Volume 40, Number 10, 1219-1226, DOI: 10.1007/s001250050810

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European Association for the Study of Diabetes

Protein intake and urinary albumin excretion rates in the EURODIAB IDDM Complications Study

M. Toeller, A. Buyken, G. Heitkamp, S. Brämswig, J. Mann, R. Milne, F. A. Gries, H. Keen and The EURODIAB IDDM Complications Study Group

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Abstract

For people with insulin-dependent diabetes mellitus (IDDM) renal disease represents a life-threatening and costly complication. The EURODIAB IDDM Complications Study, a cross-sectional, clinic-based study, was designed to determine the prevalence of renal complications and putative risk factors in stratified samples of European individuals with IDDM. The present study examined the relationship between dietary protein intake and urinary albumin excretion rate (AER). Food intake was assessed centrally by a standardized 3-day dietary record. Urinary AER was determined in a central laboratory from a timed 24-h urine collection. Complete data were available from 2696 persons with IDDM from 30 centres in 16 European countries. In individuals who reported protein consumption less than 20 % of total food energy intake, mean AER was below 20 μg/min. In those in whom protein intake constituted more than 20 %, mean AER increased, a trend particularly pronounced in individuals with hypertension and/or poor metabolic control. Trends reached statistical significance for intakes of total protein (% of energy, p = 0.01) and animal protein (% of energy, p = 0.02), while no association was seen for vegetable protein (p = 0.83). These findings support the current recommendation for people with diabetes not to exceed a protein intake of 20 % of total energy. Monitoring and adjustment of dietary protein appears particularly desirable for individuals with AER exceeding 20 μg/min (approximately 30 mg/24 h), especially when arterial pressure is raised and/or diabetic control is poor. [Diabetologia (1997) 40: 1219–1226]

Keywords Insulin-dependent diabetes mellitus - protein intake - urinary albumin excretion rate - diabetic nephropathy - diet recommendations - Europe.

Received: 11 April 1997 and in revised form: 10 June 1997

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