Metabolic syndrome-related dietary pattern and risk of mortality in kidney transplant recipients

Qingqing Cai*, Maryse C J Osté, António W Gomes-Neto, Louise H Dekker, Karin J Borgonjen-van den Berg, Johanna M Geleijnse, Stephan J L Bakker, Martin H de Borst, Gerjan J Navis

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND AND AIMS: Presence of the metabolic syndrome (MetS) importantly contributes to excess mortality in kidney transplant recipients (KTRs). However, it is unclear which dietary factors drive the adverse role of MetS in KTRs. We aimed to define a dietary pattern that maximally explained the variation in MetS components, and to investigate the association between this MetS-related dietary pattern (MetS-DP) and all-cause mortality in KTRs.

METHODS AND RESULTS: We included 429 adult KTRs who had a functioning graft ⩾1 year. A MetS-DP was constructed using habitual dietary intake derived from a 177-item food frequency questionnaire. We used reduced rank regression (RRR), and defined the six components of MetS (waist circumference, systolic blood pressure, diastolic blood pressure, serum triglycerides, HbA1c, and HDL cholesterol) as response variables and 48 food groups as predictor variables. We evaluated the association between the MetS-DP and all-cause mortality using multivariable Cox regression analysis. The MetS-DP was characterized by high intakes of processed meat and desserts, and low intakes of vegetables, tea, rice, fruits, milk, and meat substitutes. During a mean follow-up of 5.3 ± 1.2 years, 63 KTRs (14.7%) died. Compared to the lowest tertile of the Mets-DP score, those with the greatest adherence had a more than 3-fold higher risk of all-cause mortality (hazard ratio [HR] = 3.63; 95% confidence interval [CI], 1.70-7.74, P < 0.001), independent of potential confounders.

CONCLUSIONS: We identified a MetS-related dietary pattern which was independently associated with all-cause mortality in KTRs. The association between this dietary pattern and all-cause mortality was mediated by MetS. Clinical trial reg. no. NCT02811835.

Original languageEnglish
Pages (from-to)1129-1136
Number of pages8
JournalNMCD : Nutrition, Metabolism and Cardiovascular Diseases
Issue number4
Publication statusPublished - 9-Apr-2021


  • Kidney transplant recipients
  • Reduced rank regression
  • Mortality
  • Metabolic syndrome
  • Dietary pattern

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