A soybean peptide isolate diet promotes postprandial carbohydrate oxidation and energy expenditure in type II diabetic mice

The aim of the present study was to determine the effects of dietary proteins on the oxidation of dietary carbohydrate and lipids in type II diabetic mice. KK-A(y) strain mice were provided free access to a high fat diet (30% of energy as fat) for an initial 4-wk period to induce diabetes. To reduce body weight gain, the mice were subsequently fed restrictive isoenergetic and isonitrogenous diets (35% of energy as protein and 5% as fat) based on either casein or soy protein isolate hydrolysate (SPI-H) for 4 wk. To measure exogenous carbohydrate and lipid oxidation, the mice were fed a diet containing (13)C-glucose or (13)C-triolein while they were in a respiratory chamber for 72 h. Postprandial energy expenditure was higher in the SPI-H than in the casein group; this difference was due to an increase in postprandial exogenous and endogenous carbohydrate oxidation. There were no differences in 24-h energy expenditure between dietary groups. Oxidation of exogenous carbohydrate tended to be higher (P = 0.054) in the SPI-H group during the 24 h of measurement. Fecal excretion of (13)C-glucose was lower but the excretion of lipid was higher in mice fed the SPI-H diet than in casein-fed mice. These results indicate that in type II diabetic mice, dietary SPI-H not only inhibits the absorption of dietary lipids and increases the absorption of dietary carbohydrates but also augments postprandial energy expenditure, which is accompanied by a postprandial increase in oxidation of dietary carbohydrates.     

Usual dietary intake and hemoglobin A1 level in patients with insulin-dependent diabetes

Objective To explore epidemiologic evidence for the relationship between dietary intake and glycemic control.

Design/subjects We examined usual dietary intake, assessed by a food frequency questionnaire, from a random sample (n = 136) of patients who had had insulin-dependent diabetes mellitus for 15 to 21 years.

Results In men, absolute intakes of energy, carbohydrate, protein, fat, and dietary fiber were positively correlated with hemoglobin A₁ (HbA₁) (P<.05); Spearman correlation coefficients (r_s) were .28, .22, .28, 34, and .25, respectively. In women, the correlations were weaker and not significant; r_s values were .18, .13, .17, .19, and .16, respectively. When these nutrients were expressed as a percentage of energy or as an amount per 1,000 kcal, only percentage of energy from fat showed a significant association with HbA₁—but only in men (r_s=.23 for men and .02 for women). Adjustment for body weight, insulin dose, and physical activity using multiple regression analysis did not change the relationship between HbA₁ and intakes of energy and fat. Sucrose and alcohol intakes did not show any association with HbA₁.

Conclusions Among men with insulin-dependent diabetes mellitus, the major dietary correlates of poor glycemic control were high intake of energy and percentage of energy from fat. Further investigation is needed to confirm this relationship of energy, fat, and glycemic control.     

Reported dietary intakes of patients with insulin-dependent diabetes mellitus: limitations of dietary recall.

Reported dietary intakes were assessed in young patients with insulin-dependent diabetes mellitus (IDDM). We studied 44 IDDM patients (24 males, 20 females, mean +/- SD age 13.2 +/- 4.5 yr) and compared them with 44 healthy age- and sex-matched control subjects. Estimated intakes from 24-h dietary recall were analyzed in relation to body weight and degree of diabetes control. The reported energy intake of the IDDM patients with greater than 120% ideal body weight (IBW) for height was 66, 59/88% (where X = geometric mean, L1 = lower confidence limit/L2 = upper confidence limit) of recommended daily allowance (RDA), whereas those with IBW less than 120% reported 90, 67/120% (p less than 0.01). Patients with increased weights in comparison with IBW had higher hemoglobin A1c (HbA1c) levels (11.9 +/- 2.7%) than those with weights more appropriate for IBW (9.7 +/- 2.4%, p less than 0.025). IDDM patients reported overconsumption of protein and fat, but their carbohydrate intake was low. Analysis of dietary recalls revealed high protein intake (X +/- SD, 20.0 +/- 5.0% of total calorie intake), especially in older (27 +/- 4%) compared with younger (19 +/- 2%-19 +/- 4%, p less than 0.01) patients. Proportions of carbohydrate, protein, and fat did not correlate with variations in body weight and/or HbA1c. The reported intake of protein per kilogram body weight was not significantly different between appropriate-weight and overweight IDDM patients. There was no significant difference in reported total energy intakes of IDDM patients compared with their healthy control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)     

2型糖尿病患者血清白蛋白与血管并发症的关系

[目的]探讨2型糖尿病血清白蛋白与微血管和大血管病变之间的关系。[方法]选取2008年1月～2010年10月在武汉市中心医院内分泌科住院的2型糖尿病患者483人,均详细记录年龄、病程、体重指数(BMI)、糖化血红蛋白(HbA1C)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血清白蛋白(ALB)等数据,并根据是否存在糖尿病微血管(糖尿病性视网膜病变、糖尿病性肾病、糖尿病性周围神经病变)及大血管病变(糖尿病周围血管病变、冠心病),将糖尿病视网膜病变组细分为非增殖性和增殖性视网膜病变组;将糖尿病肾病组分为微量蛋白尿组、大量蛋白尿组,比较这些组白蛋白的水平。[结果]所有2型糖尿病患者中,无肾病患者245人,微量白蛋白尿163人,大量蛋白尿75人,无肾病患者血清白蛋白水平与其他两组相比差异有统计学意义;糖尿病周围血管病变组与有无周围血管病变组患者血清白蛋白水平相比较差异有统计学意义。多元回归分析显示血清白蛋白水平与糖尿病肾病及糖尿病周围血管病变呈正相关。[结论]血清白蛋白水平与2型糖尿病肾病和周围血管病变相关。     

2型糖尿病肾病与糖尿病视网膜病变的相关关系

目的探讨2型糖尿病患者肾病与视网膜病变的共同患病危险因素及二者的相关关系。方法对198例2型糖尿病患者行荧光素眼底血管造影,根据结果分为无糖球病视网膜病变组、非增殖性糖尿病视网膜病变组、增殖性糖尿病视网膜病变组。根据国际通用的Mongensen分期标准将2型糖尿病患者分为单纯糖尿病组、早期糖尿病肾病组和临床精尿病肾病组。统计学分析采用SPSS11．5进行处理,尿微量白蛋白与糖尿病视网膜病变的分析用Logistic多元逐步回归分析。结果尿蛋白组患者发生视网膜病变的比例明显高于单纯糖尿病组,临床糖尿病肾病组合并增殖性视网膜病变的概率明最高于单纯糖尿病组和微量白蛋白尿组。白蛋白尿和糖尿病病程是糖尿病视网膜病变的独直预测因素。结论糖尿病肾病与糖球病视网膜病变具有相关一致性,但糖尿病肾病分期及糖尿病视网膜病变分级之间无对应关系。     

Altering dietary protein type and quantity reduces urinary albumin excretion without affecting plasma glucose concentrations in BKS.cg-m +Lepr db/+Lepr db (db/db) mice

Protein restriction is used conventionally in the prevention and treatment of diabetic nephropathy. Recently, the use of soy protein instead of animal protein has been postulated as a new preventive and treatment option. The aim of this study was to determine the qualitative and quantitative effects of dietary protein on biomarkers of diabetic nephropathy in a Type 2 diabetes mellitus mouse model (BKS.cg-m +Lepr(db)/+Lepr(db) mice). Diabetic (+Lepr(db)/+Lepr(db)) and control (m+/m+) mice (n = 24/group) consumed one of four different diets ad libitum [20% casein, 20% soy protein, 12% casein or 12% soy protein (energy-based percentages)] from 35 +/- 4 d of age until termination (184-217 d of age). Blood and urine were collected throughout the study to measure biomarkers of diabetes and diabetic nephropathy. Kidney tissue was collected at the end of the study for weight. In diabetic mice, a 20% casein diet increased urinary albumin excretion to macroalbuminuric levels, whereas a 20% soy protein diet led to no major changes in urinary albumin excretion. Low protein diets (12%), independently of protein type, decreased urinary albumin excretion to low microalbuminuric levels. There were no significant differences in plasma glucose concentrations. These findings show lower urinary albumin excretion when a soy protein diet or a low casein diet is fed, suggesting a delay in the progression of diabetic nephropathy.     

Effect of lercanidipine compared with ramipril on albumin excretion rate in hypertensive Type 2 diabetic patients with microalbuminuria: DIAL study (diabete, ipertensione, albuminuria, lercanidipina)

Microalbuminuria and hypertension are risk factors for diabetic nephropathy in Type 2 diabetic patients. Recent data suggest that blockade of the renin-angiotensin system slows the progression of diabetic nephropathy; in contrast, the results on the renoprotective effect of calcium channel antagonists are conflicting. We evaluated the effectiveness of lercanidipine, in comparison with ramipril, on the reduction in albumin excretion rate (AER) and blood pressure in mild-to-moderate hypertensive patients with Type 2 diabetes and persistent microalbuminuria. A total of 277 patients were enrolled in a multicentric, randomized, double-blind, active-controlled, parallel-group trial; 180 were randomized to receive 10-20 mg/day of lercanidipine or 5-10 mg/day of ramipril and followed up for 9-12 months. The primary outcome was the change in AER from baseline. After 9-12 months of follow-up, a reduction in AER of -17.4+/-65 microg/min (p<0.05) and -19.7+/-52.5 (p<0.05) in the lercanidipine and ramipril group, respectively, was observed, without differences between the groups. A significant reduction in systolic and diastolic blood pressure was observed in both the lercanidipine and ramipril-based treatment groups (p<0.0001 for both). This study demonstrated that treatment with lercanidipine 10-20 mg/day does not worsen albuminuria in microalbuminuric Type 2 diabetic patients with hypertension. Indeed, both lercanidipine and ramipril treatments resulted in a significant reduction in AER without a statistically significant difference between the two groups.     

上海市某社区2012年糖尿病肾病危险因素分析

目的分析2012年上海市某社区2型糖尿病患者糖尿病肾病的危险因素．为制定糖尿病肾病临床防治措施提供依据。方法对480例社区2型糖尿病患者进行现况调查。根据尿微量白蛋白／尿肌酐比值将研究对象分为糖尿病肾病组和糖尿病非肾病组,比较两组间各因素的差异,并运用因素Logistie回归分析各影响因素与尿微量白蛋白／尿肌酐比值的关系。结果本研究436例2型糖尿病患者中,糖尿病肾病患病率为41．97％;2型糖尿病发生糖尿病肾病的前4住危险因素依次为2型糖尿病病程、糖化血红蛋白、静脉血清餐后2小时血糖和血清低密度脂蛋白胆固醇。结论糖尿病病程、高血糖和高血脂是导致2型糖尿病肾病发生的主要原因,因此,社区糖尿病管理必须超越以控制血糖为中心的治疗观念,强调全面综合治疗,防止糖尿病肾病的发生或延缓临床蛋白尿的发展。     

Isolated soy protein consumption reduces urinary albumin excretion and improves the serum lipid profile in men with type 2 diabetes mellitus and nephropathy

Soy protein was shown to exhibit several beneficial effects on renal function in nondiabetic patients with nephropathy, and to improve serum lipids. This study examined the effects of isolated soy protein consumption on urinary albumin excretion, serum lipids, plasma amino acids, and isoflavones in diabetic patients with nephropathy. Male patients (n = 14) with type 2 diabetes and nephropathy were followed in a crossover design for 7 mo. The study comprised two 8-wk intervention periods, placed between a 4-wk lead-in and two 4-wk washout periods. In the 2 intervention periods, 0.5 g/(kg. d) of the dietary protein was provided as either isolated soy protein (ISP) or casein, in random order. Blood and urine samples were collected at the beginning and end of each period. Data were analyzed by multiple linear regression for a repeated-measure design. ISP consumption led to changes of -9.5% in urinary albumin excretion (P < 0.0001), -0.45 in the total-to-HDL-cholesterol ratio (P < 0.05), -0.20 in the LDL-to-HDL cholesterol ratio (P < 0.05), and +4.3% in HDL cholesterol (P = 0.0040). Plasma arginine concentrations, the arginine-to-lysine ratio, and plasma isoflavone concentrations were higher after ISP consumption (P < 0.05). Urinary albumin excretion was negatively correlated with plasma total isoflavones (rho = -0.441), daidzein (rho = -0.326), and O-desmethylangolesin (rho = -0.389) (P < 0.05). The findings indicate that isolated soy protein consumption improves several markers that may be beneficial for type 2 diabetic patients with nephropathy.     

西宁地区老年糖尿病肾病患者同型半胱氨酸水平及检测意义

目的探讨高海拔地区老年糖尿病肾病患者同型半胱氨酸(homocysteine,Hcy)的水平,探讨血清Hcy升高的意义。方法采用随机对照方法,根据不同程度的糖尿病肾病患者(早期肾病、临床肾病、尿毒症期)及无肾病的糖尿病患者,比较分析160例老年人Hcy的水平。结果糖尿病肾病患者的Hcy的水平增高,3组不同尿白蛋白排泄率(UAER)糖尿病病人间的Hcy水平,差异有统计学意义(P﹤0.05);Hcy与UAER呈显著正相关(P﹤0.01)。结论 Hcy的水平和糖尿病肾病患者的肾功能损害程度相关,对高Hcy血症的干预治疗,可延缓糖尿病肾病的进展。     

肾脏超声检查在不同时期糖尿病肾病患者诊断中的价值与临床分析

目的:针对肾脏超声检查在糖尿病肾病患者病程确定过程中的价值进行相应的研究.方法:选取在2017年10月～2019年10月收治的300例糖尿病肾病患者,根据患者的病情发展情况划分成三个组别,每组患者100例.其中A组(尿白蛋白排泄率<30mg/24h)、B组(尿白蛋白排泄率30～300mg/24h)、C组(尿白蛋白排泄率...     

Gonadectomy and high dietary fat but not high dietary carbohydrate induce gains in body weight and fat of domestic cats

A high concentration of dietary carbohydrate is suggested to increase the risk of obesity and diabetes mellitus in domestic cats. To evaluate this, food intake, body weight, fat mass and circulating adiposity-related factors were determined in twenty-four sexually mature (9-12 months) cats assigned to four six-cat dietary groups balanced for body weight and sex. The effect of dietary fat in exchange for carbohydrate at 9, 25, 44 and 64 % of metabolisable energy (ME) in a purified diet of constant protein:ME ratio was studied 13 weeks before and 17 weeks after gonadectomy (GX). Body weight did not significantly change among the cats before GX except for an increase of 17 (sem 5) % in cats given the highest-fat diet. Following GX, all groups gained body weight, and body fat mass was positively correlated (r 0.50; P < 0.04) with dietary fat percentage. Post-GX weight gains were much greater for females (+39 (sem 5) %) than males (+10 (sem 4) %). Plasma ghrelin concentration negatively correlated (P < 0.02) with dietary fat percentage and, before GX, was greater (P < 0.05) in females than males. Plasma insulin concentration increased with weight gain induced by high dietary fat. Plasma glucose, TAG and leptin concentrations were not affected by dietary fat percentage, GX or weight gain. These data provide evidence that in cats, high dietary fat, but not carbohydrate, induces weight gain and a congruent increase in insulin, while GX increases sensitivity to weight gain induced by dietary fat.     

2型糖尿病患者膳食现况调查

目的了解2型糖尿病患者膳食摄入现况,评价其膳食质量。方法采用食物频率调查法对235例2型糖尿病患者进行调查。结果2型糖尿病患者奶类,蔬菜,畜禽肉类,蛋类以及油脂类摄入量偏高,分别为：（173．5±137．4）,（475．5±296．3）,（108．5±97．1）,（37．9±22．7）,（33．7±16．2）g／d,水果和鱼虾类摄入量偏低,仅为（70．4±83．4）和（35．7±42．6）g／d;能量来源分配比例不合理,脂肪摄入过高,占44．7％,碳水化合物摄人过低,仅占39．4％;脂肪酸供能比例不合理,饱和脂肪酸比例过高,高达17．4％。结论目前2型糖尿病患者膳食结构不合理,建议控制动物性脂肪的摄入,同时加强营养教育,促进营养干预。     

C反应蛋白与2型糖尿病肾病的相关性分析

目的检测2型糖尿病肾病患者不同时期血浆C反应蛋白（CRP）值,探讨CRP与2型糖尿病肾病的相关性。方法 216例2型糖尿病患者按尿白蛋白排泄率和肌酐水平分为正常尿蛋白组56例,微量白蛋白尿组67例,大量尿蛋白组45例和终末期肾衰组48例,并设健康对照组60例。免疫比浊法测定各组CRP值,分析CRP在各组的差异性以探讨CRP与糖尿病肾病的关系。结果 2型糖尿病各组血清CRP水平与对照组相比明显升高,而且其水平随蛋白排泄率的升高而升高（P〈0.05）。多因素相关分析显示,CRP与病程（r=0.656,P〈0.05）、肌酐（Cr）（r=0.424,P〈0.05）、UAER（r=0.681,P〈0.05）呈显著正相关。结论 CRP与糖尿病肾病的病情呈正相关,CRP可作为2型糖尿病肾病患者病情监测的新指标。     

超敏C-反应蛋白与2型糖尿病肾病的关系

目的　探讨C -反应蛋白(CRP)与不同时期糖尿病肾病的关系。方法　采用颗粒增强免疫法测定超敏CRP(usCRP)。根据尿白蛋白排泄率(UAER)将1 0 4例2型糖尿病患者分为正常蛋白尿组(48例)、微量白蛋白尿组(30例)、临床蛋白尿组(2 6例)。另选30例作为正常对照组。观察各组血清usCRP水平。结果　2型糖尿病各组血清usCRP水平较正常对照组明显升高,且usCRP水平随白蛋白尿的增加而升高;在2型糖尿病病人中,Person相关分析显示usCRP与UAER(r =0 .6 0 7,P =0 .0 0 0 )、甘油三酯(r =0 .4 2 3,P =0 .0 0 2 )及血肌酐(r =0 .32 2 ,P =0 .0 1 9)呈正相关,逐步线性回归结果表明,UAER、甘油三酯是影响usCRP的主要因素。结论　CRP与糖尿病肾病有关,且其水平与糖尿病肾病的程度呈一致性。     

糖尿病肾病患者血栓调节蛋白水平变化

目的；血浆血栓调节蛋白（TM）在糖尿病肾病中的变化及其意义。方法：检测68例2型糖尿病患者血浆TM与内皮素（ET）、血管性假血友病因子（vWF)的水平，并与30例正常人进行比较。结果：糖尿病组血浆TM水平明显高于正常对照组，临床糖尿病肾病（CDN）组的血浆TM水平明显高于早期糖尿病肾病（EDN）组及单纯糖尿病（SDM）组。血浆TM水平与ET、vWF水平及尿白蛋白排泄率均呈显著正相关。结论：血浆TM水平对糖尿病肾病的早期诊断及判断其血管内皮损伤程度有重要意义。     

2型糖尿病患者踝臂指数与糖尿病肾病的关系研究

目的 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者踝臂指数(ABI)与糖尿病肾病(diabetic kidney disease,DKD)之间的关系. 方法 485例T2DM患者及56例健康体检者为研究对象.根据24 h尿白蛋白定量将T2DM患者分为正常尿白蛋白组(尿白蛋白＜30 mg)、微量尿白蛋白组(尿白蛋白30～300 mg)和临床尿白蛋白组(尿白蛋白＞300mg).观察各组之间踝臂指数的差异,探讨踝臂指数与糖尿病肾病的关系. 结果 T2DM患者踝臂指数高于正常对照组(P＜0.05).T2DM患者中,微量尿白蛋白组的ABI较正常尿白蛋白组高(P＜0.05),大量尿白蛋白组的ABI高于其他两组(P＜0.01).尿白蛋白与ABI相关性分析显示尿白蛋白与ABI呈负相关(r=- 0.216,P＜0.01).糖尿病肾病患者的肾小球滤过率与ABI亦呈负相关(r=-0.529,P＜0.05). 结论 ABI对糖尿病肾病有很好的早期预测价值,且与糖尿病肾病严重程度相关.     

Dietary polyunsaturated fatty acids slow the progression of diabetic nephropathy in streptozotocin-induced diabetic rats

Diabetic nephropathy is associated with lipid deposits in the kidney. We hypothesized that a diet containing polyunsaturated fatty acids (PUFAs) could ameliorate pathogenesis of diabetic kidney diseases associated with lipid depositions in the kidneys. We examined if the pathogenesis and progression of diabetic nephropathy are affected by the type of dietary fat using streptozotocin (45 mg/kg body weight, intravenous)-induced diabetic rats (5-week-old male Sprague-Dawley rats). Streptozotocin-induced diabetic rats were fed a lard diet containing saturated fatty acids or a rapeseed oil diet containing PUFAs (DML and DMR, respectively) for 11 days. Similarly, streptozotocin-nontreated rats were fed a lard diet or a rapeseed oil diet (NL and NR, respectively) for 11 days. Hyperglycemia was induced in DML and DMR, compared with NL and NR groups. The levels of plasma ketone, total cholesterol, and triglyceride (TG) were significantly increased in the DML group. Moreover, albuminuria and renal TG content were enhanced in the DML group. The renal TG content correlated positively with urinary albumin excretion (P < .001). Oil-Red O staining of kidney sections indicated a marked accumulation of neutral lipids in both glomerular and tubular cells in the DML group. In addition, a renal sterol regulatory element-binding protein-1 mature protein increment was induced in the DML group. Conversely, sterol regulatory element-binding protein-1 expression in the kidney was maintained at normal levels in the DMR group. These results suggest that dietary PUFAs may slow the progression of diabetic nephropathy associated with lipid depositions in the kidney.     

High-fibre and low-fat diets in diabetes mellitus

1. Eight insulin-dependent and eight insulin-independent diabetic patients and twenty-eight non-diabetic essential hypertensive patients were given a high-fibre, high-unrefined carbohydrate and low-fat diet for 3 months duration. 2. The effects of this dietary regimen on the patients' fasting blood glucose, hypoglycaemic therapy and weight was observed. 3. Fasting lipid profiles were obtained before and after 3 months on the dietary regimen, and total serum lipids and lipoprotein fractions were analysed. 4. The insulin-dependent and insulin-independent diabetic patients showed a reduction in hypoglycaemic therapy, with no significant change in fasting blood glucose. The insulin-independent and non-diabetic groups both showed significant weight loss. 5. The three groups of patients showed a significant reduction in cardiovascular risk factors with either an elevation of high-density lipoprotein (HDL)-cholesterol or a fall in low-density lipoprotein (LDL)-cholesterol and a reduction in the total cholesterol: HDL-cholesterol value.     

Screening diabetic patients for microalbuminuria

Abnormal rates of urinary albumin excretion have been shown to predict the development of nephropathy and may signal atherosclerotic disease in diabetic patients. This study demonstrated the feasibility of measuring microalbuminuria in diabetic patients from a large family practice population. Although only one half of the 473 diabetic patients offered free screening took advantage of the testing, those participating did not differ in terms of sex, race, type of diabetes, mean age, systolic blood pressure, and fasting blood glucose levels from those not electing to participate. Over 40% of those screened had abnormally elevated albumin excretion rates as defined as greater than 0.02 g of albumin per gram of creatinine. Those participating in the screening perceived the process as useful and were able to comply with directions for overnight urine collection. Results show that screening for microalbuminuria in diabetic patients cared for by family physicians is feasible, simple, and inexpensive. Interventions to slow or reverse the progression of abnormal microalbuminuria and future risk for nephropathy in those with diabetes are underway.