Shirai Tomomi, Inaba Sakiko, Maemura Miyu, Saho Maki, Sato Miyu, Sanada Mariko, Tsukamoto Yoko, Inoue Gaku, Nagahisa Taichi, Tanaka Shinichi, Tanaka Hajime, Kurata Hideaki, Katsuki Takeshi, Kawai Toshihide, Yamada Satoru
Diabetes Center, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-0072 Japan.
Department of Food and Nutritional Science, Graduate School of Applied Bioscience, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-Ku, Tokyo, 156-8502 Japan.
Diabetol Int. 2025 Mar 21;16(3):493-503. doi: 10.1007/s13340-025-00808-y. eCollection 2025 Jul.
Recently, the Japan Diabetes Society changed its nutrition recommendations and now recognizes a low-carbohydrate diet as an effective dietary approach. There has been controversy regarding low-carbohydrate diets in relation to renal function. That is, high protein intake may lead to renal damage through hyperfiltration. Global nutritional therapy for diabetic kidney disease (DKD) recommends a protein intake of 0.8 g/kg body weight (BW)/day. In Japan, the recommended protein intake is precisely determined based on the chronic kidney disease stage. However, evidence supporting the positive health impact of such protein restriction is scarce. Therefore, we aimed to investigate the effect of a low-carbohydrate diet without protein restriction on the estimated glomerular filtration rate (eGFR) decline rate.
Clinical data of patients with DKD in Tokyo Saiseikai Central Hospital and Kitasato Institute Hospital in Japan were retrospectively analyzed between February 2019 and December 2023. Sixty-eight participants were classified into two groups based on their diet: the energy-restricted and low-carbohydrate groups.
The protein intake of the low-carbohydrate group was significantly higher than that of the energy-restricted group (1.2 ± 0.4 and 1.0 ± 0.2 g/kg BW/day, respectively). No significant differences were observed in the baseline, endpoint, or slope of eGFR between the two groups.
This study suggests that among Japanese adults with DKD, the protein intake difference between energy-restricted and low-carbohydrate diets does not form any gap in eGFR decline rates.
The online version contains supplementary material available at 10.1007/s13340-025-00808-y.
最近，日本糖尿病学会更改了其营养建议，现在认可低碳水化合物饮食是一种有效的饮食方法。关于低碳水化合物饮食与肾功能的关系一直存在争议。也就是说，高蛋白摄入可能通过超滤导致肾损伤。糖尿病肾病（DKD）的全球营养治疗建议蛋白质摄入量为0.8克/千克体重/天。在日本，推荐的蛋白质摄入量是根据慢性肾脏病阶段精确确定的。然而，支持这种蛋白质限制对健康产生积极影响的证据很少。因此，我们旨在研究不限制蛋白质的低碳水化合物饮食对估计肾小球滤过率（eGFR）下降率的影响。
回顾性分析了2019年2月至2023年12月期间日本东京济生会中央医院和北里研究所医院DKD患者的临床资料。68名参与者根据其饮食被分为两组：能量限制组和低碳水化合物组。
低碳水化合物组的蛋白质摄入量显著高于能量限制组（分别为1.2±0.4和1.0±0.2克/千克体重/天）。两组之间的eGFR基线、终点或斜率均未观察到显著差异。
本研究表明，在患有DKD的日本成年人中，能量限制饮食和低碳水化合物饮食之间的蛋白质摄入量差异在eGFR下降率方面没有形成任何差距。
在线版本包含可在10.1007/s13340-025-00808-y获取的补充材料。
