URINARY ALBUMIN EXCRETION RATE AND 24-H AMBULATORY BLOOD-PRESSURE IN NIDDM WITH MICROALBUMINURIA - EFFECTS OF A MONOUNSATURATED-ENRICHED DIET

Previous studies have shown that unsaturated fat-enriched diets may ha ve a beneficial effect on blood pressure in non-insulin-dependent diab etic (NIDDM) patients, whereas little is known about the effects on al buminuria. In a 3-week cross-over design we compared the effects of a currently recommended high-carbohydrate diet (50 % carbohydrate, 30 % fat [10 % monounsaturated fat]) vs a diet rich in monounsaturated fat (30% carbohydrate, 50% fat [30 % monounsaturated fat]) on urinary albu min excretion rate, 24-h ambulatory blood pressure and metabolic contr ol in ten NIDDM patients with persistent microalbuminuria. The 24-h am bulatory blood pressure was similar before and after both the high-car bohydrate diet (mean +/- SD: 145/78 +/- 25/10 vs 143/79 +/- 19/10 mmHg (NS) and the monounsaturated fat diet: 140/78 +/- 16/8 vs 143/79 +/- 15/8 mmHg (NS). No changes were observed in day or nighttime blood pre ssures. Urinary albumin excretion rate was unaffected after 3 weeks' t reatment by the diets: from (geometric mean x/divided by tolerance fac tor) 32.4x/divided by 2.1 to 36.0x/divided by 1.9 mu g/min (NS) vs fro m 34.2 x/divided by 1.9 to 32.1 x/divided by 2.1 mu g/min (NS). Fastin g plasma glucose, serum fructosamine and HbA(1c) as well as lipid and lipoprotein concentrations were stable during both diets. Compared to the high-carbohydrate diet a reduction in the LDL/HDL cholesterol rati o was observed during the monounsaturated fat diet (p < 0.03). In conc lusion, compared to a high-carbohydrate diet, 3 weeks' treatment with a monounsaturated fat diet did not affect the levels of 24-h ambulator y blood pressure or albuminuria in microalbuminuric NIDDM patients. Mo reover, glycaemic control and lipoprotein levels were unchanged, altho ugh a potential beneficial effect on the LDL/HDL-cholesterol ratio was noted. Monounsaturated fat represents an alternative in the diets of NIDDM patients especially when caloric intake is not a concern.