Abstract
AimThis cross-sectional study aimed to assess the association of the fat content in the diet with Diabetic Kidney Disease (DKD) in patients with type 2 diabetes.MethodologyPatients from the Diabetes research clinic at Hospital de Clínicas de Porto Alegre (Brazil) were consecutively recruited. The inclusion criterion was the diagnosis of type 2 diabetes. The exclusion criteria were as follows: body mass index >40 kg/m2, heart failure, gastroparesis, diabetic diarrhea, dietary counseling by a registered dietitian during the previous 12 months, and inability to perform the weighed diet records (WDR). The dietary fatty acids (saturated, monounsaturated and polyunsaturated) consumption was estimated by 3-day WDR. Compliance with the WDR technique was assessed by comparison of protein intake estimated from the 3-day WDR and from the 24-h urinary nitrogen output performed on the third day of the WDR period. The presence of DKD was defined as urinary albumin excretion (UAE) ≥ 30 mg / 24 h or/and glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Urinary albumin was measured twice and eGFR was estimated by using the CKD-EPI equation.ResultsA total of 366 patients were evaluated; of these, 33% (n = 121) had DKD. Multivariate analysis showed that the intake of linolenic acid was negatively associated with DKD (OR = 0.57; 95% CI 0.35–0.93; P = 0.024), adjusted for gender, smoking, cardiovascular disease, ACE inhibitors and/or angiotensin receptor blocker use, systolic blood pressure, fasting plasma glucose and HDL cholesterol. In a separate model, similar results were observed for linoleic acid, adjusting to the same co-variables (OR = 0.95; 95% CI 0.91–0.99; P = 0.006).ConclusionThe lower intake of polyunsaturated fatty acids, especially linolenic and linoleic acid, is associated with chronic kidney disease in patients with type 2 diabetes.
Highlights
Chronic kidney disease is a major microvascular complication of diabetes and affects about one third of the patients [1]
Multivariate analysis showed that the intake of linolenic acid was negatively associated with Diabetic Kidney Disease (DKD) (OR = 0.57; 95% CI 0.35–0.93; P = 0.024), adjusted for gender, smoking, cardiovascular disease, ACE inhibitors and/or angiotensin receptor blocker use, systolic blood pressure, fasting plasma glucose and HDL cholesterol
Some observational studies have reported a positive association between increasing values of albuminuria and dietary saturated fatty acids (SFA) [5,6], as well as an inverse association with polyunsaturated FA (PUFA) [5], both in patients with type 1 and type 2 diabetes
Summary
Chronic kidney disease is a major microvascular complication of diabetes and affects about one third of the patients [1]. Aggressive and multifactorial control of traditional risk factors may attenuate the progression of this complication [2], it is still an important global public health problem [3] This reinforces the importance of identifying additional risk factors that might be associated with the development of Diabetic Kidney Disease (DKD) and develop strategies to mitigate their effects. In regard to supplementation of n-3 PUFA, a beneficial effect on the reduction of albuminuria was observed in one meta-analysis of clinical trials [9], but not in others, especially when patients with diabetes were separately analyzed [10] These findings are not enough to support dietary recommendations. More clinical research about this issue has been suggested in order to establish evidence-based specific dietary recommendations
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