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      Soy Milk Consumption, Inflammation, Coagulation, and Oxidative Stress Among Type 2 Diabetic Patients With Nephropathy

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          Abstract

          OBJECTIVE

          To determine the effects of soy milk consumption compared with cow’s milk on inflammation, coagulation, and oxidative stress among patients with diabetic nephropathy.

          RESEARCH DESIGN AND METHODS

          This randomized, crossover clinical trial was conducted on 25 type 2 diabetic patients with nephropathy. This study had two trial phases, each for 4 weeks and one washout period for 2 weeks. Patients were randomly assigned to consume a diet containing soy milk or a diet containing cow’s milk.

          RESULTS

          Soy milk consumption resulted in a significant reduction in d-dimer level (percent change: −3.77 vs. 16.13%; P < 0.05). This significant effect remained even after adjusting for confounding factor (carbohydrate intake). However, soy milk consumption had no significant effects on tumor necrosis factor-α, interleukin-6, high-sensitivity C-reactive protein (hs-CRP), and malondialdehyde levels. The result was near to significance regarding the effect of soy milk consumption on hs-CRP (percent change: −35.45 vs. 36.76%; P = 0.05). However, this effect was not significant after adjusting for the confounding variable (carbohydrate intake).

          CONCLUSIONS

          Soy milk consumption could decrease serum d-dimer level among type 2 diabetic patients with nephropathy. However, markers of inflammation and oxidative stress did not change following soy milk intake among these patients.

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          Most cited references28

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          Soy protein intake, cardiorenal indices, and C-reactive protein in type 2 diabetes with nephropathy: a longitudinal randomized clinical trial.

          Several short-term trials on the effect of soy consumption on cardiovascular risks are available, but little evidence exists regarding the impact of long-term soy protein consumption among type 2 diabetic patients with nephropathy. To determine the effects of long-term soy consumption on cardiovascular risks, we measured C-reactive protein (CRP) and kidney function indexes among type 2 diabetic patients with nephropathy. This longitudinal randomized clinical trial was conducted among 41 type 2 diabetic patients with nephropathy (18 men and 23 women). Twenty patients in the soy protein group consumed a diet containing 0.8 g protein/kg body weight (35% animal proteins, 35% textured soy protein, and 30% vegetable proteins) and 21 patients in the control group consumed a similar diet containing 70% animal proteins and 30% vegetable proteins for 4 years. Soy protein consumption significantly affected cardiovascular risks such as fasting plasma glucose (mean change in the soy protein versus control groups: -18 +/- 3 vs. 11 +/- 2 mg/dl; P = 0.03), total cholesterol (-23 +/- 5 vs. 10 +/- 3 mg/dl; P = 0.01), LDL cholesterol (-20 +/- 5 vs. 6 +/- 2 mg/dl; P = 0.01), and serum triglyceride (-24 +/- 6 vs. -5 +/- 2 mg/dl; P = 0.01) concentrations. Serum CRP levels were significantly decreased by soy protein intake compared with those in the control group (1.31 +/- 0.6 vs. 0.33 +/- 0.1 mg/l; P = 0.02). Significant improvements were also seen in proteinuria (-0.15 +/- 0.03 vs. 0.02 +/- 0.01 g/day; P = 0.001) and urinary creatinine (-1.5 +/- 0.9 vs. 0.6 +/- 0.3 mg/dl, P = 0.01) by consumption of soy protein. Longitudinal soy protein consumption significantly affected cardiovascular risk factors and kidney-related biomarkers among type 2 diabetic patients with nephropathy.
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            The Dietary Approaches to Stop Hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients.

            Few studies exist regarding the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on novel cardiovascular risk factors among type 2 diabetic patients. We evaluated the effects of the DASH eating pattern on C-reactive protein (CRP) level, coagulation abnormalities, and hepatic function tests in type 2 diabetic patients. In this randomized, crossover clinical trial, 31 type 2 diabetic patients consumed a control diet or the DASH diet for 8 wk. The DASH diet was rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains, and sweets, with a total of 2400 mg/d sodium. The control diet was a standard diet for diabetic patients. There was a 4-wk washout between the 2 trial phases. The main outcome measures were CRP level, coagulation indices, and hepatic function tests. The mean percent change for plasma CRP level was -26.9 ± 3.5% after the DASH diet period and -5.1 ± 3.8% after the control diet period (P = 0.02). Decreases in both alanine aminotransferase and aspartate aminotransferase levels were greater after consuming the DASH diet compared with the control diet (-14.8 ± 3.0% vs -6.6 ± 3.4%; P = 0.001; -29.4 ± 3.7% vs -5.9 ± 1.4%; P = 0.001, respectively). The decrease in the plasma fibrinogen level during the DASH diet period (-11.4 ± 3.6%) was greater than that during the control diet (0.5 ± 3.4%) (P = 0.03). Among diabetic patients, the DASH diet can play an important role in reducing inflammation, plasma levels of fibrinogen, and liver aminotransferases. Future longer term studies are recommended.
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              Advanced glycation end products, oxidative stress and diabetic nephropathy

              About 246 million people worldwide had diabetes in 2007. The global figure of people with diabetes is projected to increase to 370 million in 2030. As the prevalence of diabetes has risen to epidemic proportions worldwide, diabetic nephropathy has become one of the most challenging health problems. Therapeutic options such as strict blood glucose and blood pressure controls are effective for preventing diabetic nephropathy, but are far from satisfactory, and the number of diabetic patients on end-stage renal disease is still increasing. Therefore, a novel therapeutic strategy that could halt the progression of diabetic nephropathy should be developed. There is accumulating evidence that advanced glycation end products (AGEs), senescent macroprotein derivatives formed at an accelerated rate under diabetes, play a role in diabetic nephropathy via oxidative stress generation. In this paper, we review the pathophysiological role of AGEs and their receptor (RAGE)-oxidative stress system in diabetic nephropathy.
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                Author and article information

                Journal
                Diabetes Care
                Diabetes Care
                diacare
                dcare
                Diabetes Care
                Diabetes Care
                American Diabetes Association
                0149-5992
                1935-5548
                October 2012
                11 September 2012
                : 35
                : 10
                : 1981-1985
                Affiliations
                [1] 1Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
                [2] 2Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
                [3] 3Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
                [4] 4Department of Food Science and Technology, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
                Author notes
                Corresponding author: Leila Azadbakht, azadbakht@ 123456hlth.mui.ac.ir .
                Article
                0250
                10.2337/dc12-0250
                3447833
                22787172
                b647d808-b744-4825-a4e4-8bf5477d393a
                © 2012 by the American Diabetes Association.

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

                History
                : 5 February 2012
                : 19 April 2012
                Categories
                Original Research
                Clinical Care/Education/Nutrition/Psychosocial Research

                Endocrinology & Diabetes
                Endocrinology & Diabetes

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