SOY PROTEIN USE IN EARLY DIABETIC NEPHROPATHY

在工业化世界中，糖尿病肾病是终末期肾病最常见的原因。减少膳食蛋白质摄入量已经实施了几十年，以改善症状并减缓慢性肾脏疾病的进展，包括糖尿病肾病。不幸的是，这种方法经常受到患者依从性差的阻碍。来自其他研究人员的证据和我们的初步研究表明，在减缓或预防糖尿病肾病的进展方面，控制饮食蛋白质的质量可能与减少摄入蛋白质的总量一样有效。我们认为，大豆蛋白是一种必需氨基酸含量相对较高的植物蛋白，具有很高的营养价值，可能对伴有早期肾脏疾病的1型糖尿病患者特别有益。提出的假设是，在1型糖尿病合并早期肾病的患者的饮食中，用大豆蛋白取代动物蛋白将使升高的肾小球滤过率正常化，纠正微量白蛋白尿。这些变化被解释为有益于早期糖尿病肾病的预防和治疗。这一假设将通过一项随机、平行设计的饮食干预试验在有GFR升高和微量白蛋白尿的1型糖尿病患者中得到验证。患者将被随机分配到以大豆蛋白为基础的饮食，或精心匹配的以动物蛋白为基础的饮食，为期16周。这项研究的具体目的是确定与动物蛋白摄入量相比，大豆蛋白摄入量是否与：1.减少微量白蛋白尿有关。2.改善肾小球高滤过。第三：总胆固醇和氧化低密度脂蛋白的降低。尽管长期以来，人们一直怀疑植物蛋白饮食在治疗慢性肾功能不全方面可能优于动物蛋白饮食，但这是第一次在一项针对1型糖尿病和早期肾病患者的良好对照研究中比较这两种饮食的效果。如果上述假设被证明是正确的，它不仅将对1型糖尿病患者的治疗产生深远的影响，而且可能对所有有患慢性肾脏疾病风险的个人产生深远的影响。此外，这项研究将为未来的动物和体外研究提供坚实的理论基础，旨在揭示大豆食品对肾脏疾病的有益作用的机制(S)。

Diabetic nephropathy is the most frequent cause of end-stage renal disease in the industrialized world. Reduction of dietary protein intake has been implemented for decades to improve the symptoms and slow down the progression of chronic renal disease, including diabetic nephropathy. Unfortunately, this approach is often hindered by poor patient compliance. Evidence from other investigators and our preliminary studies suggest that manipulation of the quality of dietary protein may be as effective as reduction of the total amount of ingested protein in slowing down the progression or preventing the onset of diabetic renal disease. We propose that soy protein, a plant protein relatively high in essential amino acids and with high nutritional value, may be particularly beneficial to Type 1 diabetic patients with incipient renal disease. The hypothesis is submitted that substitution of soy protein for animal protein in the diet of Type 1 diabetic patients with incipient nephropathy will normalize elevated glomerular filtration rate and correct microalbuminuria. These changes are interpreted as beneficial in the prevention and treatment of early stage diabetic nephropathy. This hypothesis will be tested with a randomized, parallel-design, dietary intervention trial in Type 1 diabetic patients with elevated GFR and microalbuminuria. The patients will be randomized to a soy protein-based diet, or a carefully matched animal protein-based diet, for 16 weeks. Specific aims of the study are to determine whether soy protein intake, compared to animal protein intake, is associated with: Number 1.: Reduction in microalbuminuria. Number 2.: Amelioration of glomerular hyperfiltration. Number 3.: Reduction in both total and oxidized LDL-cholesterol. Although it has long been suspected that plant protein diets may be superior to animal protein diets in the management of chronic renal insufficiency, this is the first time that the effect of these two diets will be compared in a well controlled study in patients with Type 1 diabetes and incipient nephropathy. If the above hypothesis proves correct, it will have far reaching implications in the management not only of Type 1 diabetic patients but, possibly, of all individuals at risk of developing chronic renal disease. Additionally, this study will provide solid rationale for future animal and in vitro studies aimed at revealing the mechanism(s) that underlie the proposed beneficial effects of soyfoods in kidney disease.