OBJECTIVE -To assess the effect of replacing red meat with chicken in the usual diet and the effect of a low-protein diet on glomerular filtration rate (GFR), urinary albumin excretion rate (UAER), and lipid levels in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS-A randomized, crossover, controlled trial was conducted with 28 patients with type 2 diabetes (seven women; mean age 58.1 years): 15 patients were normoalbuminuric (UAER Ͻ20 g/min), and 13 patients were microalbuminuric (UAER 20 -200 g/min). A chicken-based diet (red meat replaced with chicken) and a lowprotein diet were compared with the patients' usual diet. Patients followed each diet for 4 weeks with a 4-week washout period between. GFR ( 51 Cr-EDTA single-injection technique), 24-h UAER (immunoturbidimetry), apolipoprotein B, total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were measured after each diet.RESULTS -Normoalbuminuric and microalbuminuric patients with diabetes were analyzed separately. In normoalbuminuric patients, GFR after the chicken (101.3 Ϯ 22.9 ml ⅐ min -1 ⅐ 1.73 m -2 ) and low-protein diets (93.8 Ϯ 20.5 ml ⅐ min -1 ⅐ m -2 ) was lower than after the usual diet (113.4 Ϯ 31.4 ml ⅐ min -1 ⅐ 1.73 m -2 ; P Ͻ 0.05). In microalbuminuric patients, apolipoprotein B levels were lower after the chicken (113.5 Ϯ 36.0 mg/dl) and low-protein diets (103.5 Ϯ 40.1 mg/dl) than after the usual diet (134.3 Ϯ 30.7 mg/dl; P Ͻ 0.05). Only the chicken diet reduced UAER (median 34.3 g/min) compared with the low-protein (median 52.3 g/min) and usual (median 63.8 g/min) diets (P Ͻ 0.05). Glycemic control and blood pressure did not change after the diets.CONCLUSIONS -A normoproteic diet with chicken as the only source of meat may represent an alternative strategy for treatment of patients with type 2 diabetes and microalbuminuria. Diabetes Care 25:645-651, 2002M icroalbuminuria affects 20% of patients with type 2 diabetes (1). It is a predictor of end-stage renal failure and an independent risk factor for coronary artery disease (2), which is the main cause of death in patients with type 2 diabetes (3). The treatment of microalbuminuric patients with diabetes includes achievement of optimal metabolic and blood pressure control and use of ACE inhibitors (4). Although high levels of serum cholesterol have been considered a risk factor for development of diabetic nephropathy in patients with type 2 diabetes (5), the effect of reducing cholesterol levels on urinary albumin excretion rate (UAER) is still controversial (6,7). ACE inhibitors have a renoprotective effect on microalbuminuric patients with type 2 diabetes because they stabilize plasma creatinine and albuminuria (8). Although ACE inhibitors are associated with few adverse effects, in some cases, cough, hypersensitivity reaction, decrease of renal function, and severe hypoglycemic episodes requiring hospitalization may limit their use (9). Furthermore, the cost of these drugs may prevent their use in a significant proportion of patients, especially in countries in whic...

The hypocaloric LGI diet promoted a decrease in BMI, percentage of body fat, and leptin concentrations, which improved oocyte development and pregnancy rate. These results support the clinical recommendation to advise overweight and obese women to lose weight through a balanced diet before being submitted for treatment with assisted reproduction technologies. A hypocaloric diet combined with LGI foods seems to be beneficial for these patients, but additional studies are required before this treatment is recommended. This trial was registered at clinicaltrials.gov as NCT02416960.

Compliance with diets containing different amounts of protein was studied in 15 nonobese type 2 diabetes patients (13 males aged 38-69 y). A method based on interviews and training in the technique of weighed diet records was used. Protein intake recorded by the patients was evaluated on the basis of 24-h nitrogen output (criterion standard measurement). Three diets were prescribed in random order, each lasting 4 wk: usual diet (UD), chicken diet (CD) (both with 1.2-1.5 g protein/kg body wt), and low-protein diet (LPD; with 0.5-0.8 g protein/kg body wt). Diets were isoenergetic and similar in fat content. Nutritional status was not altered during the study according to anthropometric indexes (body mass index, triceps skinfold thickness, midupper arm muscle area, and waist-to-hip ratio) and laboratory data (serum albumin, hematocrit, and lymphocyte values). The correlation of protein intake recorded on the weighed diet records with that estimated by nitrogen output was 0.64 for the UD (P = 0.01), 0.79 for the CD (P < 0.001), and 0.66 for the LPD (P = 0.008). No difference was found in mean protein intake (g/kg body wt) calculated from the weighed diet records and nitrogen output for the UD (1.37 compared with 1.36 g/kg body wt) and CD (1.38 compared with 1.32 g/kg body wt). With the LPD, patients did not consume more protein than prescribed, but underreported their actual protein intake by 13% (0.68 compared with 0.78 g/kg body wt, P < 0.05) . In conclusion, the method of weighed diet records was sufficiently accurate for assessing protein intake in this sample of type 2 diabetes patients.

Formação para nutricionistas que atuam no Programa Nacional de Alimentação Escolar: uma avaliação da efetividade

OBJECTIVE -To determine the fatty acid composition of serum phospholipid, triglyceride, and cholesterol ester fractions and to analyze the lipid profile of microalbuminuric type 2 diabetic patients. RESEARCH DESIGN AND METHODS-A case-control study was conducted with 72 patients: 37 were normoalbuminuric (urinary albumin excretion rate [UAER] Ͻ20 g/min), and 35 were microalbuminuric (UAER 20 -200 g/min). After 4 weeks of a standardized diet, the fatty acid composition of phospholipid, triglyceride, and cholesterol ester fractions was determined by gas chromatography. Total cholesterol and triglycerides were measured by enzymaticcolorimetric methods; cholesterol HDL by double precipitation with heparin, MnCl 2 , and dextran sulfate; and apolipoprotein B by immunoturbidimetry.RESULTS -Microalbuminuric patients showed a lower proportion of polyunsaturated fatty acids (24.8 Ϯ 11.0%), especially of the n-6 family (21.7 Ϯ 10.5%), in triglyceride fraction than normoalbuminuric patients (34.1 Ϯ 11.3%, P ϭ 0.001 and 31.4 Ϯ 11.5%, P Ͻ 0.001, respectively). Patients with microalbuminuria also presented higher levels of saturated fatty acids in triglyceride fraction (43.4 Ϯ 18.0% vs. 34.7 Ϯ 13.1%, P ϭ 0.022). In the logistic regression analysis, only the proportion of polyunsaturated fatty acids in triglyceride fraction remained significantly associated with microalbuminuria (odds ratio [OR] 0.92, 95% CI 0.85-0.98, P ϭ 0.019). Total cholesterol, HDL cholesterol, triglyceride, and apolipoprotein B levels were similar in normo-and microalbuminuric patients.CONCLUSION -Microalbuminuria in type 2 diabetic patients is associated with low polyunsaturated fatty acid contents in serum triglyceride fraction. This association may represent a risk factor for cardiovascular disease and may contribute to the progression of renal disease. Diabetes Care 26:613-618, 2003M icroalbuminuria is known to be an independent risk factor for cardiovascular death in type 2 diabetic patients (1,2), but the mechanisms underlying this association have not been clarified. It could be that other cardiovascular risk factors that are frequently associated with microalbuminuria, such as hyperglycemia, hypertension (3), and endothelial dysfunction (4), might also contribute to the increased cardiovascular mortality observed in these patients. In addition, dyslipidemia has also been described in type 2 diabetic patients with microalbuminuria (2,5,6). Although those studies did not specifically assess the effect of nutrient intake, the effect of dietary habits on the development of dyslipidemia in these microalbuminuric patients cannot be ruled out.Dietary habits influence serum lipid levels and renal function in patients with diabetes. For example, higher intake of fish protein has been shown to be related to a lower risk for microalbuminuria in type 1 diabetic patients (7), and replacement of red meat with chicken reduces albumin excretion rate and serum cholesterol levels in microalbuminuric type 2 diabetic patients (8). These effects may result from the hig...