Dietary interventions on the prevention and management of diabetes in post‐kidney transplantation – A systematic review

Abstract

Post-transplant diabetes mellitus is associated with long-term immunosuppression and weight gain, and is related to an increased risk of cardiovascular disease, accelerated loss of graft and increased mortality. There is an absence of strong evidence-based dietary guidelines for the prevention and management of post-transplant diabetes mellitus in kidney transplant recipients. The aim of this study was to systematically review all dietary evidence for kidney transplant recipients on clinical outcomes relating to diabetes, patientreported outcomes and economic outcomes. A comprehensive literature search was conducted in August 2020 using the databases Medline, Embase, CENTRAL and CINAHL.Studies were critically appraised using Cochrane risk of bias tools and GRADE. A total of 12 studies and 1928 participants were included. Four papers focused on diet and exercise, one paper on diet only, two papers on magnesium supplementation, one paper on magnesium and fibre intake, two papers on Mediterranean diet, one paper on marine n-3 fatty acid supplementation and one paper on fruit and vegetable intake. There were no significant effects on outcomes relating to dietary counselling, magnesium supplementation, magnesium and fibre intake or marine n-3 fatty acid supplementation. Low-quality evidence supports the Mediterranean diet in reducing the risk of post-transplant diabetes mellitus and fasting plasma glucose levels. Low-quality evidence suggests vegetable intake being associated with a lower risk of post-transplant diabetes mellitus. This review demonstrates limited evidence for dietary interventions in the prevention and management of diabetes in post-kidney transplantation. The findings suggest that further high-quality research with robust study designs is required.

Obesity and Lifestyle Habits among Kidney Transplant Recipients

“…Efforts should be made to improve adherence to the Mediterranean diet among KT recipients. Previous evidence indicates that the Mediterranean diet could help reduce the risk of post-transplantation diabetes and the metabolic syndrome in KT recipients [ 36 , 37 ], although the quality of available data is low due to heterogeneity of interventions, as well as the duration and outcomes of these studies [ 38 ]. More recently, a study involving 632 KT recipients followed-up for a median of 5.4 years showed that an increasing adherence to Mediterranean diet was associated with a lower risk of graft failure and kidney function decline, as well as graft loss [ 39 ].…”

International consensus on post-transplantation diabetes mellitus

“…Regarding (i), uncertainty exists about the best dietary intervention [ 42 ], as observational evidence only supports Mediterranean diets [ 43 ] or increased vegetable intake [ 44 ]. With (ii), the CAVIAR (Comparing glycaemic benefits of Active Versus passive lifestyle Intervention in kidney Allograft Recipients) RCT implemented a graded exercise program with active dietician intervention (versus leaflet advice), which did not improve pathophysiological markers of glucose metabolism but reduced PTDM incidence [ 45 ].…”

Nutrition Disturbances and Metabolic Complications in Kidney Transplant Recipients: Etiology, Methods of Assessment and Prevention—A Review

“…The 2022 KIDGO guidelines for DM in CKD place nutrition and lifestyle at the base of the pyramid for lowering CV risk [ 53 ]. An increased vegetable intake and Mediterranean dietary patterns may prove beneficial in the prevention and management of PTDM; however, based on a 2022 systematic review, high-quality research is needed to confirm these findings [ 54 ].…”