Impact of low-protein diet on cardiovascular risk factors and kidney function in diabetic nephropathy: A systematic review and meta-analysis of randomized-controlled trials

Mohammad Hassan Sohouli; Parvin Mirmiran; Shaikh Sanjid Seraj; Emad Kutbi; Hadil Ali Mohammed Alkahmous; Faisal Almuqayyid; Omar Ahnaf Arafah; Abdul Rahman Riad Barakeh; Ahmed Abu-Zaid

doi:10.1016/j.diabres.2022.110068

Impact of low-protein diet on cardiovascular risk factors and kidney function in diabetic nephropathy: A systematic review and meta-analysis of randomized-controlled trials

Diabetes Res Clin Pract. 2022 Sep:191:110068. doi: 10.1016/j.diabres.2022.110068. Epub 2022 Sep 6.

Authors

Mohammad Hassan Sohouli¹, Parvin Mirmiran², Shaikh Sanjid Seraj³, Emad Kutbi⁴, Hadil Ali Mohammed Alkahmous⁵, Faisal Almuqayyid⁶, Omar Ahnaf Arafah⁶, Abdul Rahman Riad Barakeh⁶, Ahmed Abu-Zaid⁷

Affiliations

¹ Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box 19395-4741, Tehran, Iran. Electronic address: mirmiran@endocrine.ac.ir.
³ Walsall Manor Hospital, Walsall Healthcare NHS Trust, Walsall, West Midlands WS2 9PS, United Kingdom.
⁴ Department of Biorepository, Biomedical Research Administration, King Fahad Medical City, Riyadh, Saudi Arabia.
⁵ College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
⁶ College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
⁷ College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA.

PMID: 36084854
DOI: 10.1016/j.diabres.2022.110068

Abstract

Aim: To assess the efficacy of low-protein diets (LPD) on cardiovascular risk factors and kidney function in diabetic nephropathy (DN) based on randomized controlled trials (RCTs).

Methods: A comprehensive systematic search was undertaken in PubMed/MEDLINE, Web of Science, SCOPUS and Embase databases from inception until January 2022 without using time or language restrictions. RCTs which reported the effects of LPD on cardiovascular risk factors and kidney function in DN were considered.

Results: The results of the present study showed that a LPD significantly reduces urinary urea (WMD: -244.49 g/day, 95 % CI: -418.83, -70.16, P = 0.006) and HbA1c (WMD: -0.20, 95 % CI: -0.39, -0.01, P = 0.036) levels. However, the results did not show neither significant nor beneficial effect on other renal function and cardiovascular risk factors. Furthermore, the results of subgroup analysis showed LPD caused a further decrease in HbA1c during the follow-up period of ≤ 24 weeks, protein intake less than 0.8 g/kg/d and in individuals younger than 50 years. Albuminuria also showed a greater reduction in people under the age of 50 with type 1 diabetes (DMT1) following a LPD.

Conclusion: The results of the present study showed that LPD significantly reduces urinary urea and HbA1c.

Keywords: Cardiovascular risk factors; Diabetic nephropathy; Kidney function; Low protein diet; Meta-analysis; RCT.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Diabetes Mellitus* / metabolism
Diabetic Nephropathies*
Diet, Protein-Restricted / adverse effects
Glycated Hemoglobin / metabolism
Heart Disease Risk Factors
Humans
Kidney
Randomized Controlled Trials as Topic
Urea / metabolism

Substances

Glycated Hemoglobin A
Urea