Dietary Protein

A few studies suggest that persons with type 2 diabetes have an increased need for protein during moderate hyperglycemia, and an altered adaptive mechanism for protein-sparing during weight-loss, resulting in an increased protein requirement. However, in many countries the protein intake for persons with diabetes is relatively high and exceeds by far the recommended dietary allowance (RDA) of 0.8 g kg-1 desirable body weight for adults. On average, protein intake was 21% of daily energy in the UKPDS. In general, there seems to be little concern that persons with diabetes may develop a deficiency in protein intake (59). The current recommendation for people with diabetes is that protein may provide 10% to 20% of total energy intake. In individuals with controlled type 2 diabetes, ingested protein does not increase glucose concentrations (14).

An association between dietary protein intake and renal disease has been shown in a large-scale cross-sectional study of people with type 1 diabetes. Those with a protein intake above 20% of total energy intake had abnormal albumin excretion rates (AER > 20 ^g min-1), particularly when hypertension was present (59). This suggests that a very high-protein intake may have undesirable effects on renal function, and it may be prudent to avoid a very high protein intake.

Several studies have focused on reversing or retarding the progression of proteinuria, and preventing nephropathy. Only a few studies have evaluated nutritional modifications, particularly a reduction of protein intake in patients with type 2 diabetes. With reductions in protein intake, to 0.8 g kg- body weight, AER were reduced in patients with microalbuminuria (60,61), however, the studies were of short duration and do not allow a general recommendation for this kind of protein restriction in microalbuminuric persons with type 2 diabetes. Whether substituting vegetable protein for protein from animal sources might result in beneficial effects has also been explored; however, there is still insufficient evidence to make firm recommendations regarding the nature of dietary protein in individuals with diabetes.

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