Patel M G
NHS Trust, The Royal Hospitals, Whitechapel, E1 1BB, England.
J Ren Nutr. 1998 Jul;8(3):137-41. doi: 10.1016/s1051-2276(98)90005-x.
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.
Group A was studied prospectively and group B was studied retrospectively over a period of 1 year posttransplant.
Hospital transplant unit: inpatient ward and outpatient clinic.
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).
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.
Weight gained and body mass index (BMI) at 4 months and at 1 year posttransplant.
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.
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.
确定早期强化饮食干预及随访对新移植肾病患者体重增加的影响。提供移植后的适当饮食建议，包括减轻体重增加的建议。
对A组进行前瞻性研究，对B组在移植后1年进行回顾性研究。
医院移植科：住院病房和门诊诊所。
研究了33例移植患者：A组由11例患者（9名男性，2名女性）组成，在2个月内连续移植，平均年龄39岁。B组由22例患者（14名男性，8名女性）组成，在研究前4年连续移植，平均年龄40岁。两组在研究期间移植肾均功能良好（血清肌酐<200微摩尔/升[2.2毫克/分升]），且接受相似的三联免疫抑制治疗（泼尼松龙、环孢素和硫唑嘌呤）。
A组在移植后的前4个月分阶段接受强化、个性化的饮食建议，并定期随访。此后，在移植后1年的前8个月，A组未接受任何饮食建议或随访。B组移植后未接受任何饮食建议或随访。
移植后4个月和1年时的体重增加量和体重指数（BMI）。
A组在基线、移植后4个月和1年时的平均体重（BMI）分别为67±13千克（24.1±3.9千克/平方米）、69±12千克（24.6±3.5千克/平方米）和73±12千克（26.1±3.4千克/平方米）。B组在基线、移植后4个月和1年时的平均体重（BMI）分别为67±11千克（23.7±3.4千克/平方米）、74±9千克（26.3±3.3千克/平方米）和79±12千克（27.9±4千克/平方米）。对A组的分析显示，与基线相比，移植后4个月接受饮食建议和随访时，体重增加量和BMI无显著差异。与移植后4个月相比，移植后1年时体重增加量和BMI有显著差异（分别为P = 0.002，P = 0.002）。两组间分析显示，移植后4个月和1年时，A组的体重增加量均显著低于B组（分别为P = 0.01，P = 0.01）。移植后4个月和1年时，A组的BMI均显著低于B组（分别为P = 0.003，0.006）。移植后1年时，A组患者平均体重增加5.5千克，而B组患者平均体重增加11.8千克。
早期强化饮食建议和随访对控制移植后第一年的体重增加有效。饮食建议应成为移植后治疗中的重要组成部分。
