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Cited by 103Chronic Kidney Disease and DiabetesDiet and metabolism studiesDietary Effects on Health

The effect of protein restriction on albuminuria in patients with type 2 diabetes mellitus: a randomized trial

Pijls, L·1999·Nephrology Dialysis Transplantation
DOI 10.1093/ndt/14.6.1445
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Abstract

BACKGROUND: A randomized trial was conducted to assess whether protein restriction helps to delay the onset of renal disorders in type 2 diabetic patients. METHODS: Included in the trial were 121 type 2 diabetic patients with microalbuminuria or at least detectable albuminuria, or diabetes of duration > or =5 years. The experimental (39 male/19 female) and control group (35 male/28 female) received counselling on protein restriction and the usual dietary advice, respectively. The outcome measure was albuminuria (mg/24 h). Results. After 6 months in experimental and control groups the change in protein intake was -0.05+/-0.21 and +0.03+/-0.19 g/kg (P = 0.02), and in albuminuria -14% and +11% (P = 0.01), respectively. After 12 months, the differences between the experimental and the control group with respect to both protein intake and albuminuria had decreased. At 6 and 12 months, respectively, albuminuria was 28% (P<0.001) and 18% (P = 0.08) lower in the experimental than the control group. The effect in normoalbuminuric patients did not differ from that in microalbuminuric patients. In the experimental group, blood pressure, HbA1c and body weight decreased; in the control group, such decreases were less or absent. Dose-response analysis showed that a 0.10 g/kg change at 6 months in the intake of protein, of animal protein in particular, was related to an 11.1% change in albuminuria (P<0.005). Combining the intakes at 6 and 12 months suggested a percentage change of 9.1%. CONCLUSIONS: Substantial protein restriction in primary care, type 2 diabetic patients with no nephropathy is barely feasible. However, even a small reduction has a substantial and potentially beneficial effect on albuminuria.

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Crossref · 10.1093/ndt/14.6.1445

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  • The concern about diabetic nephropathy with a high-protein diet was not substantiated by Brinkworth et al., who showed no change in urinary albumin excretion in either the high- or low-protein-diet arms.

    “The concern of the development of diabetic nephropathy (69) with a high-protein diet was not substantiated by Brinkworth et al (44) who showed no change in urinary albumin excretion in either the high-or low-protein-diet arms.”

    From Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes (2013) · cites this paper as [69]

  • Studies in patients with varying stages of nephropathy have shown that protein restriction helps slow the progression of albuminuria, GFR decline, and occurrence of ESRD.

    “Studies in patients with varying stages of nephropathy have shown that protein restriction helps slow the progression of albuminuria, GFR decline, and occurrence of ESRD (243–246).”

    From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [243]

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Authors
Pijls, L.
Affiliations
Amsterdam Public Health (NL)
Corresponding author
Pijls, L
Venue
Nephrology Dialysis Transplantation
Publisher
Oxford University Press (OUP)
Published
1999-06-01
Volume
14
Issue
6
Pages
1445-1453
ISSN
  • 0931-0509 (ISSN-L)
  • 1460-2385
DOI
10.1093/ndt/14.6.1445
OpenAlex
W2156897204
Cited by
103
References
4
Citations by year
2025: 1 · 2024: 4 · 2023: 1 · 2022: 2 · 2020: 4 · 2019: 6 · 2018: 3 · 2017: 1 · 2015: 5 · 2014: 8 · 2013: 6 · 2012: 4
FWCI
2.80
Type
journal article
Language
en
Open access
closed
Locations
  • Nephrology Dialysis Transplantation (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
Keywords
protein restriction, albuminuria, type 2 diabetes, diabetic nephropathy, microalbuminuria, nutrition counseling, animal protein intake, dose-response relationship, blood pressure, HbA1c, body weight
MeSH terms
Adult, Aged, Albuminuria, Blood Pressure, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Dietary Proteins, Female, Humans, Male, Middle Aged

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