A PRELIMINARY STUDY OF CARDIOVASCULAR RISK BEHAVIORS IN ADOLESCENT TRANSPLANT PATIENTS

Abstract

690 After transplantation, many adolescents experience significant weight gain coupled with poor physical activity. These changes are generally believed to be related to the improved feeling of well being, increased appetite, and altered metabolism associated with immunosuppressive drugs and transplantation. Since renal transplant recipients' life expectancies are increasing, long term risk factors for cardiovascular disease must be addressed. To deter risk factors and help encourage compliance, an educational program including diet, medication, and risk behaviors was instituted at the time of transplantation and twice yearly thereafter. The primary purpose of this study was to determine the effectiveness of the current education program. Patients (24) receiving care at the University of Alabama at Birmingham were enrolled: median 17 months post-transplant (range 1-152), 75% male/25% female, 58% white/42% black, median age 17 years (range 13-23). Anthropo-metric data demonstrated 67% of subjects with moderate to severe growth retardation, 72% were overweight to morbidly obese (based on percent ideal body weight and body mass index), triceps skinfolds showed that 82% were obese with mildly to severely increased fat stores, mid-arm muscle circumferences indicated that 88% had mild to severe muscle wasting and protein depletion. Other data related to cardiovascular risk factors (blood pressure, lipid levels) were evaluated: 86% of subjects had significantly elevated BP, 50% had elevated cholesterol, 40% had elevated triglycerides, and 40% had elevated LDL-C and VLDL-C. Significant correlations were noted between cyclosporine levels and total cholesterol and LDL-C. To determine patient behaviors, subjects completed the Youth Risk Behavior Survey and were found to be significantly less physically active than the reference YRBSS students. To determine dietary intake, subjects completed a 3 day diet diary and 24 hour diet recall. In spite of diet education, 28% of the subjects responded that they were on no special diet, and only 5.6% described the prescribed diet regimen. Though approximately 72% were considered to be obese, 78% were below Recommended Dietary Allowances for calories. This suggests the diet records were not reliable predictors of actual intake. These data suggest that the majority of these patients are obese with a high percentage of their body composition as fat, have significantly elevated lipid levels, poorly controlled hypertension, and decreased physical activity. All of these have been demonstrated to increase their risk for cardiovascular disease. Clearly new approaches to patient care and education are needed.