Abstract
Diabetes mellitus is a metabolic disorder characterized by the development of vascular complications associated with high morbidity and mortality and the consequent relevant costs for the public health systems. Diabetic kidney disease is one of these complications that represent the main cause of end-stage renal disease in Western countries. Hyperglycemia, inflammation, and oxidative stress contribute to its physiopathology, and several investigations have been performed to evaluate the role of antioxidant supplementation as a complementary approach for the prevention and control of diabetes and associated disturbances. Vitamin E compounds, including different types of tocopherols and tocotrienols, have been considered as a treatment to tackle major cardiovascular outcomes in diabetic subjects, but often with conflicting or even negative results. However, their effects on diabetic nephropathy are even less clear, despite several intervention studies that showed the improvement of renal parameters after supplementation in patients with diabetic kidney disease. Then we performed a review of the literature about the role of vitamin E supplementation on diabetic nephropathy, also describing the underlying antioxidant, anti-inflammatory, and metabolic mechanisms to evaluate the possible use of tocopherols and tocotrienols in clinical practice.
Highlights
In the light of several epidemiological and observational studies demonstrating the beneficial effects, vitamin E supplementation was historically considered as a possible treatment for slowing progression or even prevention of atherosclerotic cardiovascular disease (ASCVD)
Along with the reduction of vitamin E concentration are well known to be associated with the development of diabetic complications [36], several studies proposed the role of antioxidant supplementation in preventing macroalbuminuria and overt nephropathy in the early phase of microalbuminuria
Diabetic kidney disease (DKD) is a relevant complication of diabetes, which is associated with a worse prognosis
Summary
In the light of several epidemiological and observational studies demonstrating the beneficial effects, vitamin E supplementation was historically considered as a possible treatment for slowing progression or even prevention of atherosclerotic cardiovascular disease (ASCVD). The majority of these studies showed negative results [1,2,3] and, the initial interest in this research area has dramatically decreased Data from these trials have been debated for a long time by the experts, identifying some limitations in these studies’ designs to explain the unexpected results. The objections to these studies were represented by the dosage of supplementation, because most of the trials were performed using a low concentration mixture (usually corresponding to about 400 IU/die of α-tocopherol), and by the different composition of the mixture, which often included other molecules in addition to vitamin E. The current opinion disagrees with indiscriminate micronutrient supplementation, promoting a more tailored approach in more selected populations [5]
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