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Renal Function Following Three Distinct Weight Loss Dietary Strategies During 2 Years of a Randomized Controlled Trial

Tirosh, Amir, Golan, Rachel, Harman-Boehm, Ilana, Henkin, Yaakov, Schwarzfuchs, Dan, Rudich, Assaf, Kovsan, Julia, Fiedler, Georg M., Blüher, Matthias, Stumvoll, Michael, Thiery, Joachim, Stampfer, Meir J., Shai, Iris·2013·Diabetes Care
DOI 10.2337/dc12-1846PMC PMC3714527
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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/m2; mean estimated glomerular filtration rate [eGFR], 70.5 mL/min/1.73 m2; mean urine microalbumin-to-creatinine ratio, 12:12) with serum creatinine <176 μmol/L (eGFR ≥30 mL/min/1.73 m2) 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 m2 (+7.1%) versus eGFR ≥60 mL/min/1.73 m2 (+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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Metadata

Authors
Tirosh, A., Golan, R., Harman-Boehm, I., Henkin, Y., Schwarzfuchs, D., Rudich, A., Kovsan, J., Fiedler, G. M., Blüher, M., Stumvoll, M., Thiery, J., Stampfer, M. J., & Shai, I.
Affiliations
  • Brigham and Women’s Hospital, Harvard School of Public Health, Boston, Massachusetts, and the Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel
  • Ben Gurion University of the Negev, Beer-Sheva, Israel
  • Soroka Medical Center, Beer-Sheva, Israel
  • Nuclear Research Center Negev, Dimona, Israel
  • University Hospital of Bern, Bern, Switzerland
  • University of Leipzig, Leipzig, Germany
  • Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, and Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, Massachusetts.
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2013-07-11
Volume
36
Issue
8
Pages
2225-2232
ISSN
  • 0149-5992
  • 1935-5548
DOI
10.2337/dc12-1846
PMC
PMC3714527
Cited by
120
References
3
Language
en
Licence
creativecommons.org/licenses/by-nc-nd/3.0/ (vor, 2970 d)

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