High-Resistant Starch, Low-Protein Flour Intervention on Patients With Early Type 2 Diabetic Nephropathy: A Randomized Trial

Objective: The objective of this study is to explore the effect of high-resistant starch (RS), low-protein flour as a source of RS on patients with early type 2 diabetic nephropathy (DN) through the clinical intervention trial. Design: This was a single center, randomized, comparative, open-label trial. Seventy-five patients with early DN, aged 18 to 80 y, were recruited and randomly assigned to two groups. During the 12-week intervention, the control group patients (38 cases) followed proteinrestriction diet daily with a common staple. The intervention group (37 cases) received 50 g of high-RS, low-protein flour instead of a common staple of equal quality at lunch and dinner each day. The blood glucose, blood lipids, nutritional parameters, indicators of renal function, oxidative stress, and inflammatory markers were measured. Results: Compared with the control group, high-RS, low-protein flour intake led to a significant reduction in fasting blood glucose, HbA1c, total cholesterol, and triglycerides levels (P < .05 for all). The changes in serum uric acid (UA) and beta 2-microglobulin beta 2-MG) level were observed after high-RS, low-protein flour intervention (uric acid [mean +/- standard deviation]: -24.7 +/- 38.5 mu mol/L, P = .001; beta 2-MG: 0.5 +/- 0.9 mg/L, P = 0.018). In addition, high-RS, low-protein flour intake increased serum superoxide dismutase level by 10.1 +/- 27.7 U/mL (P < .05); however, it did not change the interleukin-6 and Tumor Necrosis Factor alpha (TNF-alpha) concentration. Conclusions: Twelve-week intervention with high-RS, low-protein flour improved the blood glucose and blood lipid levels, decreased the serum uric acid (UA) and urine beta 2-MG, and enhanced the ability to prevent antioxidative stress in patients with early DN. (C) 2018 Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.