title: Mediterranean style diet is associated with low risk of new-onset diabetes after renal transplantation.
abstract: OBJECTIVE
  The incidence of new-onset diabetes after transplantation (NODAT) and premature mortality is high in renal transplant recipients (RTR). We hypothesized that a Mediterranean Style diet protects against NODAT and premature mortality in RTR.
  
  
  METHODS
  A prospective cohort study of adult RTR with a functioning graft for >1 year. Dietary intake was assessed with a 177-item validated food frequency questionnaire. Patients were divided based on a 9-point Mediterranean Style Diet Score (MDS): low MDS (0-4 points) versus high MDS (5-9 points). A total of 468 RTR were eligible for analyses. Logistic multivariable regression analyses were used to study the association of MDS with NODAT and Cox multivariable regression models for the association with all-cause mortality.
  
  
  RESULTS
  Mean±SD age was 51.3±13.2 years and 56.6% were men. About 50% of the patients had a high MDS. During median follow-up of 4.0 (IQR, 0.4-5.4) years, 22 (5%) RTR developed NODAT and 50 (11%) died. High MDS was significantly associated with both a lower risk of NODAT (HR=0.23; 95% CI 0.09 to 0.64; p=0.004) and all-cause mortality (HR=0.51; 95% CI 0.29 to 0.89, p=0.02) compared to low MDS, independent of age and sex. Adjustment for other potential confounders, including total energy intake, physical activity and smoking status, did not materially change the results of the analyses.
  
  
  CONCLUSIONS
  Dietary habits leading to high MDS were associated with lower risk of NODAT. These results suggest that healthy dietary habits are of paramount importance for RTR.
authors.affiliation: Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Maryse C J
authors.initials: MC
authors.lastname: Osté
authors.affiliation: Department of Epidemiology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Eva
authors.initials: E
authors.lastname: Corpeleijn
authors.affiliation: Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Gerjan J
authors.initials: GJ
authors.lastname: Navis
authors.affiliation: Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Keyzer
authors.affiliation: Department of Human Nutrition, University of Wageningen , Wageningen , The Netherlands.
authors.forename: Sabita S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.affiliation: Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Else
authors.initials: E
authors.lastname: van den Berg
authors.affiliation: Department of Epidemiology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Douwe
authors.initials: D
authors.lastname: Postmus
authors.affiliation: Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Martin H
authors.initials: MH
authors.lastname: de Borst
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Human Nutrition,University of Wageningen, Wageningen, The Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
authors.affiliation: Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
keywords: Dietary Patterns; Mortality; Post-Transplant Diabetes; Renal Transplantation