Dietary correction of metabolic disorders in patients with diabetic nephropathy

Abstract

One of the ways to optimize the complex treatment of patients with diabetic nephropathy (DN) is the use of therapeutic nutrition with the inclusion of foods for special dietary use (FSDU) that correct carbohydrate and lipid metabolism disorders and have antioxidant and anti-inflammatory, properties. The aim of the research was to study the effect of a low-protein diet with the inclusion of FSDU on some clinical and biochemical parameters in patients with DN. Material and methods. 30 patients with DN and concomitant obesity of I-III stages were examined, which were divided into two groups of 15 people each. Patients of the main group received a low-protein diet for 14 days (protein 62.4 g/day, energy value 1360 kcal/day) with the inclusion of FSDU (124 kcal per portion), modified by protein, fat and carbohydrate profile (dry instant mixture), and the comparison group - a low-protein diet without the inclusion of FSDU. In blood serum, the content of glucose, glycated hemoglobin (HbA1c), total cholesterol (CH), triglycerides, cholesterol of low and high density lipoproteins (LDL, HDL), urea, creatinine, total protein, albumin, total bilirubin, alanine and aspartate aminotransferase activity, levels of potassium, phosphorus, calcium. Glomerular filtration rate was calculated and body composition indicators were studied using the bioimpedancemetry. Results. Patients of the main group showed a statistically significant decrease in fat mass by an average of 5.5% (p=0.0001) and a tendency to increase muscle mass by 1.7% (p>0.05) from the initial level. Among the patients of the comparison group, the decrease in fat mass was 4.9% (p=0.0001) against the background of a decrease in lean body mass by 2.5% (p>0.05). When comparing biochemical parameters, positive dynamics of glycemic control indicators was noted in both groups: the level of glucose in blood serum decreased (p<0.005) by 10.9 and 9.3% from the initial level in the main group and the comparison group. A more pronounced decrease in LDL and triglycerides was noted in patients of the main group (29.4 and 26.2%, respectively, p=0.005), in the comparison group the decrease in these indicators was less pronounced and statistically insignificant. Conclusion. The results obtained indicate an increase in the effectiveness of therapeutic nutrition in patients with DN and concomitant obesity when an FSDU with a modified protein, fat and carbohydrate profile is included in a low-protein diet.