title: Intake of n-3 fatty acids and long-term outcome in renal transplant recipients: a post hoc analysis of a prospective cohort study.
abstract: Supplementation with n-3 fatty acids may improve long-term outcomes of renal transplant recipients (RTR). Recent evidence suggests that EPA and DHA have different outcomes compared with α-linolenic acid (ALA). We examined the prospective associations of EPA-DHA and ALA intakes with graft failure and all-cause mortality in 637 RTR. During 3·1 years (interquartile range 2·7, 3·8) of follow-up, forty-one developed graft failure and sixty-seven died. In age- and sex-adjusted analyses, EPA-DHA and ALA intakes were not associated with graft failure. EPA-DHA intake was not significantly associated with mortality (hazard ratio (HR) 0·79; 95% CI 0·54, 1·15 per 0·1 energy% difference). ALA intake was significantly associated with mortality (HR 1·17; 95% CI 1·04, 1·31 per 0·1 energy% difference). This association remained following adjustments for BMI, proteinuria and intakes of fat, carbohydrate and protein. RTR in the highest tertile of ALA intake exhibited about 2-fold higher mortality risk (HR 2·21; 95% CI 1·23, 3·97) compared with the lowest tertile. In conclusion, ALA intake may be associated with increased mortality in RTR. Future RCT are needed to confirm these results.
authors.affiliation: 1Internal Medicine,University of Groningen and University Medical Center Groningen,PO Box 30.001, 9700 RB Groningen,The Netherlands.
authors.forename: Ilse G
authors.initials: IG
authors.lastname: Pranger
authors.affiliation: 1Internal Medicine,University of Groningen and University Medical Center Groningen,PO Box 30.001, 9700 RB Groningen,The Netherlands.
authors.forename: Eke G
authors.initials: EG
authors.lastname: Gruppen
authors.affiliation: 1Internal Medicine,University of Groningen and University Medical Center Groningen,PO Box 30.001, 9700 RB Groningen,The Netherlands.
authors.forename: Else
authors.initials: E
authors.lastname: van den Berg
authors.affiliation: 3Division of Human Nutrition,Wageningen University,Stippeneng 4, 6708 WE Wageningen,The Netherlands.
authors.forename: Sabita S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.affiliation: 1Internal Medicine,University of Groningen and University Medical Center Groningen,PO Box 30.001, 9700 RB Groningen,The Netherlands.
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.affiliation: 1Internal Medicine,University of Groningen and University Medical Center Groningen,PO Box 30.001, 9700 RB Groningen,The Netherlands.
authors.forename: Rijk O B
authors.initials: RO
authors.lastname: Gans
authors.affiliation: 2Laboratory Medicine,University of Groningen and University Medical Center Groningen,PO Box 30.001, 9700 RB Groningen,The Netherlands.
authors.forename: Frits A J
authors.initials: FA
authors.lastname: Muskiet
authors.affiliation: 2Laboratory Medicine,University of Groningen and University Medical Center Groningen,PO Box 30.001, 9700 RB Groningen,The Netherlands.
authors.forename: Ido P
authors.initials: IP
authors.lastname: Kema
authors.affiliation: 1Internal Medicine,University of Groningen and University Medical Center Groningen,PO Box 30.001, 9700 RB Groningen,The Netherlands.
authors.forename: Michel M
authors.initials: MM
authors.lastname: Joosten
authors.affiliation: 1Internal Medicine,University of Groningen and University Medical Center Groningen,PO Box 30.001, 9700 RB Groningen,The Netherlands.
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004032:Diet / Q000009:adverse effects*; D019587:Dietary Supplements / Q000009:adverse effects*; D004281:Docosahexaenoic Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D057566:Self Report; D055815:Young Adult; D017962:alpha-Linolenic Acid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D017962:alpha-Linolenic Acid; D004281:Docosahexaenoic Acids; D015118:Eicosapentaenoic Acid
keywords: 
                 n-3 Fatty acids;  ALA α-linolenic acid;  En% energy percentage;  HR hazard ratio;  IQR interquartile range;  RTR renal transplant recipients; Graft failure; Mortality; Renal transplant recipients