Diet, Dietary Guideline Adherence, and Clinical Determinants of Diet in Kidney Transplant Recipients: Results of the Active Care After Transplantation Study

<h2>Abstract</h2><h3>Background</h3> Diet-related morbidity is high in kidney transplant recipients (KTR), but detailed dietary assessments are limited. In this study, we evaluated diet and dietary guideline adherence in KTR compared to the general population, and identified KTR-specific dietary determinants. <h3>Methods</h3> Cross-sectional dietary data from KTR (<1 year post-transplantation), obtained using 3-day food diaries at baseline in the <i>[anonymized]</i> Study in four study centers throughout <i>[anonymized]</i>, were analyzed. Food group and nutrient intake were evaluated using Dutch food-based dietary guidelines and Dutch Dietary Reference Values. Results were compared to the national Food Consumption Survey data from the general population. Associations of clinical characteristics with dietary intake were assessed using linear regression. <h3>Results</h3> Dietary assessments of 167 KTR (40% female, age 51.9±13.5 years 147 [94–227] days post-transplantation) showed low dietary guideline adherence for intake of fruits (recommendation: >200 g/day, 22% adherent, median intake [interquartile range]: 110 [41-190] g/day), vegetables (recommendation: >200g/day, 28% adherent, intake: 137 [83-211] g/day), fiber (recommendation: >25 g/day, 26% adherent, intake: 20.5 [16.3-25.8] g/day) and plant-to-total protein ratio (recommendation: >0.50, 12% adherent, intake: 0.37 [0.31-0.45]). Diet of KTR was largely similar to that of the general population and slightly healthier in some aspects, including lower intake of salt, red meat, sugary beverages and soft drinks, and higher soft fat intake. Deceased donor status was associated with lower vegetable intake (st.β (95%CI)=-0.45 (-0.75, -0.14), p=0.004). Polypharmacy (≥5 daily medications) was associated with a lower plant-to-total protein ratio (st.β (95%CI)=-0.43 (-0.82, -0.05), p=0.03). <h3>Conclusion</h3> Dietary guideline adherence in KTR was low and diet was comparable to that of the general population. Considering the high diet-related morbidity burden in KTR, dietary adherence deserves priority as a prevention target in this population, especially in patients with a deceased donor or polypharmacy.