Department of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Japan.
Division of Anticipatory Molecular Food Science and Technology, Medical Research Institute, Kanazawa Medical University, Uchinada, Japan.
Nephrology (Carlton). 2017 Dec;22(12):1030-1034. doi: 10.1111/nep.13152.
A low-protein diet (LPD), particularly, very low-protein diet (VLPD) is expected for reno-protection in advanced chronic kidney disease, including diabetic nephropathy. We previously also demonstrated that a VLPD clearly improved advanced diabetic nephropathy in a type 2 diabetes and obesity rat. However, clinically, an everyday long-term VLPD contributes to poor adherence, which may be related to controvertial results of an LPD on the suppression for diabetic nephropathy, and has nutritional issues, such as sarcopenia or protein-energy wasting. The aim of this study is to elucidate the reno-protective effect of a cyclic and intermittent VLPD, not an everyday VLPD, against the advanced experimental diabetic nephropathy. Diabetic male Wistar fatty (fa/fa) rats (WFRs) were treated with a standard diet (STD; 23.84% protein) or a cyclic and intermittent VLPD (5.77% protein) consisting of an STD for 3 days and a VLPD for 4 days a week for 20 weeks beginning at 24 weeks of age. A cyclic and intermittent VLPD significantly improved renal hypertrophy, and significantly decreased urinary albumin and liver-type fatty acid binding protein (L-FABP) excretion without changes in body weight or exacerbation of HbA1c levels in diabetic rats. Additionally, diabetes-induced renal injuries including fibrosis, tubular cell damage and inflammation were significantly ameliorated by a cyclic and intermittent VLPD in diabetic rats. Thus, based on our experimental data, a cyclic and intermittent VLPD may be a dietary regimen that is easy to continue and has less risk of malnutrition, compared to an everyday long-term VLPD, against advanced diabetic nephropathy.
低蛋白饮食（LPD），特别是极低蛋白饮食（VLPD），预计可用于保护慢性肾脏病晚期患者的肾脏，包括糖尿病肾病。我们之前还证明，VLPD 可明显改善 2 型糖尿病和肥胖大鼠的晚期糖尿病肾病。然而，临床上，长期每天摄入 VLPD 会导致患者顺应性差，这可能与 LPD 对糖尿病肾病抑制作用的争议结果有关，还存在营养问题，如肌肉减少症或蛋白质能量消耗。本研究的目的是阐明周期性和间歇性 VLPD 对晚期实验性糖尿病肾病的肾脏保护作用，而不是每天摄入 VLPD。雄性 Wistar 肥胖（fa/fa）大鼠（WFRs）从 24 周龄开始，20 周内每周接受 3 天标准饮食（STD；23.84%蛋白质）和 4 天周期性和间歇性 VLPD（5.77%蛋白质）治疗。周期性和间歇性 VLPD 可显著改善肾脏肥大，显著减少尿白蛋白和肝型脂肪酸结合蛋白（L-FABP）的排泄，而不改变体重或加重糖尿病大鼠的 HbA1c 水平。此外，糖尿病大鼠的肾脏损伤包括纤维化、肾小管细胞损伤和炎症，通过周期性和间歇性 VLPD 可显著改善。因此，根据我们的实验数据，与长期每天摄入 VLPD 相比，周期性和间歇性 VLPD 可能是一种更容易坚持且营养不良风险较低的饮食方案，可用于治疗晚期糖尿病肾病。
