title: [Effect of protein restriction on renal function and nutritional status of type 1 diabetes at the stage of renal impairment].
abstract: BACKGROUND
  In an effort to slow the deterioration of renal function, several authors have recommended in the diabetic stage renal disease with moderate renal impairment decreased protein intake to 0.7 or 0.3 g / kg / day associated with energy intake of at least 30 to 35 kcal / kg / day. However, in clinical practice this proved difficult to achieve without exposing patients to the risk of under nutrition.
  
  
  OBJECTIVE
  To evaluate the effects of a protein restricted diet on the development of diabetic nephropathy and the nutritional status of diabetic patients with renal impairment at the stage of moderate renal impairment compared with those of a group of diabetics with the same characteristics put under basal diabetic diet.
  
  
  METHODS
  Prospective study of 57 diabetic patients in moderate stage renal disease of middle age (32 ± 0.6 years) followed at the National Institute of Nutrition of Tunis in 2010. Our patients were separated into two groups (group A comprising 30 patients, put on diabetic diet basal and group B comprising 27 patients used in protein-deficient diet: 0.6 to 0.7 g / kg /d). We followed the evolution of certain parameters: glomerular filtration rate (GFR), serum albumin, albuminuria, nutritional risk index (NRI) and we analyzed dietary intake at D0, D90 and D180.
  
  
  RESULTS
  Renal function in patients in group B improved as demonstrated by the trend towards higher GFR. It increased from day 0 to day 90 and at day 180. In parallel, there was a beneficial effect on albuminuria which was reduced from 380 ± 56 mg/24h on day 0, to 322 ± 50mg/24h at day J90 and 302 ± 16 mg/24h at day 180. In group A, the opposite phenomena occurred. The patients in Group B have also reduced their overall caloric intake to less than 1800 kcal / day making sure that the balance of their diet quality could no longer be assured the result has a tendency to under nutrition noted more frequently in the latter group (NRI0 = 97.90%, NRI 90= 90.10% , NRI180=90,0%). In the literature these results were found by several studies.
  
  
  CONCLUSIONS
  The protein-deficient diet (0.6 to 0.7 g/ kg /d) must be integrated into the overall care of diabetic renal insufficiency with moderate renal impairment but requires rigorous repeated dietary interviews and customized to avoid malnutrition can result.
authors.affiliation: Universite Tunis, Tunisie.
authors.forename: Abdelmajid
authors.initials: A
authors.lastname: Trimeche
authors.forename: Yosra
authors.initials: Y
authors.lastname: Selmi
authors.forename: Fethi
authors.initials: F
authors.lastname: Ben Slama
authors.forename: Hayet
authors.initials: H
authors.lastname: Ben Amara
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Hazar
authors.forename: Faika
authors.initials: F
authors.lastname: Ben Mami
authors.forename: Ahmed
authors.initials: A
authors.lastname: Achour
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy*; D003928:Diabetic Nephropathies / Q000178:diet therapy*; D018753:Diet, Protein-Restricted; D005919:Glomerular Filtration Rate; D006801:Humans; D011446:Prospective Studies; D055815:Young Adult