Nephropathy from Type 2 diabetes mellitus is one of the most prevalant kidney diseases and is the leading cause of end-stage renal disease in the United States, accounting or approximately 50% of all dialysis patients currently. Although some predictors for the development and progression of diabetic nephropathy have been identified, including hypertension, poor glucose control, and cigarette smoking, the role of potential modifiable dietary risk factors, as well as lipid and inflammatory biomarkers, may also play important roles. We propose to study prospectively risk factors for albuminuria and progressive decline in renal function as measured by estimated glomerular filtration rate (GFR) 780 women with Type 2 diabetes who are participants in the Nurses' Health Study. We hypothesize that higher dietary intake of saturated fats and elevated serum levels of lipids are associated with higher levels of albuminuria and lower GFR through a mechanism of glomerular endothelial microvascular dysfunction, whereas higher dietary intake of unsaturated fats, fiber, and higher levels of physical activity are associated with lower levels of albuminuria and higher GFR. The objective of this proposal is to use multivariable regression analysis, adjusting for such factors as A1C, hypertension, smoking, obesity, and angiotensin-inhibition medication use, to identify independent dietary and biomarker risk factors for nephropathy in Type 2 diabetes.
The specific aims of this proposal are:
Specific Aim #1 : Assess the relation of modifiable dietary and lifestyle factors and change in albuminuria and GFR in Type 2 diabetes.
Specific Aim #2 : Assess the relation of lipid and inflammatory biomarkers and change in albuminuria and GFR in Type 2 diabetes. The candidate for this K08 award is Julie Lin, M.D., M.P.H., a nephrologist on the faculty of the Brigham and Women's Hospital and an Instructor in Medicine at Harvard Medical School. She is seeking further training and experience in advanced epidemiologic methods under the guidance of Gary Curhan, M.D., a well-known renal epidemiologist, and Frank Hu, M.D., Ph.D., a leading investigator in the field of nutritional epidemiology. This project proposal will provide the foundation for the candidate's future career as an independent and successful clinical scientist in renal research.
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