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Clinical care/education/nutrition/psychosocial research
Mediterranean style diet is associated with low risk of new-onset diabetes after renal transplantation
  1. Maryse C J Osté1,
  2. Eva Corpeleijn2,
  3. Gerjan J Navis1,
  4. Charlotte A Keyzer1,
  5. Sabita S Soedamah-Muthu3,
  6. Else van den Berg1,
  7. Douwe Postmus2,
  8. Martin H de Borst1,
  9. Daan Kromhout2,3,
  10. Stephan J L Bakker1
  1. 1Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  3. 3Department of Human Nutrition, University of Wageningen, Wageningen, The Netherlands
  1. Correspondence to Maryse C J Osté; m.c.j.oste{at}umcg.nl

Abstract

Objective The incidence of new-onset diabetes after transplantation (NODAT) and premature mortality is high in renal transplant recipients (RTR). We hypothesized that a Mediterranean Style diet protects against NODAT and premature mortality in RTR.

Research design and methods A prospective cohort study of adult RTR with a functioning graft for >1 year. Dietary intake was assessed with a 177-item validated food frequency questionnaire. Patients were divided based on a 9-point Mediterranean Style Diet Score (MDS): low MDS (0–4 points) versus high MDS (5–9 points). A total of 468 RTR were eligible for analyses. Logistic multivariable regression analyses were used to study the association of MDS with NODAT and Cox multivariable regression models for the association with all-cause mortality.

Results Mean±SD age was 51.3±13.2 years and 56.6% were men. About 50% of the patients had a high MDS. During median follow-up of 4.0 (IQR, 0.4–5.4) years, 22 (5%) RTR developed NODAT and 50 (11%) died. High MDS was significantly associated with both a lower risk of NODAT (HR=0.23; 95% CI 0.09 to 0.64; p=0.004) and all-cause mortality (HR=0.51; 95% CI 0.29 to 0.89, p=0.02) compared to low MDS, independent of age and sex. Adjustment for other potential confounders, including total energy intake, physical activity and smoking status, did not materially change the results of the analyses.

Conclusions Dietary habits leading to high MDS were associated with lower risk of NODAT. These results suggest that healthy dietary habits are of paramount importance for RTR.

  • Renal Transplantation
  • Dietary Patterns
  • Post-Transplant Diabetes
  • Mortality

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjdrc-2016-000283

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    Footnotes

    • Contributors MCJO analyzed the data and wrote the first draft of the paper. EC, GJN, CAK, DK and SJLB contributed to the interpretation of the results and important intellectual content. MCJO, EB, CAK and MHdB collaborated in the data collection. All authors had access to the data, contributed to the critical revision of the manuscript and approved the final version of the manuscript.

    • Funding This work was supported by a grant from the Dutch Top Institute Food and Nutrition (A-1003).

    • Competing interests None declared.

    • Ethics approval METc 2008/186.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.