鸡肉和鱼类饮食可降低1型糖尿病患者的肾小球高滤过。

Chicken and fish diet reduces glomerular hyperfiltration in IDDM patients.

作者信息

Pecis M, de Azevedo M J, Gross J L

机构信息

Endocrine Unit, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Brazil.

出版信息

Diabetes Care. 1994 Jul;17(7):665-72. doi: 10.2337/diacare.17.7.665.

DOI:10.2337/diacare.17.7.665

PMID:7924775

Abstract

OBJECTIVE

To compare the effect of a normal protein diet (test diet) in which chicken and fish were substituted for red meat with a low-protein diet (LPD) on glomerular filtration rate (GFR) in normoalbuminuric insulin-dependent-diabetes mellitus (IDDM) patients.

RESEARCH DESIGN AND METHODS

A crossover randomized clinical trial was performed in 15 normoalbuminuric IDDM patients, 9 normofiltering, and 6 hyperfiltering patients. They followed three diets for a 3-week period each: a usual diet (UD), an LPD (0.5 g.kg-1.day-1 of proteins, 7% calories as protein, 33% as fat, and 60% as carbohydrates), and a normoproteic isocaloric test diet in which white meat (chicken and fish) was substituted for red meat of the UD. At the end of each diet, a clinical evaluation and measurements of GFR (51Cr-ethylenediaminetetraacetate (EDTA) single injection technique), urinary albumin excretion (UAE), and plasma amino acids were performed. Dietary compliance was assessed by a 24-h urinary urea and weekly interviews with the dietitian.

RESULTS

In all diabetic patients, GFR after the LPD (114.9 +/- 16.5 ml.min-1 x 1.73 m-2) and after the test diet (122.7 +/- 16.7 ml.min-1 x 1.73 m-2) was significantly lower than after the UD (132.0 +/- 27.7 ml.min-1 x 1.73 m-2) (P = 0.001). Similar results were found in the hyperfiltering group: after UD = 161.1 +/- 15.4 ml.min-1 x 1.73 m-2, after LPD = 129.8 +/- 9.0 ml.min-1 x 1.73 m-2, and after the test diet = 136.5 +/- 3.1 ml.min-1 x 1.73 m-2, (P < 0.001). In the normofiltering group, no significant changes in GFR were observed after the three diets. Metabolic control, nutritional indexes, blood pressure (BP), and UAE did not change after the three diets in all patients.

CONCLUSIONS

A normoproteic diet with chicken and fish as the only meat protein source decreases the GFR in the hyperfiltering normoalbuminuric IDDM patients. The GFR reduction after this diet is similar to that observed after an LPD.

摘要

目的

比较用鸡肉和鱼肉替代红肉的正常蛋白质饮食（试验饮食）与低蛋白饮食（LPD）对正常白蛋白尿的胰岛素依赖型糖尿病（IDDM）患者肾小球滤过率（GFR）的影响。

研究设计与方法

对15例正常白蛋白尿的IDDM患者进行了一项交叉随机临床试验，其中9例为正常滤过患者，6例为高滤过患者。他们每种饮食各遵循3周：常规饮食（UD）、LPD（蛋白质0.5 g·kg⁻¹·天⁻¹，蛋白质供能占7%，脂肪占33%，碳水化合物占60%），以及一种等热量的正常蛋白质试验饮食，其中用白肉（鸡肉和鱼肉）替代UD中的红肉。每种饮食结束时，进行临床评估并测量GFR（⁵¹Cr-乙二胺四乙酸（EDTA）单次注射技术）、尿白蛋白排泄量（UAE）和血浆氨基酸。通过24小时尿尿素和每周与营养师面谈评估饮食依从性。

结果

在所有糖尿病患者中，LPD后（114.9±16.5 ml·min⁻¹×1.73 m⁻²）和试验饮食后（122.7±16.7 ml·min⁻¹×1.73 m⁻²）的GFR显著低于UD后（132.0±27.7 ml·min⁻¹×1.73 m⁻²）（P = 0.001）。在高滤过组中也发现了类似结果：UD后 = 161.1±15.4 ml·min⁻¹×1.73 m⁻²，LPD后 = 129.8±9.0 ml·min⁻¹×1.73 m⁻²，试验饮食后 = 136.5±3.1 ml·min⁻¹×1.73 m⁻²，（P < 0.001）。在正常滤过组中，三种饮食后未观察到GFR有显著变化。所有患者在三种饮食后代谢控制、营养指标、血压（BP）和UAE均未改变。