Healthy Diet Lowers CKD Risk in Type 2 Diabetes Patients

A diet full of fruits and vegetables appears to slow the development of chronic kidney disease (CKD) in high-risk patients with type 2 diabetes, but protein and sodium intake has little effect, a new observational study has found.

The results, from a substudy of the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET), were published online August 12 in JAMA Internal Medicine by Daniela Dunkler, PhD, from McMaster University, Hamilton, Ontario, and colleagues.

“The absolute novelty is that weelucidated the associations of diet on the incidence of kidney disease in patients with diabetes,” principal investigator Rainer Oberbauer, MD, professor of medicine at the University of Vienna, Austria, told Medscape Medical News. The finding of a lack of effect for protein and sodium intake was somewhat surprising, he said, given that it counters long-held dogma. “We were all taught the mantra of protein restriction and prevention of progression.”

However, he cautions, “It is of note that our study is an observational study, and causal inference is not justified from these findings.”

But the authors, as well as an editorial accompanying the paper, by Holly Kramer, MD, from Loyola University, Chicago, Illinois, and Alex Chang, MD, from Johns Hopkins University, Baltimore, Maryland, agree that the study, albeit with limitations, nonetheless points to clear benefit for consumption of fruits and vegetables and for moderate alcohol intake.

“Perhaps the best dietary advice we can give patients with type 2 diabetes and kidney disease is the same as the advice for those who want to avoid chronic kidney disease and the same dietary advice for everyone: eat a diet rich in fruits and vegetables, low-fat dairy products, and whole grains while minimizing saturated and total fat,” Drs. Kramer and Chang write.

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