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Effects of polyunsaturated fatty acid consumption in diabetic nephropathy

Nature Reviews Nephrology volume 7, pages 110–121 (2011)Cite this article

Abstract

The complex metabolic, vascular and inflammatory perturbations that characterize diabetes mellitus often lead to progressive albuminuria, renal injury and dysfunction (diabetic nephropathy [DN]), and diabetes is the leading cause of end-stage renal disease in the US and Europe. Diet has an important role in cardiometabolic disorders and its potential influence on DN is of interest. Fatty acids are a major source of energy, but in excess, fatty acids (particularly saturated fatty acids) can induce lipotoxicity. Omega-3 polyunsaturated fatty acids (PUFAs) confer protection against cardiovascular disease—the major cause of death in patients with DN—by virtue of their antihyperlipidemic, antihypertensive, anti-inflammatory and other properties. Omega-6 PUFAs are also cardioprotective. However, a significant proportion of adults consume insufficient quantities of these essential nutrients. This Review describes the role of omega-3 and omega-6 PUFAs in nutrition and metabolism, with a focus on experimental, epidemiologic and clinical studies that have investigated their renoprotective effect in patients with diabetes. Results from a number of studies suggest, but do not firmly establish, that long-chain omega-3 PUFAs (found in fish oil) reduce albuminuria in the setting of DN. Intake of omega-6 fatty acids is associated with reduced albuminuria in experimental settings and in epidemiologic studies of DN. Although PUFAs do not seem to attenuate glomerular dysfunction, insufficient evidence exists to rule out such an effect. We feel that further research is needed into the potential of PUFA consumption and supplementation in DN.

Key Points

  • Plant-derived omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) and fish-oil-derived long-chain omega-3 PUFAs attenuate hypertension, inflammation, glomerulosclerosis and albuminuria in most experimental studies of diabetic nephropathy

  • Epidemiologic studies suggest that increased intake of PUFAs protects against albuminuria in humans with type 1 and 2 diabetes mellitus

  • In clinical trials, the reduction in albuminuria in patients with type 1 and 2 diabetes mellitus receiving fish oil supplementation approaches statistical significance

  • PUFAs do not seem to attenuate glomerular dysfunction in diabetic nephropathy, but insufficient evidence exists to rule out such an effect

  • Further mechanistic, epidemiologic and clinical studies are warranted to determine a role for dietary or supplemental PUFAs in the prevention and treatment of diabetic nephropathy

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Figure 1: Classification of fatty acids.
Figure 2: Long-chain PUFAs are incorporated into phospholipids and serve as oxygenated PUFA precursors.
Figure 3: Extrarenal and intrarenal factors involved in DN and ways in which they might be ameliorated by long-chain omega-3 PUFA consumption.

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  1. The Institute for Nutrition Research, Rabin Medical Center, Beilinson Campus, 49100, Petah Tikva, Israel

    Haim Shapiro, Miryam Theilla & Pierre Singer

  2. Endocrinology Department, Diabetes Services, Rabin Medical Center, Beilinson Campus, 49100, Petah Tikva, Israel

    Joelle Attal-Singer

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H. Shapiro, M. Theilla and P. Singer researched data for the article. H. Shapiro, J. Attal-Singer and P. Singer provided a substantial contribution to discussions of content. H. Shapiro wrote the article. H. Shapiro, M. Theilla and P. Singer were involved in the review/editing of the manuscript before submission.

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Correspondence to Haim Shapiro.

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H. Shapiro declares an association with Fischer Pharmaceutical Laboratories (lecture fees). The other authors declare no competing interests.

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Shapiro, H., Theilla, M., Attal-Singer, J. et al. Effects of polyunsaturated fatty acid consumption in diabetic nephropathy. Nat Rev Nephrol 7, 110–121 (2011). https://doi.org/10.1038/nrneph.2010.156

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