Progressive improvement in short‐, medium‐ and long‐term graft survival in kidney transplantation patients in Ireland – a retrospective study

It is often quoted that while short‐term graft survival in kidney transplantation has improved in recent years, it has not translated into a commensurate improvement in long‐term graft survival. We considered whether this was true of the entire experience of the national kidney transplant program in Ireland. A retrospective analysis of the National Kidney Transplant Service (NKTS) database was undertaken to investigate patient and graft survival for all adult first deceased donor kidney transplant recipients in Ireland, 1971–2015. Three thousand two hundred and sixty recipients were included in this study. Kaplan–Meier methods were used to estimate survival at each time period post transplant for the various eras of transplantation. Uncensored graft survival has improved over the course of the program in Ireland at various time points despite risk factors for graft failure progressively increasing over successive eras. For example the graft survival at 15 years post transplant has increased from 10% in 1971–1975 to 45% by 1996–2000. Ireland has experienced a progressive improvement in long‐term graft survival following kidney transplantation. Whether these trends are attributable to biological or nonbiological factors is unclear but likely involves a combination of both.     

The effect of the Malaysian Food Guideline guidance on a group of overweight and obese women during Ramadan

Objectives:

To determine the effect of imparting knowledge of the Malaysian Food Guideline (MFG) on a group of overweight and obese women during Ramadan.

Methods:

This intervention study was conducted during the months of Ramadan 2011. A group of 84 Malay Muslim women with a body mass index (BMI) ≥25 kg/m² were recruited. Prior to Ramadan, the respondents were educated regarding MFG, and how to monitor and record their daily food intake in a food diary. Their quantity of food intake, BMI, blood pressure (BP), blood lipid profile, and fasting blood sugar (FBS) were measured before Ramadan as a baseline. Their quantity of food intake was then measured again in the third week, whereas their BMI, BP, blood lipid profile, and FBS were determined on the fourth week of Ramadan.

Results:

At baseline, compared with the MFG recommendations, the intake of protein (107.5%), and milk and dairy products (133%) was higher, whereas the intake of carbohydrates (78.5%), and vegetables and fruits (44.4%) was lower. During Ramadan, carbohydrate intake, BMI, high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL)-C (all p=0.000), triglyceride (p=0.005), and FBS (p=0.002) were reduced, but the TC/HDL-C ratio was increased (p=0.000).

Conclusion:

A month-long Ramadan fast guided by the knowledge of MFG resulted in certain positive changes in this group of respondents. These changes can be a good start for health improvement, provided that they are followed-up after Ramadan.Dietary patterns are often influenced by religious practices. This is because most religions prescribe certain dietary patterns, standards and prohibitions.1 For Muslims, dietary patterns markedly change during the month of Ramadan, when they observe a month-long, obligatory fasting period. During Ramadan, Muslims completely refrain from consuming any food or drink from dawn until dusk. While the frequency of eating normally decreases during Ramadan, whether there is a reduction in quantity and total energy intake remains questionable because dietary practices during Ramadan are influenced by local culture, economic status and individual dietary behavior. Therefore, although rationally, Ramadan should provide a supportive environment for diet control, as food is not easily available during the day (because most food outlets are closed during the daytime during Ramadan in many Muslim countries), on the contrary, Ramadan has become known as a month of feasting in many Muslim societies. Several studies have shown that there are significant increases in protein and carbohydrate intake during Ramadan, and in fact, certain studies have reported significant weight gain during Ramadan.2-7 In this study, an attempt was made to take advantage of the environment of Ramadan to control the quantity of food intake in a group of overweight and obese Malay Muslim women because there is a high probability that the quantity of food consumed by those who are overweight or obese is more than the recommended quantity. The choice of gender in this study was based on the sociodemographic analysis of the Third Malaysia National Health and Morbidity Survey (NHMS III) in 2006, which reported that the prevalence of obesity was significantly higher among women.8 The choice of ethnic group was based on another national study, which observed that the probability of Malay Muslim women becoming obese was 3.63 times higher than in the reference group (that is, Chinese Buddhist women).9 In the present study, the 2010 Malaysian Food Guideline (MFG) was used to increase respondents’ knowledge, and a simple food diary was used to increase their skill in estimating their quantity of food intake. The objectives of this study were to determine the respondents’ pre-Ramadan food consumption and then to observe their dietary changes during Ramadan with the intervention. This study period also provided a good opportunity to study body mass index (BMI), blood pressure (BP), fasting blood lipid profile (that is, total cholesterol (TC), high density lipoprotein-cholesterol [HDL]-C, low density lipoprotein-cholesterol [LDL-C], and triglyceride [TG]), and fasting blood sugar (FBS) changes during Ramadan. Although the study had certain limitations, the findings of this single-group intervention study hopefully provide useful information for the development of health programs to control excess weight gain among Muslims in Malaysia, and specifically programs taking advantage of the environment of Ramadan.