Introduction: Whilst dietary AGE restriction in animal models has been shown to improve insulin sensitivity, prevent atherosclerosis and ameliorate the micro and macrovascular complications of diabetes, the benefits of low-AGE diets in humans are unclear.

Aim: To determine the effect of low-AGE (Advanced Glycation Endproduct) diets on the inflammatory profiles of healthy adults and adults with diabetes or renal failure.

Study Design: A systematic review of randomised controlled trials.

Methods: We searched eight computer databases for trials published in English between January 1997 and December 2011. Human trials were included if at least one group received an AGE-restricted dietary intervention. Methodological quality of trials was assessed using the Academy of Nutrition and Dietetics primary research Quality Criteria Checklist.

Results: A total of 12 RCTs reporting on 289 participants were included in the review. Seven trials (58%) were of high methodological quality. Meta-analysis of two high-quality trials revealed that a long-term (16 week) low-AGE diet is an effective intervention for the reduction of biochemical indicators of oxidative stress (8-isoprostanes) and inflammation (TNFα) in healthy adults. Moderate evidence also favours medium-term low-AGE diets in adults with chronic renal failure, reducing indicators associated with endothelial dysfunction (VCAM-1) and atherosclerosis (AGE-modified LDL). Individual high-quality trials provided moderate evidence that medium-long term dietary AGE restriction reduces markers of insulin resistance (HOMA), endothelial dysfunction, oxidative stress, inflammation and atherosclerosis in adults with type 2 diabetes.

Conclusion: Moderate evidence supports the efficacy of medium-long term dietary AGE restriction for alleviating the pro-inflammatory milieu in healthy individuals and patients with diabetes or renal failure. Additional long-term high-quality RCTs with larger sample sizes measuring patient-important outcomes are required to strengthen the evidence supporting the effects of low-AGE diets.

Contact author: Nicole Kellow - nicolekellow@live.com.au

NJK is supported by an NHMRC Postgraduate Public Health Scholarship (APP1039709)