地中海饮食降低循环中的甲基乙二酸水平与 2 型糖尿病和冠心病患者肾功能的保护有关：来自 CORDIOPREV 随机对照试验的结论

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism Pub Date : 2023-12-12 DOI:10.1016/j.diabet.2023.101503

Francisco M. Gutierrez-Mariscal , Alicia Podadera-Herreros , Juan F. Alcalá-Diaz , Magdalena P. Cardelo , Antonio P. Arenas-de Larriva , Silvia de la Cruz-Ares , Jose D. Torres-Peña , Raul M. Luque , Pablo Perez-Martinez , Javier Delgado-Lista , Jose Lopez-Miranda , Elena M. Yubero-Serrano

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引用次数: 0

摘要

目的-- 高级糖化终产物（AGEs）在 2 型糖尿病（T2DM）肾脏疾病中扮演着重要角色。然而，目前还没有对照临床试验研究特定饮食对 AGE 代谢的影响及其对肾功能的影响。我们的目的是评估在摄入两种健康饮食后，调节 AGE 代谢以降低 AGEs 水平是否能延缓 T2DM 和冠心病（CHD）患者肾功能的衰退。方法--T2DM 患者（CORDIOPREV 研究 1002 例患者中的 540 例）的估计肾小球滤过率（eGFR）≥ 30 ml/min/1.73 m2，根据其基线肾功能分为：正常 eGFR（≥ 90 ml/min/1.73m2）、轻度 eGFR 下降（60- < 90 ml/min/1.73m2）和中度 eGFR 下降（<60 ml/min/1.73m2）。在进行为期 5 年的饮食干预（地中海饮食或低脂饮食）前后，测量了血清 AGE 水平（甲基乙二酸（MG）和 N-羧甲基乙二酸-CML）以及与 AGE 代谢相关的基因表达（AGER1、RAGE 和 GloxI mRNA）。结果--与低脂饮食相比，地中海饮食仅在 eGFR 轻度下降的患者中产生较低的 eGFR 下降率（P = 0.035）。此外，地中海饮食能降低正常和轻度 eGFR 下降患者的甲基乙二酸-MG 水平，增加 GloxI 的表达（所有 P 均为 0.05）。结论-- 我们的研究表明，采用地中海饮食降低循环中的 AGE（尤其是 MG）水平可能与肾功能的保护有关，这体现在患有心脏病的 T2DM 患者的 eGFR 下降率降低。eGFR轻度下降的患者可能会从减少AGE以保持肾功能中获益更多。

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Reduction of circulating methylglyoxal levels by a Mediterranean diet is associated with preserved kidney function in patients with type 2 diabetes and coronary heart disease: From the CORDIOPREV randomized controlled trial

Aim

Advanced glycation end products (AGEs) play a role in kidney disease in type 2 diabetes mellitus (T2DM). However, there have been no prior controlled clinical trials examining the effects of specific diets on AGE metabolism and their impact on kidney function. Our aim was to assess whether modulating AGE metabolism resulting in reduced AGEs levels, after consumption of two healthy diets, could delay kidney function decline in patients with T2DM and coronary heart disease (CHD).

Methods

T2DM patients (540 out of 1002 patients from the CORDIOPREV study), with estimated glomerular filtration rate (eGFR) ≥ 30 ml/min/1.73 m², were classified based on their baseline kidney function: normal eGFR (≥ 90 ml/min/1.73 m²), mildly decreased eGFR (60- < 90 ml/min/1.73 m²) and moderately decreased eGFR (<60 ml/min/1.73 m²). Serum AGE levels, methylglyoxal (MG) and N-carboximethyllysine (CML), and gene expression related to AGE metabolism (AGER1, RAGE, and GloxI mRNA) were measured before and after 5-years of dietary intervention (a Mediterranean diet or a low-fat diet).

Results

Mediterranean diet produced a lower declined of eGFR compared to the low-fat diet only in patients with mildly decreased eGFR (P = 0.035). Moreover, Mediterranean diet was able to decrease MG levels and increase GloxI expression in normal and mildly decreased eGFR patients (all P < 0.05). One standard deviation increment of MG levels after dietary intervention resulted in a 6.8-fold (95 % CI 0.039;0.554) higher probability of eGFR decline.

Conclusion

Our study showed that lowering circulating AGE levels, specifically MG, after following a Mediterranean diet, might be linked to the preservation of kidney function, evidenced by a decreased decline of eGFR in T2DM patients with CHD. Patients with mildly decreased eGFR could potentially benefit more from AGE reduction in maintaining kidney function.

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来源期刊

Diabetes & metabolism 医学-内分泌学与代谢

CiteScore

12.00

自引率

4.20%

发文量

审稿时长

13 days

期刊介绍： A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.