Weight-loss diets in people with type 2 diabetes and renal disease: a randomized controlled trial of the effect of different dietary protein amounts
Weight-loss diets in people with type 2 diabetes and renal disease: a randomized controlled trial of the effect of different dietary protein amounts
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DOI：
10.3945/ajcn.113.060889
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发表时间：
2013-08-01
影响因子：
7.1
通讯作者：
Clifton, Peter M.
中科院分区：
文献类型：
--
作者：
Jesudason, David R.;Pedersen, Eva;Clifton, Peter M.
背景资料：高蛋白减肥饮食（定义为>25%的能量为蛋白质）不推荐给2型糖尿病患者，因为它们对肾功能有潜在的不利影响。目的：我们的目的是检查这种饮食对2型糖尿病和早期肾病患者12个月以上肾功能的影响。设计：对超重和肥胖的2型糖尿病患者进行筛查，以确定白蛋白：肌酐比值为3至30 mg/mmol的患者。76名受试者被随机分配到中等蛋白质减肥饮食或标准蛋白质减肥饮食12个月。主要终点是通过同位素肾小球滤过率（GFR）、估计的GFR和半胱氨酸蛋白酶抑制剂C评估的肾功能变化。45名受试者（中等蛋白质：n = 21;标准蛋白质：n = 24）完成了研究。结果：饮食之间的平均（+/- SE）体重减轻没有差异，中等蛋白质饮食为9.7 +/- 13.4 kg，标准蛋白质饮食为6.6 +/- 7.1 kg。尽管两种饮食均降低了糖化血红蛋白，但肾功能、蛋白尿或血压均无变化。肾功能变化与基线估计GFR相关。1-3期肾病患者（< 120 mL . min（-1）。1.73 m（-2）; n = 33）的患者肾功能有所改善，而高滤过（>120 mL . min（-1）。1.73 m（-2）; n = 12）的GFR降低。在调整体重减轻后，基线GFR仍然是一个重要的预后预测因子，而饮食治疗没有影响。饮食之间的蛋白质摄入量的平均差异为19 +/- 6 g/dachieved.Conclusion：体重减轻改善肾功能，但饮食蛋白质的差异没有影响。本试验在澳大利亚和新西兰临床试验注册中心注册为ACTRN 12608000045314。
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.