Background: Renal transplant recipients have an increased incidence of cardiovascular disease. These patients present abnormalities of lipoprotein profile which are persistent and involve an increasing number of individuals, suggesting the opportunity of an early therapeutic intervention. Methods: We evaluated the effects of a 10- to 12-week diet based on the American Heart Association step-one diet criteria, modified with an increased intake of monounsaturated fats and alimentary fibers, on lipid profile and lipid-related cardiovascular risk in 78 normolipidemic and hyperlipidemic renal transplant recipients. Results: Diet led to a significant reduction in total cholesterol levels by 10%, triglycerides by 6.5%, low-density lipoprotein (LDL)-cholesterol by 10.4% and LDL-cholesterol/high-density lipoprotein (HDL)-cholesterol ratio by 10%, whereas HDL-cholesterol levels remained unchanged. Dividing renal transplant recipients into risk classes according to the National Cholesterol Expert Program guidelines and LDL-cholesterol levels, we observed a progressively increasing reduction in total cholesterol and LDL-cholesterol levels among ‘desirable LDL-cholesterol’, ‘borderline high-risk LDL-cholesterol’ and ‘high-risk LDL-cholesterol’ patients, while HDL-cholesterol levels did not change in any group and the LDL-cholesterol/HDL-cholesterol ratio significantly decreased in ‘borderline high-risk LDL-cholesterol’ and in ‘high-risk LDL-cholesterol’ patients (respectively by 6.8%, p < 0.05, and by 21.1%, p < 0.0001). Reduction in triglyceride levels was statistically significant only in subjects with ‘desirable LDL-cholesterol’ (by 12.3%, p < 0.01). Patients in the ‘desirable LDL-cholesterol’ class increased from 28 (35.9% of total patients) before diet to 45 (57.7% of total patients, p < 0.01), while subjects in the ‘high-risk LDL-cholesterol’ class reduced from 24 (30.8% of total patients) to 8 (10.2% of total patients, p < 0.005). Conclusion: These data suggest the possibility of a nutritional hypolipidemic approach in renal transplant recipients, even if normolipidemic. Dietetic treatment determined an inversion in the typical trend of renal transplant recipients, reducing instead of increasing the number of subjects with hypercholesterolemia, permitting the selection of individual candidates for further pharmacological treatment by carefully evaluating risk/benefit costs.

Keywords:
Cardiovascular risk, Mediterranean diet, Nutrition, Plasma lipids, Renal transplant recipients
1.
Bagdade D, Casaretto A, Albers J: Effects of chronic uremia, hemodialysis and renal transplantation on plasma lipids and lipoproteins in man. J Lab Clin Med 1976;87:37–48.
2.
Kasiske BL: Risk factors for accelerated atherosclerosis in renal transplant recipients. Am J Med 1984;84:985–992.
3.
Chan MK, Varghese Z, Persaud JW, Fernando ON, Moorhead JF: The role of multiple pharmaco-therapy in the pathogenesis of hyperlipidemia after renal transplantation. Clin Nephrol 1981;15:309–313.
4.
Bittar AE, Ratcliffe PJ, Richardson AJ, et al: The prevalence of hyperlipidemia in renal transplant recipients. Associations with immunosuppressive and antihypertensive therapy. Transplantation 1990;50:987–992.
5.
Gokal R, Mann JI, Moore RA, Morris PJ: Hyperlipidemia following renal transplantation: A study of the prevalence, natural history and dietary treatment? Q J Med 1979;48:507–517.
6.
Disler PB, Goldberg RB, Kuhn L, Meyers AM, Joffe BI, Seftel HC: The role of diet in the pathogenesis and control of hyperlipidemia after renal transplantation. Clin Nephrol 1981;16:29–34.
7.
Kasiske BL, Umen AJ: Persistent hyperlipidemia in renal transplant patients. Medicine 1987;66:309–316.
8.
Averna MR, Barbagallo CM, Sparacino V, et al: Follow-up of lipid and apoprotein levels in renal transplant recipients. Nephron 1991;58:255–256.
9.
Massy ZA, Ma JZ, Louis TA, Kasiske BL: Lipid-lowering therapy in patients with renal disease. Kidney Int 1995;48:188–198.
10.
East C, Alivizatos PA, Grundy SM, Jones PH, Farmer JA: Rhabdomyolysis in patients receiving lovastatin after cardiac transplantation. N Engl J Med 1988;318:47–48.
11.
Koegh A, Day R, Critchley L, Duggin G, Baron D: The effect of food and cholestiramine on the absorption of cyclosporine in cardiac transplant recipients. Transplant Proc 1988;20:27–30.
12.
Shen SY, Lukens CW, Alongi SV, Sfeir RE, Dagert FJ, Sadler JH: Patient profile and effect of dietary therapy in post transplant hyperlipidemia. Kidney Int 1983;24(suppl 16):147–152.
13.
Moore RA, Callahan MF, Cody M, et al: The effect of American Heart Association step one diet on hyperlipidemia following renal transplantation. Transplantation 1990;49:60–62.
14.
Nelson J, Beauregard H, Gelinas M, et al: Rapid improvement of hyperlipidemia in kidney transplant patients with a multifactorial hypolipidemic diet. Transplant Proc 1988;20:1264–1270.
15.
Lal SM, Trivedi HS, Van Stone JC, Ross G Jr: Effects of dietary therapy on post renal transplant hyperlipidemia. A prospective study. Int J Artif Org 1994;17:461–465.
16.
Tonstad S, Holdaas H, Gorbitz C, Ose L: Is dietary intervention effective in post-transplant hyperlipidemia? Nephrol Dial Transplant 1995;10:82–85.
17.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel II). JAMA 1993;269:3015–3022.
18.
Rivellese AA, Mancini M: Populations diets influencing cardiovascular risk. Curr Opin Lipidol 1991;1:16–19.
19.
Ferro-Luzzi A, Branca F: Mediterranean diet, Italian-style: Prototype of a healthy diet. Am J Clin Nutr 1995;61(suppl 6):1338–1345.
20.
Roschlau P: enzymatische Bestimmung des Gesamte-Cholesterins in Serum. Chem Klin Biochem 1974;12:226–227.
21.
Wahalefeld AW: Triglyceride determination after enzymatic hydrolysis; in Bergmeyer HU (ed): Methods of Enzymatic Analysis, vol 4. New York, Academic Press, 1974, pp 1831–1835.
22.
Lopez-Virella HF, Stone P, Ellis J, Coltwell LA: Cholesterol determination in the HDL separated by precipitation with polianions. J Lipid Res 1970;11:583–595.
23.
Friedewald WT, Levy RJ, Frederickson DS: Estimation of the concentration of low density lipoproteins cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1980;18:499–502.
24.
Snedecor GW, Cochran WG: Statistical Methods. Ames, Iowa State University Press, 1964.
25.
Bagdade JD, Porte D Jr, Bierman EL: Hypertriglyceridemia: A metabolic consequence of chronic renal failure. N Engl J Med 1968;279:181–185.
26.
Chan MK, Varghese Z, Moorhead JF: Lipid abnormalities in uremia, dialysis, and transplantation. Kidney Int 1981;19:625–637.
27.
Averna MR, Barbagallo CM, Galione A, et al: Serum apolipoprotein profile of hypertriglyceridemic patients with chronic renal failure on hemodialytic therapy: A comparison with type IV hyperlipoproteinemia. Metabolism 1989;38:601–602.
28.
Savdie E, Gibston JC, Stewart JH, Simons LA: High density lipoprotein in chronic renal failure and after renal transplantation. Br Med J 1979;i:928–930.
29.
Barbagallo CM, Averna MR, Sparacino V, et al: Lp(a) levels in end-stage renal failure and renal transplantation. Nephron 1993;64:560–564.
30.
Ettinger WH, Bender WL, Goldberg AP, Hazzard WR: Lipoprotein lipid abnormalities in healthy renal transplant recipients: Persistence of low HDL2 cholesterol. Nephron 1987;47:17–21.
31.
Webb AT, Reaveley DA, O’Donnell M, O’Connor B, Seed M, Brown EA: Does cyclosporine increase lipoprotein(a) concentrations in renal transplant patients? Lancet 1993;341:268–270.
32.
Black IW, Wilcken DEL: Decreases in apolipoprotein(a) after renal transplantation: Implications for lipoprotein(a) metabolism. Clin Chem 1992;38:353–357.
33.
Chapman JR, Marcen R, Arias M, Raine AEG, Dunnil MS, Morris PJ: Hypertension after renal transplantation. Transplantation 1987;43:860–864.
34.
Henkin Y, Garber DW, Osterlund LC, Darnell BE: Saturated fats, cholesterol and dietary compliance. Arch Intern Med 1988;152:1167–1174.
35.
Salen P, de Lorgeril M, Boissonnat P, et al: Effects of French Mediterranean diet on heart transplant recipients with hypercholesterolemia. Am J Cardiol 1995;73:825–827.
36.
Sanders TA: Dietary fatty acids: effects on lipid metabolism. Curr Opin Lipidol 1990;1:14–17.
1999
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