Nutritional management of dyslipidaemia in adult kidney transplant recipients

Abstract

Once graft is functioning:• A diet rich in wholegrain, low glycaemic index and high fibre carbohydrates as well as rich sources of vitamin E and monounsaturated fat should be recommended to adult kidney transplant recipients with elevated serum total cholesterol, LDL-cholesterol and triglycerides. (Level III-IV) • Weight reduction in overweight or obese kidney transplant recipients should be encouraged and supported. (Level IV) (Refer to CARI Guideline: Nutritional management of overweight and obesity in adult kidney transplant patients)• Kidney transplant recipients with dyslipidaemia should be advised to eat a diet which reflects the evidence described above while being in line with lipid management guidelines for the general population as follows:1 Carbohydrate Carbohydrate should be consumed predominantly in the form of wholegrains and foods with a low energy density and/or low glycaemic index, aiming for a daily fibre intake of 25 g for females and 30 g for males. The inclusion of the soluble fibre beta-glucan should be encouraged as it has been shown to lower LDLcholesterol in non-transplant populations. 1-4 2 FatTotal fat should contribute 30-35% of total energy intake. Saturated and trans fatty acids together should contribute no more than 8% of total energy intake. n-6 polyunsaturated fat should contribute 8-10% of total energy. Monounsaturated fat may contribute up to 20% of total energy intake. n-3 polyunsaturated fat should be included in the diet as both plant and marine sources. 6,7• Alcohol should be limited to no more than two standard drinks on any day for both men and women. This advice is based on NHMRC guidelines for lifetime health risks associated with daily alcohol consumption by 'healthy' men and women. 8 The potential direct effect of alcohol consumption on serum lipids, as well as the energy yield of alcohol (29 kilojoules per gram) and the contribution it may make to excessive energy intake and weight gain, should also be considered. BACKGROUNDDyslipidaemia is common after renal transplantation, estimated to be present in around 60% of kidney transplant recipients. The definition of dyslipidaemia which has been adopted by the National Kidney Foundation KDOQI, 10 based on that of the Adult Treatment Panel III, 11 is the presence of one or more of the following: total serum cholesterol >200 mg/dL; LDL-cholesterol >130 mg/dL; triglycerides >150 mg/dL; HDL-cholesterol <40 mg/dL. The typical lipid profile of transplant recipients includes elevated total serum cholesterol and low-density lipoprotein cholesterol (LDL-C), with variable high-density lipoprotein cholesterol (HDL-C) and triglycerides. [12][13][14][15] Studies have shown that lipoprotein abnormalities are a persistent problem even 10 years post-transplant. 16,17 The correlation between dyslipidaemia and cardiovascular disease (CVD) risk in non-transplant populations has been well established.11 Several studies have reported a positive association between total cholesterol and atherosclerotic CVD in kidney transplant recipients, si...

Nutrition Care for Renal Transplant Recipients: An Evaluation of Service Delivery and Outcomes

“…), dyslipidaemia (Chadban et al . ) and overweight and obesity (Chadban et al . ) guidelines, providing targeted post‐transplant dietetic care across the first three months.…”

Nutritional Management of Kidney Transplant Recipients

“…In summary, the dietary recommendations for posttransplantation dyslipidemia are in line with national dietary guidelines for healthy adults [58,62] and renal guidelines [78] that a diet should be high in wholegrain, plant foods (including fruit, vegetables and legumes rich NUTRITIONAL MANAGEMENT OF RENAL DISEASE in phytosterols), of low glycemic index, high in dietary fiber (soluble and insoluble) and rich in sources of vitamin E and monounsaturated fats. Overweight/ obese patients should lose weight through an energy controlled diet combined with an increase in exercise.…”

Actualización sobre el papel de la terapia nutricional en pacientes sometidos a trasplante renal: de la enfermedad renal al trasplante

“…A su vez, debe fomentarse la inclusión del ꞵ-glucano de fibra soluble (avena, centeno, cebada, quinoa, amaranto, arroz integral, levaduras, trigo y maíz), ya que ha demostrado reducir el colesterol vinculado a lipoproteínas de baja densidad en las poblaciones que no reciben un trasplante. En el caso de las grasas polinsaturadas n-3, deben incluirse como fuentes vegetales y marinas 28 (Tabla 2).…”