EAL

CKD: Dietary Protein (2001)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To provide evidence-based principles and recommendations for diabetes medical nutrition therapy.

Inclusion Criteria:

Based on the American Diabetes Association technical review "Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications".

Exclusion Criteria:

Not specified.

Description of Study Protocol:

Recruitment: Article inclusion methods not specified. Based on technical review.

Design: Consensus Report

Blinding Used (if applicable): not applicable

Intervention (if applicable): Classified according to the level of evidence available using the American Diabetes Association (ADA) evidence grading system.

Statistical Analysis: not applicable

Data Collection Summary:

Timing of Measurements: not applicable

Dependent Variables: not applicable

Independent Variables: not applicable

Control Variables: not applicable

Description of Actual Data Sample:

Initial N: 7 references cited, 1 being the Technical Review

Attrition (Final N): 7

Age: not applicable

Ethnicity: not applicable

Other relevant demographics: not applicable

Anthropometrics: not applicable

Location:

Summary of Results:

Goals of Medical Nutrition Therapy for Diabetes

1. Attain and maintain optimal metabolic outcomes including:

a. blood glucose as close the normal range as possible to prevent or decrease the risk for complications of diabetes.

b. a lipid and lipoprotein profile that decrease the risk of macrovascular disease.

c. blood pressure levels that decrease the risk for vascular disease.

2. Prevent and treat chronic complications of diabetes. Modify nutrient intake and lifestyle for prevention and treatment of obesity, dyslipidemia, cardiovascular disease, hypertension, and nephropathy.

3. Improve health through healthy food choices and physical activity.

4. Address individual nutritional needs taking into consideration personal, ethnic and cultural preferences and lifestyle while respecting the individual’s wishes and willingness to change.

Protein

B Level Evidence:

1. In those with controlled type 2 diabetes, ingested protein does not increase plasma glucose, although protein stimulates insulin secretion to the same extent as carbohydrate.

2. For those in less than optimal control, protein may be greater than the RDA.

Fat

A Level Evidence:

1. <10% of energy should come from SF. Those with LDL-cholesterol >100 gm/dL may benefit from <7% SF.

2. Dietary cholesterol should be <300 mg/d and for those with LDL-cholesterol > 100 gm/dL may benefit from <200 mg/d

B Level Evidence:

1. To lower LDL-cholesterol, energy derived from SFA can be decreased if weight loss is desirable or replaced with either carbohydrate or MUFA if weight loss is not a goal.

2. Intake of trans fatty acids should be minimized.

3. Low fat diets when maintained long-term, contribute to modest weight loss and improvement in dyslipidemia.

MNT for the Treatment/ Prevention of Co-Morbid Conditions

Hypertension

A Level Evidence:

2. A modest amount of weight loss beneficially affects blood pressure.

Dyslipidemia

B Level Evidence:

2. For persons with increased TG, decreased HDL cholesterol (metabolic syndrome), increased glycemic control, modest weight loss, restriction of SFA and use of MUFA and increased physical activity may be beneficial.

Nephropathy 1. For those with microalbuminuria, decreasing dietary protein to 0.8 to 1.0 g/kg/d and in those with overt nephropathy, decreasing to 0.8 g/kg/d may slow the progression of nephropathy.

C Level Evidence:

1. For those with increased LDL cholesterol, energy from fatty acids should be limited to <10% SFA and <7% trans fatty acids. 1. In both normotensive and hypertensive individuals, a decrease in sodium intake decreases blood pressure.

Author Conclusion:

MNT for people with diabetes should be individualized, with consideration given to the individual's food and eating habits, metabolic profile, treatment goals and desired outcomes. Monitoring of metabolic parameters, including glucose, HbA1c, lipids, blood pressure, body weight and renal function, when appropriate, as well as quality of life is essential to assess the need for changes in therapy and ensure successful outcomes. Ongoing nutrition self-management education and care needs to be available for individuals with diabetes. Additionally many areas of nutrition and diabetes require additional research.

Funding Source:

Not-for-profit

Foundation associated with industry:

Reviewer Comments:

Quality Criteria Checklist: Review Articles
Relevance Questions
	1.	Will the answer if true, have a direct bearing on the health of patients?	Yes
	2.	Is the outcome or topic something that patients/clients/population groups would care about?	Yes
	3.	Is the problem addressed in the review one that is relevant to dietetics practice?	Yes
	4.	Will the information, if true, require a change in practice?	Yes

Validity Questions
	1.	Was the question for the review clearly focused and appropriate?	Yes
	2.	Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?	No
	3.	Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?	No
	4.	Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?	Yes
	5.	Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?	No
	6.	Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?	Yes
	7.	Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?	No
	8.	Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?	Yes
	9.	Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?	Yes
	10.	Was bias due to the review's funding or sponsorship unlikely?	Yes