Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Brief Reports

Polyunsaturated Fatty Acid Consumption May Play a Role in the Onset and Regression of Microalbuminuria in Well-Controlled Type 1 and Type 2 Diabetic People

A 7-year, prospective, population-based, observational multicenter study

  1. The Diabetes and Nutrition Study Group of the Spanish Diabetes Association (GSEDNu)*
  1. From the Department of Endocrinology and Nutrition, San Carlos University Hospital, Madrid, Spain
  1. Address correspondence and reprint requests to Alfonso L. Calle-Pascual, MD, PhD, Department of Endocrinology and Nutrition, 1ŞS, San Carlos University Hospital, c/Prof. Martín Lagos s/n, E-28040 Madrid, Spain. E-mail: acalle.hcsc{at}salud.madrid.org
Diabetes Care 2004 Jun; 27(6): 1454-1457. https://doi.org/10.2337/diacare.27.6.1454
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • PDF
Loading

A 7-year, prospective, population-based, observational multicenter study

  • DNCT, Diabetes and Nutrition Clinical Trial
  • MUFA, monounsaturated fatty acid
  • PUFA, polyunsaturated fatty acid
  • SFA, saturated fatty acid

The risk of developing microalbuminuria at some point in the life of a diabetic patient has been estimated to be >60% (1,2). The main risk factors associated with the presence of microalbuminuria have already been identified (3–9). Recently, 32–58% regression of microalbuminuria in type 1 diabetic patients has been reported (10–13). Modifiable factors associated with regression, such as low blood pressure, low cholesterol and triglyceride levels, and HbA1c <8%, suggest that diet can play a relevant role in reducing the risk of microalbuminuria (14–18).

The Diabetes and Nutrition Clinical Trial (DNCT) is a prospective, population-based, observational multicenter study designed to evaluate the nutritional pattern (based on 7-day food diaries) of diabetic patients in Spain and its relation with the development of diabetes complications. In this study, we report changes in nephropathy status and their connection with nutritional patterns that occurred during the 7-year follow-up in a sample of Spanish people with diabetes.

RESEARCH DESIGN AND METHODS

A total of 192 diabetic patients (93 type 1 diabetic and 99 type 2 diabetic patients) attended the four centers between 1993 and 2000 and completed the study. Selection criteria and a wide description of the experimental design have been previously reported (19,20). Diabetic nephropathy was defined by the albumin-to-creatinine ratio in the three first-morning urine samples.

Nephropathy progression was considered when diabetic patients were normoalbuminuric in 1993 and were micro- or macroalbuminuric in 2000 or if they had microalbuminuria in 1993 and macroalbuminuria in 2000. Patients were considered to have nephropathy regression if they presented with microalbuminuria in 1993 and normoalbuminuria in 2000 or if they presented with macroalbuminuria in 1993 and micro- or normoalbuminuria in 2000.

RESULTS

At baseline, 37 (19.3%) diabetic patients had diabetic nephropathy, 23 (12.0%) microalbuminuria, and 14 (7.3%) macroalbuminuria. After a median follow-up period of 6.5 years, 3 type 1 diabetic patients (nephropathy progression rate 3.9%, 0.6%/year) and 12 type 2 diabetic patients (nephropathy progression rate 15.2%, 2.3%/year) progressed to microalbuminuria and 2 type 1 diabetic patients (nephropathy progression rate 2.6%, 0.4%/year) progressed to macroalbuminuria. Two type 2 diabetic patients (nephropathy progression rate 16.7%, 2.6%/year) progressed from microalbuminuria to macroalbuminuria. Seven type 1 diabetic patients (nephropathy regression rate 63.6%, 9.8%/year) and two type 2 diabetic patients (nephropathy regression rate 16.7%, 2.6%/year) regressed from microalbuminuria to normoalbuminuria, whereas one type 1 diabetic patient (nephropathy regression rate 16.7%, 2.6%/year) and four type 2 diabetic patients (nephropathy regression rate 50%, 7.7%/year) passed from macroalbuminuria to microalbuminuria. One type 2 diabetic patient (nephropathy regression rate 12.5%, 1.9%/year) regressed from macroalbuminuria to normoalbuminuria. Table 1 shows the nutrient intake, clinical characteristics, and laboratory data of the study subjects by nephropathy status. The nutritional pattern of patients with nephropathy regression was characterized by greater polyunsaturated fatty acid (PUFA) and smaller saturated fatty acid (SFA) intakes than those of patients with nephropathy (P < 0.05), whereas the PUFA-to-SFA and monounsaturated fatty acid (MUFA)-to-SFA ratios were significantly greater (P < 0.001). The opposite pattern is associated with progression of nephropathy.

CONCLUSIONS

Different factors that can confuse the interpretation of these data have been analyzed in this study. Protein consumption could affect nephropathy progression (14–16,21,22). Even though the median of protein consumption in this study is closer to the recommended level (<20%), it is still >0.8 g/kg body wt, which is recommended when microalbuminuria is present. This could explain why no association was found between protein consumption and nephropathy. When regression patients were compared with nonregression patients, both groups were treated with ACE inhibitors and/or angiotensin receptor blockers as expected, and no difference was obtained. We have also evaluated the existence of polymorphisms of different alleles potentially associated with nephropathy. Although the presence of risk polymorphism alleles in this population is greater than that in the nondiabetic population (23), we did not observe any associations with nephropathy progression or regression, indicating that this nonmodifiable factor is not determined in the evolution of nephropathy, as previously described (24).

According to the data obtained in our study, normoalbuminuria and nephropathy regression in well-controlled diabetic patients with long-term diabetes duration are associated with greater PUFA consumption and lesser SFA consumption and specifically with higher PUFA-to-SFA and MUFA-to-SFA ratios, whereas the opposite pattern is associated with the progression of nephropathy.

Various mechanisms that relate to the type of fat intake and microalbuminuria development may explain these findings. The consumption of SFAs induces insulin resistance and a hypercoagulable state and in turn worsens diabetes metabolic control (25,26). PUFAs inhibit platelet aggregation and inflammation, reduce some proatherogenic factors, and reduce triglyceride, chylomicron, and lipoprotein(a) levels, and an increase in MUFA or PUFA consumption favorably modifies lipid profiles and reduces their oxidative capacity (25–29). A strong association between MUFA-to-SFA and PUFA-to-SFA ratios and decreased cardiovascular mortality has recently been described (30). The present study data support this hypothesis. Therefore, both ratios are nutritional variables that allow us to more clearly differentiate the patients who are going to regress or progress.

The present study findings are potentially important: first, because microalbuminuria is associated with an increment in cardiovascular mortality in both type 1 and type 2 diabetic patients and, second, because its prevalence is high. Micro- and macroalbuminuria do not have to inevitably progress to end-stage kidney disease, whereas the regression from both conditions is quite frequent. Strict control of glycemia and blood pressure should be a priority. Treatment with ACE inhibitors and/or angiotensin receptor blockers and cessation of smoking remain the therapeutic objectives for modifiable risk factors. When these objectives are attained, other therapeutic measures, such as encouraging PUFA and MUFA consumption over that of SFA, can help prevent micro- and macroalbuminuria. Keeping in mind that nutritional patterns are the base of integral diabetes care, more efforts should be directed to increase PUFA and MUFA intake and to reduce SFA consumption, particularly in people with diabetes and nephropathy.

APPENDIX

The Diabetes and Nutrition Study Group (GSEDNu)

P. Manzano, MD, Service of Endocrinology and Nutrition, Clínica Puerta de Hierro, Madrid, Spain; A. Picó, MD, Service of Endocrinology and Nutrition, Alicante General Hospital, Alicante, Spain; F. Casimiro-Soriguer (coordinator), MD, S. Gonzalez, MD, and F. Tinahones, MD, Service of Endocrinology and Nutrition, CSCH, Málaga, Spain; E. León, RN, and P. Matia, MD, CEP Hermanos Sangro, Madrid, Spain; A.L. Calle-Pascual (coordinator), MD, PhD, M.P. de Miguel, MD, M.A. Rubio, MD, E. Bordiu, PhD, J.R. Calle, MD, A.L. Charro, MD, PhD, Department of Endocrinology and Nutrition, and J. Bagazgoitia, PhD, Diabetes Laboratory, San Carlos University Hospital, Madrid, Spain; P.J. Martín-Alvarez, PhD, CSIC, Madrid, Spain; and A. Coloma, MD, PhD, A. Ocaña, MD, PhD, Molecular Genetic Laboratory, King Juan Carlos University (URJC), Mostoles, Madrid, Spain.

This work was written on behalf of the Diabetes and Nutrition Study Group of the Spanish Diabetes Association by C. Cárdenas, MD, E. Bordiu, PhD, J. Bagazgoitia, PhD, and A.L. Calle-Pascual, MD, PhD, Department of Endocrinology and Nutrition, San Carlos University Hospital, Madrid, Spain. All of the investigators from all of the centers also provided comments on relevant aspects of the drafts.

View this table:
  • View inline
  • View popup
Table 1—

Clinical characteristics, nutrient intake, and laboratory data for the diabetic subjects

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

  • *

    ↵* A list of the members of the GSEDNu Study Group can be found in the appendix.

    • Accepted March 17, 2004.
    • Received March 10, 2004.
  • DIABETES CARE

References

  1. ↵
    Warram JH, Gearin G, Laffel L, Krolewski AS: Effect of duration of type 1 diabetes on the prevalence of stages of diabetic nephropathy defined by urinary albumin/creatinine ratio. J Am Soc Nephrol 7:930–937, 1996
    OpenUrlAbstract
  2. ↵
    Niskanen LK, Penttilä I, Parviainen M, Uusitupa MIJ: Evolution, risk factors, and prognostic implications of albuminuria in NIDDM. Diabetes Care 19:486–493, 1996
    OpenUrlAbstract/FREE Full Text
  3. ↵
    Rossing P, Hougaard P, Parving HH: Risk factors for development of incipient and over diabetic nephropathy in type 1 diabetic patients: a 10-year prospective observational study. Diabetes Care 25:859–864, 2002
    OpenUrlAbstract/FREE Full Text
  4. Microalbuminuria Collaborative Study Group: Predictors of the development of microalbuminuria in patients with type 1 diabetes mellitus: a seven-year prospective study. Diabet Med 16:918–925, 1999
    OpenUrlCrossRefPubMedWeb of Science
  5. Mattock MB, Cronin N, Cavallo-Perin P, Idzior-Walus B, Penno G, Bandinelli S, Standl E, Kofinis A, Fuller JH, EURODIAB IDDM Complications Study: Plasma lipids and urinary albumin excretion rate in type 1 diabetes mellitus: the EURODIAB IDDM Complications Study. Diabet Med 18:59–67, 2001
    OpenUrlCrossRefPubMed
  6. Gambaro G, Bax G, Fusaro M, Normanno M, Manani SM, Zanella, Dangelo A, Fedele D, Favaro S: Cigarette smoking is a risk factor for nephropathy and its progression in type 2 diabetes mellitus. Diabetes Nutr Metab 14:337–342, 2001
    OpenUrlPubMedWeb of Science
  7. Torffvit O, Agardh CD: The impact of metabolic and blood pressure control on incidence and progression of nephropathy: a 10-year study in 385 type 2 diabetic patients. J Diabetes Complications 15:307–313, 2001
    OpenUrlCrossRefPubMedWeb of Science
  8. Chaturvedi N, Bandinelli S, Mangili R, Penno G, Rottiers RE, Fuller JH: Microalbuminuria in type 1 diabetes: rates, risk factors and glycemic threshold. Kidney Int 60:219–227, 2001
    OpenUrlCrossRefPubMedWeb of Science
  9. ↵
    Bruno G, Cavallo-Perin P, Bargero G, Borra M, Calvi V, D′Errico D, Deambrogio P, Pagano G: Prevalence and risk factors for micro- and macroalbuminuria in an Italian population-based cohort of NIDDM subjects. Diabetes Care 19:43–47, 1996
    OpenUrlAbstract/FREE Full Text
  10. ↵
    Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS: Regression of microalbuminuria in type 1 diabetes. N Engl J Med 348:2285–2293, 2003
    OpenUrlCrossRefPubMedWeb of Science
  11. Bojestig M, Arnqvist HJ, Karlberg BE, Ludvigsson J: Glycemic control and prognosis in type 1 diabetic patients with microalbuminuria. Diabetes Care 19:313–317, 1996
    OpenUrlAbstract/FREE Full Text
  12. Kullberg CE, Arnqvist HJ: Glycemic control in patients with type 1 diabetes and normoalbuminuria after long diabetes duration. J Diabetes Complications 11:151–157, 1997
    OpenUrlCrossRefPubMed
  13. ↵
    Ruberg S, Dahlquist G: Determinants of progression of microalbuminuria in adolescents with IDDM. Diabetes Care 19:369–371, 1996
    OpenUrlAbstract/FREE Full Text
  14. ↵
    Toeller M, Buyken A, Heitkamp G, Brämswig S, Mann J, Milne R, Gries FA, Keen H, EURODIAB IDDM Complications Study Group: Protein intake and urinary albumin excretion rates in the EURODIAB IDDM Complications Study. Diabetologia 40:1219–1226, 1997
    OpenUrlCrossRefPubMedWeb of Science
  15. Pijls LT, de Vries H, Donker AJ, van Eijk JT: The effect of protein restriction on albuminuria in patients with type 2 diabetes mellitus: a randomized trial. Nephrol Dial Transplant 14:1445–1453, 1999
    OpenUrlAbstract/FREE Full Text
  16. ↵
    Riley MD, Dwyer T: Microalbuminuria is positively associated with usual dietary saturated fat intake and negatively associated with usual dietary protein intake in people with insulin-dependent diabetes mellitus. Am J Clin Nutr 67:50–57, 1998
    OpenUrlAbstract
  17. Franz MJ, Wheeler ML: Nutrition therapy for diabetic nephropathy. Curr Diab Rep 3:412–417, 2003
    OpenUrlPubMed
  18. ↵
    American Diabetes Association: Diabetic nephropathy (Position Statement). Diabetes Care 26 (Suppl. 1):S94–S98, 2003
  19. ↵
    Diabetes and Nutrition Study Group of the Spanish Diabetes Association (GSEDNu): Diabetes Nutrition and Complications Trial (DNCT): food intake and targets of diabetes treatment in a sample of Spanish people with diabetes. Diabetes Care 20:1078–1080, 1997
    OpenUrlAbstract/FREE Full Text
  20. ↵
    Diabetes and Nutrition Study Group of the Spanish Diabetes Association (GSEDNu): Diabetes Nutrition and Complications Trial: trends in nutritional pattern between 1993 and 2000 and targets of diabetes treatment in a sample of Spanish people with diabetes. Diabetes Care 27:984–987, 2004
    OpenUrlFREE Full Text
  21. ↵
    Bouhanick B, Hadjadj S, Marre M: Microalbuminuria, glomerular filtration rate and dietary fat and protein intakes in type 1 diabetes (Letter). Am J Clin Nutr 69:153, 1999
    OpenUrlFREE Full Text
  22. ↵
    Möllsten AV, Dahlquist GG, Stattin EL, Rudberg S: Higher intakes of fish protein are related to a lower risk of microalbuminuria in young Swedish type 1 diabetic patients. Diabetes Care 24:805–810, 2001
    OpenUrlAbstract/FREE Full Text
  23. ↵
    Ocaña A, Coloma A, Grupo de la Sociedad Española de Diabetes para el estudio de la Nutricion: Factores genéticos de riesgo micro- y macrovascular en la diabetes mellitus [in Spanish]. Av Diabetol 19:115–120, 2003
  24. ↵
    Krolewski AS: Genetics of diabetic nephropathy: evidence for major and minor gene effects. Kidney Int 55:1582–1596, 1999
    OpenUrlCrossRefPubMedWeb of Science
  25. ↵
    Summers LK, Fielding BA, Bradshaw HA, Ilic V, Beysen C, Clark ML, Moore NR, Frayn KN: Substituting dietary saturated fat with polyunsaturated fat changes abdominal fat distribution and improves insulin sensitivity. Diabetologia 45:369–377, 2002
    OpenUrlCrossRefPubMedWeb of Science
  26. ↵
    Harding AH, Sargeant LA, Welch A, Oakes S, Luben RN, Bingham S, Day NE, Khaw KT, Wareham NJ: Fat consumption and HbA1c levels. Diabetes Care 24:1911–1916, 2001
    OpenUrlAbstract/FREE Full Text
  27. Hu FB: The Mediterranean diet and mortality: olive oil and beyond. N Engl J Med 348:2595–2596, 2003
    OpenUrlCrossRefPubMedWeb of Science
  28. Ramirez-Tortosa MC, Lopez-Pedrosa JM, Suarez A, Ros E, Mataix J, Gil A: Olive oil and fish oil enriched diets modify plasma lipids and the susceptibility of low-density lipoproteins to oxidative modification in free-living male patients with peripheral vascular disease: the Spanish Nutrition Study. Br J Nutr 82:31–39, 1999
    OpenUrlPubMedWeb of Science
  29. ↵
    Ramirez-Tortosa MC, Lopez-Pedrosa JM, Suarez A, Ros E, Mataix J, Gil A: Effect of extra-virgin olive oil and fish oil supplementation on plasma lipids and susceptibility of low-density lipoproteins to oxidative alteration in free-living Spanish male patients with peripheral vascular disease. Clin Nutr 18:167–174, 1999
    OpenUrlCrossRefPubMedWeb of Science
  30. ↵
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D: Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608, 2003
    OpenUrlCrossRefPubMedWeb of Science
PreviousNext
Back to top
Diabetes Care: 27 (6)

In this Issue

June 2004, 27(6)
  • Table of Contents
  • About the Cover
  • Index by Author
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Polyunsaturated Fatty Acid Consumption May Play a Role in the Onset and Regression of Microalbuminuria in Well-Controlled Type 1 and Type 2 Diabetic People
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Polyunsaturated Fatty Acid Consumption May Play a Role in the Onset and Regression of Microalbuminuria in Well-Controlled Type 1 and Type 2 Diabetic People
Diabetes Care Jun 2004, 27 (6) 1454-1457; DOI: 10.2337/diacare.27.6.1454

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Polyunsaturated Fatty Acid Consumption May Play a Role in the Onset and Regression of Microalbuminuria in Well-Controlled Type 1 and Type 2 Diabetic People
Diabetes Care Jun 2004, 27 (6) 1454-1457; DOI: 10.2337/diacare.27.6.1454
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • RESEARCH DESIGN AND METHODS
    • RESULTS
    • CONCLUSIONS
    • APPENDIX
    • Footnotes
    • References
  • Figures & Tables
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • β-Cell Transplantation Restores Metabolic Control and Quality of Life in a Patient With Subcutaneous Insulin Resistance
  • Hematocrit and the Incidence of Type 2 Diabetes in the Pima Indians
  • The Impact of Family History of Diabetes on Glucose Testing and Counseling Behavior in Primary Care
Show more Brief Reports

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.