Entry #: 36
Date: 24 February 2018
Section: Mediterranean diet
Topic: Mediterranean diet and thoracic transplant
Type: Human trial
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D. Elizabeth McCord, Nancy B. Ray and Tom C. Karagiannis
Adherence to Mediterranean and low-fat diets among heart and lung transplant recipients: a randomized feasibility study
Entwistle et al
Citation / Year
(1) / 2018
Mediterranean diet, low-fat diet, cardiovascular disease, thoracic transplant, heart transplant, lung transplant
It is well known that heart and lung transplantation is associated with cardiovascular disease leading to increased morbidity and mortality (2, 3). Further, blood pressure, blood lipids and significant weight gain have been observed after thoracic transplantation (4-6). For example, in the first year following lung transplantation an average weight gain of 10 kg has been observed in heart transplant recipients (4). Weight gain is thought to be associated to changes in energy metabolism and adverse of medications has also been implicated (7, 8). In this context, dietary interventions to prevent these effects have not been well-investigated to date. Given that the Mediterranean and low-fat diets have been shown to have beneficial effects in cardiovascular disease (9-12), the overall aim of this study was to investigate adherence to these diets in people receiving a heart or lung transplantation.
Key points and implications
This study represents a randomised clinical trial referred to as the “Assessment of the MEditerraneaN Diet In heart and lung Transplantation” study (AMEND-IT). This was essentially a feasibility study with the overall end-point being to examine whether thoracic transplant recipients would adhere to the assigned Mediterranean or low-fat diets for an intervention period of 12 months and, whether this would persist into a six-week post-intervention period. The total participants that were analysed were stratified as follows: 1) Mediterranean diet (n=20, 10 lung transplant and 10 heart transplant), and 2) low-fat diet (n=19, 9 lung transplant and 10 heart transplant). The Mediterranean diet group was advised to consume a typical diet consisting of vegetables, fruits and wholegrains, with seafood, nuts and, legumes. Importantly, high intake of extra-virgin olive oil was advised with participants receiving a five litre container to encourage consumption. The British Heart Foundation low-fat dietary guidelines were advised for the low-fat diet group.
Overall the findings indicate relatively high adherence to the Mediterranean and low-fat diets, with tangible beneficial effects on anthropometric and biochemical measurements. Adherence to Mediterranean diet significantly increased from baseline over the initial six-month period, reaching a plateau which was maintain until the end of the 12 month intervention period and lasted until at least the six-week post-invention period. Similarly, adherence to the low-fat diet, which was already relatively high at baseline, persisted for the entire study period. Although modest, particularly for the low-fat diet group compare to the Mediterranean diet group, objective reductions were observed in body weight, body mass index, and triglycerides over the intervention period. These findings highlight the potential of dietary interventions, especially with a Mediterranean diet, in managing the increased cardiovascular risk associated with thoracic transplantation. On the basis of this feasibility study, further research in this area, perhaps adopting even more aggressive nutritional intervention, is highly warranted.
- T. R. Entwistle, A. C. Green, J. E. Fildes, K. Miura, Adherence to Mediterranean and low-fat diets among heart and lung transplant recipients: a randomized feasibility study. Nutrition journal 17, 22 (2018).
- L. H. Lund et al., The registry of the International Society for Heart and Lung Transplantation: thirty-first official adult heart transplant report–2014; focus theme: retransplantation. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 33, 996-1008 (2014).
- R. D. Yusen et al., The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Lung and Heart-Lung Transplantation Report–2015; Focus Theme: Early Graft Failure. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 34, 1264-1277 (2015).
- J. J. Williams et al., Excessive weight gain in cardiac transplant recipients. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 25, 36-41 (2006).
- L. G. Singer et al., Weight gain after lung transplantation. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 22, 894-902 (2003).
- C. Kugler et al., Postoperative weight gain during the first year after kidney, liver, heart, and lung transplant: a prospective study. Progress in transplantation 25, 49-55 (2015).
- L. Forli et al., Disturbed energy metabolism after lung and heart transplantation. Clinical transplantation 25, E136-143 (2011).
- M. R. Mehra, Contemporary concepts in prevention and treatment of cardiac allograft vasculopathy. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 6, 1248-1256 (2006).
- F. Fuentes et al., Mediterranean and low-fat diets improve endothelial function in hypercholesterolemic men. Annals of internal medicine 134, 1115-1119 (2001).
- A. Trichopoulou, T. Costacou, C. Bamia, D. Trichopoulos, Adherence to a Mediterranean diet and survival in a Greek population. The New England journal of medicine 348, 2599-2608 (2003).
- W. C. Willett, The Mediterranean diet: science and practice. Public health nutrition 9, 105-110 (2006).
- 12. R. Estruch et al., Primary prevention of cardiovascular disease with a Mediterranean diet. The New England journal of medicine 368, 1279-1290 (2013).