The effect of n-3 long-chain polyunsaturated fatty acid supplementation on urine protein excretion and kidney function: meta-analysis of clinical trials
The effect of n-3 long-chain polyunsaturated fatty acid supplementation on urine protein excretion and kidney function: meta-analysis of clinical trials
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DOI：
10.3945/ajcn.2008.26867
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发表时间：
2009-06-01
影响因子：
7.1
通讯作者：
Guallar, Eliseo
中科院分区：
文献类型：
--
作者：
Miller, Edgar R., III;Juraschek, Stephen P.;Guallar, Eliseo
背景：慢性肾脏疾病是一个世界性的重大问题。虽然流行病学和实验研究表明，补充n-3长链多不饱和脂肪酸(n-3 LCPUFA)可以预防或减缓肾脏疾病的进展，但临床试验的证据并不一致。目的：目的：结合对照临床试验的证据，评估补充n-3 LCPUFA对尿蛋白排泄(UPE)和肾小球滤过率(GFR)的影响。设计：我们对补充n-3 LCPUFA对肾脏损伤标志物UPE和肾功能标志物GFR的影响进行了荟萃分析。结果：17项试验、626名参与者进入Meta分析。大多数试验集中在只有一个基本诊断的患者身上：IGA肾病(n=5)、糖尿病(n=7)或狼疮性肾炎(n=1)。N-3LCPUFAs剂量为0.7~5.1g/d，中位随访时间为9mo。在合并分析中，n-3LCPUFA组的UPE下降幅度大于对照组：所有试验的Cohen‘s d为-0.19(95%CI：-0.34，-0.04；P=0.01)。在每天服用1克Upe的患者中，这相当于每天减少190毫克。12项试验报告了对GFR的影响。N-3LCPUFA组的GFR下降较对照组缓慢，但差异无统计学意义(0.11；95%CI：-0.07，0.29；P=0.24)。结论：在我们的Meta分析中，补充n-3LCPUFA可减少UPE，但不影响GFR的下降。然而，试验参与者人数较少，评估蛋白尿和肾小球滤过率的方法不同，以及数据报告不一致，限制了这些结论的力度。具有临床结果的大型、高质量试验是必要的。Am J Clin Nutr 2009；89：1937-45。
Background: Chronic kidney disease is a major worldwide problem. Although epidemiologic and experimental studies suggest that n-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) supplementation may prevent or slow the progression of kidney disease, evidence from clinical trials is inconsistent.Objective: The objective was to combine evidence from controlled clinical trials to assess the effect of n-3 LCPUFA supplementation on the change in urine protein excretion (UPE) and on glomerular filtration rate (GFR).Design: We performed a meta-analysis of clinical trials that tested the effect of n-3 LCPUFA supplementation on UPE, a marker of kidney damage, and on GFR, a marker of kidney function. A random-effects model was used to pool SD effect size (Cohen's d) across studies.Results: Seventeen trials with 626 participants were included in the meta-analysis. Most trials focused on patients with a single underlying diagnosis: IgA nephropathy (n = 5), diabetes (n = 7), or lupus nephritis (n = 1). The dose of n-3 LCPUFAs ranged from 0.7 to 5.1 g/d, and the median follow-up was 9 mo. In the pooled analysis, there was a greater reduction in UPE in the n-3 LCPUFA group than in the control group: Cohen's d for all trials was -0.19 (95% CI: -0.34, -0.04; P = 0.01). In a patient with 1 g UPE/d, this corresponds to a reduction of 190 mg/d. Effects on GFR were reported in 12 trials. The decline in GFR was slower in the n-3 LCPUFA group than in the control group, but this effect was not significant (0.11; 95% CI: -0.07, 0.29; P = 0.24).Conclusions: In our meta-analysis, use of n-3 LCPUFA supplements reduced UPE but not the decline in GFR. However, small numbers of participants in trials, different methods of assessing proteinuria and GFR, and inconsistent data reporting limit the strength of these conclusions. Large, high-quality trials with clinical outcomes are warranted. Am J Clin Nutr 2009; 89: 1937-45.