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Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial.

Abstract

OBJECTIVE

This study addressed the long-term effect of various diets, particularly low-carbohydrate high-protein, on renal function on participants with or without type 2 diabetes.

RESEARCH DESIGN AND METHODS

In the 2-year Dietary Intervention Randomized Controlled Trial (DIRECT), 318 participants (age, 51 years; 86% men; BMI, 31 kg/m(2); mean estimated glomerular filtration rate [eGFR], 70.5 mL/min/1.73 m(2); mean urine microalbumin-to-creatinine ratio, 12:12) with serum creatinine <176 μmol/L (eGFR ≥ 30 mL/min/1.73 m(2)) were randomized to low-fat, Mediterranean, or low-carbohydrate diets. The 2-year compliance was 85%, and the proportion of protein intake significantly increased to 22% of energy only in the low-carbohydrate diet (P < 0.05 vs. low-fat and Mediterranean). We examined changes in urinary microalbumin and eGFR, estimated by Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration formulas.

RESULTS

Significant (P < 0.05 within groups) improvements in eGFR were achieved in low-carbohydrate (+5.3% [95% CI 2.1-8.5]), Mediterranean (+5.2% [3.0-7.4]), and low-fat diets (+4.0% [0.9-7.1]) with similar magnitude (P > 0.05) across diet groups. The increased eGFR was at least as prominent in participants with (+6.7%) or without (+4.5%) type 2 diabetes or those with lower baseline renal function of eGFR <60 mL/min/1.73 m(2) (+7.1%) versus eGFR ≥ 60 mL/min/1.73 m(2) (+3.7%). In a multivariable model adjusted for age, sex, diet group, type 2 diabetes, use of ACE inhibitors, 2-year weight loss, and change in protein intake (confounders and univariate predictors), only a decrease in fasting insulin (β = -0.211; P = 0.004) and systolic blood pressure (β = -0.25; P < 0.001) were independently associated with increased eGFR. The urine microalbumin-to-creatinine ratio improved similarly across the diets, particularly among participants with baseline sex-adjusted microalbuminuria, with a mean change of -24.8 (P < 0.05).

CONCLUSIONS

A low-carbohydrate diet is as safe as Mediterranean or low-fat diets in preserving/improving renal function among moderately obese participants with or without type 2 diabetes, with baseline serum creatinine <176 μmol/L. Potential improvement is likely to be mediated by weight loss-induced improvements in insulin sensitivity and blood pressure.

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  • Authors+Show Affiliations

    ,

    Brigham and Women’s Hospital, Harvard School of Public Health, Boston, Massachusetts, USA.

    , , , , , , , , , , ,

    Source

    Diabetes care 36:8 2013 Aug pg 2225-32

    MeSH

    Adult
    Albuminuria
    Creatinine
    Diabetes Mellitus, Type 2
    Diet, Carbohydrate-Restricted
    Diet, Fat-Restricted
    Diet, Mediterranean
    Female
    Glomerular Filtration Rate
    Humans
    Kidney
    Kidney Function Tests
    Male
    Middle Aged
    Obesity
    Patient Compliance
    Renal Insufficiency, Chronic
    Weight Loss

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    23690533

    Citation

    Tirosh, Amir, et al. "Renal Function Following Three Distinct Weight Loss Dietary Strategies During 2 Years of a Randomized Controlled Trial." Diabetes Care, vol. 36, no. 8, 2013, pp. 2225-32.
    Tirosh A, Golan R, Harman-Boehm I, et al. Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial. Diabetes Care. 2013;36(8):2225-32.
    Tirosh, A., Golan, R., Harman-Boehm, I., Henkin, Y., Schwarzfuchs, D., Rudich, A., ... Shai, I. (2013). Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial. Diabetes Care, 36(8), pp. 2225-32. doi:10.2337/dc12-1846.
    Tirosh A, et al. Renal Function Following Three Distinct Weight Loss Dietary Strategies During 2 Years of a Randomized Controlled Trial. Diabetes Care. 2013;36(8):2225-32. PubMed PMID: 23690533.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial. AU - Tirosh,Amir, AU - Golan,Rachel, AU - Harman-Boehm,Ilana, AU - Henkin,Yaakov, AU - Schwarzfuchs,Dan, AU - Rudich,Assaf, AU - Kovsan,Julia, AU - Fiedler,Georg M, AU - Blüher,Matthias, AU - Stumvoll,Michael, AU - Thiery,Joachim, AU - Stampfer,Meir J, AU - Shai,Iris, Y1 - 2013/05/20/ PY - 2013/5/22/entrez PY - 2013/5/22/pubmed PY - 2014/3/19/medline SP - 2225 EP - 32 JF - Diabetes care JO - Diabetes Care VL - 36 IS - 8 N2 - OBJECTIVE: This study addressed the long-term effect of various diets, particularly low-carbohydrate high-protein, on renal function on participants with or without type 2 diabetes. RESEARCH DESIGN AND METHODS: In the 2-year Dietary Intervention Randomized Controlled Trial (DIRECT), 318 participants (age, 51 years; 86% men; BMI, 31 kg/m(2); mean estimated glomerular filtration rate [eGFR], 70.5 mL/min/1.73 m(2); mean urine microalbumin-to-creatinine ratio, 12:12) with serum creatinine <176 μmol/L (eGFR ≥ 30 mL/min/1.73 m(2)) were randomized to low-fat, Mediterranean, or low-carbohydrate diets. The 2-year compliance was 85%, and the proportion of protein intake significantly increased to 22% of energy only in the low-carbohydrate diet (P < 0.05 vs. low-fat and Mediterranean). We examined changes in urinary microalbumin and eGFR, estimated by Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration formulas. RESULTS: Significant (P < 0.05 within groups) improvements in eGFR were achieved in low-carbohydrate (+5.3% [95% CI 2.1-8.5]), Mediterranean (+5.2% [3.0-7.4]), and low-fat diets (+4.0% [0.9-7.1]) with similar magnitude (P > 0.05) across diet groups. The increased eGFR was at least as prominent in participants with (+6.7%) or without (+4.5%) type 2 diabetes or those with lower baseline renal function of eGFR <60 mL/min/1.73 m(2) (+7.1%) versus eGFR ≥ 60 mL/min/1.73 m(2) (+3.7%). In a multivariable model adjusted for age, sex, diet group, type 2 diabetes, use of ACE inhibitors, 2-year weight loss, and change in protein intake (confounders and univariate predictors), only a decrease in fasting insulin (β = -0.211; P = 0.004) and systolic blood pressure (β = -0.25; P < 0.001) were independently associated with increased eGFR. The urine microalbumin-to-creatinine ratio improved similarly across the diets, particularly among participants with baseline sex-adjusted microalbuminuria, with a mean change of -24.8 (P < 0.05). CONCLUSIONS: A low-carbohydrate diet is as safe as Mediterranean or low-fat diets in preserving/improving renal function among moderately obese participants with or without type 2 diabetes, with baseline serum creatinine <176 μmol/L. Potential improvement is likely to be mediated by weight loss-induced improvements in insulin sensitivity and blood pressure. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/23690533/full_citation L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=23690533 DB - PRIME DP - Unbound Medicine ER -