non-vegetarian south Indian diabetic patients. V Viswanathan ... Conclusions:
Protein content of non-vegetarian diet was higher compared to the vegetarian
diet.
Indian J Nephrol 2002;12: 73-76
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ARTICLE
Prevalence of albuminuria among vegetarian and non-vegetarian south Indian diabetic patients V Viswanathan, C Snehalatha, MP Varadharani, BM Nair, M Jayaraman, A Ramachandran Diabetes Research Centre, Chennai - India.
Abstract Aim: To determine the prevalence of diabetic nephropathy among vegetarians and nonvegetarians. Patients and methods: Type 2 diabetic subjects (n=405) from the Diabetes Research Centre & M.V. Hospital for Diabetes, Chennai consisting of vegetarians (group 1, n=155) and non-vegetarians (group 2, n=250) were studied. Blood pressure, anthropometry, fasting and post-prandial plasma glucose, HbA1C, urea, creatinine were measured. Protein intake was calculated by estimating 24 hour urinary nitrogen. Dietary recall method was used to assess the diet pattern. Subjects were classified as having normoalbuminuria ( 500 mg/day) based on 24 hour albumin excretion. Results: Group 1 and Group 2 were matched for duration of diabetes. The prevalence of nephropathy (total protein >500 mg/day with diabetic retinopathy) was 11.6% (n=18) in group 1 and 13.6% (n=34) in group 2. Mean albuminuria (mg albumin/mg creatinine) in group 1 was 67.5+38.6 and in group 2, 72.5+45.9. Mean protein intake was significantly higher in non-vegetarians but was within the recommended limits. Multiple logistic regression analysis showed that only hypertension and duration of diabetes were associated with MAU and macro proteinuria; amount of protein intake or type of protein did not show correlation. Conclusions: Protein content of non-vegetarian diet was higher compared to the vegetarian diet. However, prevalence of MAU and macro proteinuria did not vary in these groups. Protein restriction may be required only in the non-vegetarians with nephropathy, and can be done by reducing the intake of animal protein. Key words: Diabetic nephropathy, dietary intake, proteinuria, animal proteins, dietary habits.
Introduction Kidney disease is a major microvascular complication of diabetes mellitus, often requiring dialysis or transplantation. In many countries, diabetic nephropathy is the most frequent reason for renal replacement therapy today. Extrapolations suggest that the number of patients with type 2 diabetes will multiply in coming years. It is feared that the number of patients with terminal renal insufficiency will also rise unless efforts are taken to make an early diagnosis of diabetic nephropathy and treat it aggressively. In a study conducted at Diabetes Research Centre involving 410 Address for Correspondence: Dr. V Viswanathan Diabetes Research Centre 4, Main Road, Royapuram Chennai - 600 013. INDIA Email :
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patients, the incidence of renal failure was found to be 0.69% per annum (CI 0.28-1.0%)1. Experimental evidence suggests that dietary protein restriction has a beneficial effect in retarding the progression of diabetic renal disease both in man and in experimentally induced renal diseases in animals2-6. The incidence of diabetic nephropathy is higher in northern Europe with higher proportion of animal protein in the food than in western countries of Europe in which the diet contains more fat or carbohydrate7. Dietary protein intake may be an important determinant of the rate of decline in renal function in patients with chronic renal insufficiency. In most forms of chronic renal insufficiency, progression to end stage renal failure is inevitable once a certain percentage of nephrons is lost4. Recommended dietary allowance of protein intake is 0.8 gm/kg body weight/day in patients with overt Copyright © 2002 by The Indian Society of Nephrology
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nephropathy. It is generally believed that an average Indian diet does not exceed this limit. Once the glomerular filtration rate (GFR) begins to fall, further restriction to 0.6 gm/kg body weight/day may prove useful in slowing the decline of GFR in selected patients8. Aim of the study : 1. To look for differences in protein intake among vegetarian and non-vegetarian Indians. 2. To study whether the vegetarian / non-vegetarian diet influences the prevalence of diabetic nephropathy in South Indians.
Patients and Methods 405 consecutive type 2 diabetic (WHO Criteria) subjects from the Diabetes Research Centre & M. V. Hospital for Diabetes, Chennai were selected for the study. All the study subjects gave their informed consent. They were grouped as follows: 1. Vegetarians (group1, n=155, mainly subjects from the Hindu Brahmin and Jain community) who took cereals, pulses, milk products, green leafy vegetables and fruits 2. Non-Vegetarians (group 2, n=250, mainly subjects from the Hindu non-Brahmin, Christian and Muslim community) who took animal protein at least thrice a week. All the subjects had clinical examination with measurement of blood pressure, age, body mass index (BMI); duration of diabetes was recorded in each patient.
Laboratory methods Fasting plasma glucose and post prandial plasma glucose (PPG; Normal value
