Efficacy of low-protein diet for diabetic nephropathy: a systematic review of randomized controlled trials

Abstract

BackgroundA low-protein diet (LPD) is believed to be beneficial in slowing the progression of kidney disease. It is reported that low protein diet can improve protein, sugar and lipid metabolism, and reduce the symptoms and complications of renal insufficiency. However, there has been controversial regarding the effects of protein restriction on diabetic nephropathy (DN).ObjectiveTo investigate the efficacy of LPD on renal function in patients with type 1 or 2 DN by meta-analysis of randomized controlled trials (RCTs).DesignPubMed, MEDLINE, EMBASE and China National Knowledge Infrastructure databases were searched. Eleven randomized controlled trials met the inclusion criteria, of which 10 were English and 1 was Chinese. The primary outcome was a change in glomerular filtration rate (GFR). The secondary outcome was a change in proteinuria. Random-effects models were used to calculate the standardized mean difference (SMD) and the corresponding 95% confidence intervals (CI). Subgroup analyses were also performed.ResultsOur research indicated that LPD was not associated with a significant improvement in GFR (1.59 ml · min−1 · 1.73 m−2, 95% CI -0.57, 3.75, I2 = 76%; p = 0.15). This effect was consistent across the subgroups regardless of type of diabetes, course of diabetes and intervention period. Our results also showed that there was no significant difference on improvement of proteinuria in patients of LPD and those in normal-protein diet groups (− 0.48, 95%CI-1.70, 0.74, I2 = 94%, p = 0.44). Subgroup analysis revealed that LPD resulted in increased excretion of proteinuria in patients with type 2 diabetes (1.32, 95% CI 0.17, 2.47, I2 = 86%, p = 0.02).ConclusionThe present research showed that LPD was not significantly associated with improvement of renal function in patients with either type 1 or 2 diabetic nephropathy. Although these results do not completely eliminate the possibility that LPD is beneficial for patients with diabetic nephropathy, it does not seem to be significant benefit to renal function.

Identification of key lncRNAs contributing to diabetic nephropathy by gene co-expression network analysis

“…From the enrichment analysis, we could see that these lncRNAs in each module participated in different biological processes. DN is known to be a metabolic problem such as energy, protein and lipid disorder 24,25 . Clinical trials have suggested that nutritional and dietary interventions in DN are an essential aspect of management and patients will benefit from a strict dietary protein and carbohydrates control 26 .…”

The Effects of a High-Protein Diet on Bone Mineral Density in Exercise-Trained Women: A 1-Year Investigation

“…It has been postulated that high protein consumption (i.e., greater than the recommended daily allowance [RDA]) may pose a health risk in certain conditions [ 1 , 2 , 3 , 4 ]; however, these concerns are not applicable to a healthy exercise-trained population. Protein restriction might play a key role in the management of chronic kidney disease (CKD) [ 3 ].…”

Impact of isolated high home systolic blood pressure on diabetic nephropathy in patients with type 2 diabetes mellitus: A 5-year prospective cohort study

“…Nevertheless, this study has several limitations, which should be considered when interpreting its ndings. First, we did not have data on salt intake, protein intake, or levels of exercise, which would be associated with the development of diabetic nephropathy [27,[35][36][37]. In this regard, we could not clearly identify the prognostic signi cance of HBP for the development of diabetic nephropathy even in a longer study.…”