Osté Maryse C J, Corpeleijn Eva, Navis Gerjan J, Keyzer Charlotte A, Soedamah-Muthu Sabita S, van den Berg Else, Postmus Douwe, de Borst Martin H, Kromhout Daan, Bakker Stephan J L
Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
Department of Epidemiology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
BMJ Open Diabetes Res Care. 2017 Jan 13;5(1):e000283. doi: 10.1136/bmjdrc-2016-000283. eCollection 2017.
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.
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.
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.
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.
肾移植受者（RTR）中移植后新发糖尿病（NODAT）的发病率和过早死亡率较高。我们假设地中海式饮食可预防RTR发生NODAT和过早死亡。
对移植肾功能正常超过1年的成年RTR进行一项前瞻性队列研究。通过一份包含177个条目的经过验证的食物频率问卷评估饮食摄入量。根据9分的地中海式饮食评分（MDS）将患者分为两组：低MDS（0 - 4分）与高MDS（5 - 9分）。共有468名RTR符合分析条件。采用逻辑多变量回归分析研究MDS与NODAT的关联，并采用Cox多变量回归模型研究其与全因死亡率的关联。
平均年龄±标准差为51.3±13.2岁，男性占56.6%。约50%的患者MDS较高。在中位随访4.0（四分位间距，0.4 - 5.4）年期间，22名（5%）RTR发生了NODAT，50名（11%）死亡。与低MDS相比，高MDS与较低的NODAT风险（风险比[HR]=0.23；95%置信区间[CI] 0.09至0.64；p = 0.004）和全因死亡率（HR = 0.51；95% CI 0.29至0.89，p = 0.02）均显著相关，且独立于年龄和性别。对其他潜在混杂因素进行调整，包括总能量摄入、身体活动和吸烟状况，并未实质性改变分析结果。
导致高MDS的饮食习惯与较低的NODAT风险相关。这些结果表明，健康的饮食习惯对RTR至关重要。
