Department of Endocrinology, Shanxi Provincial People's Hospital, No. 256 West Youyi Road, Xi'an, 710068, China.
Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
Lipids Health Dis. 2019 Apr 1;18(1):82. doi: 10.1186/s12944-019-1007-6.
We aimed to systematically assess the efficacy of low-protein diet preventing progression of diabetic nephropathy based on randomized controlled trials (RCTs).
A 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 Itests. The main outcomes were then analyzed through the use of relative risks (RR), mean difference (MD) and its 95% confidence interval (95% CI).
Twenty 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.
The 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.
我们旨在通过随机对照试验（RCT）系统评估低蛋白饮食预防糖尿病肾病进展的疗效。
进行了系统的电子搜索。使用以下数据库对文献进行了初始搜索，更新至 2018 年 9 月，包括中国知网、维普、万方、Cochrane、PubMed 和 Embase，使用合格 RCT 的索引词。进行了额外的搜索以识别相关的文献来源。提取了低蛋白饮食与对照饮食的 RCT 数据、肾功能、营养状况或蛋白尿的疗效分析。应用随机效应模型和固定效应模型对数据进行合并，进一步采用卡方检验和 I 检验进行分析。然后使用相对风险（RR）、均数差（MD）及其 95%置信区间（95%CI）对主要结局进行分析。
本荟萃分析共纳入 20 篇文章，低蛋白饮食组（LPD）共 690 例，对照组共 682 例。中等至强证据表明，与对照组相比，LPD 显著降低尿白蛋白排泄率（SMD：0.62，95%CI：0.06-1.19）和蛋白尿（SMD：0.69，95%CI：0.22-1.16）。然而，两组之间糖化血红蛋白（SMD：0.17，95%CI：-0.18-0.51）、血肌酐（SMD：0.20，95%CI：-0.26-0.66）和肾小球滤过率（SMD：0.21，95%CI：-0.29-0.71）无统计学差异。
本荟萃分析显示低蛋白饮食在改善糖尿病肾病方面具有有效作用。然而，纳入患者数量较少可能限制了结果的准确性。未来需要进行高质量、样本量更大的 RCT 以证实当前的研究结果。
