixtures corresponding to low- or high-protein diets to diabetic mice. METHODS In diet experiments, under pair-feeding (equivalent energy and fat) conditions using a metabolic cage, mice were fed diets with different protein content (L diet: 12 % protein, 71 % carbohydrate, 17 % fat; H diet: 24 % protein, 59 % carbohydrate, 17 % fat) for 15 days. In oral administration experiments, the respective mixtures (L mixture: 12 % proline, 71 % maltose or starch, 17 % linoleic acid; H mixture: 24 % proline, 59 % maltose or starch, 17 % linoleic acid) were supplied to mice. Biochemical parameters related to glucose metabolism were measured. RESULTS The db-H diet mice showed significantly higher water intake, urinary volume, and glucose levels than db-L diet mice but similar levels of excreted urinary C-peptide. In contrast, control-H diet mice showed significantly higher C-peptide excretion than control-L diet mice. Both types of mice fed H diet excreted high levels of urinary albumin. When maltose mixtures were administered, db-L mixture mice showed significantly higher blood glucose after 30 min than db-H mixture mice. However, db mice administered starch-H mixture showed significantly higher blood glucose 120-300 min post-administration than db-L mixture mice, although both groups exhibited similar insulin levels. CONCLUSIONS High-protein, low-carbohydrate diets deteriorated diabetic conditions and were associated with insufficient insulin secretion in db mice. Our findings may have implications for dietary management of diabetic symptoms in human patients.
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Affiliation(s)
- Emi Arimura
- Major in Food and Nutrition, Department of Life and Environmental Science, Kagoshima Prefectural College, 1-52-1 Shimo-Ishiki, Kagoshima, 890-0005, Japan
- Department of Hygiene and Health Promotion Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Wijang Pralampita Pulong
- Department of Hygiene and Health Promotion Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Ancah Caesarina Novi Marchianti
- Department of Hygiene and Health Promotion Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
- Medical Faculty of Jember University, Kalimantan Street 37, East Java, Indonesia
| | - Miwa Nakakuma
- Department of Hygiene and Health Promotion Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
- Takata Hospital, 5-1 Horie-cho, Kagoshima, 892-0824, Japan
| | - Masaharu Abe
- Department of Hygiene and Health Promotion Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Miharu Ushikai
- Department of Hygiene and Health Promotion Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Masahisa Horiuchi
- Department of Hygiene and Health Promotion Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
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Pisani A, Riccio E, Bellizzi V, Caputo DL, Mozzillo G, Amato M, Andreucci M, Cianciaruso B, Sabbatini M. 6-tips diet: a simplified dietary approach in patients with chronic renal disease. A clinical randomized trial. Clin Exp Nephrol 2015; 20:433-42. [PMID: 26453483 DOI: 10.1007/s10157-015-1172-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/23/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The beneficial effects of dietary restriction of proteins in chronic kidney disease are widely recognized; however, poor compliance to prescribed low-protein diets (LPD) may limit their effectiveness. To help patients to adhere to the dietary prescriptions, interventions as education programmes and dietary counselling are critical, but it is also important to develop simple and attractive approaches to the LPD, especially when dietitians are not available. Therefore, we elaborated a simplified and easy to manage dietary approach consisting of 6 tips (6-tip diet, 6-TD) which could replace the standard, non-individualized LPD in Nephrology Units where dietary counselling is not available; hence, our working hypothesis was to evaluate the effects of such diet vs a standard moderately protein-restricted diet on metabolic parameters and patients' adherence. METHODS In this randomized trial, 57 CKD patients stage 3b-5 were randomly assigned (1:1) to receive the 6-TD (Group 6-TD) or a LPD containing 0.8 g/kg/day of proteins (Group LPD) for 6 months. The primary endpoint was to evaluate the effects of the two different diets on the main "metabolic" parameters and on patients' adherence (registration number NCT01865526). RESULTS Both dietary regimens were associated with a progressive reduction in protein intake and urinary urea excretion compared to baseline, although the decrease was more pronounced in Group 6-TD. Effects on serum levels of urea nitrogen and urinary phosphate excretion were greater in Group 6-TD. Plasma levels of phosphate, bicarbonate and PTH, and urinary NaCl excretion remained stable in both groups throughout the study. 44 % of LPD patients were adherent to the dietary prescription vs 70 % of Group 6-TD. CONCLUSIONS A simplified diet, consisting of 6 clear points easily managed by CKD patients, produced beneficial effects either on the metabolic profile of renal disease and on patients' adherence to the dietary plan, when compared to a standard LPD.
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Affiliation(s)
- Antonio Pisani
- Chair of Nephrology, Department of Public Health, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - Eleonora Riccio
- Chair of Nephrology, Department of Public Health, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy.
| | - Vincenzo Bellizzi
- Division of Nephrology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | - Giusi Mozzillo
- Chair of Nephrology, Department of Public Health, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - Marco Amato
- Chair of Nephrology, Department of Public Health, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - Michele Andreucci
- Division of Nephrology, University "Magna Graecia", Catanzaro, Italy
| | - Bruno Cianciaruso
- Chair of Nephrology, Department of Public Health, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - Massimo Sabbatini
- Chair of Nephrology, Department of Public Health, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy
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Abstract
Kidney disease is common in patients with type 1 and type 2 diabetes mellitus and is associated with adverse health outcomes, including progression to end-stage renal disease. In the general population, adherence to a healthy lifestyle is known to reduce the risk of cardiovascular events and death. Among individuals with diabetic kidney disease, modifications in lifestyle factors, including diet, physical activity, smoking habits, and body mass index, represent a promising cost-effective therapeutic adjunct to pharmacologic treatment of kidney disease incidence and progression.
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Affiliation(s)
- Chijoke Onyenwenyi
- Department of Medicine, Division of Nephrology, The University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, Chicago, IL 60612, Phone (312) 996-6736, Fax (312) 996-7378,
| | - Ana C. Ricardo
- Department of Medicine, Division of Nephrology, The University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, Chicago, IL 60612, Phone (312) 996-8392, Fax (312) 996-7378,
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Magalhães FG, Goulart RMM. Doença renal crônica e tratamento em idosos: uma revisão integrativa. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.14132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
ResumoO envelhecimento populacional, juntamente com a crescente incidência de doenças crônicas, tem contribuído para o aumento mundial da prevalência da doença renal crônica (DRC). O objetivo deste estudo foi realizar uma revisão integrativa sobre os tratamentos propostos para idosos portadores de DRC na fase não dialítica. Foi efetuada uma busca na literatura, considerando-se o período entre janeiro de 2002 e maio de 2013, nas bases de dados eletrônicas MEDLINE, LILACS, SciELO e Science Direct, a partir das palavras-chave: chronic kidney disease, treatment e elderly. Foram incluídos os artigos livremente disponíveis e completos. Inicialmente, foram identificados 215 artigos. Após a etapa de elegibilidade, 13 artigos foram incluídos nessa revisão integrativa. As intervenções terapêuticas recomendadas para a gestão da DRC incluem o controle de hipertensão arterial, diabetes e dislipidemia, alterações alimentares, redução de peso e abstinência do fumo. Em relação ao tratamento, para muitos idosos com DRC, uma abordagem individualizada centrada no paciente pode ter mais a oferecer do que a abordagem tradicional orientada na doença. Quanto ao encaminhamento precoce ao nefrologista, esse parece ser um procedimento que apresenta benefícios na gestão da doença renal. Embora haja um esforço aparente dos pesquisadores em instituir abordagens terapêuticas mais adequadas, ainda são escassas as evidências de intervenções que melhorem a sobrevida de pacientes idosos com DRC. Contudo, algumas intervenções evitam agudizações e retardam a evolução da DRC. Nesse sentido, há necessidade da realização de estudos randomizados controlados de longo prazo incluindo indivíduos idosos com DRC, a fim de se conhecer procedimentos terapêuticos mais eficazes para o controle dessa doença.
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Abstract
IN BRIEF For the goals of reducing diabetic kidney disease (DKD) onset and progression, approaches to nutritional therapy are a subject of much debate. This article discusses selected nutrients that have a role in affecting DKD outcomes and introduces application of newer, individualized concepts for healthful eating, as supported by clinical evidence relevant to patients with DKD. Selected aspects of management of advanced DKD are also reviewed.
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Kawasaki T, Maeda Y, Matsuki H, Matsumoto Y, Akazawa M, Kuyama T. Urinary phosphorus excretion per creatinine clearance as a prognostic marker for progression of chronic kidney disease: a retrospective cohort study. BMC Nephrol 2015. [PMID: 26215643 PMCID: PMC4517498 DOI: 10.1186/s12882-015-0118-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Whether phosphate itself has nephrotoxicity in patients with chronic kidney disease (CKD) is controversial, although phosphate excretion into urine may cause tubular damage in rat models. To evaluate actual phosphate load on each nephron, we examined the association between 24-h urinary phosphorus excretion per creatinine clearance (24-h U-P/CCr), a newly proposed index that is a surrogate for nephron load, and CKD progression in patients with CKD. Methods We conducted a single-center, retrospective cohort study. To avoid potential confounders for protein intake, only patients on our educational program for CKD with a fixed diet regimen and aged 20 years or older were included. The observation period was 3 years. Primary outcomes were CKD progression defined as a composite of end-stage kidney disease (ESKD) or 50 % reduction of estimated glomerular filtration rate. Patients were stratified by quartiles of 24-h U-P/CCr levels as Quartiles 1–4. The association was examined in three models: unadjusted (Model 1), adjusted for risk factors for CKD progression (Model 2), and factors that affect renal phosphate handling (Model 3). Results A total of 191 patients met the eligibility criteria. Patients with higher 24-h U-P/CCr showed a higher risk for the composite outcomes. The hazard ratios [95 % confidence interval] for 24-h U-P/CCr levels in Quartile 2, 3, and 4, respectively, versus Quartile 1 were 2.56 (1.15–6.24), 7.53 (3.63–17.62), and 12.17 (5.82–28.64) in Model 1; 1.66 (0.63–4.97), 3.57 (1.25–11.71), and 5.34 (1.41–22.32) in Model 2; and 3.07 (0.97–11.85), 7.52 (2.13–32.69), and 7.89 (1.74–44.33) in Model 3. Conclusions Our study showed that higher phosphorus excretion per creatinine clearance was associated with CKD progression.
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Affiliation(s)
- Tomoki Kawasaki
- Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Ibaraki, Japan.
| | - Yoshitaka Maeda
- Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Ibaraki, Japan.
| | - Hisazumi Matsuki
- Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Ibaraki, Japan.
| | - Yuko Matsumoto
- Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Ibaraki, Japan.
| | - Masanobu Akazawa
- Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Ibaraki, Japan.
| | - Tamaki Kuyama
- Nephrology Division, Department of Internal Medicine, JA Toride Medical Center, Ibaraki, Japan.
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(4) Foundations of care: education, nutrition, physical activity, smoking cessation, psychosocial care, and immunization. Diabetes Care 2015; 38 Suppl:S20-30. [PMID: 25537702 DOI: 10.2337/dc15-s007] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Diabetes now affects more than 29 million Americans, and more than 9 million of these people do not know they have diabetes. In adults, type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes and is the focus of this article. Lifestyle intervention is part of the initial treatment as well as the ongoing management of type 2 diabetes. Lifestyle intervention encompasses a healthful eating plan, physical activity, and often medication to assist in achievement of glucose, lipid, and blood pressure goals. Patient education and self-care practices are also important aspects of disease management.
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Affiliation(s)
- Alison B Evert
- Diabetes Education Programs, Diabetes Care Center, University of Washington Medical Center, 4245 Roosevelt Way Northeast, 3rd Floor, Seattle, WA 98105, USA.
| | - Michael C Riddell
- Muscle Health Research Center, School of Kinesiology and Health Science, Bethune College, York University, 4700 Keele Street, 3rd Floor, Toronto, Ontario M3J1P3, Canada
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Dietary strategies for adult type 1 diabetes in light of outcome evidence. Eur J Clin Nutr 2014; 69:285-90. [DOI: 10.1038/ejcn.2014.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/21/2014] [Accepted: 09/02/2014] [Indexed: 12/18/2022]
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Tuttle KR, Bakris GL, Bilous RW, Chiang JL, de Boer IH, Goldstein-Fuchs J, Hirsch IB, Kalantar-Zadeh K, Narva AS, Navaneethan SD, Neumiller JJ, Patel UD, Ratner RE, Whaley-Connell AT, Molitch ME. Diabetic Kidney Disease: A Report From an ADA Consensus Conference. Am J Kidney Dis 2014; 64:510-33. [DOI: 10.1053/j.ajkd.2014.08.001] [Citation(s) in RCA: 365] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/24/2014] [Indexed: 12/19/2022]
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67
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Tuttle KR, Bakris GL, Bilous RW, Chiang JL, de Boer IH, Goldstein-Fuchs J, Hirsch IB, Kalantar-Zadeh K, Narva AS, Navaneethan SD, Neumiller JJ, Patel UD, Ratner RE, Whaley-Connell AT, Molitch ME. Diabetic kidney disease: a report from an ADA Consensus Conference. Diabetes Care 2014; 37:2864-83. [PMID: 25249672 PMCID: PMC4170131 DOI: 10.2337/dc14-1296] [Citation(s) in RCA: 705] [Impact Index Per Article: 70.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world. Although incidence rates for ESRD attributable to DKD have recently stabilized, these rates continue to rise in high-risk groups such as middle-aged African Americans, Native Americans, and Hispanics. The costs of care for people with DKD are extraordinarily high. In the Medicare population alone, DKD-related expenditures among this mostly older group were nearly $25 billion in 2011. Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions. Major topic areas in DKD included 1) identification and monitoring, 2) cardiovascular disease and management of dyslipidemia, 3) hypertension and use of renin-angiotensin-aldosterone system blockade and mineralocorticoid receptor blockade, 4) glycemia measurement, hypoglycemia, and drug therapies, 5) nutrition and general care in advanced-stage chronic kidney disease, 6) children and adolescents, and 7) multidisciplinary approaches and medical home models for health care delivery. This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.
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Affiliation(s)
- Katherine R Tuttle
- University of Washington School of Medicine, Seattle, WA, and Providence Health Care, Spokane, WA
| | - George L Bakris
- Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL (National Kidney Foundation liaison)
| | | | | | - Ian H de Boer
- Division of Nephrology, University of Washington, Seattle, WA
| | | | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, Seattle, WA
| | | | - Andrew S Narva
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Sankar D Navaneethan
- Department of Nephrology and Hypertension, Novick Center for Clinical and Translational Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, WA
| | - Uptal D Patel
- Divisions of Nephrology and Pediatric Nephrology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (American Society of Nephrology liaison)
| | | | - Adam T Whaley-Connell
- Harry S. Truman Memorial Veterans Hospital, Columbia, MO, and Department of Internal Medicine, Division of Nephrology and Hypertension, University of Missouri School of Medicine, Columbia, MO
| | - Mark E Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Whitham D. Nutrition for the prevention and treatment of chronic kidney disease in diabetes. Can J Diabetes 2014; 38:344-8. [PMID: 25201774 DOI: 10.1016/j.jcjd.2014.07.222] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 02/01/2023]
Abstract
The prevention and treatment of chronic kidney disease (CKD) in diabetes through diet and lifestyle have been a topic of much interest over the years. Consideration of the type and amount of carbohydrate, protein and fat is required for optimal blood glucose control, for clinical outcomes related to renal function and for consideration of risk reduction for cardiovascular disease. Controversy has existed regarding the clinical significance of a protein-controlled diet, not to mention the ideal recommended intake in view of the benefits and risks. Furthermore, the level of CKD with which to implement dietary changes should also be considered. This review seeks to provide guidance and clarity concerning the nutritional management of CKD in diabetes.
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Affiliation(s)
- Dana Whitham
- Diabetes Comprehensive Care Program, St Michael's Hospital, Toronto, Ontario, Canada.
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Abstract
In the past couple of decades, evidence from prospective observational studies and clinical trials has converged to support the importance of individual nutrients, foods, and dietary patterns in the prevention and management of type 2 diabetes. The quality of dietary fats and carbohydrates consumed is more crucial than is the quantity of these macronutrients. Diets rich in wholegrains, fruits, vegetables, legumes, and nuts; moderate in alcohol consumption; and lower in refined grains, red or processed meats, and sugar-sweetened beverages have been shown to reduce the risk of diabetes and improve glycaemic control and blood lipids in patients with diabetes. With an emphasis on overall diet quality, several dietary patterns such as Mediterranean, low glycaemic index, moderately low carbohydrate, and vegetarian diets can be tailored to personal and cultural food preferences and appropriate calorie needs for weight control and diabetes prevention and management. Although much progress has been made in development and implementation of evidence-based nutrition recommendations in developed countries, concerted worldwide efforts and policies are warranted to alleviate regional disparities.
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Affiliation(s)
- Sylvia H Ley
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | | | - Viswanathan Mohan
- Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Frank B Hu
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
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Shide K, Takada Y, Nakashima A, Tsuji H, Wada K, Kuwabara A, Tanaka K, Inagaki N. Patients' perception on the nutritional therapy for diabetic nephropathy. JAPANESE CLINICAL MEDICINE 2014; 5:9-13. [PMID: 24855408 PMCID: PMC4011811 DOI: 10.4137/jcm.s13315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/14/2013] [Accepted: 12/05/2013] [Indexed: 11/30/2022]
Abstract
Low protein diet (LPD) plays an important role in preventing the progression of diabetic nephropathy. However, it is a great burden to the patients. In this paper, we have studied the quality of life (QOL) in such patients. The study subjects were 59 patients (male 38, female 21) with type 2 diabetes. The patients were classified into tertiles based on their protein intake (g/kg BW). Scores from the diet-related QOL questionnaire were summarized by principal component analysis into four components; mental health, less burden, satisfaction and merit, and less social restriction. Higher protein intake was associated with less burden and less social restriction. In multiple regression analysis, the significant predictors for the “less burden” component were higher protein intake/BW and estimated glomerular filtration rate (eGFR). In summary, registered dietitians and clinicians must keep in mind that LPD is a serious burden to the patients and efforts must be made to minimize their burden in order to avoid discontinuation.
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Affiliation(s)
- Kenichiro Shide
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Yuka Takada
- Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan
| | - Asuka Nakashima
- Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan
| | - Hidemi Tsuji
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Keiko Wada
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Akiko Kuwabara
- Department of Health and Nutrition, Osaka Shoin Women's University, Osaka, Japan
| | - Kiyoshi Tanaka
- Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology, and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Chapter 6. Hypertension associated with organ damage. Hypertens Res 2014. [DOI: 10.1038/hr.2014.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Protein intake in relation to risk of hypertension and microalbuminuria in patients with type 1 diabetes: the EURODIAB Prospective Complications Study. J Hypertens 2014; 31:1151-9. [PMID: 23524911 DOI: 10.1097/hjh.0b013e328360418e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A beneficial association between dietary protein intake (especially from plant sources) with incident hypertension, being strongly correlated to microalbuminuria, has been suggested in healthy populations. Evidence from diabetic populations, in which the prevalence of these diseases is high, is lacking. We examined the associations of total, animal and plant protein intake with incident hypertension (n = 1319) and microalbuminuria (n = 1045) in patients from 16 European countries with type 1 diabetes from the clinic-based EURODIAB Prospective Complications study. METHODS Odds ratios (OR) with 95% confidence intervals (CI) for incident hypertension after 7 years of follow-up were calculated in tertiles of protein intake (energy%) with adjustments for age, sex, diabetes duration, HbA1c, BMI, physical activity, smoking, alcohol, total energy, total fat and carbohydrate intake. RESULTS After adjustment for potential confounders, total, animal and plant protein intakes were not related to incident hypertension (298 cases). OR's (95% CI) across increasing tertiles of total protein were 1.00 (ref), 0.86 (0.60-1.25) and 0.91 (0.59-1.43). Furthermore, no relation was observed with incident microalbuminuria (135 cases), with ORs (95% CI) across increasing tertiles of total protein being 1.00 (ref), 0.88 (0.53-1.48) and 1.08 (0.57-2.04). CONCLUSION Results from our study did not provide evidence that a protein intake commonly consumed by European patients with type 1 diabetes is associated with incident hypertension or microalbuminuria. Prospective studies with more detailed information on dietary intake (including mineral intake) are needed to confirm these findings, and to investigate the impact on vascular and renal complications of a long-term very high protein intake in patients with type 1 diabetes.
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Ran J, Ma J, Liu Y, Tan R, Liu H, Lao G. Low protein diet inhibits uric acid synthesis and attenuates renal damage in streptozotocin-induced diabetic rats. J Diabetes Res 2014; 2014:287536. [PMID: 24772444 PMCID: PMC3976836 DOI: 10.1155/2014/287536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 11/17/2022] Open
Abstract
AIM Several studies indicated that hyperuricemia may link to the worsening of diabetic nephropathy (DN). Meanwhile, low protein diet (LPD) retards exacerbation of renal damage in chronic kidney disease. We then assessed whether LPD influences uric acid metabolism and benefits the progression of DN in streptozotocin- (STZ-) induced diabetic rats. METHODS STZ-induced and control rats were both fed with LPD (5%) and normal protein diet (18%), respectively, for 12 weeks. Vital signs, blood and urinary samples for UA metabolism were taken and analyzed every 3 weeks. Kidneys were removed at the end of the experiment. RESULTS Diabetic rats developed into constantly high levels of serum UA (SUA), creatinine (SCr) and 24 h amounts of urinary albumin excretion (UAE), creatinine (UCr), urea nitrogen (UUN), and uric acid (UUA). LPD significantly decreased SUA, UAE, and blood glucose, yet left SCr, UCr, and UUN unchanged. A stepwise regression showed that high UUA is an independent risk factor for DN. LPD remarkably ameliorated degrees of enlarged glomeruli, proliferated mesangial cells, and hyaline-degenerated tubular epithelial cells in diabetic rats. Expression of TNF-α in tubulointerstitium significantly decreased in LPD-fed diabetic rats. CONCLUSION LPD inhibits endogenous uric acid synthesis and might accordingly attenuate renal damage in STZ-induced diabetic rats.
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Affiliation(s)
- Jianmin Ran
- Department of Endocrinology, Guangzhou Red Cross Hospital, Medical College of Jinan University, No. 396 Tong Fu Zhong Road, Guangzhou 510220, China
- *Jianmin Ran:
| | - Jing Ma
- Department of Endocrinology, Guangzhou Red Cross Hospital, Medical College of Jinan University, No. 396 Tong Fu Zhong Road, Guangzhou 510220, China
| | - Yan Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Medical College of Jinan University, No. 396 Tong Fu Zhong Road, Guangzhou 510220, China
| | - Rongshao Tan
- Clinical Institute of Nutrition, Guangzhou Red Cross Hospital, Medical College of Jinan University, No. 396 Tong Fu Zhong Road, Guangzhou 510220, China
| | - Houqiang Liu
- Department of Endocrinology, Guangzhou Red Cross Hospital, Medical College of Jinan University, No. 396 Tong Fu Zhong Road, Guangzhou 510220, China
| | - Gancheng Lao
- Department of Endocrinology, Guangzhou Red Cross Hospital, Medical College of Jinan University, No. 396 Tong Fu Zhong Road, Guangzhou 510220, China
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Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2014; 37 Suppl 1:S120-43. [PMID: 24357208 DOI: 10.2337/dc14-s120] [Citation(s) in RCA: 421] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Diabetic nephropathy is the leading cause of progressive kidney disease, leading to end-stage renal disease and renal replacement therapy. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers have been considered effective at slowing the progression of kidney function deterioration. However, these drugs cannot sufficiently halt the progression of nephropathy to the extent that is required. A low-protein diet (LPD) is believed to be a nutritional intervention that may slow kidney disease progression. In fact, preclinical animal experiments have demonstrated excellent renoprotective effects of an LPD. However, in human clinical trials, analyses of the effects of protein restriction on diabetic nephropathy have not yet revealed consistently positive outcomes of this nutritional intervention. In this review, we analyze the potential renoprotective effects of an LPD on diabetic nephropathy and summarize the outcomes of clinical trials that have systematically investigated the efficacy of an LPD in diabetic nephropathy. In addition, we discuss some potential approaches associated with nutritional interventions to combat progressive kidney disease.
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Affiliation(s)
- Toshiki Otoda
- Department of Diabetology & Endocrinology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
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Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013; 36:3821-42. [PMID: 24107659 PMCID: PMC3816916 DOI: 10.2337/dc13-2042] [Citation(s) in RCA: 356] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is no standard meal plan or eating pattern that works universally for all people with diabetes. In order to be effective, nutrition therapy should be individualized for each patient/client based on his or her individual health goals; personal and cultural preferences; health literacy and numeracy; access to healthful choices; and readiness, willingness, and ability to change. Nutrition interventions should emphasize a variety of minimally processed nutrient dense foods in appropriate portion sizes as part of a healthful eating pattern and provide the individual with diabetes with practical tools for day-to-day food plan and behavior change that can be maintained over the long term.
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Affiliation(s)
- Alison B. Evert
- University of Washington Medical Center, Seattle,
Washington
| | | | - Marjorie Cypress
- Department of Endocrinology, ABQ Health Partners,
Albuquerque, New Mexico
| | | | | | - Elizabeth J. Mayer-Davis
- Gillings School of Global Public Health and School of
Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North
Carolina
| | - Joshua J. Neumiller
- Department of Pharmacotherapy, Washington State
University, Spokane, Washington
| | - Robin Nwankwo
- University of Michigan Medical School and the Center for
Preventive Medicine, Ann Arbor, Michigan
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Jesudason DR, Pedersen E, Clifton PM. Weight-loss diets in people with type 2 diabetes and renal disease: a randomized controlled trial of the effect of different dietary protein amounts. Am J Clin Nutr 2013; 98:494-501. [PMID: 23719550 DOI: 10.3945/ajcn.113.060889] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Higher-protein weight-loss diets (defined as >25% of energy as protein) are not recommended for individuals with type 2 diabetes because of their potential adverse effect on renal function. OBJECTIVE We aimed to examine the effect of such diets on renal function over 12 mo in people with type 2 diabetes and early renal disease. DESIGN Overweight and obese people with type 2 diabetes were screened to identify those with an albumin:creatinine ratio from 3 to 30 mg/mmol. Seventy-six subjects were randomly assigned to either a moderate-protein weight-loss diet or a standard-protein weight-loss diet for 12 mo. The primary endpoint was the change in renal function as assessed by the isotope glomerular filtration rate (GFR), estimated GFR, and cystatin C. Forty-five subjects (moderate protein: n = 21; standard protein: n = 24) completed the study. RESULTS The mean (±SE) weight loss was not different between diets at 9.7 ± 13.4 kg for the moderate-protein diet and 6.6 ± 7.1 kg for the standard-protein diet. There were no changes in renal function or albuminuria or blood pressure, although glycated hemoglobin was lowered with both diets. Changes in renal function were related to the baseline estimated GFR. Patients with stage 1-3 renal disease (<120 mL · min(-1) · 1.73 m(-2); n = 33) had an improvement in renal function, whereas patients with hyperfiltration (>120 mL · min(-1) · 1.73 m(-2); n = 12) had a decrease in the GFR. After adjustment for weight loss, the baseline GFR remained a significant predictor of outcomes with no effect of dietary treatment. An average difference in protein intake between diets of 19 ± 6 g/d was achieved. CONCLUSION Weight loss improved renal function, but differences in dietary protein had no effect. This trial was registered at the Australian and New Zealand Clinical Trial Register as ACTRN12608000045314.
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Affiliation(s)
- David R Jesudason
- Commonwealth Scientific and Industrial Research Organisation Animal Food and Health Science, Adelaide University, Centre for Clinical Research Excellence in Nutrition and University of South Australia, Adelaide, Australia
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Thilly N. Low-protein diet in chronic kidney disease: from questions of effectiveness to those of feasibility. Nephrol Dial Transplant 2013; 28:2203-5. [PMID: 23787548 DOI: 10.1093/ndt/gft235] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Thilly
- Clinical Epidemiology and Evaluation, CIC-EC CIE6 Inserm, University Hospital of Nancy, Nancy, France
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Nezu U, Kamiyama H, Kondo Y, Sakuma M, Morimoto T, Ueda S. Effect of low-protein diet on kidney function in diabetic nephropathy: meta-analysis of randomised controlled trials. BMJ Open 2013; 3:e002934. [PMID: 23793703 PMCID: PMC3664345 DOI: 10.1136/bmjopen-2013-002934] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 04/25/2013] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To evaluate the effect of low-protein diet on kidney function in patients with diabetic nephropathy. DESIGN A systematic review and a meta-analysis of randomised controlled trials. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, International Standard Randomised Controlled Trial Number (ISRCTN) Register and University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) from inception to 10 December 2012. Internet searches were also carried out with general search engines (Google and Google Scholar). STUDY SELECTION Randomised controlled trials that compared low-protein diet versus control diet and assessed the effects on kidney function, proteinuria, glycaemic control or nutritional status. PRIMARY AND SECONDARY OUTCOME MEASURES AND DATA SYNTHESIS The primary outcome was a change in the glomerular filtration rate (GFR). The secondary outcomes were changes in proteinuria, post-treatment value of glycated haemoglobin A1C (HbA1c) and post-treatment value of serum albumin. The results were summarised as the mean difference for continuous outcomes and pooled by the random effects model. Subgroup analyses and sensitivity analyses were conducted regarding patient characteristics, intervention period, methodological quality and assessment of diet compliance. The assessment of diet compliance was performed based on the actual protein intake ratio (APIR) of the low-protein diet group to the control group. RESULTS We identified 13 randomised controlled trials enrolling 779 patients. A low-protein diet was associated with a significant improvement in GFR (5.82 ml/min/1.73 m(2), 95% CI 2.30 to 9.33, I(2)=92%; n=624). This effect was consistent across the subgroups of type of diabetes, stages of nephropathy and intervention period. However, GFR was improved only when diet compliance was fair (8.92, 95% CI 2.75 to 15.09, I(2)=92% for APIR <0.9 and 0.03, 95% CI -1.49 to 1.56, I(2)=90% for APIR ≥0.9). Proteinuria and serum albumin were not differed between the groups. HbA1c was slightly but significantly decreased in the low-protein diet group (-0.26%, 95% CI -0.35 to -0.18, I(2)=0%; n=536). CONCLUSIONS Low-protein diet was significantly associated with improvement of diabetic nephropathy. The adverse effects of low-protein diet were not apparent such as worsening of glycaemic control and malnutrition.
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Affiliation(s)
- Uru Nezu
- Department of Clinical Pharmacology & Therapeutics, University of the Ryukyus, Okinawa, Japan
| | - Hiroshi Kamiyama
- Department of Endocrinology & Metabolism, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Yoshinobu Kondo
- Department of Endocrinology & Metabolism, Chigasaki Municipal Hospital, Kanagawa, Japan
| | - Mio Sakuma
- Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Morimoto
- Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology & Therapeutics, University of the Ryukyus, Okinawa, Japan
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Associations between dietary patterns and kidney function indicators in type 2 diabetes. Clin Nutr 2013; 33:98-105. [PMID: 23706976 DOI: 10.1016/j.clnu.2013.04.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 04/05/2013] [Accepted: 04/08/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Dietary patterns link to risks for chronic diseases. Few studies explore relationships between dietary patterns and kidney function in adult type 2 diabetes in Asian. METHODS Diabetic patients (n = 635) were selected from a cohort participating in a diabetic control study in Taiwan. Three dietary patterns, high fat (meats, processed meats, seafood, fatty foods, eggs), vegetable and fish (light- or dark- colored vegetables, pond and marine fish) and traditional Chinese-snack (soy/gluten products, rice, noodles, root vegetables, nuts), were generated using factor analysis. Urinary albumin to creatinine (ACR), creatinine and estimated glomerular filtration rate (eGFR) served as clinical indicators of kidney function. RESULTS After adjusting for confounders, tertile scores of vegetable and fish dietary patterns correlated significantly (p-trend = 0.032) and dose-responsively with multivariable-adjusted means of decreased creatinine and marginally with increased eGFR (p- trend = 0.065). Traditional Chinese-snack dietary pattern was marginally associated with creatinine (p-trend = 0.065) and eGFR (p-trend = 0.064). High fat dietary patterns did not correlate with any kidney function indicator. CONCLUSIONS Healthy diets such as frequent intake of fish and vegetable may be related to indicators of better kidney function in type 2 diabetes. Further prospective studies with larger sample sizes and use of sensitive indicators for studying early renal function decline are needed to confirm this association.
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Esau N, Koen N, Herselman M. Adaptation of the RenalSmart® web-based application for the dietary management of patients with diabetic nephropathy. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2013. [DOI: 10.1080/16070658.2013.11734457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nakao T. [Chronic kidney disease (CKD)--recent progress. Topics: VII. Management of chronic kidney disease (CKD) and treatment; 1. Dietary treatment and life-style management in CKD patients]. ACTA ACUST UNITED AC 2012; 101:1340-6. [PMID: 22693855 DOI: 10.2169/naika.101.1340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Scialla JJ, Appel LJ, Wolf M, Yang W, Zhang X, Sozio SM, Miller ER, Bazzano LA, Cuevas M, Glenn MJ, Lustigova E, Kallem RR, Porter AC, Townsend RR, Weir MR, Anderson CAM. Plant protein intake is associated with fibroblast growth factor 23 and serum bicarbonate levels in patients with chronic kidney disease: the Chronic Renal Insufficiency Cohort study. J Ren Nutr 2012; 22:379-388.e1. [PMID: 22480598 PMCID: PMC3383455 DOI: 10.1053/j.jrn.2012.01.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 01/18/2012] [Accepted: 01/31/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Protein from plant, as opposed to animal, sources may be preferred in chronic kidney disease (CKD) because of the lower bioavailability of phosphate and lower nonvolatile acid load. STUDY DESIGN Observational cross-sectional study. SETTING AND PARTICIPANTS A total of 2,938 participants with CKD and information on their dietary intake at the baseline visit in the Chronic Renal Insufficiency Cohort Study. PREDICTORS Percentage of total protein intake from plant sources (percent plant protein) was determined by scoring individual food items using the National Cancer Institute Diet History Questionnaire (DHQ). OUTCOMES Metabolic parameters, including serum phosphate, bicarbonate (HCO₃), potassium, and albumin, plasma fibroblast growth factor 23 (FGF-23), and parathyroid hormone (PTH), and hemoglobin levels. MEASUREMENTS We modeled the association between percent plant protein and metabolic parameters using linear regression. Models were adjusted for age, sex, race, diabetes status, body mass index, estimated glomerular filtration rate, income, smoking status, total energy intake, total protein intake, 24-hour urinary sodium concentration, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and use of diuretics. RESULTS Higher percent plant protein was associated with lower FGF-23 (P = .05) and higher HCO₃ (P = .01) levels, but not with serum phosphate or parathyroid hormone concentrations (P = .9 and P = .5, respectively). Higher percent plant protein was not associated with higher serum potassium (P = .2), lower serum albumin (P = .2), or lower hemoglobin (P = .3) levels. The associations of percent plant protein with FGF-23 and HCO₃ levels did not differ by diabetes status, sex, race, CKD stage (2/3 vs. 4/5), or total protein intake (≤0.8 g/kg/day vs. >0.8 g/kg/day; P-interaction >.10 for each). LIMITATIONS This is a cross-sectional study; determination of percent plant protein using the Diet History Questionnaire has not been validated. CONCLUSIONS Consumption of a higher percentage of protein from plant sources may lower FGF-23 and raise HCO₃ levels in patients with CKD.
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Affiliation(s)
- Julia J Scialla
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA.
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Hildebrand AM, Iansavichus AV, Lee CWC, Haynes RB, Wilczynski NL, McKibbon KA, Hladunewich MA, Clark WF, Cattran DC, Garg AX. Glomerular disease search filters for Pubmed, Ovid Medline, and Embase: a development and validation study. BMC Med Inform Decis Mak 2012; 12:49. [PMID: 22672435 PMCID: PMC3471011 DOI: 10.1186/1472-6947-12-49] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 05/14/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tools to enhance physician searches of Medline and other bibliographic databases have potential to improve the application of new knowledge in patient care. This is particularly true for articles about glomerular disease, which are published across multiple disciplines and are often difficult to track down. Our objective was to develop and test search filters for PubMed, Ovid Medline, and Embase that allow physicians to search within a subset of the database to retrieve articles relevant to glomerular disease. METHODS We used a diagnostic test assessment framework with development and validation phases. We read a total of 22,992 full text articles for relevance and assigned them to the development or validation set to define the reference standard. We then used combinations of search terms to develop 997,298 unique glomerular disease filters. Outcome measures for each filter included sensitivity, specificity, precision, and accuracy. We selected optimal sensitive and specific search filters for each database and applied them to the validation set to test performance. RESULTS High performance filters achieved at least 93.8% sensitivity and specificity in the development set. Filters optimized for sensitivity reached at least 96.7% sensitivity and filters optimized for specificity reached at least 98.4% specificity. Performance of these filters was consistent in the validation set and similar among all three databases. CONCLUSIONS PubMed, Ovid Medline, and Embase can be filtered for articles relevant to glomerular disease in a reliable manner. These filters can now be used to facilitate physician searching.
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Affiliation(s)
| | | | | | - R Brian Haynes
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Nancy L Wilczynski
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - K Ann McKibbon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | | | - William F Clark
- Division of Nephrology, University of Western Ontario, London, Canada
| | | | - Amit X Garg
- Division of Nephrology, University of Western Ontario, London, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
- London Kidney Clinical Research Unit, Room ELL-101, Westminster, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 4 G5, Canada
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Wheeler ML, Dunbar SA, Jaacks LM, Karmally W, Mayer-Davis EJ, Wylie-Rosett J, Yancy WS. Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010. Diabetes Care 2012; 35:434-45. [PMID: 22275443 PMCID: PMC3263899 DOI: 10.2337/dc11-2216] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Lindsay M. Jaacks
- School of Public Health, Nutritional Epidemiology, The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Wahida Karmally
- Irving Institute for Clinical and Translational Research, Columbia University, New York, New York
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - William S. Yancy
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
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88
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Sasatomi Y, Ito K, Abe Y, Miyake K, Ogahara S, Nakashima H, Saito T. Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis. Ren Fail 2012; 34:189-93. [DOI: 10.3109/0886022x.2011.646885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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89
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Bonnet F, Gauthier E, Gin H, Hadjadj S, Halimi JM, Hannedouche T, Rigalleau V, Romand D, Roussel R, Zaoui P. Expert consensus on management of diabetic patients with impairment of renal function. DIABETES & METABOLISM 2011; 37 Suppl 2:S1-25. [DOI: 10.1016/s1262-3636(11)70961-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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90
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Gordon J, Kopp JB. Off the beaten renin-angiotensin-aldosterone system pathway: new perspectives on antiproteinuric therapy. Adv Chronic Kidney Dis 2011; 18:300-11. [PMID: 21782136 DOI: 10.1053/j.ackd.2011.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/31/2011] [Accepted: 06/01/2011] [Indexed: 01/23/2023]
Abstract
CKD is a major public health problem in the developed and the developing world. The degree of proteinuria associated with renal failure is a generally well accepted marker of disease severity. Agents with direct antiproteinuric effects are highly desirable therapeutic strategies for slowing, or even halting, progressive loss of kidney function. We review progress on therapies acting further downstream of the renin-angiotensin-aldosterone system pathway (e.g., transforming growth factor-beta antagonism, endothelin antagonism) and on those acting independent of the renin-angiotensin-aldosterone system pathway. In all, we discuss 26 therapeutic targets or compounds and 2 lifestyle changes (dietary modification and weight loss) that have been used clinically for diabetic or nondiabetic kidney disease. These therapies include endogenous molecules (estrogens, isotretinoin), biologic antagonists (monoclonal antibodies, soluble receptors), and small molecules. Where mechanistic data are available, these therapies have been shown to exert favorable effects on glomerular cell phenotype. In some cases, recent work has indicated surprising new molecular pathways for some therapies, such as direct effects on the podocyte by glucocorticoids, rituximab, and erythropoietin. It is hoped that recent advances in the basic science of kidney injury will prompt development of more effective pharmaceutical and biologic therapies for proteinuria.
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91
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Fechete R, Heinzel A, Perco P, Mönks K, Söllner J, Stelzer G, Eder S, Lancet D, Oberbauer R, Mayer G, Mayer B. Mapping of molecular pathways, biomarkers and drug targets for diabetic nephropathy. Proteomics Clin Appl 2011; 5:354-66. [PMID: 21491608 DOI: 10.1002/prca.201000136] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/04/2011] [Accepted: 01/17/2011] [Indexed: 11/07/2022]
Abstract
PURPOSE For diseases with complex phenotype such as diabetic nephropathy (DN), integration of multiple Omics sources promises an improved description of the disease pathophysiology, being the basis for novel diagnostics and therapy, but equally important personalization aspects. EXPERIMENTAL DESIGN Molecular features on DN were retrieved from public domain Omics studies and by mining scientific literature, patent text and clinical trial specifications. Molecular feature sets were consolidated on a human protein interaction network and interpreted on the level of molecular pathways in the light of the pathophysiology of the disease and its clinical context defined as associated biomarkers and drug targets. RESULTS About 1000 gene symbols each could be assigned to the pathophysiological description of DN and to the clinical context. Direct feature comparison showed minor overlap, whereas on the level of molecular pathways, the complement and coagulation cascade, PPAR signaling, and the renin-angiotensin system linked the disease descriptor space with biomarkers and targets. CONCLUSION AND CLINICAL RELEVANCE Only the combined molecular feature landscapes closely reflect the clinical implications of DN in the context of hypertension and diabetes. Omics data integration on the level of interaction networks furthermore provides a platform for identification of pathway-specific biomarkers and therapy options.
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92
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Franz MJ, Powers MA, Leontos C, Holzmeister LA, Kulkarni K, Monk A, Wedel N, Gradwell E. The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. ACTA ACUST UNITED AC 2011; 110:1852-89. [PMID: 21111095 DOI: 10.1016/j.jada.2010.09.014] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 05/06/2010] [Indexed: 12/12/2022]
Abstract
This article reviews the evidence and nutrition practice recommendations from the American Dietetic Association's nutrition practice guidelines for type 1 and type 2 diabetes in adults. The research literature was reviewed to answer nutrition practice questions and resulted in 29 recommendations. Here, we present the recommendations and provide a comprehensive and systematic review of the evidence associated with their development. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, registered dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes.
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Affiliation(s)
- Marion J Franz
- Nutrition Concepts by Franz, Inc, Minneapolis, MN 55439, USA.
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93
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Current Opinion in Lipidology. Current world literature. Curr Opin Lipidol 2010; 21:84-8. [PMID: 20101119 DOI: 10.1097/mol.0b013e32833592e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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94
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Darmon P, Kaiser MJ, Bauer JM, Sieber CC, Pichard C. Restrictive diets in the elderly: never say never again? Clin Nutr 2009; 29:170-4. [PMID: 19932533 DOI: 10.1016/j.clnu.2009.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 08/11/2009] [Accepted: 11/04/2009] [Indexed: 12/17/2022]
Abstract
Restrictive diets have long been an essential part of standard nutritional therapy for a wide range of diseases like obesity, diabetes, hyperlipidaemia, arterial hypertension and chronic renal failure. Although a relevant number of studies have been published in this field, most of these have concentrated on adults below age 65. Data on the effects of restrictive diets in older persons are still scarce. With increasing age, restrictive diets seem to be less effective with regard to relevant study endpoints like morbidity, quality of life and mortality. This applies in particular to chronic indications which are in most cases associated with additional co-morbidities. Here the focus shifts towards providing adequate nutritional intake rich in macro- and especially micronutrients and a diet that is also highly palatable as older individuals are at increased risk of becoming malnourished and sarcopenic. In this context, nutritional prevention and therapy are of utmost importance for maintaining quality of life. This review summarizes the present evidence for the application of restrictive diets in older persons and balances it against potential risks.
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Affiliation(s)
- Patrice Darmon
- Médecin Responsable, Nutrition Clinique, Hôpitaux Universitaires de Genève, 1211 Genève 14, Switzerland
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95
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Zelmanovitz T, Gerchman F, Balthazar APS, Thomazelli FCS, Matos JD, Canani LH. Diabetic nephropathy. Diabetol Metab Syndr 2009; 1:10. [PMID: 19825147 PMCID: PMC2761852 DOI: 10.1186/1758-5996-1-10] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Accepted: 09/21/2009] [Indexed: 12/21/2022] Open
Abstract
Diabetic nephropathy is the leading cause of chronic renal disease and a major cause of cardiovascular mortality. Diabetic nephropathy has been categorized into stages: microalbuminuria and macroalbuminuria. The cut-off values of micro- and macroalbuminuria are arbitrary and their values have been questioned. Subjects in the upper-normal range of albuminuria seem to be at high risk of progression to micro- or macroalbuminuria and they also had a higher blood pressure than normoalbuminuric subjects in the lower normoalbuminuria range. Diabetic nephropathy screening is made by measuring albumin in spot urine. If abnormal, it should be confirmed in two out three samples collected in a three to six-months interval. Additionally, it is recommended that glomerular filtration rate be routinely estimated for appropriate screening of nephropathy, because some patients present a decreased glomerular filtration rate when urine albumin values are in the normal range. The two main risk factors for diabetic nephropathy are hyperglycemia and arterial hypertension, but the genetic susceptibility in both type 1 and type 2 diabetes is of great importance. Other risk factors are smoking, dyslipidemia, proteinuria, glomerular hyperfiltration and dietary factors. Nephropathy is pathologically characterized in individuals with type 1 diabetes by thickening of glomerular and tubular basal membranes, with progressive mesangial expansion (diffuse or nodular) leading to progressive reduction of glomerular filtration surface. Concurrent interstitial morphological alterations and hyalinization of afferent and efferent glomerular arterioles also occur. Podocytes abnormalities also appear to be involved in the glomerulosclerosis process. In patients with type 2 diabetes, renal lesions are heterogeneous and more complex than in individuals with type 1 diabetes. Treatment of diabetic nephropathy is based on a multiple risk factor approach, and the goal is retarding the development or progression of the disease and to decrease the subject's increased risk of cardiovascular disease. Achieving the best metabolic control, treating hypertension (<130/80 mmHg) and dyslipidemia (LDL cholesterol <100 mg/dl), using drugs that block the renin-angiotensin-aldosterone system, are effective strategies for preventing the development of microalbuminuria, delaying the progression to more advanced stages of nephropathy and reducing cardiovascular mortality in patients with diabetes.
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Affiliation(s)
- Themis Zelmanovitz
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Brazil
| | - Fernando Gerchman
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Luís H Canani
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Brazil
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96
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Azadbakht L, Esmaillzadeh A. Soy-protein consumption and kidney-related biomarkers among type 2 diabetics: a crossover, randomized clinical trial. J Ren Nutr 2009; 19:479-86. [PMID: 19758824 DOI: 10.1053/j.jrn.2009.06.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Renal disease is a major problem among diabetic patients. The type of protein consumed may affect alterations in kidney-related biomarkers in these patients. This study sought to assess the effects of soy-protein consumption on renal-related markers among type 2 diabetic patients with nephropathy. METHODS A crossover, randomized clinical trial was conducted among 14 patients (10 men and 4 women). One diet contained 0.8 g/kg protein (70% animal and 30% vegetable proteins), and a similar diet contained the same amount of protein with 35% animal protein, 35% soy protein, and 30% other vegetable proteins. These two diets were prescribed in each phase of the trial for 7 weeks. There was a 4-week washout between the two phases of the study. RESULTS Consumption of soy protein reduced urinary urea nitrogen (-0.9 +/- 0.8 vs. 0.2 +/- 0.6 mg/dL, respectively, SD; P < .001), proteinuria (-78 +/- 37 vs. 42 +/- 39 mg/day, respectively, SD; P < .001), blood sodium (-2 +/- 0.04 vs. 2.0 +/- 0.06 mg/dL, respectively, SD; P < .01), and serum phosphorus (-0.03 +/- 0.2 vs. 0.2 +/- 0.3 mg/dL, respectively, SD; P < .01) compared with animal protein. Serum and urinary creatinine, blood urea nitrogen, serum calcium, and potassium levels were not significantly changed in soy-protein versus anima-protein consumption. CONCLUSION Soy-protein consumption reduces proteinuria in type 2 diabetes with nephropathy.
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Affiliation(s)
- Leila Azadbakht
- Department of Nutrition, School of Public Health, and Food Security and Nutrition Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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97
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Tuttle KR, Sunwold D, Kramer H. Can Comprehensive Lifestyle Change Alter the Course of Chronic Kidney Disease? Semin Nephrol 2009; 29:512-23. [DOI: 10.1016/j.semnephrol.2009.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Proteinuria, defined as urine protein excretion greater than 300 mg over 24 h, is a strong and independent predictor of increased risk for all-cause and cardiovascular mortality in patients with and without diabetes. Proteinuria is a sign of persistent dysfunction of the glomerular barrier and often precedes any detectable decline in renal filtration function. Measurement of proteinuria is important in stratifying the risk for cardiovascular disease and chronic kidney disease progression. A variety of basic pathophysiologic mechanisms that can partially explain simultaneous renal and cardiac disease will be discussed in this Review. In addition to being a prognostic marker, proteinuria is being considered as a therapeutic target in cardiovascular medicine. Therapeutic strategies for amelioration of proteinuria by achieving blood pressure targets, glycemic control in diabetes, treatment of hyperlipidemia, and reducing dietary salt and protein intake are also reviewed in this paper. Future clinical studies are needed to assess if proteinuria reduction should be a target of treatment to reduce the burden of end-stage renal disease, cardiovascular disease, and improve survival in this high-risk population.
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100
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Pan Y, Jin HM, Guo LL. Reply to V Rigalleau et al. Am J Clin Nutr 2009. [DOI: 10.3945/ajcn.2009.27512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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