Long-term effect of a chicken-based diet versus enalapril on albuminuria in type 2 diabetic patients with microalbuminuria.
OBJECTIVE
In short-term studies, the replacement of red meat in the diet with chicken reduced the urinary albumin excretion rate (UAER) and improved lipid profile in type 2 diabetic patients with diabetic nephropathy. The present study sought to assess these effects over a long-term period, comparing the effects of a chicken-based diet (CD) versus enalapril on renal function and lipid profile in microalbuminuric type 2 diabetic patients.


METHODS
This was a randomized, open-label, controlled clinical trial with a follow-up of 1 year.


METHODS
The trial involved outpatients with type 2 diabetes attending a clinic of the Division of Endocrinology at a tertiary-care hospital.


METHODS
Twenty-eight microalbuminuric patients completed the study and were evaluated.


METHODS
Patients were randomized to an experimental diet (CD plus active placebo) or to treatment with enalapril (10 mg/day plus usual diet).


METHODS
The main outcome measure was UAER (according to immunoturbidimetry). Blood pressure, anthropometric indices, and compliance were also evaluated monthly. The glomerular filtration rate ((51)Cr-EDTA), and lipid, glycemic, and nutritional indices, were measured at baseline and quarterly.


RESULTS
The UAER was reduced after CD (n = 13; from 62.8 [range, 38.4 to 125.1] to 49.1 [range, 6.2 to 146.5] microg/min; P < .001) and after enalapril (n = 15; from 55.8 [range, 22.6 to 194.3] to 23.1 [range, 4.0 to 104.9] microg/min; P < .001), and this was already significant at month 4. The reduction in UAER after CD (32%; 95% confidence interval, 6.7% to 57.6%) and after enalapril treatment (44.7%; 95% confidence interval, 28.3% to 61.1%; P = .366) were not significantly different.


CONCLUSIONS
The CD and the angiotensin-converting enzyme inhibitor enalapril promoted a similar reduction of UAER in patients with type 2 diabetes and microalbuminuria in a 12-month follow-up period.
de Mello
Vanessa D F
VD
Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Zelmanovitz
Themis
T
Azevedo
Mirela J
MJ
de Paula
Tatiana P
TP
Gross
Jorge L
JL
D000419:Albuminuria / Q000178:diet therapy* / Q000188:drug therapy* / Q000209:etiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D002645:Chickens; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004032:Diet; D004044:Dietary Proteins / Q000494:pharmacology; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008460:Meat; D008875:Middle Aged; D015596:Nutrition Assessment; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D001786:Blood Glucose; D004044:Dietary Proteins; D008055:Lipids; D004656:Enalapril