Modifying dietary patterns in cardiothoracic transplant patients to reduce cardiovascular risk: The AMEND‐IT Trial

Abstract

Background Cardiovascular disease (CVD) is common after cardiothoracic transplantation and causes substantial morbidity. Aims To assess feasibility and potential effectiveness of dietary interventions to reduce CVD risk. Materials and Methods In a pilot intervention, we recruited patients from a tertiary hospital and randomly allocated them to a Mediterranean or low‐fat diet for 12 months. Feasibility was measured by patient participation, retention, and adherence. Changes in weight, body mass index (BMI), heart rate, blood pressure, glucose markers, and blood lipids were assessed using longitudinal generalized estimating equation regression models with 95% confidence intervals. Results Of 56 heart and 60 lung transplant recipients, 52 (45%) consented, 41 were randomized, and 39 (95%) completed the study with good adherence to randomized diets. After 12 months, changes in many risk factors were seen in the Mediterranean and low‐fat‐diet groups, respectively, including mean BMI (–0.5 vs. 0.0 kg/m2), systolic/diastolic blood pressure +0.5/+0.1 vs –4.4/–3.5 mmHg; fasting glucose –0.26 vs –0.27 mmol/L; total cholesterol –0.56 vs –0.40 mmol/L. Changes in BMI and systolic/diastolic blood pressure in 49 eligible patients who did not take part were +0.7 kg/m2 and +2.5/+1.8 mmHg. Discussion Dietary interventions in cardiothoracic transplant patients are feasible and potentially beneficial. Conclusion A definitive nutritional intervention study in these high‐risk patients is warranted.

Long‐term changes in body weight and serum cholesterol in heart transplant recipients

“… 26 Cholesterol and triglyceride levels decreased with both diets. 26 Likewise, among 42 Italian HTRs followed‐up for 48 months, those who adhered to dietary advice reduced weight and lipids, while those who did not increase weight and lipids at 12 and 48 months. 21 Similar beneficial effects on weight and blood lipids were observed after a 6‐month lifestyle intervention.…”

“…While the primary approach to treating dyslipidaemia in HTRs is through medications, dietary approaches favorably combat lipid and weight increases 21 . In a UK feasibility study, 41 thoracic transplant recipients were randomly allocated to either a Mediterranean or low‐fat diet for 12 months, and showed weight reduction in the former (−1.8 kg), negligible weight gain in the latter (.2 kg), but 2‐kg gain in those who did not participate 26 . Cholesterol and triglyceride levels decreased with both diets 26 .…”

“…In a UK feasibility study, 41 thoracic transplant recipients were randomly allocated to either a Mediterranean or low‐fat diet for 12 months, and showed weight reduction in the former (−1.8 kg), negligible weight gain in the latter (.2 kg), but 2‐kg gain in those who did not participate 26 . Cholesterol and triglyceride levels decreased with both diets 26 . Likewise, among 42 Italian HTRs followed‐up for 48 months, those who adhered to dietary advice reduced weight and lipids, while those who did not increase weight and lipids at 12 and 48 months 21 .…”

Association of diet quality and weight increase in adult heart transplant recipients

“…In a dietary intervention study among thoracic transplant recipients in England, baseline diet was found to be low in fruit and vegetables 8 . In the same study, the weight of HTRs decreased slightly after 12 months of dietary intervention, whereas the weights of control HTRs who did not participate in the study, increased 9 . Similarly, in a study of US HTRs at least 12 months post‐transplantation, 50% (14/24) were consuming high‐fat diets (≥ 37% energy from fats) and significantly increased their mean weight (73 kg pre‐transplant to 83 kg 12 months post‐transplant p < 0.05) 10 .…”

“…8 In the same study, the weight of HTRs decreased slightly after 12 months of dietary intervention, whereas the weights of control HTRs who did not participate in the study, increased. 9 Similarly, in a study of US HTRs at least 12 months post-transplantation, 50% (14/24) were consuming high-fat diets (≥ 37% energy from fats) and significantly increased their mean weight (73 kg pretransplant to 83 kg 12 months post-transplant p < 0.05). 10 Dietary studies of other organ transplant recipient groups have also shown low adherence to recommended diets, with subsequent weight increase.…”