Influence of diet on atherogenic risk in children with renal transplants

Byline: Luis Aldamiz-Echevarria (1), Alfredo Vallo (2), Pablo Sanjurjo (1), Javier Elorz (1), Jose Angel Prieto (1), Jose Ignacio Ruiz (1), Juan Rodriguez-Soriano (2,3) Keywords: Renal transplantation; Atherogenesis; Diet; Fatty acids; Plasma plasminogen activator inhibitor-1 activity; Insulin resistance; Plasma homocysteine concentration Abstract: Cardiovascular disease is one of the main causes of morbidity and mortality in recipients of renal transplants. Although the risk for cardiovascular disease is in part genetically determined, it may also be influenced by diet. The aim of the present study was to analyze the cross-sectional association of dietary intake of nutrients with biochemical markers of atherogenic risk. The influence of diet on the plasma profile of fatty acids was specifically investigated. Twenty-nine children and adolescents (mean age 14 years, range 6--18 years) with stable renal transplants and on a normal diet recorded their food intake for a period of 3 days. The mean calorie intake was 40.6 kcal/kg per day (protein provided 16% of total calories, carbohydrates 45%, and fat 39%). Plasma levels of total cholesterol and low-density lipoprotein-cholesterol were significantly and positively related to intake of monounsaturated fatty acids ( r =0.66, P =0.007 and r =0.62, P =0.02, respectively) and to plasma levels of elaidic acid, a trans fatty acid ( r =0.43, P =0.02 and r =0.54, P =0.01, respectively). Insulin resistance, estimated from values of plasma glucose ( r =0.70, P =0.03), plasma insulin ( r =0.59, P =0.02), and HOMA index ( r =0.62, P =0.01), was also directly related to the intake of monounsaturated fatty acids. Plasma plasminogen activator inhibitor-1 activity correlated positively with total fat intake ( r =0.59, P =0.04). Plasma levels of homocysteine were negatively related to the intake of carbohydrates ( r =-0.62, P =0.02). We conclude that reasonable dietary recommendations to minimize the atherogenic risk in children with stable renal transplants should include a protein intake adjusted to the requirements for age, a large intake of carbohydrates leading to a low glycemic load, and a fat intake of less than 30% of the total calorie intake. The amount of monounsaturated and trans fatty acids in the diet should be especially limited. A sufficient intake of polyunsaturated fatty acids, with an adequate ratio between [omega]6 and [omega]3 components, should also be provided. Author Affiliation: (1) Division of Metabolism, Department of Pediatrics, Hospital de Cruces, Basque University School of Medicine, Bilbao, Pais Vasco, Spain (2) Division of Nephrology, Department of Pediatrics, Hospital de Cruces, Basque University School of Medicine, Bilbao, Pais Vasco, Spain (3) Department of Pediatrics, Hospital de Cruces, Plaza de Cruces s/n, 48903 Baracaldo, Vizcaya, Spain Article History: Registration Date: 19/05/2004 Received Date: 22/01/2004 Accepted Date: 14/05/2004 Online Date: 16/07/2004