Abstract
PurposeWe aimed to systematically assess the efficacy of low-protein diet preventing progression of diabetic nephropathy based on randomized controlled trials (RCTs).MethodsA systematic and electronic search was conducted. Initial searches of literature updated to September 2018 were made using the following databases including CNKI, VIP, Wanfang, Cochrane, PubMed, and Embase using the index words for qualified RCTs. Additional searches were performed to identify linked literature sources. Data of RCTs on low-protein diet versus control diet, efficacy analysis of kidney function, nutritional status or proteinuria were extracted. Random effects model and fixed effects model were applied to combine the data which were further analyzed by Chi-squared test and I2tests. The main outcomes were then analyzed through the use of relative risks (RR), mean difference (MD) and its 95% confidence interval (95% CI).ResultsTwenty articles were included in the present meta-analysis with a total of 690 patients in the low-protein diet group (LPD) and a total of 682 patients in the control group. Moderate to strong evidence indicated that LPD was significantly effective for decreasing the urinary albumin excretion rate (SMD:0.62, 95%CI:0.06–1.19) and proteinuria (SMD:0.69, 95%CI:0.22–1.16) versus the control group. No statistical difference, however, was found in glycosylated hemoglobin (SMD:0.17, 95%CI:-0.18–0.51), serum creatinine (SMD:0.20, 95%CI:-0.26–0.66), as well as glomerular filtration rate (SMD:0.21, 95%CI:-0.29–0.71) between the two groups.ConclusionThe current meta-analysis reveals an effective role of low-protein diet in improving diabetic nephropathy. However, the small number of involved patients may limit the accuracy of results. High-quality RCTs with a larger sample size in the future are required to confirm the current findings.
Highlights
Diabetes is a highly prevalent chronic disease constitutes a major public health issue and inflicts a severe financial burden on the society and family
Selection criteria To be included in the current meta-analysis, studies should meet the following criteria: [1] randomized controlled trials (RCTs); [2] patients had type 1 or 2 diabetic nephropathy; [3] patients received low-protein diet group (LPD) or normal protein diet; [4] at least one clinical outcome was reported for analysis; [5] publications were English or Chinese
During full-text screening, 74 publications were excluded due to duplicated publications [15], non-RCTs [29], review or theoretical research [17], animal studies [8], or insufficient data [5]
Summary
Diabetes is a highly prevalent chronic disease constitutes a major public health issue and inflicts a severe financial burden on the society and family. About 40% of diabetes patients would develop diabetic nephropathy [1]. Diabetic nephropathy associated with type 1 as well as type 2 diabetes mellitus is considered a leading cause of end-stage renal disease worldwide [4, 5]. According to Diabetes and Nutrition Study Group of the European Association, the Study of Diabetes suggests that the dietary approach for weight loss and treating diabetes is a low-fat, high-carbohydrate, and energy-deficient diet [6, 7]. Earlier animal experiment and humans studies supported by American Diabetes Association recommendslow-protein diet (LPD) as a dietary approach in clinical guidelines [8]. LPD is proven to have beneficial effect in decreasing the progression of renal disease as well as improving survival rate in patients harboring various glomerulopathies, such as diabetic kidney
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