Low Vegetable Intake is Associated with High Risk of New-Onset Diabetes After Renal Transplantation

A.W. Gomes Neto, M.C.J. Osté, E. van den Berg, R.O.B. Gans, J.M. Geleijnse, S.J.L. Bakker, G.J. Navis

Thursday 15 march 2018

15:20 - 15:25h at Willem Burger Foyer

Categories: Clinical, Session (poster)

Parallel session: Poster session 3: Clinical

Background & Objectives

New-Onset Diabetes After Transplantation (NODAT) occurs in 4-25% of renal transplant recipients (RTR) and increases risk of cardiovascular disease, graft failure and mortality in this population. NODAT is generally attributed to adverse effects of immune-suppressants (i.e. steroids and tacrolimus), however little is known about whether the risk of NODAT is modifiable by dietary factors, such as fruit and vegetable intake. Therefore we investigated whether fruit and vegetable intake is associated with risk of NODAT in RTR.

Methods

This study was conducted in the Transplantlines Food and Nutrition Biobank Cohort Study of 707 adult RTR with a functioning graft for ≥ 1 year. Dietary intake was assessed using a validated Food Frequency Questionnaire consisting of 177 food items. RTR with a medical history of diabetes or RTR missing dietary data were excluded, leaving 473 RTR eligible for analyses. RTR were considered to have NODAT when ≥ 1 of the following criteria was met: repeated fasting plasma glucose ≥ 7.0 mmol/l, HbA1c ≥ 6.5%, or anti-diabetic drug use. Cox regression analysis was used to study whether fruit and vegetable intake were associated with risk of NODAT.

Results

 Mean ± SD age was 51.3±13.2 years, 57% were male. Median [IQR] fruit and vegetable intake was 99 [44-192] g/d and 108 [72-154] g/d, respectively. Only 22% met the recommended intake for fruit (200g/d), and only 11% met the recommended intake for vegetables (200g/d). During median follow-up of 5.3 years, 52 RTR (7%) developed NODAT. Fruit intake was not associated with risk of NODAT (HR 0.91 [95%CI 0.80-1.04] per ²log g/d, P = 0.013; P_trend=0.32 when analyzed in tertiles_). Vegetable intake was inversely associated with NODAT (HR 0.77; 95%CI 0.63-0.94 per ²log g/d, P = 0.009; P_trend=0.02). RTR in the lowest tertile of vegetable intake (median intake: 54 [34-72] g/d) had more than 2 times higher risk of NODAT compared to RTR in the highest tertile of vegetable intake (median intake: 175 [153-216] g/d), independent after adjustment for age, sex, time after transplantation, total energy intake, and physical activity (HR 2.23; 95%CI 1.11-4.52).

Conclusion

 The majority of RTR do not meet the recommended intake of vegetable and fruit. Low vegetable intake is associated with higher risk of NODAT. Stimulating vegetable intake may reduce risk for NODAT in RTR. This study shows that even in the context of allegedly iatrogenic diabetes, dietary factors are important.