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Meta-Analysis
. 2018 Jun 19;17(1):141.
doi: 10.1186/s12944-018-0791-8.

Efficacy of low-protein diet for diabetic nephropathy: a systematic review of randomized controlled trials

Huan-Gao Zhu  1 , Zhao-Shun Jiang  2 , Pi-Yun Gong  1 , Dong-Mei Zhang  3 , Zhi-Wei Zou  1 , Qian-Zhang  1 , Hui-Mei Ma  1 , Zhen-Gang Guo  4 , Jun-Yu Zhao  5 , Jian-Jun Dong  6 , Lin-Liao  7
Affiliations
Meta-Analysis

Efficacy of low-protein diet for diabetic nephropathy: a systematic review of randomized controlled trials

Huan-Gao Zhu et al. Lipids Health Dis. .

Abstract

Background: A low-protein diet (LPD) is believed to be beneficial in slowing the progression of kidney disease. It is reported that low protein diet can improve protein, sugar and lipid metabolism, and reduce the symptoms and complications of renal insufficiency. However, there has been controversial regarding the effects of protein restriction on diabetic nephropathy (DN).

Objective: To investigate the efficacy of LPD on renal function in patients with type 1 or 2 DN by meta-analysis of randomized controlled trials (RCTs).

Design: PubMed, MEDLINE, EMBASE and China National Knowledge Infrastructure databases were searched. Eleven randomized controlled trials met the inclusion criteria, of which 10 were English and 1 was Chinese. The primary outcome was a change in glomerular filtration rate (GFR). The secondary outcome was a change in proteinuria. Random-effects models were used to calculate the standardized mean difference (SMD) and the corresponding 95% confidence intervals (CI). Subgroup analyses were also performed.

Results: Our research indicated that LPD was not associated with a significant improvement in GFR (1.59 ml · min-1 · 1.73 m-2, 95% CI -0.57, 3.75, I2 = 76%; p = 0.15). This effect was consistent across the subgroups regardless of type of diabetes, course of diabetes and intervention period. Our results also showed that there was no significant difference on improvement of proteinuria in patients of LPD and those in normal-protein diet groups (- 0.48, 95%CI-1.70, 0.74, I2 = 94%, p = 0.44). Subgroup analysis revealed that LPD resulted in increased excretion of proteinuria in patients with type 2 diabetes (1.32, 95% CI 0.17, 2.47, I2 = 86%, p = 0.02).

Conclusion: The present research showed that LPD was not significantly associated with improvement of renal function in patients with either type 1 or 2 diabetic nephropathy. Although these results do not completely eliminate the possibility that LPD is beneficial for patients with diabetic nephropathy, it does not seem to be significant benefit to renal function.

Keywords: Diabetic nephropathy; Low-protein diet; Protein restriction.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of the process for study selection
Fig. 2
Fig. 2
The forest plot of meta-analysis
Fig. 3
Fig. 3
The funnel plot
Fig. 4
Fig. 4
The forest plot of meta-analysis
Fig. 5
Fig. 5
The forest plot of meta-analysis
See this image and copyright information in PMC

References

    1. Packham DK, Alves TP, Dwyer JP, et al. Relative incidence of ESRD versus cardiovascular mortality in proteinuric type 2 diabetes and nephropathy: results from the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database. Am J Kidney Dis. 2012;59:75–83. doi: 10.1053/j.ajkd.2011.09.017. - DOI - PubMed
    1. Valmadrid CT, Klein R, Moss SE, et al. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Inter Med. 2000;160:1093–1100. doi: 10.1001/archinte.160.8.1093. - DOI - PubMed
    1. Association AD Nutritional recommendations and interventions for diabetes. A position statement of the American Diabetes Association. Diabetes Care. 2008;30(Suppl 1):S61–S78. doi: 10.2337/dc08-S061. - DOI - PubMed
    1. Molitch ME, DeFronzo RA, Franz MJ, et al. Diabetic nephropathy. Diabetes Care. 2003;26(Suppl 1):S94–S98. - PubMed
    1. American Diabetes Association Standards of medical care in diabetes—2013. Diabetes Care. 2012;36:S11–S66. doi: 10.2337/dc13-S011. - DOI - PMC - PubMed