Improving Adherence to Mediterranean Diet to prevent or reduce Metabolic Syndrome in Heart Transplanted Patients

The Metabolic Syndrome (MetS) is a multi-factorial condition, which enhances the risk to develop chronic related diseases. Despite many advances in patients’ management and pharmacological treatment, MetS represents a real burden in heart transplanted (HTx) patients, mainly due to the side effects of immunosuppressive therapy which severely affects their long-term outcomes. The improvement of dietary habits seems to represent an effective strategy to reduce the MetS in general population, decreasing the cardiovascular risk factors. Among all, number of studies associate the Mediterranean diet (MedDiet) to a reduction of cardiovascular incidence and of all-cause mortality. Unfortunately, dietary programs for the long-term period after HTx are not yet adequately provided in the routine follow-up of these patients. The first Aim of this PhD research was to assess the prevalence of MetS in HTx patients at the University Hospital of Udine, since 2007, and evaluate the impact on the long-term outcome in terms of morbidity and mortality. Through a retrospective collection of clinical data, we observed that more than half (52%) of the patients were affected by MetS at 5 years of follow-up and that the early development of this condition, both before and within 1 year of HTx, were associated to a worst survival and to a higher risk to develop cardiac allograft vasculopathy. Since the beneficial effects of MedDiet on cardiovascular risk factors, the second Aim of the project was to assess the adherence to the MedDiet of 143 HTx patients. Through the administration of a validated Food Frequency Questionnaire (FFQ) we observed an overall weak adherence to the MedDiet, together with an inadequate consumption of many healthy foods characteristic of this dietary pattern. Finally, the Aim 3 was to evaluate any beneficial effect of a structured and personalized dietary intervention in a sample of HTx patients. Changes were compared at baseline and at each timepoint, within the intervention group and between the intervention and the control group, which followed general nutritional advices. The variables of interest were the adherence to the MedDiet, clinical, anthropometric, body composition and blood parameters data, and general dietary habits. Fifteen patients were recruited for the intervention group versus 13 in the control group. The comparison between intervention and control group occurred at baseline and at the intermediate meeting, after 6 months, reached by 11 patients of the intervention group versus and 10 patients of the control group. The analysis within the intervention group included also the final meeting, after 12 months, reached by 7 patients. The main findings were: 1) MedDiet adherence significantly increased in the intervention group during the study period, both comparing the intervention and the control group, and within the intervention group over the three timepoints; 2) moreover, parameters of body composition in the intervention group significantly changed over the study period, with a significant decrease of fat mass % and a subsequent increase of fat free mass %, and body cell mass %; also waist circumference decreased on average of -1.3±2.6cm. Furthermore, both blood pressure and renal function resulted significantly improved in the intervention group versus the control group, at the intermediate timepoint. 3) finally, dietary habits of the intervention group showed an improvement of macronutrients balance, a significant decrease of energy from saturated fatty acids and soluble sugars, and a positive trend to micronutrients intake. Concluding, we confirmed that the implementation of a structured and personalized dietary programme may be feasible in HTx population and exerts many beneficial effects. The future goal will be to offer a nutritional education, in line with the MedDiet principles, to all HTx patients at the University Hospital of Udine.