Re: Soy Intake and Type 2 Diabetes Nephropathy
- From: Quentin Grady <quentin@xxxxxxxxxxxxxxx>
- Date: Sun, 20 Apr 2008 19:49:21 +1200
G'da G'day Folks,
Medscape often has some useful articles.
One has to subscribe to Medscape but the subscription is free.
The results of this particular experiment fit the general hypothesis
that it is wise to combine animal and vegetable sources of protein.
There are some interesting points.
Here is one of them. Neither version of the diet is likely to lead
to rapid weight loss as both arms of the experiment were likely to
have only 15% protein. (There are some very rough approximations in
reaching that figure so maybe it isn't correct.) Rapid weight loss is
easier with a higher percentage of protein. It is then that
combinations of animal and vegetable protein come into their own. One
option is for a third animal, one third fish and one third vegetable.
Soy protein has been popular with certain populations eg the
Okinawans. Another option would be for the vegetable protein to come
from flax fibre.
Best wishes,
Quentin.
--http://www.medscape.com/viewarticle/572440
April 3, 2008 -- Intake of soy protein had beneficial effects on
cardiovascular risk factors and kidney-related biomarkers in patients
with type 2 diabetes and nephropathy, according to the results of a
longitudinal, randomized trial published in the April issue of
Diabetes Care.
"Several short-term trials on the effect of soy consumption on
cardiovascular risks are available, but little evidence exists
regarding the impact of long-term soy protein consumption among type 2
diabetic patients with nephropathy," write Leila Azadbakht, PhD, from
the Isfahan University of Medical Sciences in Isfahan, Iran, and
colleagues. "To determine the effects of long-term soy consumption on
cardiovascular risks, we measured C-reactive protein (CRP) and kidney
function indexes among type 2 diabetic patients with nephropathy."
Of 41 patients with type 2 diabetes and nephropathy who were enrolled
in this study, 18 were men and 23 were women. The soy protein group (n
= 20) was assigned to a diet containing 0.8 g protein/kg body weight
(35% animal proteins, 35% textured soy protein, and 30% vegetable
proteins), whereas the control group
(n = 21) was assigned to a similar diet containing 70% animal proteins
and 30% vegetable proteins. Duration of the study was 4 years.
The soy protein group fared better than the control group regarding
effects on cardiovascular risk factors. Mean change in the soy protein
vs control groups for fasting plasma glucose levels was
-18 ? 3 vs 11 ? 2 mg/dL (P = .03); for total cholesterol levels,
-23 ? 5 vs 10 ? 3 mg/dL (P =.01); for low-density lipoprotein (LDL)
cholesterol levels, -20 ? 5 vs 6 ? 2 mg/dL (P = .01); and for serum
triglyceride levels, -24 ? 6 vs -5 ? 2 mg/dL (P = .01).
Compared with the control group, the soy protein group also had
greater decreases in serum CRP levels (1.31 ? 0.6 vs 0.33 ? 0.1 mg/L;
P = .02) and significant reductions in proteinuria (-0.15 ? 0.03 vs
0.02 ? 0.01 g/day;
P = .001) and urinary creatinine levels (-1.5 ? 0.9 vs 0.6 ? 0.3 mg/
dL; P = .01).
Limitations of the study include evaluation of only CRP rather than
other inflammatory markers, evaluation of only a single dosage range
and formulation of soy protein, lack of data on the effects of soy
protein according to estrogen receptor genotype, and measurement of
urinary urea nitrogen and urinary creatinine as concentrations rather
than as 24-hour excretions.
"Longitudinal soy protein consumption significantly affected
cardiovascular risk factors and kidney-related biomarkers among type 2
diabetic patients with nephropathy," the study authors write. "As
diabetic nephropathy is a progressive disease, we expected that the
conditions of these patients would have gotten worse after 4 years,
but because of medical and dietary control, their conditions improved
in some respects."
The costs of publication of this article were defrayed in part by the
payment of page charges, mandating that it must therefore be hereby
marked "advertisement" solely to indicate this fact.
Diabetes Care. 2008;31:648-654.
Clinical Context
Diet is a cornerstone of the management of diabetes, and the authors
of the current study previously demonstrated that the inclusion of soy
and vegetable protein can improve laboratory variables in the short
term among patients with diabetes. They performed a crossover clinical
trial among 14 patients with diabetes and nephropathy, which was
published in the October 2003 issue of the European Journal of
Clinical Nutrition. In this study, the use of a diet in which 35% of
the protein was derived from soy and another 30% from vegetable
sources improved levels of total cholesterol, triglycerides, and LDL
cholesterol after 7 weeks. The soy and vegetable protein diet also
reduced proteinuria but did not affect levels of high-density
lipoprotein (HDL) cholesterol.
The current study observes a larger patient cohort for a longer period
to determine the significance of a soy protein diet among patients
with type 2 diabetes and nephropathy.
Study Highlights
Participants in the current study had type 2 diabetes and proteinuria,
with a total urinary protein excretion between 300 and 1000 mg/day.
Participants' serum creatinine level was between 1 and 2.5 mg/dL, and
the serum urea nitrogen level was between 20 and 40 mg/dL. Subjects'
systolic and diastolic blood pressure was greater than 140 and 90 mm
Hg, respectively.
Subjects were randomized to a control diet consisting of 0.8 g protein/
kg body weight, with 70% animal protein and 30% vegetable protein; or
a soy protein group consisting of 0.8 g protein/kg body weight, with
35% animal protein, 35% soy protein, and 30% vegetable proteins.
Participants received visits with a dietician to encourage adherence
to their randomized diet.
The outcomes of the study were renal function, degree of proteinuria,
serum lipid levels, and CRP levels. These outcomes were assessed every
6 months for 4 years.
41 participants provided data for analysis. 43% of subjects were men,
and the mean age of subjects was 62.1 years. The mean duration of
diabetes was 10 years, and the mean glycated hemoglobin level was
6.2%.
There was no difference in total mean energy intake or activity levels
between groups during the trial.
Mean body weight was similar between diet groups at 4 years.
Mean fasting plasma glucose levels decreased by 18 mg/dL in the soy
protein diet group but increased by 11 mg/dL in the control group,
which is a significant difference.
Total cholesterol levels decreased by 23 mg/dL in the soy protein diet
group and increased by 5 mg/dL in the control group, which was also
statistically significant. LDL cholesterol and triglyceride levels
also were reduced more significantly in the soy protein vs the control
diet groups. HDL cholesterol levels were similar in both groups.
CRP levels decreased by 1.31 in the soy protein diet group and 0.33 in
the control group, which is a significant difference.
Proteinuria decreased slightly in the soy protein diet group and
increased slightly in the control group, and this difference was also
statistically significant.
Urinary urea nitrogen and urinary creatinine levels were improved in
the soy protein vs control diet groups, but serum creatinine and serum
urea nitrogen levels and the glomerular filtration rate were similar
at 4 years between groups.
The favorable effects of the soy protein diet on proteinuria were
independent of its effects on plasma glucose, but not lipid, levels.
Pearls for Practice
A small trial of a soy-based and vegetable-based protein diet among
patients with diabetes and nephropathy demonstrated that this diet
could reduce levels of total cholesterol, triglycerides, and LDL
cholesterol and decrease proteinuria in the short term.
The current study finds that a soy protein diet can reduce levels of
fasting plasma glucose, cholesterol, and CRP and decrease proteinuria
vs a control diet among patients with type 2 diabetes and nephropathy.
However, body weight was similar between the 2 groups.
Quentin Grady ^ ^ /
New Zealand, >#,#< [
/ \ /\
"... and the blind dog was leading."
http://homepages.paradise.net.nz/quentin
.
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