Effect of Dietary Protein Restriction and Nutritional Assessment on Early-Stage Diabetic Nephropathy.

We evaluated the effects of a protein-limited diet on renal function, urinary albumin excretion and nutritional status of 16 patients with non-insulin dependent diabetes mellitus (11 males and 5 females, mean age 60.5 years) had a urinary albumin excretion rate of between 15 and 200μg/min and were c1assified into two groups : group Ⅰ patients were placed on a protein-limited diet (0.77g/kg/day), and group Ⅱ followed a conventional diabetic diet (1.33g/kg/day). After six months, the value of creatinine c1earance was significantly reduced in group Ⅰ, but urinary albumin excretion did not change in either group. Anthropometric measurements revealed no significant change in body weight, body mass index, arm circumference or triceps skinfold thickness in either group during the study period, but the arm musc1ec ircumference significantly increased in group Ⅰ. No significant differences were observed in either group with regard to serum level of protein, in c1uding total protein, albumin, prealbumin or transferrin, In conc1usion, a protein-limited diet was useful for prevention of diabetic nephropathy in patients with early-stage diabetic nephropathy

Association of Chlamydia pneumoniae infection with diabetic nephropathy

W badaniu oceniano związek pomiędzy zakażeniem Chlamydia pneumoniae (CP) a rozwojem nefropatii cukrzycowej. W zależności od zaawansowania rozlanych zmian kłębuszkowych, stosując kryteria Gellmana, 60 chorych na cukrzycę typu 2 podzielono na 2 grupy: z rozpoczynającą się i z zaawansowaną nefropatią cukrzycową. Grupę kontrolną stanowiło 34 chorych na cukrzycę typu 2 bez nefropatii (normoalbuminuria) oraz 59 osób niechorujących na cukrzycę. Stężenie przeciwciał IgG przeciwko CP mierzono za pomocą testu ELISA. Przeciwciała przeciw CP wykryto u 45,8% osób z grupy kontrolnej niechorujących na cukrzycę, u 47,1% chorych na cukrzycę bez nefropatii, u 52,6% chorych na cukrzycę z rozpoczynającą się nefropatią oraz u 78% chorych na cukrzycę z zaawansowaną nefropatią. Obecność przeciwciał przeciw CP powodowała 4,22-krotny wzrost ryzyka wystąpienia zaawansowanej nefropatii. Wyniki badania wskazują na związek pomiędzy przewlekłym zakażeniem CP a zaawansowaną nefropatią cukrzycową.We evaluated the association of Chlamydia pneumoniae (CP) infection with progression of diabetic nephropathy. Type 2 diabetic patients (60) were divided into two groups, those with incipient nephropathy and those with advanced nephropathy, based on the severity of diffuse glomerular lesions using Gellman’s criteria. Type 2 (34) diabetic patients without nephropathy (normoalbuminuria) and 59 nondiabetics served as control groups. Serum IgG- -antibody against CP was measured using ELISA. CP antibody was detected in 45.8% of nondiabetic controls, in 47.1% of diabetic patients without nephropathy, in 52.6% of diabetic patients with incipient nephropathy, and 78% of diabetic patients with advanced nephropathy. There was 4.22-fold increase in the risk of advanced nephropathy associated with the presence of CP antibody. Our findings indicate an association between chronic CP infection and advanced diabetic nephropathy

QUALITY OF LIFE IN PATIENTS WITH DIABETES MELLITUS

We evaluated the quality of life (QOL) in 268 patients with diabetes mellitus (NIDDM, 250 cases; IDDM, 10 cases; and other type of diabetes, 8 cases) to determine which aspects were adversely affected by the disease. Information concerning life satisfaction, social activities, ability to work, sexual problems and physical symptoms was obtained from a 30-item questionnaire. Clinical characteristics including duration of diabetes, glycemic control, current treatment, obesity, hypertension, hyperlipidemia, macro- and microvascular complications were obtained from medical records. Diminished QOL was most pronounced in patients who had had a long duration of disease, required insulin therapy, and whose health was disturbed by cerebrovascular disease, end-stage renal disease, mono- and autonomic neuropathy. A significant difference in the subdimensional QOL score was noted in life satisfaction, social activities, ability to work, sexual problems and physical symptoms under these circumstances

The World Health Organization's Healthy Diet Indicator and its associated factors: A cross-sectional study in central Kinki, Japan

The Healthy Diet Indicator (HDI), which is based on adherence to World Health Organization's (WHO) nutrition guidelines, is used worldwide. In 2015, the WHO updated the Fact Sheet for their recommended healthy diet. We investigated diet quality assessed by the updated HDI (HDI-2015) and factors related to adherence to this diet in a Japanese population. We conducted a cross-sectional study of 1370 participants from 8 workplaces, 1 college, and 2 communities. All participants completed a brief-type self-administered diet history questionnaire. The HDI-2015 assesses 7 components: fruits and vegetables, total fat, saturated fatty acid, polyunsaturated fatty acid, free sugar, dietary fiber, and potassium. Only 6.6% of subjects demonstrated high adherence to HDI-2015 (met ≥6 components), whereas 52.0% demonstrated moderate adherence (4–5 components), and 41.4% demonstrated low adherence (0–3 components). Male sex, older age, and regular physical activity were associated with higher adherence. The contemporary Japanese population has an overall low diet quality as evaluated by the updated HDI score. Improving adherence to healthier dietary patterns may promote better health in Japan. Keywords: Diet quality, Healthy Diet Indicator, Japanese, World Health Organizatio

Proposal for an Empirical Japanese Diet Score and the Japanese Diet Pyramid

A traditional Japanese diet (JD) has been widely regarded as healthy, contributing to longevity. The modern Japanese lifestyle has become markedly westernized, and it is speculated that the number of people who eat JD is decreasing. A simple evaluation of people with low adherence to JD will help improve dietary life. We developed a simple assessment tool that can capture JD, and examined factors associated with low adherence to JD. A total of 1458 subjects aged 18 to 84 years completed a brief self-administered diet history questionnaire. We constructed an empirical Japanese diet score (eJDS) consisting of 12 items from the common characteristics of a JD. In our participants, 47.7% of subjects reported low adherence to JD and only 11.1% demonstrated high adherence. In multivariate logistic regression analysis, younger age persons, physically inactive persons, and heavy drinkers were associated with low adherence to JD. Based on the cutoff values of eJDS, we proposed to create a Japanese diet pyramid that is easy to use visually. In conclusion, the eJDS and the Japanese diet pyramid will be useful tools for nutrition education and dietary guidance

Development of a Mediterranean diet score adapted to Japan and its relation to obesity risk

Background: The Mediterranean diet (MD) is well known as a healthy diet that protects against several chronic diseases. However, there is no appropriate and easy index to assess adherence to the MD pattern in Japan. Objective: The aim of this study was to develop a novel instrument to measure MD adherence adapted to a Japanese diet and to examine its association with overweight/obesity risk. Methods: A cross-sectional nutritional survey provided the data for construction of a novel MD score. In total, 1,048 subjects who were employees and university students, aged 18–68 years (645 men and 403 women), completed a 58-item brief-type self-administered dietary history questionnaire. We constructed a Japanese-adapted MD score (jMD score) focusing on 13 components. Adherence to the jMD was categorized as low (score 0–4), moderate (5–7), or high (8–13). Results: Men had higher jMD scores than women, and adherence to the jMD score increased with age. Only 11.6% of subjects showed high adherence to the jMD, whereas 29.6% showed low adherence. A higher jMD adherence was associated with a higher intake of favorable nutrients with the exception of salt. The jMD adherence was significantly associated with a reduced likelihood of having overweight/obesity for the highest category compared with lowest category (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.30–0.85, p-trend=0.017) after adjusting for age, sex, smoking, physical activity, alcohol intake, and hypertension. A two-point increment in jMD score was related to a reduced likelihood of having overweight/obesity with an odds ratio of 0.76 (95% CI 0.65–0.90, p=0.002). Conclusions: Our novel jMD score confirmed reasonable associations with nutrient intakes, and higher MD adherence was associated with a lower prevalence of overweight/obesity

CURRENT STATUS OF ELDERLY DIABETIC PATIENTS ON MAINTENANCE HEMODIALYSIS IN NARA PREFECTURE

The clinical characteristics of elderly hemodialysis patients with diabetes mellitus (DM) were compared with those with non-diabetic renal diseases (NDM). The subjects were 432 patients over 65 years of age undergoing maintenance hemodialysis at 28 dialysis centers in Nara Prefecture. The presence or absence of 8 different co-morbid illnesses was ascertained for each study patient. These conditions included congestive heart failure (CHF), ischemic heart disease (IHD), cerebrovascular disease (CVD), peripheral vascular disease (PVD), serious infections, severe visual disturbance, malnutrition and dementia. The prevalence of complications related to CHF, IHD, CVD, PVD, and severe visual disturbance was significantly higher in DM than in NDM. Activities of daily living (ADL) status was also evaluated. Degree of conditions of ADL was divided into four classes : no disability, needs assistance, wheelchair use, and bedridden. Disability of ADL was observed in 34.9% of DM patients and 22.3% of NDM patients (p<0.01). The mean numbers of co-morbid illnesses in the no disability and bedridden classes were significantly higher in DM than in NDM. We conclude that cardiovascular complications and visual disturbance are the main causes of disability in elderly diabetic patients undergoing hemodialysis

CLINICAL CHARACTERISTICS OF ISCHEMIC STROKE IN PATIENTS WITH DIABETES MELLITUS

To investigate the clinical characteristics of ischemic stroke and its associa- tions with hypertension, obesity, hyperlipidemia, and diabetic microangiopathy in patients with diabetes mellitus, we estimated the average period between onset of diabetes and ischemic stroke, and the incidences of complications. A total of 544 patients with diabetes mellitus who were admitted to our hospital over the past 10 years were analyzed, forty of whom were diabetic patients who suffered ischemic stroke as diagnosed by clinical exami- nation. As controles, 40 subjects matched for sex, age, and duration of diabetes were identified, one for each patient with ischemic stroke. The average period between onset of diabetes and ischemic stroke was significantly shorter for patients with hypertension than for normotensive patients ; however, there were no differences in the length of this period between the groups with and without obesity or hyperlipidemia. Hypertension was present in 63% of patients with ischemic stroke, and the incidence of hypertension was significantly higher in the stroke group than in the control group. There was no difference between the groups with and without ischemic stroke with respect to the incidence of obesity, hyper- lipidemia, retinopathy and nephropathy. We conclude that diabetic patients with hyperten- sion appear to be at high risk for ischemic stroke

RENAL HISTOLOGY IN TYPE 2 DIABETES MELLITUS : CLINICOPATHOLOGIC CORRELATION IN 301 PATIENTS

Renal pathologic features in type 2 diabetes and their correlation with clinical manifestations are incompletely known. Renal biopsy specimens from 301 patients were analyzed retrospectively. Light microscopic findings were graded by Gellman's criteria for diffuse glomerular lesions, which included 44 cases in grade D0, 81 in D1, 98 in D2, 49 in D3, and 29 in D4. Amounts of albuminuria or proteinuria correlated significantly with the grade of diffuse glomerular lesions, as did serum creatinine concentration. Creatinine clearance decreased significantly with increasing severity of glomerular lesions. This evidence strongly supports a close relationship between structural changes and functional abnormalities in diabetic nephropathy