{ "document_id": "fresh-bethgelab-298331", "source_sha256": "b7eff773bb1f99e0ec70566688feff4ba5a0189784a14a115bf01994215833e7", "kind": "ku", "status": "generated", "result": { "schema_version": "1.0", "title": "A six-month periodic fasting reduces microalbuminuria and improves metabolic control in patients with type 2 diabetes and diabetic nephropathy: a randomized controlled study", "abstract_sha256": "", "mode": "sequential", "model": "trained", "config": { "mode": "sequential", "chunk_words": 500, "context_words": 0, "previous_units": 10, "canonicalize": false, "minhash_permutations": 16, "canonicalization_max_tokens": 4096, "parse_retries": 0 }, "knowledge_units": [ { "chunk_index": 0, "context_summary": "A randomized controlled study compared a fasting-mimicking diet to a Mediterranean diet in patients with type 2 diabetes and diabetic nephropathy. The fasting-mimicking diet reduced microalbuminuria and improved metabolic markers like HOMA-IR and suPAR in the short term. The study suggests that the lack of changes in the detoxification of dicarbonyl compounds and markers for DNA damage may explain the recurrence of albuminuria at follow-up. 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Secondary endpoints included changes in metabolic markers, dicarbonyl detoxification products, and DNA damage markers. The study utilized an intention-to-treat analysis with ANCOVA adjusted for baseline characteristics, and a sample size of 40 was calculated to detect a 30% reduction in ACR.", "entities": [ { "name": "Primary endpoint", "entity_id": "primary_endpoint", "entity_type": "measurement", "aliases": [], "attributes": { "definition": "Absolute difference of change of ACR from baseline to after six diet cycles between FMD and M-Diet group", "subgroup_analysis": "Micro-versus macroalbuminuria levels at baseline" }, "relationships": [ { "predicate": "comprises", "target": "Absolute difference of change of ACR after three diet cycles", "attributes": {}, "target_id": null }, { "predicate": "comprises", "target": "Absolute difference of change of ACR after six diet cycles", "attributes": {}, "target_id": null } ] }, { "name": "Secondary endpoints", "entity_id": "secondary_endpoints", "entity_type": "measurement", "aliases": [], "attributes": { "markers": "HOMA-IR, plasma MG-H1, plasma MG, Glo-1 activity, pGlo-1 expression in WBC, hydroxyacetone in RBC, plasma AC profile, yH2Ax expression in WBC, suPAR" }, "relationships": [ { "predicate": "measured_at", "target": "Three diet cycles", "attributes": {}, "target_id": null }, { "predicate": "measured_at", "target": "Six diet cycles", "attributes": {}, "target_id": null } ] }, { "name": "Dicarbonyl detoxification markers", "entity_id": "dicarbonyl_detoxification_markers", "entity_type": "concept", "aliases": [], "attributes": { "components": "Glo-1 activity, pGlo-1 expression in WBC, hydroxyacetone in RBC" }, "relationships": [ { "predicate": "measured_at", "target": "Three diet cycles", "attributes": {}, "target_id": null }, { "predicate": "measured_at", "target": "Six diet cycles", "attributes": {}, "target_id": null } ] }, { "name": "Fatty acid oxidation marker", "entity_id": "fatty_acid_oxidation_marker", "entity_type": "concept", "aliases": [], "attributes": { "component": "Plasma AC profile" }, "relationships": [ { "predicate": "measured_at", "target": "Three diet cycles", "attributes": {}, "target_id": null }, { "predicate": "measured_at", "target": "Six diet cycles", "attributes": {}, "target_id": null } ] }, { "name": "DNA-damage/repair marker", "entity_id": "dna_damage_repair_marker", "entity_type": "concept", "aliases": [], "attributes": { "component": "yH2Ax expression in WBC" }, "relationships": [ { "predicate": "measured_at", "target": "Three diet cycles", "attributes": {}, "target_id": null }, { "predicate": "measured_at", "target": "Six diet cycles", "attributes": {}, "target_id": null } ] }, { "name": "Kidney injury and senescence marker", "entity_id": "kidney_injury_and_senescence_marker", "entity_type": "concept", "aliases": [], "attributes": { "component": "suPAR" }, "relationships": [ { "predicate": "measured_at", "target": "Three diet cycles", "attributes": {}, "target_id": null }, { "predicate": "measured_at", "target": "Six diet cycles", "attributes": {}, "target_id": null } ] }, { "name": "Power calculation", "entity_id": "power_calculation", "entity_type": "method", "aliases": [], "attributes": { "required_sample_size": 34, "estimated_dropout_rate": "15%", "final_sample_size": 40, "detection_threshold": "30% reduction in ACR", "standard_deviation": "30%", "significance_level": "alpha=5%", "power": "at least 80%" }, "relationships": [ { "predicate": "performed_in", "target": "PASS 16.0.12", "attributes": {}, "target_id": null } ] }, { "name": "Statistical analysis", "entity_id": "statistical_analysis", "entity_type": "method", "aliases": [], "attributes": { "population": "Intention-to-treat", "missing_value_handling": "Not imputed", "available_case_analysis": "Performed", "variable_representation": "Mean±SEM for normal, median with IQR for log-normal, frequencies for categorical", "comparison_method": "The ANCOVA analysis was adjusted for age, gender, weight loss, and the initial value of the outcome variable. ", "multiple_testing_procedure": "Hierarchical test procedure for secondary endpoints", "software": "R (version 3.6.1 2019-07-05)", "visualization_tools": "R core packages, tiduverse, pheatmap, GraphPad Prism version 5.00" }, "relationships": [ { "predicate": "performed_on", "target": "FMD and M-Diet group", "attributes": {}, "target_id": null } ] }, { "name": "Study population", "entity_id": "study_population", "entity_type": "event", "aliases": [], "attributes": { "randomization_period": "March 2018 to May 2020", "total_randomized": 41, "FMD_group_size": 21, "M-Diet_group_size": 20, "discontinuation_reason": "Erysipelas", "discontinuation_count": 1, "completed_three_cycles": 38, "completed_study": 33, "follow_up_count": 31, "follow_up_time": "112±31 days" }, "relationships": [ { "predicate": "excluded_from_analysis", "target": "1 patient from M-Diet group", "attributes": {}, "target_id": null } ] } ], "source": { "chunk_index": 3, "start_word": 1439, "end_word": 1932, "word_count": 493, "sha256": "0635085d24fe345380e5f09e70331157570e5370693183d6494a604ae7ea3ce8", "sentence_minhash": [ 143470254565919416, 60625189416255572, 13745959893517690, 148613333131239159, 31941388625203915, 62667647458868521, 99359698575653691, 40361113771795953, 166844233492045914, 9462436175016187, 42389510456722272, 95656761971753031, 38129318889309710, 906306679132868, 29116561381011342, 489599467541456454 ] }, "extraction_warnings": [] }, { "chunk_index": 4, "context_summary": "The study found that a six-month periodic fasting-mimicking diet significantly reduced microalbuminuria and improved metabolic control in type 2 diabetes patients with diabetic nephropathy. The fasting-mimicking diet resulted in a 17% reduction in HbA1c and a 60% decrease in HOMA-IR in non-insulin-treated participants. The study found that the main reason for participants withdrawing was related to restrictions imposed as a result of the COVID-19 pandemic. ", "entities": [ { "name": "Fasting-Mimicking Diet (FMD)", "entity_id": "fasting_mimicking_diet_fmd", "entity_type": "method", "aliases": [], "attributes": { "duration": "six months", "withdrawal_reason": "Covid-19 pandemic restrictions" }, "relationships": [ { "predicate": "reduces", "target": "microalbuminuria", "attributes": { "reduction_after_six_cycles": "54%", "reduction_after_three_cycles": "37%" }, "target_id": null }, { "predicate": "reduces", "target": "HbA1c", "attributes": { "reduction_after_six_cycles": "17%", "reduction_after_three_cycles": "0%" }, "target_id": null }, { "predicate": "reduces", "target": "HOMA-IR", "attributes": { "reduction_after_six_cycles": "60%", "reduction_after_three_cycles": "0%" }, "target_id": null }, { "predicate": "reduces", "target": "urea levels", "attributes": { "reduction_after_three_cycles": "11.8 mg/dl", "reduction_after_six_cycles": "17.9 mg/dl" }, "target_id": null }, { "predicate": "reduces", "target": "suPAR", "attributes": { "reduction_after_three_cycles": "214.8 pg/ml", "reduction_after_six_cycles": "156.6 pg/ml" }, "target_id": null }, { "predicate": "improves", "target": "eGFR based on cystatin C", "attributes": { "difference_after_six_cycles": "8.3 ml/min/1.73m²", "difference_after_three_cycles": "2.4 ml/min/1.73m²" }, "target_id": null }, { "predicate": "maintains", "target": "LDL, HDL, and triglyceride levels", "attributes": { "change": "no change" }, "target_id": null } ] }, { "name": "Mediterranean Diet (M-Diet)", "entity_id": "mediterranean_diet_m_diet", "entity_type": "method", "aliases": [], "attributes": { "caloric_intake": "maintained", "adaptation": "Mediterranean Diet Score" }, "relationships": [ { "predicate": "compared_to", "target": "Fasting-Mimicking Diet (FMD)", "attributes": {}, "target_id": null } ] }, { "name": "Type 2 diabetes", "entity_id": "type_2_diabetes", "entity_type": "other", "aliases": [], "attributes": { "status": "controlled", "model_entity_type": "condition" }, "relationships": [ { "predicate": "associated_with", "target": "Diabetic nephropathy", "attributes": {}, "target_id": null } ] }, { "name": "Diabetic nephropathy", "entity_id": "diabetic_nephropathy", "entity_type": "other", "aliases": [], "attributes": { "status": "elevated ACR", "model_entity_type": "condition" }, "relationships": [ { "predicate": "treated_by", "target": "Fasting-Mimicking Diet (FMD)", "attributes": {}, "target_id": null } ] }, { "name": "Microalbuminuria", "entity_id": "microalbuminuria", "entity_type": "measurement", "aliases": [], "attributes": { "reduction_after_six_cycles": "54%", "reduction_after_three_cycles": "37%" }, "relationships": [ { "predicate": "subgroup_of", "target": "Diabetic nephropathy", "attributes": {}, "target_id": null } ] }, { "name": "Macroalbuminuria", "entity_id": "macroalbuminuria", "entity_type": "measurement", "aliases": [], "attributes": { "reduction_after_six_cycles": "434.0 mg/g", "reduction_after_three_cycles": "176.2 mg/g" }, "relationships": [ { "predicate": "subgroup_of", "target": "Diabetic nephropathy", "attributes": {}, "target_id": null } ] }, { "name": "Albumin-to-creatinine ratio (ACR)", "entity_id": "albumin_to_creatinine_ratio_acr", "entity_type": "measurement", "aliases": [], "attributes": { "difference_after_six_cycles": "110.3 mg/g", "difference_after_three_cycles": "62.5 mg/g" }, "relationships": [ { "predicate": "primary_endpoint", "target": "study", "attributes": {}, "target_id": null } ] }, { "name": "HOMA-IR", "entity_id": "homa_ir", "entity_type": "measurement", "aliases": [], "attributes": { "reduction_after_six_cycles": "60%" }, "relationships": [ { "predicate": "measured_in", "target": "non-insulin treated participants", "attributes": {}, "target_id": null } ] }, { "name": "Fasting plasma glucose (FPG)", "entity_id": "fasting_plasma_glucose_fpg", "entity_type": "measurement", "aliases": [], "attributes": { "change": "no change" }, "relationships": [ { "predicate": "compared_to", "target": "M-Diet group", "attributes": {}, "target_id": null } ] }, { "name": "Cystatin C", "entity_id": "cystatin_c", "entity_type": "measurement", "aliases": [], "attributes": { "eGFR_difference_after_six_cycles": "8.3 ml/min/1.73m²" }, "relationships": [ { "predicate": "used_to_calculate", "target": "eGFR", "attributes": {}, "target_id": null } ] } ], "source": { "chunk_index": 4, "start_word": 1932, "end_word": 2387, "word_count": 455, "sha256": "e1d37a9a844d3015c7d18e20b7f3373ad64aa9a97ed85d08a19568155cf6265d", "sentence_minhash": [ 6919897742352966, 60625189416255572, 40863640610520970, 22894168227513268, 117184690827267154, 39127440086368283, 99359698575653691, 341714292460901511, 149650309763788182, 2607707833378508, 104535835787444099, 95656761971753031, 38129318889309710, 906306679132868, 98254322503569589, 240807075185782334 ] }, "extraction_warnings": [ "normalized unsupported entity type 'condition' for 'Type 2 diabetes'", "normalized unsupported entity type 'condition' for 'Diabetic nephropathy'" ] }, { "chunk_index": 5, "context_summary": "The FMD group experienced greater weight loss than the M-Diet group, though body composition remained unchanged between groups. Plasma MG-H1 levels decreased significantly in the FMD group after three cycles, but this change did not correlate with ACR reduction. Participants who showed a reduction in ACR (Area Under the Curve) in the group with FMD (Fat-induced Modalkrankheit) had higher initial ACR values compared to those who did not respond to the treatment. Only the reduction in HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) was maintained in the subsequent investigation. ", "entities": [ { "name": "Fasting-Mimicking Diet (FMD) group", "entity_id": "fasting_mimicking_diet_fmd_group", "entity_type": "other", "aliases": [], "attributes": { "weight_loss_3_cycles": "-5.6 kg (-5.9%)", "weight_loss_6_cycles": "-7.2 kg (-7.5%)", "body_composition_change": "no change compared to M-Diet group", "plasma_MG-H1_reduction_3_cycles": "62%", "baseline_ACR_responders": "85.7 mg/g", "baseline_ACR_non_responders": "271 mg/g", "baseline_ACR_M-Diet_responders": "55.5 mg/g", "baseline_ACR_M-Diet_non_responders": "563.0 mg/g", "follow_up_HOMA-IR_change": "-1.9 [-3.7, -0.1]", "model_entity_type": "study_group" }, "relationships": [ { "predicate": "compared_to", "target": "Mediterranean Diet group", "attributes": {}, "target_id": null }, { "predicate": "shows_no_change_in", "target": "body composition", "attributes": {}, "target_id": null }, { "predicate": "shows_no_association_between", "target": "plasma MG-H1 change and ACR change", "attributes": {}, "target_id": null }, { "predicate": "shows_higher_baseline_ACR_than", "target": "FMD non-responders", "attributes": {}, "target_id": null }, { "predicate": "shows_higher_baseline_ACR_than", "target": "M-Diet responders", "attributes": {}, "target_id": null } ] }, { "name": "Mediterranean Diet (M-Diet) group", "entity_id": "mediterranean_diet_m_diet_group", "entity_type": "other", "aliases": [], "attributes": { "weight_loss_3_cycles": "-0.7 kg (-0.8%)", "weight_loss_6_cycles": "-1.1 kg (-1.2%)", "body_composition_change": "no change compared to FMD group", "baseline_ACR_responders": "55.5 mg/g", "baseline_ACR_non_responders": "563.0 mg/g", "model_entity_type": "study_group" }, "relationships": [ { "predicate": "compared_to", "target": "Fasting-Mimicking Diet (FMD) group", "attributes": {}, "target_id": null }, { "predicate": "shows_no_change_in", "target": "body composition", "attributes": {}, "target_id": null }, { "predicate": "shows_no_association_between", "target": "plasma MG-H1 change and ACR change", "attributes": {}, "target_id": null } ] }, { "name": "Responders (ACR reduction)", "entity_id": "responders_acr_reduction", "entity_type": "other", "aliases": [], "attributes": { "definition": "participants with at least 30% improvement in ACR", "baseline_ACR_FMD": "85.7 mg/g", "baseline_ACR_M-Diet": "55.5 mg/g", "model_entity_type": "study_subgroup" }, "relationships": [ { "predicate": "show_distinct_AC_profile_in", "target": "FMD group", "attributes": {}, "target_id": null }, { "predicate": "show_distinct_AC_profile_in", "target": "M-Diet group", "attributes": {}, "target_id": null } ] }, { "name": "Non-responders (ACR reduction)", "entity_id": "non_responders_acr_reduction", "entity_type": "other", "aliases": [], "attributes": { "baseline_ACR_FMD": "271 mg/g", "baseline_ACR_M-Diet": "563.0 mg/g", "model_entity_type": "study_subgroup" }, "relationships": [ { "predicate": "show_distinct_AC_profile_in", "target": "FMD group", "attributes": {}, "target_id": null }, { "predicate": "show_distinct_AC_profile_in", "target": "M-Diet group", "attributes": {}, "target_id": null } ] }, { "name": "Acetylcarnitine levels (C2)", "entity_id": "acetylcarnitine_levels_c2", "entity_type": "other", "aliases": [], "attributes": { "change_in_responders": "The value increased after three dietary cycles in the FMD group. ", "model_entity_type": "metabolic_marker" }, "relationships": [ { "predicate": "distinct_response_in", "target": "FMD responders", "attributes": {}, "target_id": null } ] }, { "name": "Plasma MG-H1", "entity_id": "plasma_mg_h1", "entity_type": "other", "aliases": [], "attributes": { "reduction_in_FMD_3_cycles": "62%", "no_association_with_ACR_change": "in M-Diet and FMD groups", "model_entity_type": "biomarker" }, "relationships": [ { "predicate": "no_change_in", "target": "plasma MG, Glo-1 activity, pGlo-1 expression in WBC, hydroxyacetone levels in RBC, yH2Ax levels in WBC", "attributes": {}, "target_id": null } ] }, { "name": "Refeeding period", "entity_id": "refeeding_period", "entity_type": "event", "aliases": [], "attributes": { "timing": "one week after third and sixth diet cycle", "comparable_markers": "HbA1c, FPG, LDL, HDL, triglyceride, HOMA-IR, eGFR, ACR, plasma MG-H1, suPAR" }, "relationships": [ { "predicate": "comparable_between", "target": "FMD and M-Diet groups", "attributes": {}, "target_id": null } ] }, { "name": "Follow-up period", "entity_id": "follow_up_period", "entity_type": "event", "aliases": [], "attributes": { "sustained_reduction": "HOMA-IR", "no_change_in": "body weight or body composition" }, "relationships": [ { "predicate": "sustains_reduction_in", "target": "HOMA-IR", "attributes": {}, "target_id": null }, { "predicate": "no_change_in", "target": "body weight or body composition", "attributes": {}, "target_id": null } ] }, { "name": "Antihyperglycemic medication", "entity_id": "antihyperglycemic_medication", "entity_type": "other", "aliases": [], "attributes": { "increase_in_FMD_group": "increased for all but three participants", "model_entity_type": "treatment" }, "relationships": [ { "predicate": "increase_in", "target": "FMD group", "attributes": {}, "target_id": null } ] } ], "source": { "chunk_index": 5, "start_word": 2387, "end_word": 2864, "word_count": 477, "sha256": "ac7403a5bc713946b85e663e8b2362b98033e2fc0998eaeb4af1e7a98ef0e4c9", "sentence_minhash": [ 123739674064968645, 76987600409896885, 153262400589127199, 10004148275772588, 31941388625203915, 62667647458868521, 89633613770379075, 85390325476433150, 34383880606747972, 2607707833378508, 104535835787444099, 95656761971753031, 38129318889309710, 906306679132868, 95169533629451962, 109206766937244242 ] }, "extraction_warnings": [ "normalized unsupported entity type 'study_group' for 'Fasting-Mimicking Diet (FMD) group'", "normalized unsupported entity type 'study_group' for 'Mediterranean Diet (M-Diet) group'", "normalized unsupported entity type 'study_subgroup' for 'Responders (ACR reduction)'", "normalized unsupported entity type 'study_subgroup' for 'Non-responders (ACR reduction)'", "normalized unsupported entity type 'metabolic_marker' for 'Acetylcarnitine levels (C2)'", "normalized unsupported entity type 'biomarker' for 'Plasma MG-H1'", "normalized unsupported entity type 'treatment' for 'Antihyperglycemic medication'" ] }, { "chunk_index": 6, "context_summary": "The study found that the diet, which was similar to fasting, was safe and well-tolerated, with most participants reporting no negative side effects. It led to a reduction in the use of medications to lower blood sugar and blood pressure in the group that followed the fasting-like diet, compared to the group that followed a Mediterranean diet. The FMD also caused a transient increase in blood ketones and a distinct response in fatty acid oxidation markers among ACR responders.", "entities": [ { "name": "Fasting-Mimicking Diet (FMD)", "entity_id": "fasting_mimicking_diet_fmd", "entity_type": "method", "aliases": [], "attributes": { "safety_profile": "well tolerated", "adverse_event_rate": "71 to 95% reported no adverse effects", "common_symptoms": "weakness, muscle pain, dizziness, headache", "grade_3_or_higher_adverse_events": "none reported", "hypoglycemic_episodes": "10% (grade 1) and 5% (grade 2) in FMD group", "blood_ketones_increase": "3-fold after three and six diet cycles", "ACR_reduction_response": "distinct response in fatty acid oxidation markers among responders" }, "relationships": [ { "predicate": "reduces", "target": "antihyperglycemic medication use", "attributes": { "after_three_cycles": "57% of participants", "after_six_cycles": "67% of participants" }, "target_id": null }, { "predicate": "reduces", "target": "antihypertensive medication use", "attributes": { "after_three_cycles": "10% of participants", "after_six_cycles": "10% of participants" }, "target_id": null }, { "predicate": "increases", "target": "blood ketones", "attributes": { "after_three_cycles": "3-fold", "after_six_cycles": "3-fold" }, "target_id": null } ] }, { "name": "Mediterranean Diet (M-Diet)", "entity_id": "mediterranean_diet_m_diet", "entity_type": "method", "aliases": [], "attributes": { "hypoglycemic_episodes": "11% (grade 1) and 11% (grade 2) in M-Diet group", "antihyperglycemic_medication_increase": "5% after three cycles, 21% after six cycles", "antihypertensive_medication_increase": "5% after three cycles, 10% after six cycles", "MDS_compliance": "6.1 after three and six diet cycles" }, "relationships": [ { "predicate": "increases", "target": "antihyperglycemic medication use", "attributes": { "after_three_cycles": "5% of participants", "after_six_cycles": "21% of participants" }, "target_id": null }, { "predicate": "increases", "target": "antihypertensive medication use", "attributes": { "after_three_cycles": "5% of participants", "after_six_cycles": "10% of participants" }, "target_id": null } ] }, { "name": "ACR", "entity_id": "acr", "entity_type": "measurement", "aliases": [], "attributes": { "change_reversal": "reversed to baseline values at follow-up" }, "relationships": [ { "predicate": "reduced_by", "target": "FMD", "attributes": {}, "target_id": null }, { "predicate": "transient_reduction_in", "target": "MG-H1 plasma levels", "attributes": {}, "target_id": null } ] }, { "name": "MG-H1 plasma levels", "entity_id": "mg_h1_plasma_levels", "entity_type": "measurement", "aliases": [], "attributes": { "change_reversal": "reversed to baseline values at follow-up" }, "relationships": [ { "predicate": "transient_reduction_in", "target": "ACR responders", "attributes": {}, "target_id": null } ] }, { "name": "suPAR", "entity_id": "supar", "entity_type": "measurement", "aliases": [], "attributes": { "change_reversal": "reversed to baseline values at follow-up" }, "relationships": [ { "predicate": "transient_reduction_in", "target": "ACR responders", "attributes": {}, "target_id": null } ] }, { "name": "dicarbonyl detoxification markers", "entity_id": "dicarbonyl_detoxification_markers", "entity_type": "measurement", "aliases": [], "attributes": { "change_reversal": "no difference observed" }, "relationships": [ { "predicate": "no_difference_observed_in", "target": "FMD vs M-Diet", "attributes": {}, "target_id": null } ] }, { "name": "DNA-damage/repair markers", "entity_id": "dna_damage_repair_markers", "entity_type": "measurement", "aliases": [], "attributes": { "change_reversal": "no difference observed" }, "relationships": [ { "predicate": "no_difference_observed_in", "target": "FMD vs M-Diet", "attributes": {}, "target_id": null } ] }, { "name": "HOMA-IR", "entity_id": "homa_ir", "entity_type": "measurement", "aliases": [], "attributes": { "sustained_improvement": "sustained improvement observed at follow-up" }, "relationships": [ { "predicate": "improved_by", "target": "FMD", "attributes": {}, "target_id": null } ] } ], "source": { "chunk_index": 6, "start_word": 2864, "end_word": 3363, "word_count": 499, "sha256": "d7704b202ad10d8b841117183b3a73ade4e887ce7803ccd67b62181f560ab0e2", "sentence_minhash": [ 228487063155910791, 18551641988871988, 153262400589127199, 61919449716151556, 439990425904285965, 99436724310786061, 134854053530791596, 84916492449827032, 149650309763788182, 316267458192039586, 128047967744972732, 95656761971753031, 38129318889309710, 906306679132868, 161357415568664162, 187819574551997385 ] }, "extraction_warnings": [] }, { "chunk_index": 7, "context_summary": "The study found that the fasting-mimicking diet (FMD) only reduced microalbuminuria in patients with type 2 diabetes and diabetic nephropathy, with effects reversing after refeeding. The reduction in microalbuminuria was comparable to that seen with SGLT-2 inhibitors, but FMD did not affect macroalbuminuria, suggesting a point of no return after established renal damage. 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The authors suggest that a sustained metabolic redirection, rather than just caloric restriction, is responsible for the observed changes. 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}, { "name": "FMD group", "entity_id": "fmd_group", "entity_type": "other", "aliases": [], "attributes": { "weight_loss": "higher and significant compared to baseline and control group", "model_entity_type": "study_group" }, "relationships": [ { "predicate": "experienced_greater_weight_loss_than", "target": "control group", "attributes": {}, "target_id": null } ] }, { "name": "control group", "entity_id": "control_group", "entity_type": "other", "aliases": [], "attributes": { "diet_type": "isocaloric", "weight_loss": "mild", "model_entity_type": "study_group" }, "relationships": [ { "predicate": "received_isocaloric_diet_in_contrast_to", "target": "FMD group", "attributes": {}, "target_id": null } ] }, { "name": "albuminuria reduction", "entity_id": "albuminuria_reduction", "entity_type": "other", "aliases": [], "attributes": { "overall_group_change": "no significant change", "subgroup_change": "significant reduction in microalbuminuria", "model_entity_type": "clinical_outcome" }, 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