[Effect of protein restriction on renal function and nutritional status of type 1 diabetes at the stage of renal impairment]

In an effort to slow the deterioration of renal function, several authors have recommended in the diabetic stage renal disease with moderate renal impairment decreased protein intake to 0.7 or 0.3 g / kg / day associated with energy intake of at least 30 to 35 kcal / kg / day. However, in clinical practice this proved difficult to achieve without exposing patients to the risk of under nutrition. To evaluate the effects of a protein restricted diet on the development of diabetic nephropathy and the nutritional status of diabetic patients with renal impairment at the stage of moderate renal impairment compared with those of a group of diabetics with the same characteristics put under basal diabetic diet. Prospective study of 57 diabetic patients in moderate stage renal disease of middle age [32 +/- 0.6 years] followed at the National Institute of Nutrition of Tunis in 2010. Our patients were separated into two groups [group A comprising 30 patients, put on diabetic diet basal and group B comprising 27 patients used in protein-deficient diet: 0.6 to 0.7 g / kg /d]. We followed the evolution of certain parameters: glomerular filtration rate [GFR], serum albumin, albuminuria, nutritional risk index [NRI] and we analyzed dietary intake at D0, D90 and D180. Renal function in patients in group B improved as demonstrated by the trend towards higher GFR. It increased from day 0 to day 90 and at day 180. In parallel, there was a beneficial effect on albuminuria which was reduced from 380 +/- 56 mg/24h on day 0, to 322 +/- 50mg/24h at day J90 and 302 +/- 16 mg/24h at day 180. In group A, the opposite phenomena occurred. The patients in Group B have also reduced their overall caloric intake to less than 1800 kcal / day making sure that the balance of their diet quality could no longer be assured the result has a tendency to under nutrition noted more frequently in the latter group [NRI0 = 97.90%, NRI 90= 90.10%, NRI180=90,0%]. In the literature these results were found by several studies. The protein-deficient diet [0.6 to 0.7 g/ kg /d] must be integrated into the overall care of diabetic renal insufficiency with moderate renal impairment but requires rigorous repeated dietary interviews and customized to avoid malnutrition can result

[Analysis of spontaneous food type 2 diabetes secondary prevention]

Macroangiopathic lesion occurrence increases dramatically an already high cardiovascular risk in diabetic patient. It may necessitate polymedication. An adapted diet may offer a better result than hypolipemic drugs alone. We analysed spontaneous food intake in a group of diabetic patients in secondary prevention in order to identify the modifications needed to reduce cardiovascular risk. Our results showed the existence of an hypercaloric food intake with a high lipid ration rich in satured fatty acid and N-6 polyinsatured acids. All our patients presented at least two nutritional cardiovascular risk factors. This points out the need for nutritional prescriptions based upon systematic and periodical food evaluation in the preventive strategy against cardiovascular risk in diabetic patients