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The effect of dietary intervention on weight gains after renal transplantation
1NHS Trust, The Royal Hospitals, Whitechapel, E1 1BB, England.
Objectives:
To determine the effect of early intensive dietary intervention and follow-up on weight gains in newly transplanted renal patients. To provide appropriate dietary advice posttransplant that included advice to reduce weight gains.
Design:
Group A was studied prospectively and group B was studied retrospectively over a period of 1 year posttransplant.
Setting:
Hospital transplant unit: inpatient ward and outpatient clinic.
Patients:
Thirty-three transplant patients were studied: Group A consisted of 11 patients (9 men, 2 women) transplanted consecutively over 2 months, with a mean age of 39 years. Group B consisted of 22 patients (14 men, 8 women) who had been transplanted consecutively 4 years before the study, with a mean age of 40 years. Both groups had functioning grafts (serum creatinine <200 micromol/L [2.2 mg/dL]) over the study period, and similar triple immunosuppressive therapy (prednisolone, cyclosporine, and azathioprine).
Intervention:
Group A received intensive, individualized dietary advice in stages, with regular follow-up for the first 4 months posttransplant. Thereafter group A did not receive any dietary advice or follow-up for the 8 months leading up to 1 year posttransplant. Group B had not received any dietary advice or follow-up posttransplant.
Main Outcome Measure:
Weight gained and body mass index (BMI) at 4 months and at 1 year posttransplant.
Results:
The mean weight (BMI) for group A at baseline, 4 months and at 1 year posttransplant was 67 +/- 13 kgs (24.1 +/- 3.9 kg/m2), 69 +/- 12 kgs (24.6 +/- 3.5 kg/m2), and 73 +/- 12 kgs (26.1 +/- 3.4 kg/m2), respectively. The mean weight (BMI) for group B at baseline, 4 months and at 1 year posttransplant were 67 +/- 11 kgs (23.7 +/- 3.4 kg/m2), 74 +/- 9 kgs (26.3 +/- 3.3 kg/m2), and 79 +/- 12 kgs (27.9 +/- 4 kg/m2), respectively. Analysis of group A showed no significant difference in weight gained and BMI with dietary advice and follow-up at 4 months posttransplant compared with baseline. There was a significant difference in weight gain and BMI at 1 year posttransplant compared with 4 months posttransplant (P = .002, P = .002, respectively). Analysis between groups showed a significantly lower weight gain in group A compared with group B both at 4 months and at 1 year posttransplant (P = .01, P = .01 respectively). Group A had a significantly lower BMI than group B at 4 months and at 1 year posttransplant (P = .003, .006, respectively). At 1 year posttransplant, group A had a mean weight gain of 5.5 kg per patient compared with a mean of 11.8 kg per patient in group B.
Conclusion:
Early intensive dietary advice and follow-up is effective in controlling weight gains in the first year posttransplant. Dietary advice should be an important part of posttransplant treatment.