Renal, Metabolic, and Hormonal Responses to Proteins of Different Origin in Normotensive, Nonproteinuric Type I Diabetic Patients

Kontessis, Panayotis A; Bossinakou, Irini; Sarika, Leda; Iliopoulou, Elsa; Papantoniou, Antonis; Trevisan, Roberto; Roussi, Demetra P.; Stipsanelli, K.; Grigorakis, S I; Souvatzoglou, A.

doi:10.2337/diacare.18.9.1233

Cited by 85 publications

(71 citation statements)

References 36 publications

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“…The statistically significant relationship between intakes of total protein and AER was observed for animal protein, but not for vegetable protein, a finding which supports other evidence of the specially deleterious effect on renal function of animal protein [21,24,27,56]. Since long-term compliance to low-protein diets is often poor [21,22] a modification of protein intake [22,25,27,28,56,57], substituting vegetable protein for protein from animal sources, should be more fully explored as a feasible therapeutic approach which would also reduce total fat and saturated fatty acid consumption.…”

Section: Discussionsupporting

confidence: 76%

“…Since long-term compliance to low-protein diets is often poor [21,22] a modification of protein intake [22,25,27,28,56,57], substituting vegetable protein for protein from animal sources, should be more fully explored as a feasible therapeutic approach which would also reduce total fat and saturated fatty acid consumption. While high protein intakes were a unanimous finding in all EU-RODIAB centres [32] the pattern of food groups providing protein/animal protein may vary considerably across European countries.…”

Section: Discussionmentioning

confidence: 99%

“…The level to which protein intake should be modified in order to achieve these beneficial effects has been examined in studies conducted in individuals with miro- [21,25] and macroalbuminuria [16][17][18][19]26]. However, a uniform therapeutic approach has not yet been established and the question as to whether even normoalbuminuric individuals with diabetes should decrease or modify their current protein intake to avoid the development of renal disease remains to be clarified [27,28]. The Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes (EASD) [29] and the American Diabetes Association (ADA) [30] have recently recommended that protein intake in people with diabetes should range between 10 and 20 % of total energy.…”

mentioning

confidence: 99%

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Protein intake and urinary albumin excretion rates in the EURODIAB IDDM Complications Study

et al. 1997

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Kidney disease is a common and costly complication [1,2] of diabetes mellitus, with individuals often requiring dialysis or renal transplantation. More than 30 % of people with insulin-dependent diabetes mellitus (IDDM) are at risk of manifest renal disease [3][4][5]. In the EURODIAB IDDM Complications Study 30.6 % of a stratified European sample of individuals with IDDM aged 15-60 years (mean diabetes duration: 15 years) had albumin excretion rates (AER) of 20 m g/min or higher. In persons with a diabetes duration of 1-5 years the rate of elevated AER was 19.3 % [6]. This high prevalence of micro-and macroalbuminuria even early in IDDM and its predictive association for both clinical nephropathy [7][8][9][10][11][12] and increased cardiovascular disease risk [6,[13][14][15] highlight the potential for early detection and effective prevention of diabetic vascular complications.The use of low protein diets has been shown to reduce the progression of nephropathy in patients with clinically overt diabetic nephropathy [16][17][18][19]. In Diabetologia (1997) Summary For people with insulin-dependent diabetes mellitus (IDDM) renal disease represents a lifethreatening and costly complication. The EURODI-AB IDDM Complications Study, a cross-sectional, clinic-based study, was designed to determine the prevalence of renal complications and putative risk factors in stratified samples of European individuals with IDDM. The present study examined the relationship between dietary protein intake and urinary albumin excretion rate (AER). Food intake was assessed centrally by a standardized 3-day dietary record. Urinary AER was determined in a central laboratory from a timed 24-h urine collection. Complete data were available from 2696 persons with IDDM from 30 centres in 16 European countries. In individuals who reported protein consumption less than 20 % of total food energy intake, mean AER was below 20 m g/min. In those in whom protein intake constituted more than 20 %, mean AER increased, a trend particularly pronounced in individuals with hypertension and/or poor metabolic control. Trends reached statistical significance for intakes of total protein (% of energy, p = 0.01) and animal protein (% of energy, p = 0.02), while no association was seen for vegetable protein (p = 0.83). These findings support the current recommendation for people with diabetes not to exceed a protein intake of 20 % of total energy. Monitoring and adjustment of dietary protein appears particularly desirable for individuals with AER exceeding 20 m g/min (approximately 30 mg/24 h), especially when arterial pressure is raised and/or diabetic control is poor. [Diabetologia (1997[Diabetologia ( ) 40: 1219[Diabetologia ( -1226

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Protein intake and urinary albumin excretion rates in the EURODIAB IDDM Complications Study

et al. 1997

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“…The lack of an effect among participants taking ACE inhibitors/ARBs may be due to the possibility that both MeDi and ACE inhibitors/ARBs could work through overlapping mechanisms such as lowering intraglomerular pressure or by decreasing inflammation. For instance, the amino acid profile associated with an animal protein diet (compared with a vegetable protein diet) has been associated with increased eGFR (44). Therefore, it is possible that the higher vegetable intake of a Mediterranean diet may exert beneficial effects through improved glomerular hemodynamics, which is a similar effect to that of ACEI/ARBs.…”

Section: Discussionmentioning

confidence: 74%

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

Khatri¹,

Moon

Scarmeas

et al. 2014

Clinical Journal of the American Society of Nephrology

116

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Background and objectives Various dietary strategies have been investigated to slow kidney function decline. However, it is unknown whether a Mediterranean diet, which has been associated with improved cardiovascular risk, is associated with change in kidney function.Design, setting, participants, & measurements This study used the Northern Manhattan Study, a prospective, multiethnic, observational cohort of participants who were stroke free at baseline. Data were collected between 1993 and 2008. Serum creatinine measurements were taken a mean 6.9 years apart. A baseline dietary questionnaire was extrapolated into a previously used 9-point scoring system (MeDi). The primary outcome was incident eGFR,60 ml/min per 1.73 m 2 using the Modification of Diet in Renal Disease formula. A secondary outcome was the upper quartile of annualized eGFR decline ($2.5 ml/min per 1.73 m 2 per year). Conditional logistic regression models adjusted for demographics and baseline vascular risk factors.Results Mean baseline age was 64 years, with 59% women and 65% Hispanics (N=900); mean baseline eGFR was 83.1 ml/min per 1.73 m 2 . Incident eGFR,60 ml/min per 1.73 m 2 developed in 14% . In adjusted models, every 1-point increase in the MeDi score, indicating increasing adherence to a Mediterranean diet, was associated with decreased odds of incident eGFR,60 ml/min per 1.73 m 2 (odds ratio, 0.83; 95% confidence interval, 0.71 to 0.96) and decreased odds of being in the upper quartile of eGFR decline (odds ratio, 0.88; 95% confidence interval, 0.79 to 0.98).Conclusions A Mediterranean diet was associated with a reduced incidence of eGFR,60 ml/min per 1.73 m 2 and upper quartile of eGFR decline in a multiethnic cohort.

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“…The (33) demonstrated that an animal protein diet was associated with higher plasma levels of valine and lysine than a vegetable protein diet, and plasma valine levels were strongly correlated with GFR. Increases in GFR may cause intraglomerular hypertension, which may lead to progressive loss of renal function (7).…”

Section: Discussionmentioning

confidence: 98%

The Impact of Protein Intake on Renal Function Decline in Women with Normal Renal Function or Mild Renal Insufficiency

Knight

Stampfer²,

Hankinson³

et al. 2003

Ann Intern Med

368

243

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Renal, Metabolic, and Hormonal Responses to Proteins of Different Origin in Normotensive, Nonproteinuric Type I Diabetic Patients

Abstract: A VPD has significantly different renal effects from an APD equal in protein intake in normotensive type I diabetic patients. This could be explained partly by differences in plasma concentrations of amino acids and IGF-I.

Cited by 85 publications

References 36 publications

Protein intake and urinary albumin excretion rates in the EURODIAB IDDM Complications Study

Protein intake and urinary albumin excretion rates in the EURODIAB IDDM Complications Study

The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

The Impact of Protein Intake on Renal Function Decline in Women with Normal Renal Function or Mild Renal Insufficiency

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