Higher Intakes of Fish Protein Are Related to a Lower Risk of Microalbuminuria in Young Swedish Type 1 Diabetic Patients

Abstract

OBJECTIVE -To examine the influence of dietary intake from various protein and fat sources on the occurrence of microalbuminuria in type 1 diabetic patients.RESEARCH DESIGN AND METHODS -In this nested case control study, 1,150 patients with diabetes duration Ͼ5 years reported dietary habits for the previous 12 months and submitted urinary samples for the analysis of albumin excretion rate (AER). A total of 75 cases of albuminuria (overnight AER Ն15 g/min) were identified and compared with 225 durationmatched control subjects.RESULTS -Neither mean protein, fat intake, average fish protein intake (control subjects 4.56 Ϯ 3.83 g/day and cases 3.82 Ϯ 2.87 g/day; P ϭ 0.12), nor intake of meat and vegetable protein differed between the cases of albuminuria and the control subjects. High consumers of fish protein (greater than the 75th percentile) (12 cases and 63 control subjects, mean intake 9.35 g fish protein/day, i.e., ϳ53 g fish/day) had lower odds ratios (ORs) for microalbuminuria than individuals consuming less fish protein (mean 2.72 g/day) (crude OR 0.49 and 95% CI 0.25-0.97). When adjusted for known confounding factors, such as HbA 1c , mean arterial pressure, diabetes duration, age, sex, smoking, BMI, country region, and total energy, individuals with a high intake of fish protein and fish fat showed a reduction in the risk for microalbuminuria (OR 0.22 and 0.31, respectively; 95% CI 0.09 -0.56 and 0.13-0.76, respectively). When fish protein and fat were adjusted for each other, a high intake of fish protein but not of fish fat was still significantly associated with a decrease in the risk for microalbuminuria.CONCLUSIONS -Total protein and fat intake were not associated with the presence of microalbuminuria, but a diet including a high amount of fish protein seemed to lessen the risk. Diabetes Care 24:805-810, 2001

Diabetic Nephropathy: Diagnosis, Prevention, and Treatment

“…Another alternative is to use a qualitative test for proteinuria (dipstick) (33) or a quantitative measurement of protein in a (60,61), and dietary factors, such as the amount and source of protein (62)(63)(64) and fat (65) in the diet.…”

Diet, Lifestyle and Chronic Complications in Type 1 Diabetic Patients

“…The effect of total fat intake on nephropathy is still not elucidated. The cross-sectional study of Watts et al (Watts GF et al 1988) and the case control study of Möllsten et al (Möllsten AV et al 2001) were in contrast with each other. Also the effect of PUFAs on nephropathy is still doubtful, but there seems to be an inverse association between n-3 PUFAs and the degree of albuminuria.…”

“…No association between energy adjusted MUFA and energy adjusted PUFA and microalbuminuria was found. In a case-control study (Möllsten AV et al 2001), no association between total fat intake and microalbuminuria was found. In a prospective study (Cárdenas C et al 2004) a progression of nephropathy with greater saturated fatty acid (SFA) consumption and lesser polyunsaturated fatty acid consumption (PUFA) was demonstrated.…”

“…In the case-control study (Möllsten AV et al 2001) total protein intake was not associated with the presence of microalbuminuria, but a diet including a high amount of fish protein seemed to decrease the risk. Furthermore they could not confirm an association between a high total animal protein intake and having microalbuminuria.…”

“…Of the thirteen studies that reported an association between protein and nephropathy there were three cross-sectional studies (Toeller M et al 1997;Riley MD& Dwyer T 1998;O'Hayon BE et al 2000), one case control study (Möllsten AV et al 2001), two cohort studies (Jibani MM et al 1991;Barsotti G et al 1998), six randomized controlled trials (Brouhard BH& LaGrone L 1990;Zeller K et al 1991;Dullaart RP et al 1993;Raal FJ et al 1994;Hansen HP et al 1999;Hansen HP et al 2002) and a pilot study (Percheron C et al 1995). These will be discussed in the following paragraphs by study design.…”