Implementing a Healthy Eating Strategy after Heart and Lung Transplantation:A Randomised Controlled Feasibility Study

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Abstract

Background: Studies evaluating the possible health-promoting effects of sound nutrition in heart and lung transplant recipients are currently lacking. Despite advances in drug treatment and patient monitoring, lifestyle-associated complications such as obesity, diabetes and cardiovascular disease occur frequently. Following transplantation, a low-fat eating pattern is currently viewed as best standard care. However, a Mediterranean diet based on a varied range of fresh unprocessed foods and supplemented with extra virgin olive oil has demonstrated clinical benefit in various non-transplant populations. The aim of this study was to evaluate the feasibility and acceptability of a Mediterranean vs a low-fat diet intervention in heart and lung transplant recipients, and to assess clinical and biochemical outcomes. Methods: This was a randomised controlled feasibility trial to evaluate a Mediterranean diet supplemented with extra-virgin olive oil, vs a modified low-fat diet in heart and lung transplant recipients at a single centre. In total, 41 clinically stable male and female (median age 55 years) transplant recipients were randomly assigned (1:1) in two separate 12-month waves (n=24 and n=17) to one of these diet interventions. A range of validated food frequency and adherence questionnaires captured changes in participants’ reported eating habits to 6 weeks post-study. Clinical and biochemical analysis was conducted at baseline, 25 and 52 weeks. Telephone and outpatient contact provided a support mechanism to reinforce dietary behavioural change. Caloric intake and physical exercise awareness were discussed, but not promoted. Results: Thirty nine participants completed the trial (95%). Adherence to both interventions improved significantly at week 25, and was maintained at 52 and 58 weeks. Compared with baseline, waist circumference decreased in both groups at week 25 (p=0.024). A decrease in blood pressure and heart rate occurred at 52 weeks in the low-fat group only. At 52 weeks, higher adherence resulted in significant improvements in fasting glucose in the Mediterranean (<4.8%) and low-fat (<5%) groups. This respective pattern was also observed with total cholesterol (≤9% and ≤7%), triglycerides (≤9% and ≤20%) and IGF-1 (≤9% and ≤15%). A significant decrease in the LDL/HDL ratio (≤12%) occurred in the Mediterranean group only. Moreover, clinically relevant lipid and glucose regulation changes were observed in each intervention. Conclusions: The implementation of a prospective 12-month Mediterranean or low-fat diet is feasible and acceptable in a heart and lung transplant outpatient setting. Both interventions were positively associated with improvements in lipid and blood glucose regulation and circulating IGF-1. As part of a multidisciplinary framework, these findings offer an additional therapeutic strategy to optimise outpatient care.

Keyword(s)

Mediterranean diet, Low-fat diet, Heart transplant, Lung transplant, Feasibility

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