Alves, R

Baptista, C

Bastos, M

Carvalheiro, M

Furtado, AL

Loureiro, H

Machado, C

Mota, A

Saldanha, MH

Silva, RS

Name not available

Kidney transplantation and posttransplantation diabetes: nutritional evaluation

CHUC Institutional Repository

Repositório Institucional dos Hospitais da Universidade de Coimbra

Kidney Transplantation and Posttransplantation Diabetes:Nutritional EvaluationH. Loureiro, R.S. Silva, C. Machado, M. Bastos, C. Baptista, R. Alves, A. Mota, L. Furtado,M. Carvalheiro, and H. SaldanhaPROPER NUTRITION is important for a healthy life-style after kidney transplantation. Long-term immuno-suppression proffers an increased risk of cardiovasculardisease and of posttransplantation diabetes.1–3 The graftitself may be affected by the amount of dietary protein, byhyperlipidemia, and by hyperglycemia.4 Obesity is presentin 15% to 20% of patients at the time of transplantation. By1 year after the transplantation the recipients display weightgains of 10% or more.5,6 The prevalence posttransplanta-tion diabetes in our center is 9.8% (1997), demandingcareful attention to the nutritional and metabolic state ofthese individuals.The purposes of this study were to evaluate a group ofpatients who have undergone kidney transplantation withposttransplantation diabetes according to their body massindex (BMI) when submitted to the first intervention anddiscern the most common nutritional errors among thisgroup during a nutritional, therapeutic, and educationalintervention.PATIENTS AND METHODSA sample of 38 among 50 patients who underwent kidney trans-plantation with posttransplantation diabetes was analyzed for age(years), weight (kg), height (cm), BMI (kg/m2), meal number, andphysical activity. The dietitian used clinical information, anthropo-metric data, nutritional history, and prescription of a suitable diet.The balanced and personalized nutrition plan varied between 1700to 2000 Kcal distributed among the three most important and threeinterpolated meals.RESULTSThe 38 patients who underwent kidney transplantation withposttransplantation diabetes had a mean age of 42.2  10.5years (range: 30 to 65 years) in men (n  20) and 56.67 9.37 years (range: 37 to 72 years) in women (n  18). MeanBMI were 24.7  3.1 kg/m2 in men and 29.09  6.05 kg/m2in women, which corresponds to the overweight rangeaccording to the World Health Organization classification.From their nutritional history, we concluded that the aver-age caloric consumption was 2487.3  639.5 Kcal for themen and 2236.46  581.97 Kcal for the women, includingan average protein ingestion of 20.1  3.0% for men and19.89  3.72% for women. The carbohydrate contentaveraged 49.1  9.7% for men and 45.67  6.61% forwomen; the average fat 32.8  8.4% and 34.78  6.18%,respectively. All of the affected patients had sedentarylifestyles with a mean number of meals of three (breakfast,lunch, and a light dinner).DISCUSSIONThe side effects of the immunosuppression drugs steroids,cyclosporine, tacolimus, azathioprine, mycophenolate, andsirolimus lead to a gain in weight or obesity, which signifi-cantly increase morbidity and mortality in kidney transplantrecipients.1–3 The most important problems are hyperten-sion, diabetes, hyperlipidemia, coronary artery disease andaccelerated atherosclerosis. Obesity and diabetes are linkedto certain cancers, including those of the colon, rectum,prostate, and breast.7 Recommendations for diet in theimmediate and long-term posttransplantation period arenecessary.8–10 The preliminary data presented herein isbeing followed by a second evaluation thus we cannotderive final conclusions about nutrition intervention. How-ever, we did observe the common denominator in oursample to be a ponderal excess among females, with themost frequent nutritional error being a low number ofmeals, excessive use of proteins and fat, chiefly by thefemale group, as well as a sedentary lifestyle. Nutritionalintervention is crucial for graft and patients survival.REFERENCES1. Pirsch JD, Armbrust MJ, Knechtle SJ, et al: Transplantation59:631, 19952. UNOS Registry: in Cecka JM, Terasaky Pl (eds): ClinicalTransplants 1995. Los Angeles, Calif:UCLA Tissue Typing Labo-ratory: 1996, p 405From the Departments of Alimentac¸a˜o e Diete´tica (H.L.,R.S.S., C.M., H.S.), Endocrinologia e Diabetes (M.B., C.B., M.C.),Nefrologia and Urologia (R.A.), e Transplantac¸a˜o (A.M., L.F.),Hospitais da Universidade de Coimbra, Coimbra, Portugal.Address reprint requests to H. Loureiro, S. Endocrinologia eDiabetes, Hospitais da Universidade de Coimbra, Praceta MotaPinto, 3000-075 Coimbra, Portugal.© 2003 by Elsevier Science Inc. 0041-1345/03/$–see front matter360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/S0041-1345(03)00321-XTransplantation Proceedings, 35, 1091–1092 (2003) 10913. Steinmuller TM, Graft K-J, Schleicher J, et al: Transplanta-tion 58:669, 19944. Brener BM, Meyer TW, Hosteter TH: N Engl J Med 307:652,19825. Moore LW, Gaber AO: J Renal Nutr 6:21, 19966. Chertow GM, Lazzarus MJ, Melford EL: J Renal Nutr 6:134,19967. Kath R, Schiel R, Muller UA, et al: J Cancer Res Clin Oncol126:412, 20008. Bertolatus JA, Hunsicker LG: In Handbook of Nutrition andthe Kidney, 3rd Ed. Philadelphia, Penn: Lippincott-Raven; 1998, p2949. Patel MG, Mondakini G: J Renal Nutr 8:137, 199810. Jaggers HJ, Allman MA, Chan M: J Renal Nutr. 6:12, 19961092 LOUREIRO, SILVA, MACHADO ET AL

Kidney transplantation and posttransplantation diabetes: nutritional evaluation

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