title: A low-iron-available, polyphenol-enriched, carbohydrate-restricted diet to slow progression of diabetic nephropathy.
abstract: Diabetic nephropathy has become the leading cause of uremia. Several lines of evidence suggest dietary factors other than protein intake have a substantial role in the progression of diabetic nephropathy to end-stage renal disease. The present investigation was initiated to evaluate whether a carbohydrate-restricted, low-iron-available, polyphenol-enriched (CR-LIPE) diet may delay and improve the outcome of diabetic nephropathy to a greater extent than standard protein restriction. To this aim, 191 diabetic patients, all with type 2 diabetes, were randomized to either CR-LIPE or standard protein restriction and the following outcomes monitored: doubling of serum creatinine, cumulative incidence of end-stage renal disease, and all cause mortality. Over a mean follow-up interval of 3.9 +/- 1.8 years, serum creatinine concentration doubled in 19 patients on CR-LIPE (21%) and in 31 control subjects (39%) (P < 0.01). Renal replacement therapy or death occurred in 18 patients on CR-LIPE (20%) and in 31 control subjects (39%) (P < 0.01). These differences were independent from follow-up interval, sex, mean arterial blood pressure, HbA(1c), initial renal dysfunction, and angiotensin system inhibitor use. In conclusion, CR-LIPE was 40-50% more effective than standard protein restriction in improving renal and overall survival rates.
authors.affiliation: Department of Medicine, Division of Nephrology, San Francisco General Hospital and University of California-San Francisco, Box 1342 UCSF, San Francisco, CA 94143-1341, USA. fste2000@yahoo.com
authors.forename: Francesco S
authors.initials: FS
authors.lastname: Facchini
authors.forename: Kami L
authors.initials: KL
authors.lastname: Saylor
mesh_terms: D015992:Body Mass Index; D003928:Diabetic Nephropathies / Q000178:diet therapy / Q000517:prevention & control*; D003927:Diet, Diabetic; D004040:Dietary Carbohydrates; D018450:Disease Progression; D005260:Female; D005419:Flavonoids; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron; D007676:Kidney Failure, Chronic / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010636:Phenols; D011108:Polymers; D059808:Polyphenols; D012016:Reference Values; D013997:Time Factors
chemical_list: D004040:Dietary Carbohydrates; D005419:Flavonoids; D006454:Hemoglobins; D010636:Phenols; D011108:Polymers; D059808:Polyphenols; D007501:Iron