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

Objective: 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. Methods: Cross-sectional dietary data from KTR (200 g/day, 22% adherent, median intake [interquartile range]: 110 [41-190] g/day), vegetables (recommendation: >200 g/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% confidence interval] = −0.45 [−0.75, −0.14], P = .004). Polypharmacy (≥5 daily medications) was associated with a lower plant-to-total protein ratio (st.β [95% confidence interval] = −0.43 [−0.82, −0.05], P = .03). Conclusion: 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.