Nephrology Dialysis Transplantation, Vol 14, Issue 6 1445-1453, Copyright © 1999 by Oxford University Press
L Pijls, H de Vries, A Donker and J van Eijk
Background: A randomized trial was conducted to assess
whether protein restriction helps to delay the onset of renal disorders in
type 2 diabetic patients. Methods: Included in the
trial were 121 type 2 diabetic patients with microalbuminuria or at least
detectable albuminuria, or diabetes of duration ⩾5 years. The
experimental (39♂/19♀) and control group
(35♂/28♀) received counselling on protein restriction
and the usual dietary advice, respectively. The outcome measure was
albuminuria (mg/24 h). Results: After 6 months in
experimental and control groups the change in protein intake was -0.05
± 0.21 and +0.03 ± 0.19 g/kg (P = 0.02), and in
albuminuria -14% and +11% (P = 0.01), respectively. After 12 months, the
differences between the experimental and the control group with respect to
both protein intake and albuminuria had decreased. At 6 and 12 months,
respectively, albuminuria was 28% (P <0.001) and 18% OP = 0.08)
lower in the experimental than the control group. The effect in
normoalbuminuric patients did not differ from that in microalbuminuric
patients. In the experimental group, blood pressure, HbA1c and body weight
decreased; in the control group, such decreases were less or absent.
Dose-response analysis showed that a 0.10 g/kg change at 6 months in the
intake of protein, of animal protein in particular, was related to an 11.1%
change in albuminuria (P <0.005) Combining the intakes at 6 and 12
months suggested a percentage change of 9.1%.
Conclusions: Substantial protein restriction in
primary care, type 2 diabetic patients with no nephropathy is barely
feasible. However, even a small reduction has a substantial and potentially
beneficial effect on albuminuria. Key words:
albuminuria; diet; dietary proteins; non-insulin-dependent diabetes
mellitus; plant proteins; protein-restricted diet
ORIGINAL ARTICLES
The effect of protein restriction on albuminuria in patients with type 2 diabetes mellitus: a randomized trial
Institute for Research in Extramural Medicine (EMGO Institute) and Department of Internal Medicine, Vrije Universiteit Amsterdam, The Netherlands; Corresponding author at: Health Council of the Netherlands, PO Box 16052, 2500 BB Den Haag, The Netherlands
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