Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Diabetes Care. 2019 Sep;42(9):1645-1652. doi: 10.2337/dc19-0224. Epub 2019 Jul 11.
Posttransplantation diabetes mellitus (PTDM) contributes to risk for cardiovascular morbidity and mortality in renal transplant recipients (RTRs). In the general population, consumption of a diet containing few fruits and vegetables predisposes to type 2 diabetes. The role of diet as a potential modifiable risk factor for PTDM has not been explored. Our focus was to investigate the prospective associations of fruit and vegetable intake with risk of PTDM in stable RTRs.
We included 472 adult RTRs who had a functioning graft ≥1 year. Fruit and vegetable intake was assessed by using a 177-item food frequency questionnaire. PTDM was defined according the American Diabetes Association's diagnostic criteria for diabetes.
During 5.2 years of follow-up, 52 RTRs (11%) developed PTDM. Fruit intake was not associated with PTDM (hazard ratio [HR] 0.90 [95% CI 0.79-1.03] per log g/day; = 0.13), whereas vegetable intake was inversely associated with PTDM (HR 0.77 [95% CI 0.63-0.94] per log g/day; = 0.009). Mediation analyses revealed that ±50% of the association between vegetable intake and PTDM was mediated by variations in key components of the metabolic syndrome (i.e., HDL cholesterol, triglycerides, and waist circumference) as determined by the National Cholesterol Education Program's Adult Treatment Panel III Expert Panel.
In this study vegetable intake, but not fruit intake, was associated with lower risk of PTDM in RTRs, likely largely through beneficial effects on key components of the metabolic syndrome. These findings further support accumulating evidence that supports a recommendation of higher vegetable intake by RTRs.
移植后糖尿病（PTDM）会增加肾移植受者（RTR）发生心血管疾病发病率和死亡率的风险。在普通人群中，水果和蔬菜摄入量低会增加 2 型糖尿病的发病风险。饮食作为 PTDM 的潜在可改变的危险因素的作用尚未被探索。我们的重点是研究水果和蔬菜摄入量与稳定 RTR 中 PTDM 发病风险的前瞻性相关性。
我们纳入了 472 名移植后至少 1 年肾功能正常的成年 RTR。采用 177 项食物频率问卷评估水果和蔬菜的摄入量。根据美国糖尿病协会的糖尿病诊断标准定义 PTDM。
在 5.2 年的随访期间，52 名 RTR（11%）发生了 PTDM。水果摄入量与 PTDM 无关（风险比[HR] 0.90 [95%CI 0.79-1.03]； = 0.13），而蔬菜摄入量与 PTDM 呈负相关（HR 0.77 [95%CI 0.63-0.94]； = 0.009）。中介分析显示，蔬菜摄入量与 PTDM 之间 50%的关联可由代谢综合征的关键成分（即高密度脂蛋白胆固醇、甘油三酯和腰围）的变化所介导，这是由国家胆固醇教育计划成人治疗专家组 III 确定的。
在这项研究中，蔬菜摄入量与 RTR 中 PTDM 的低风险相关，而水果摄入量与 PTDM 无关，这可能主要是通过对代谢综合征的关键成分产生有益影响。这些发现进一步支持了越来越多的证据，支持建议 RTR 增加蔬菜摄入量。
