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Fish Intake Lowers Albuminuria in People With Diabetes

Nov 11, 2008

Fish intake lowered the risk for macroalbuminuria and kidney disease in patients with diabetes, according to the results of a cross-sectional study.

Albuminuria is common in patients with diabetes and hypertension and is associated with adverse renal and cardiovascular outcomes. Fish consumption has been suggested to be beneficial for microalbuminuria, with the renal benefit attributed to fish protein or an effect on lipid profile.

This is a cross-sectional study within the European Prospective Investigation of Cancer, a prospective population-based longitudinal cohort study, to examine the prevalence of albuminuria and the association between fish consumption and albuminuria in patients with diabetes and in those without diabetes.

“Modification of risk factors through lifestyle interventions to limit the progression of albuminuria may have an impact on subsequent complications, save money, and improve patient well-being,” write Chee-Tin Christine Lee, from the Medical Research Council Epidemiology Unit in Cambridge, United Kingdom, and colleagues from the European Prospective Investigation of Cancer-Norfolk Study. “Studies have shown a potential beneficial role for fish and fish oil consumption in the management of diabetes and its complications. The aim of this study is to examine the association between fish consumption and albuminuria in individuals with and without diabetes.”

This cross-sectional analysis conducted as part of a UK population-based cohort study included 22,384 men and women from general practices in the city of Norwich and vicinity, of whom 517 had self-reported diabetes and 21,867 did not have diabetes.

With use of a validated semiquantitative food frequency questionnaire, fish consumption was categorized as less than 1, 1 to 2, and more than 2 portions per week, and interaction between fish intake and diabetes status was hypothesized a priori. Log-transformed albumin-creatinine ratio was used as a continuous variable.

Microalbuminuria, defined as urinary albumin-creatinine ratio of 2.5 mg/mmol or greater to 24.9 mg/mmol, occurred in 22.6% of participants with diabetes and in 11.4% of participants without diabetes. Macroalbuminuria, defined as urinary albumin-creatinine ratio of 25 mg/mmol or greater, occurred in 8.3% and 0.6%, respectively.

In participants with diabetes, fish consumption was associated with a reduced risk for macroalbuminuria, after adjustment for confounding. For more than 2 portions vs less than 1 portion of fish per week, the odds ratio was 0.22 (95% confidence interval, 0.07 – 0.70; P for trend = .009). Diabetic participants with microalbuminuria and participants without diabetes did not demonstrate this association. Regarding the risk for macroalbuminuria, there was a significant interaction between diabetes status and fish consumption of 1 to 2 portions per week (P = .03) and more than 2 portions per week (P = .007).
“Greater fish intake was associated with a lower risk of macroalbuminuria in a self-defined diabetic population,” the study authors write. “These findings merit confirmation in prospective studies and intervention trials and suggest that fish intake may be beneficial for albuminuria in people with diabetes.”

Limitations of this study include cross-sectional design, reliance on self-report for fish intake and diabetes status, and lack of information regarding angiotensin-converting enzyme inhibitor or angiotensin-II receptor blocker use.

“The level of consumption of 2 portions of fish per week, which constitutes the category with the lower risk of macroalbuminuria, complies with recommendations of the Department of Health Committee on Medical Aspects of Food and Nutrition Policy and the American Health Association Dietary Guidelines,” the study authors conclude. “Prospective studies can determine whether fish consumption precedes the development of albuminuria in patients with diabetes and provide the basis for nutritional intervention trials incorporating precise biomarkers of fish intake.”

Practice Pearls

  • Diabetes mellitus is associated with a prevalence of microalbuminuria of 22.6% of participants with diabetes and 11.4% of those without diabetes; the prevalence of macroalbuminuria was 8.3% and 0.6%, respectively.
  • High fish consumption is associated with reduction in the rate of macroalbuminuria in patients with diabetes but not in those without diabetes.

Am J Kidney Dis. 2008;52:876-886.



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