Role of Dietary Intervention on Metabolic Abnormalities and Nutritional Status After Renal Transplantation

Bruna Guida; Rossella Trio; Roberta Laccetti; Annamaria Nastasi; Elena Salvi; Nunzia Ruggiero Perrino; Carmela Caputo; Eliana Rotaia; Stefano Federico; Massimo Sabbatini

Disclosures

Nephrol Dial Transplant. 2007;22(11):3304-3310. 

In This Article

Abstract and Introduction

Background: In these last years, several traditional risk factors for cardiovascular disease, like obesity, dyslipidaemia, hypertension and post-transplant diabetes mellitus have been also identified as important non-immunological risk factors leading to the development of chronic allograft nephropathy, the first cause of graft loss in transplanted patients. The aim of the present study was to determine the effects of a 12-month dietary regimen on the nutritional status and metabolic outcome of renal transplant recipients in the first post-transplant year.
Methods: Forty-six cadaver-donor renal transplant recipients (mean age 40.8 ± 10.1-years), enrolled during the first post-transplant year (4.8 ± 3.3 months) and followed prospectively for a 12 month period. Biochemical and nutritional markers, anthropometric measurements, body composition (by conventional bioelectrical impedance analysis) and dietary records (using a detailed food-frequency questionnaire) at baseline and after 12 months.
Results: Compliance to the diet was related to sex (male better than female) and was associated with weight loss primarily due to a decrease in fat mass, with decrease in total cholesterol and glucose plasma levels and with a concomitant rise in serum albumin.
Conclusion: After renal transplantation, health benefits of proper metabolic balance that include reduced body fat, weight loss, lower cholesterol and triglycerides levels and an improvement, fasting glucose levels can be obtained when dietary intervention occurred.

The importance of metabolic factors in conditioning the outcome of a renal graft is widely recognized. There is strong evidence, in fact, that the presence of metabolic syndrome (MS), which includes obesity, dyslipidaemia, hypertension and reduced tolerance to glucose, is associated with impaired renal allograft function after the first post-transplant year[1] and may strongly influence the onset and the progression of cardiovascular (CV) diseases: many of the traditional CV risk factors, in fact, lead to the development of chronic allograft dysfunction (CAD).[2] The optimal control of metabolic abnormalities and the prevention of MS, therefore, should be considered mandatory for the correct management of renal transplant patients.

The first year after transplantation is crucial in determining important modifications in body weight and body mass index (BMI) and in developing hyperlipidaemia (HLP) or altered peripheral resistance to glucose.[3] A recent study by de Vries et al.[1] has stressed the difficulty to treat efficaciously these metabolic alterations once they have established, clearly suggesting the need of an 'early' therapeutic intervention to correct the poor dietary habits of transplant patients, further influenced by a reduced renal function, the presence of proteinuria, the use of immunosuppressive drugs, or by dialysis-related problems. It is well known, in fact, that moderately obese patients gain more weight after transplantation than patients with a normal BMI[4] and that patients with a familiar history of diabetes are more prone to develop reduced tolerance to glucose when treated with tacrolimus; thus, prevention of metabolic risk factors must start when the patients still are on the waiting list.[5]

Several studies have investigated the modifications of nutritional status after kidney transplantation, but only a few of them have described these changes during a controlled dietary regimen, started in the first months after transplantation. Therefore, the aim of the present work was to determine the effects of a 12-month dietary regimen on some of the parameters defining the MS and on the nutritional status of renal transplant recipients.

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