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Review
. 2022 Oct 28;14(21):4547.
doi: 10.3390/nu14214547.

Resistant Starch as a Dietary Intervention to Limit the Progression of Diabetic Kidney Disease

Anna M Drake  1 , Melinda T Coughlan  1   2 , Claus T Christophersen  3   4 , Matthew Snelson  1
Affiliations
Review

Resistant Starch as a Dietary Intervention to Limit the Progression of Diabetic Kidney Disease

Anna M Drake et al. Nutrients. .

Abstract

Diabetes is the leading cause of kidney disease, and as the number of individuals with diabetes increases there is a concomitant increase in the prevalence of diabetic kidney disease (DKD). Diabetes contributes to the development of DKD through a number of pathways, including inflammation, oxidative stress, and the gut-kidney axis, which may be amenable to dietary therapy. Resistant starch (RS) is a dietary fibre that alters the gut microbial consortium, leading to an increase in the microbial production of short chain fatty acids. Evidence from animal and human studies indicate that short chain fatty acids are able to attenuate inflammatory and oxidative stress pathways, which may mitigate the progression of DKD. In this review, we evaluate and summarise the evidence from both preclinical models of DKD and clinical trials that have utilised RS as a dietary therapy to limit the progression of DKD.

Keywords: diabetes; diabetic kidney disease; diet; gut microbiota; high-amylose maize starch; resistant starch; short chain fatty acids.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Long-term major complications of diabetes mellitus. Created with Biorender.com.
Figure 2
Figure 2
Overview of the mechanisms implicated in DKD pathogenesis. RAAS: Renin Angiotensin Aldosterone System, ROS: Reactive Oxygen Species, NF-κB: Nuclear Factor Kappa B, IL-6: Interleukin 6, IL-1: Interleukin 1, IL-18: Interleukin 18, TNF-α: Tumour Necrosis Factor Alpha, TGF-β: Transforming Growth Factor Beta, ↑: Increased, ↓: Decreased. Created with Biorender.com.
Figure 3
Figure 3
Overview of the gut-kidney axis in DKD. GFR: Glomerular Filtration Rate, LPS: Lipopolysaccharide, SCFA: Short Chain Fatty Acid, ↑: Increased, ↓: Decreased. Created with Biorender.com.
Figure 4
Figure 4
A venn diagram placing dietary fibre types in relation to their associations with bulking, fermenting and viscous functions. This is not a comprehensive overview of fibre types or functional associations but aims to demonstrates the wide diversity of the dietary fibre class. Created with Biorender.com.
Figure 5
Figure 5
An overview of bacteria associated with resistant starch and the production of butyrate. Created with Biorender.com.
Figure 6
Figure 6
An overview of the mechanisms of resistant starch. GLP1: Glucagon Like Peptide 1, IL-6: Interleukin 6, NF-κB: Nuclear Factor Kappa B, SCFA: Short Chain Fatty Acid, Treg: Regulatory T cells, ↑: Increased, ↓: Decreased. Created with Biorender.com.
See this image and copyright information in PMC

References

    1. Magliano D.J., Boyko E.J., Balkau B., Barengo N., Barr E., Basit A., Bhata D., Bommer C., Booth G., Cariou B., et al. IDF Diabetes Atlas. 10th ed. 2022. [(accessed on 15 March 2022)]. Available online: https://diabetesatlas.org/atlas/tenth-edition.
    1. Forbes J.M., Cooper M.E. Mechanisms of Diabetic Complications. Physiol. Rev. 2013;93:137–188. doi: 10.1152/physrev.00045.2011. - DOI - PubMed
    1. Thomas M.C., Brownlee M., Susztak K., Sharma K., Jandeleit-Dahm K.A.M., Zoungas S., Rossing P., Groop P.-H., Cooper M.E. Diabetic kidney disease. Nat. Rev. Dis. Prim. 2015;1:15018. doi: 10.1038/nrdp.2015.18. - DOI - PMC - PubMed
    1. Thornton Snider J., Sullivan J., van Eijndhoven E., Hansen M.K., Bellosillo N., Neslusan C., O’Brien E., Riley R., Seabury S., Kasiske B.L. Lifetime benefits of early detection and treatment of diabetic kidney disease. PLoS ONE. 2019;14:e0217487. doi: 10.1371/journal.pone.0217487. - DOI - PMC - PubMed
    1. Alicic R.Z., Rooney M.T., Tuttle K.R. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. Clin. J. Am. Soc. Nephrol. 2017;12:2032–2045. doi: 10.2215/CJN.11491116. - DOI - PMC - PubMed