Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-A randomized controlled trial.

<h4>Introduction</h4>There is limited data on the effects of low carbohydrate diets on renal outcomes particularly in patients with underlying diabetic kidney disease. Therefore, this study determined the safety and effects of very low carbohydrate (VLCBD) in addition to low protein diet...

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Autores principales:	Nur Aisyah Zainordin, Nur' Aini Eddy Warman, Aimi Fadilah Mohamad, Fatin Aqilah Abu Yazid, Nazrul Hadi Ismail, Xin Wee Chen, Marymol Koshy, Thuhairah Hasrah Abdul Rahman, Nafeeza Mohd Ismail, Rohana Abdul Ghani
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/af75dfa82d954914b3ba8798083df854
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spelling	oai:doaj.org-article:af75dfa82d954914b3ba8798083df8542021-12-02T20:19:14ZSafety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-A randomized controlled trial.1932-620310.1371/journal.pone.0258507https://doaj.org/article/af75dfa82d954914b3ba8798083df8542021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0258507https://doaj.org/toc/1932-6203<h4>Introduction</h4>There is limited data on the effects of low carbohydrate diets on renal outcomes particularly in patients with underlying diabetic kidney disease. Therefore, this study determined the safety and effects of very low carbohydrate (VLCBD) in addition to low protein diet (LPD) on renal outcomes, anthropometric, metabolic and inflammatory parameters in patients with T2DM and underlying mild to moderate kidney disease (DKD).<h4>Materials and methods</h4>This was an investigator-initiated, single-center, randomized, controlled, clinical trial in patients with T2DM and DKD, comparing 12-weeks of low carbohydrate diet (<20g daily intake) versus standard low protein (0.8g/kg/day) and low salt diet. Patients in the VLCBD group underwent 2-weekly monitoring including their 3-day food diaries. In addition, Dual-energy x-ray absorptiometry (DEXA) was performed to estimate body fat percentages.<h4>Results</h4>The study population (n = 30) had a median age of 57 years old and a BMI of 30.68kg/m2. Both groups showed similar total calorie intake, i.e. 739.33 (IQR288.48) vs 789.92 (IQR522.4) kcal, by the end of the study. The VLCBD group showed significantly lower daily carbohydrate intake 27 (IQR25) g vs 89.33 (IQR77.4) g, p<0.001, significantly higher protein intake per day 44.08 (IQR21.98) g vs 29.63 (IQR16.35) g, p<0.05 and no difference in in daily fat intake. Both groups showed no worsening of serum creatinine at study end, with consistent declines in HbA1c (1.3(1.1) vs 0.7(1.25) %) and fasting blood glucose (1.5(3.37) vs 1.3(5.7) mmol/L). The VLCBD group showed significant reductions in total daily insulin dose (39(22) vs 0 IU, p<0.001), increased LDL-C and HDL-C, decline in IL-6 levels; with contrasting results in the control group. This was associated with significant weight reduction (-4.0(3.9) vs 0.2(4.2) kg, p = <0.001) and improvements in body fat percentages. WC was significantly reduced in the VLCBD group, even after adjustments to age, HbA1c, weight and creatinine changes. Both dietary interventions were well received with no reported adverse events.<h4>Conclusion</h4>This study demonstrated that dietary intervention of very low carbohydrate diet in patients with underlying diabetic kidney disease was safe and associated with significant improvements in glycemic control, anthropometric measurements including weight, abdominal adiposity and IL-6. Renal outcomes remained unchanged. These findings would strengthen the importance of this dietary intervention as part of the management of patients with diabetic kidney disease.Nur Aisyah ZainordinNur' Aini Eddy WarmanAimi Fadilah MohamadFatin Aqilah Abu YazidNazrul Hadi IsmailXin Wee ChenMarymol KoshyThuhairah Hasrah Abdul RahmanNafeeza Mohd IsmailRohana Abdul GhaniPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0258507 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Nur Aisyah Zainordin Nur' Aini Eddy Warman Aimi Fadilah Mohamad Fatin Aqilah Abu Yazid Nazrul Hadi Ismail Xin Wee Chen Marymol Koshy Thuhairah Hasrah Abdul Rahman Nafeeza Mohd Ismail Rohana Abdul Ghani Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-A randomized controlled trial.
description	<h4>Introduction</h4>There is limited data on the effects of low carbohydrate diets on renal outcomes particularly in patients with underlying diabetic kidney disease. Therefore, this study determined the safety and effects of very low carbohydrate (VLCBD) in addition to low protein diet (LPD) on renal outcomes, anthropometric, metabolic and inflammatory parameters in patients with T2DM and underlying mild to moderate kidney disease (DKD).<h4>Materials and methods</h4>This was an investigator-initiated, single-center, randomized, controlled, clinical trial in patients with T2DM and DKD, comparing 12-weeks of low carbohydrate diet (<20g daily intake) versus standard low protein (0.8g/kg/day) and low salt diet. Patients in the VLCBD group underwent 2-weekly monitoring including their 3-day food diaries. In addition, Dual-energy x-ray absorptiometry (DEXA) was performed to estimate body fat percentages.<h4>Results</h4>The study population (n = 30) had a median age of 57 years old and a BMI of 30.68kg/m2. Both groups showed similar total calorie intake, i.e. 739.33 (IQR288.48) vs 789.92 (IQR522.4) kcal, by the end of the study. The VLCBD group showed significantly lower daily carbohydrate intake 27 (IQR25) g vs 89.33 (IQR77.4) g, p<0.001, significantly higher protein intake per day 44.08 (IQR21.98) g vs 29.63 (IQR16.35) g, p<0.05 and no difference in in daily fat intake. Both groups showed no worsening of serum creatinine at study end, with consistent declines in HbA1c (1.3(1.1) vs 0.7(1.25) %) and fasting blood glucose (1.5(3.37) vs 1.3(5.7) mmol/L). The VLCBD group showed significant reductions in total daily insulin dose (39(22) vs 0 IU, p<0.001), increased LDL-C and HDL-C, decline in IL-6 levels; with contrasting results in the control group. This was associated with significant weight reduction (-4.0(3.9) vs 0.2(4.2) kg, p = <0.001) and improvements in body fat percentages. WC was significantly reduced in the VLCBD group, even after adjustments to age, HbA1c, weight and creatinine changes. Both dietary interventions were well received with no reported adverse events.<h4>Conclusion</h4>This study demonstrated that dietary intervention of very low carbohydrate diet in patients with underlying diabetic kidney disease was safe and associated with significant improvements in glycemic control, anthropometric measurements including weight, abdominal adiposity and IL-6. Renal outcomes remained unchanged. These findings would strengthen the importance of this dietary intervention as part of the management of patients with diabetic kidney disease.
format	article
author	Nur Aisyah Zainordin Nur' Aini Eddy Warman Aimi Fadilah Mohamad Fatin Aqilah Abu Yazid Nazrul Hadi Ismail Xin Wee Chen Marymol Koshy Thuhairah Hasrah Abdul Rahman Nafeeza Mohd Ismail Rohana Abdul Ghani
author_facet	Nur Aisyah Zainordin Nur' Aini Eddy Warman Aimi Fadilah Mohamad Fatin Aqilah Abu Yazid Nazrul Hadi Ismail Xin Wee Chen Marymol Koshy Thuhairah Hasrah Abdul Rahman Nafeeza Mohd Ismail Rohana Abdul Ghani
author_sort	Nur Aisyah Zainordin
title	Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-A randomized controlled trial.
title_short	Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-A randomized controlled trial.
title_full	Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-A randomized controlled trial.
title_fullStr	Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-A randomized controlled trial.
title_full_unstemmed	Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-A randomized controlled trial.
title_sort	safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-a randomized controlled trial.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/af75dfa82d954914b3ba8798083df854
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Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease-A randomized controlled trial.

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