{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:27:55Z","timestamp":1789576075004,"version":"build-2803163510"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T00:00:00Z","timestamp":1634083200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Malaysian Endocrine & Metabolic Society","award":["MEMS-LR1"],"award-info":[{"award-number":["MEMS-LR1"]}]},{"name":"International Medical University (IMU) Malaysia","award":["IMU 418\/2018"],"award-info":[{"award-number":["IMU 418\/2018"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>There is limited data on the effects of low carbohydrate diets on renal outcomes particularly in patients with underlying diabetic kidney disease. Therefore, this study determined the safety and effects of very low carbohydrate (VLCBD) in addition to low protein diet (LPD) on renal outcomes, anthropometric, metabolic and inflammatory parameters in patients with T2DM and underlying mild to moderate kidney disease (DKD).<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Materials and methods<\/jats:title><jats:p>This was an investigator-initiated, single-center, randomized, controlled, clinical trial in patients with T2DM and DKD, comparing 12-weeks of low carbohydrate diet (&lt;20g daily intake) versus standard low protein (0.8g\/kg\/day) and low salt diet. Patients in the VLCBD group underwent 2-weekly monitoring including their 3-day food diaries. In addition, Dual-energy x-ray absorptiometry (DEXA) was performed to estimate body fat percentages.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The study population (n = 30) had a median age of 57 years old and a BMI of 30.68kg\/m2. Both groups showed similar total calorie intake, i.e. 739.33 (IQR288.48) vs 789.92 (IQR522.4) kcal, by the end of the study. The VLCBD group showed significantly lower daily carbohydrate intake 27 (IQR25) g vs 89.33 (IQR77.4) g, p&lt;0.001, significantly higher protein intake per day 44.08 (IQR21.98) g vs 29.63 (IQR16.35) g, p&lt;0.05 and no difference in in daily fat intake. Both groups showed no worsening of serum creatinine at study end, with consistent declines in HbA1c (1.3(1.1) vs 0.7(1.25) %) and fasting blood glucose (1.5(3.37) vs 1.3(5.7) mmol\/L). The VLCBD group showed significant reductions in total daily insulin dose (39(22) vs 0 IU, p&lt;0.001), increased LDL-C and HDL-C, decline in IL-6 levels; with contrasting results in the control group. This was associated with significant weight reduction (-4.0(3.9) vs 0.2(4.2) kg, p = &lt;0.001) and improvements in body fat percentages. WC was significantly reduced in the VLCBD group, even after adjustments to age, HbA1c, weight and creatinine changes. Both dietary interventions were well received with no reported adverse events.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrated that dietary intervention of very low carbohydrate diet in patients with underlying diabetic kidney disease was safe and associated with significant improvements in glycemic control, anthropometric measurements including weight, abdominal adiposity and IL-6. Renal outcomes remained unchanged. These findings would strengthen the importance of this dietary intervention as part of the management of patients with diabetic kidney disease.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0258507","type":"journal-article","created":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T18:49:47Z","timestamp":1634150987000},"page":"e0258507","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":30,"title":["Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease\u2014A randomized controlled trial"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3970-8511","authenticated-orcid":true,"given":"Nur Aisyah","family":"Zainordin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur\u2019 Aini","family":"Eddy Warman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimi Fadilah","family":"Mohamad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatin Aqilah","family":"Abu Yazid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5366-7296","authenticated-orcid":true,"given":"Nazrul Hadi","family":"Ismail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin Wee","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marymol","family":"Koshy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thuhairah Hasrah","family":"Abdul Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nafeeza","family":"Mohd Ismail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3520-8472","authenticated-orcid":true,"given":"Rohana","family":"Abdul Ghani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,10,13]]},"reference":[{"key":"pone.0258507.ref001","unstructured":"World Health Organisation (WHO) Fact Sheet on Diabetes. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diabetes (last accessed on 25th May 2021)"},{"key":"pone.0258507.ref002","volume-title":"2015 (NHMS 2015) Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems (Vol. 2)","author":"National Health and Morbidity Survey"},{"key":"pone.0258507.ref003","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1038\/ki.2013.220","article-title":"A population-based study measuring the prevalence of chronic kidney disease among adults in West Malaysia","volume":"84","author":"LS Hooi","year":"2013","journal-title":"Kidney Int"},{"key":"pone.0258507.ref004","volume-title":"Twenty-First Report of the Malaysian Dialysis and Transplant 2013","author":"B Goh","year":"2014"},{"issue":"9","key":"pone.0258507.ref005","article-title":"Weight loss variability with SGLT2 inhibitors and GLP\u20101 receptor agonists in type 2 diabetes mellitus and obesity: Mechanistic possibilities","volume":"20","author":"E Brown","year":"2019","journal-title":"Obesity Reviews"},{"key":"pone.0258507.ref006","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.orcp.2015.05.005","article-title":"Predicting dropout in dietary weight loss trials using demographic and early weight change characteristics; 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