Plasma homocysteine and folate levels and dietary folate intake in adolescents and young adults who underwent kidney transplantation during childhood.

BACKGROUND: Hyperhomocysteinemia (hyper-Hcy) is an important and reversible cardiovascular disease risk factor. We examined the prevalence of hyper-Hcy, plasma folate levels, and dietary folate intake in adolescents and young adults who had undergone kidney transplantation during childhood to assess the necessity for managing dietary folate. METHODS: This cross-sectional study was performed in 89 kidney transplant recipients (age at kidney transplantation: 12.6 ± 4.1 years; age during study: 21.2 ± 5.5 years). Hyper-Hcy and plasma folate deficiency were defined as plasma homocysteine (Hcy) >15 nmol/ml and plasma folate <3.0 ng/ml, respectively. RESULTS: Of the patients, 60 (67.4 %) had hyper-Hcy and 14 (15.7 %) had plasma folate deficiency. Plasma homocysteine levels correlated negatively with estimated glomerular filtration rate (eGFR; r = -0.565, p < 0.01) and plasma folate levels (r = -0.434, p < 0.01). For determinants of plasma homocysteine levels, a priori selected variables included kind of calcineurin inhibitor, age at kidney transplantation, pretransplant duration of dialysis, time since transplantation, age at examination, eGFR, and plasma folate. Stepwise multiple linear regression analysis revealed eGFR and plasma folate levels as significant independent variables influencing plasma homocysteine levels. Dietary folate intake in 11 of 16 patients (66.8 %) with eGFR ≥ 60 ml/min/1.73 m(2) was below the recommended dietary allowance for Japanese. CONCLUSIONS: The prevalence of hyper-Hcy and plasma folate deficiency, as well as the low dietary folate intake, suggest that dietary management of folate is necessary for adolescents and young adults who have undergone kidney transplantation during childhood.

[Nutrient intake and dietary habit in pediatric, adolescent, and young adult kidney transplant recipients].

AIM: Dietary advice by dietitians based on various factors of nutrient intake and dietary habit is important for preventing postoperative complications in adult kidney transplant recipients, but little is known about whether such advice is also important for pediatric, adolescent, and young adult kidney transplant recipients. The purpose of this study was to examine the nutrient intake profiles and dietary habits of these recipients and to ascertain the need for dietary advice by dietitians. SUBJECTS AND METHODS: This study involved 22 kidney transplant recipients with an estimated glomerular filtration rate> or =60 mL/min/1.73 m2 with no dietary restrictions. Nutrient intake was measured using a food frequency questionnaire based on food groups and evaluated using the reference values given in the Dietary Reference Intakes for Japanese (DRIs-J)for 2010 and the daily average intake of the National Health and Nutrition Survey Japan, 2010. RESULTS: The mean age of the patients at the time of enrollment was 17.6+/-4.4 years(8.7 28.5 years). Energy and carbohydrate intakes were below the DRIs-J reference value in 18 patients(81.8 %), and the ratio of total fat to total energy was above the DRIs-J reference value in 20 patients(90.9 %). Vitamin B, vitamin B6, magnesium, and zinc intakes were below the DRIs-J reference value in all patients (100 %). Food group intakes that were less than 75 % of the values reported in the National Health and Nutrition Survey Japan were pulses and algae in 18 patients(81.8 %), green and yellow vegetables in 14 patients(63.6 %), other vegetables in 19 patients(86.4 %), and nuts and seeds in 16 patients(72.7 %). CONCLUSION: This study suggests that dietary advice by dietitians is necessary for pediatric, adolescent, and young adult kidney transplant recipients to improve their nutrient intake and dietary habits.