Associação do hábito de realizar desjejum com parâmetros antropométricos e metabólicos em pacientes pós-transplante renal

Um estilo de vida mais saudável está associado ao hábito de realizar desjejum e a escolha por alimentos mais saudáveis, podendo prevenir o desenvolvimento de sobrepeso e obesidade, que são comumente observados no primeiro ano pós-transplante renal. Essas complicações metabólicas podem ser fatores de risco para doenças cardiovasculares e demais desfechos negativos. Objetivo: Avaliar a associação do hábito de realizar o desjejum e a qualidade desta refeição com a prevalência de sobrepeso e obesidade em pacientes pós-transplante renal. Métodos: Foram incluídos 119 pacientes, os quais foram avaliados 60 dias após a realização do transplante renal no Hospital de Clínicas de Porto Alegre, RS. O presente estudo trata-se de uma análise secundária de um ensaio clínico randomizado (NCT 02883777). Foram coletados dados sócio demográficos, clínicos, laboratoriais e antropométricos. A realização de desjejum foi avaliada através de um questionário específico de desjejum. Para análise das características clínicas e laboratoriais entre os grupos foram utilizados teste t de Student e qui-quadrado. Para avaliar a qualidade do desjejum, foi utilizado o coeficiente da correlação de Spearman. Resultados: Os grupos foram classificados como consumidores de desjejum (CD) e não consumidores (NCD). Dos 119 pacientes, 74 (62,2%) foram classificados como CD. Os grupos não diferiram quanto à idade (51,1±13,6 anos vs. 46,6 ± 12,6 anos, p=0,075), estado civil (casados) (48; 65,8% vs. 22; 51,2%, p=0,175) e sexo masculino (45; 60,8% vs. 29; 64,4%, p=0,840). Não houve diferença na prevalência de excesso de peso entre os grupos de CD e NCD (38; 51,35% vs. 28; 62,22%, p=0,541) e nos valores de peso (70,0 ± 12,6kg vs. 75,6 ± 16,2kg, p=0,051). Entretanto, a média de índice de massa corporal (IMC) foi maior entre os indivíduos que não realizavam desjejum (25,7 ± 4,1 kg/m2 vs. 27,6 ± 4,7 kg/m2, p=0,025). Contudo, os pacientes que realizavam a primeira refeição do dia, apresentaram taxa metabólica basal mais baixa (1301,1 ± 331,6 kcal vs. 1729,0 ± 499,1 kcal, <0,001). Em relação à qualidade do carboidrato, verificou-se uma carga glicêmica diária classificada como média em ambos os grupos, sendo 107,8g (39,1 – 320,5) vs. 105,6g (52,5 – 210,6), p<0,910, para CD e NCD, respectivamente. A mesma classificação foi encontrada na carga glicêmica do desjejum do grupo dos CD, apresentando-se em 27,2g (±14,9). Quanto ao consumo de fibras diárias do grupo de CD, o valor apresentado foi de 19,2g (±9,2) e dos NCD foi de 18,5g (±11,5), não havendo diferença. Entretanto, o consumo de fibras no desjejum, correlacionou-se positivamente com o consumo diário desse nutriente (r= 0,309; p=0,007), enquanto o consumo energético matinal apresentou correlação negativa com o VET diário (r= -0,389; p <0,001). Conclusão: O presente estudo sugere que o hábito de omitir o desjejum pode estar associado a valores basais mais altos de IMC e que a qualidade do carboidrato e de fibras do desjejum pode repercutir nas escolhas alimentares ao longo do dia.A healthier lifestyle is associated with breakfast eating habit and choosing healthier foods, which can prevent the development of overweight and obesity, both conditions very often observed at the first year after kidney transplantation. These metabolic complications are traditional risk factors for cardiovascular diseases and other negative outcomes. Objective: To evaluate the relationship between of breakfast eating habit and the quality of this meal with the prevalence of overweight and obesity in post-renal transplant patients. Methods: A sample of 119 patients were included and evaluated 60 days after renal transplantation at Hospital de Clínicas de Porto Alegre, RS. The present study is a secondary analysis of a randomized clinical trial (NCT 02883777). For the statistical analysis of clinical and laboratory characteristics between the groups, Student's t-test and chi-square test were used. To evaluate the impact of breakfast quality, the Spearman rank correlation was used. Results: The patients were classified as breakfast consumers (BC) and breakfast skippers (BS). Of the 119 patients, 74 (62.2%) patients were classified as BC. The groups did not differ in age (51.1 ± 13.6 years vs. 46.6 ± 12.6 years, p = 0.075), civil status (48; 65.8% vs. 22; 51.2 %, p = 0.175) and gender (Males: 45, 60.8% vs. 29, 64.4%, p = 0.840). There was no difference in the prevalence of overweight between the groups of BC and BS (38, 51.35% vs. 28, 62.22%, p = 0.541) and body weight values (70.05 ± 12 .6kg vs. 75.6 ± 16.2kg, p = 0.051), while mean body mass index (BMI) was higher among subjects who did not eat breakfast (25.7 ± 4.1 kg/m2 vs. 27. 6 ± 4.7 kg/m2, p = 0.025). However, the patients who performed the first meal of the day presented lower TMB (1301.1 ± 331.6 kcal vs. 1729.0 ± 499.1 kcal, <0.001). Regarding the quality of the carbohydrate, a daily glycemic load was classified as average in both groups, being 107.8g (39.1 – 320.5) vs. 105.6g (52.5 - 210.6), p <0.910, for BC and BS, respectively. The same classification was found in the glycemic load of the group of consumers, presenting in 27.2g (± 14.9). Regarding the daily fiber consumption of the BC group, the value presented was 19.2g (± 9.2) and non-consumers was 18.5g (± 11.5), and there was no difference. However, the consumption of fiber in the breakfast was positively correlated with the daily consumption of this nutrient (r= 0.309, p=0.007), while the morning energy consumption presented a negative correlation with the daily energy consumption (r= -0.389, p <0.001). Conclusion: The present study with kidney transplant patients suggests that the habit of skipping breakfast may be associated with an increased baseline values of BMI and that the carbohydrate and fiber quality of the breakfast can affect food choices throughout the day

Effect of an intensive nutrition intervention of a high protein and low glycemic-index diet on weight of kidney transplant recipients: study protocol for a randomized clinical trial

Abstract Background Excessive weight gain is commonly observed within the first year after kidney transplantation and is associated with negative outcomes, such as graft loss and cardiovascular events. The purpose of this study is to evaluate the effect of a high protein and low glycemic-index diet on preventing weight gain after kidney transplantation. Methods We designed a prospective, single-center, open-label, randomized controlled study to compare the efficacy of a high protein (1.3–1.4 g/kg/day) and low-glycemic index diet versus a conventional diet (0.8–1.0 g/kg/day of protein) on preventing weight gain after kidney transplantation. A total of 120 eligible patients 2 months after transplantation will be recruited. Patients with an estimated glomerular filtration rate through the modification of diet of renal disease (MDRD) formula  300 mg/24 h will be excluded. Patients’ diets will be allocated through simple sequential randomization. Patients will be followed-up for 12 months with nine clinic appointments with a dietitian and the evaluations will include nutritional assessment (anthropometrics, body composition, and resting metabolic rate) and laboratory tests. The primary outcome is weight maintenance or body weight gain under 5% after 12 months. Secondary outcomes include body composition, resting metabolic rate, satiety sensation, kidney function, and other metabolic parameters. Discussion Diets with higher protein content and lower glycemic index may lead to weight loss because of higher satiety sensation. However, there is a concern about the association of high protein intake and kidney damage. Nevertheless, there is little evidence on the impact of high protein intake on long-term kidney function outcome. Therefore, we designed a study to test if a high protein diet with low-glycemic index will be an effective and safe nutritional intervention to prevent weight gain in kidney transplant patients. Trial Registration ClinicalTrials.gov identifier, NCT02883777 . Registered on 3 August 2016