Adherence to Mediterranean and low-fat diets among heart and lung transplant recipients: a randomized feasibility study

Abstract

BackgroundHeart and lung transplant recipients are at a substantially increased risk of cardiovascular disease (CVD). Since both low-fat and Mediterranean diets can reduce CVD in immunocompetent people at high risk, we assessed adherence among thoracic transplant recipients allocated to one or other of these diets for 12 months.MethodsForty-one transplant recipients (20 heart; 21 lung) randomized to a Mediterranean or a low-fat diet for 12 months received diet-specific education at baseline. Adherence was primarily assessed by questionnaire: 14-point Mediterranean diet (score 0–14) and 9-point low-fat diet (score 0–16) respectively, high scores indicating greater adherence. Median scores at baseline, 6 months, 12 months, and 6-weeks post-intervention were compared by dietary group. We further assessed changes in weight, body mass index (BMI) and serum triglycerides from baseline to 12 months as an additional indicator of adherence.ResultsIn those randomized to a Mediterranean diet, median scores increased from 4 (range 1–9) at baseline, to 10 (range 6–14) at 6-months and were maintained at 12 months, and also at 6-weeks post-intervention (median 10, range 6–14). Body weight, BMI and serum triglycerides decreased over the 12-month intervention period (mean weight − 1.8 kg, BMI –0.5 kg/m2, triglycerides − 0.17 mmol/L). In the low-fat diet group, median scores were 11 (range 9–14) at baseline; slightly increased to 12 (range 9–16) at 6 months, and maintained at 12 months and 6 weeks post-intervention (median 12, range 8–15). Mean changes in weight, BMI and triglycerides were − 0.2 kg, 0.0 kg/m2 and − 0.44 mmol/L, respectively.ConclusionsThoracic transplant recipients adhered to Mediterranean and low-fat dietary interventions. The change from baseline eating habits was notable at 6 months; and this change was maintained at 12 months and 6 weeks post-intervention in both Mediterranean diet and low-fat diet groups. Dietary interventions based on comprehensive, well-supported education sessions targeted to both patients and their family members are crucial to success. Such nutritional strategies can help in the management of their substantial CVD risk.Trial registrationThe IRAS trial registry (ISRCTN63500150). Date of registration 27 July 2016. Retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s12937-018-0337-y) contains supplementary material, which is available to authorized users.

Nutritional Requirements of Lung Transplant Recipients: Challenges and Considerations

“…In one of the few nutritional intervention studies performed in LTx recipients, Entwistle et al compared the acceptability and adherence to two dietary interventions, the Mediterranean diet and the Low-Fat Diet, in individuals who had undergone either a lung or heart transplant [ 33 ]. Changes in weight and triglycerides after one year of intervention were used to objectively assess adherence and data from all recipients were analyzed together regardless of the organ transplanted.…”

“…Changes in weight and triglycerides after one year of intervention were used to objectively assess adherence and data from all recipients were analyzed together regardless of the organ transplanted. The Mediterranean diet led to a 1.8 kg and a 0.17 mmol/L reduction in weight and triglycerides levels respectively while the Low-Fat Diet resulted in a modest weight loss of 0.2 kg but a greater decline in serum triglycerides (mean of 0.44 mmol/L) [ 33 ]. Despite the feasibility nature of this trial, these findings underscore the potential of tailored dietary interventions to partially offset the rise in triglycerides levels observed after transplant.…”

Mediterranean-Style Diet for the Primary and Secondary Prevention of Cardiovascular Disease: A Cochrane Review

“…The majority of participants were enrolled in one large multicentre trial with 7747 participants [51]. The majority of participants were described as at increased cardiovascular risk [33,34,40,42,45,49,50,51,52,56,57,60]. One study recruited women with breast cancer [55], two trials recruited only women [34,55].…”

“…One study recruited women with breast cancer [55], two trials recruited only women [34,55]. The trials were conducted in Spain [45,51], Italy [40,49,56], Greece [33,55], France [60], the UK [42,57], Poland [34], Australia 52], and China [50]. The duration of the intervention and follow-up periods varied: three months [40,52,56,60], four months [33,34], six months [49,55], one year [42,50,57], two years [45], and up to five years [51].…”

“…The trials were conducted in Spain [45,51], Italy [40,49,56], Greece [33,55], France [60], the UK [42,57], Poland [34], Australia 52], and China [50]. The duration of the intervention and follow-up periods varied: three months [40,52,56,60], four months [33,34], six months [49,55], one year [42,50,57], two years [45], and up to five years [51]. The dietary interventions in the comparison group varied, including low-fat [33,42,45,50,51,52,57,60], the traditional diet of that country [34], national recommendations/disease-specific guidance [49,55], and vegetarian [40,56].…”