Improving access to ‘healthy food’ may lower risk for post-liver transplant diabetes
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Key takeaways:
- Limited access to healthy food increased risk for new onset post-transplant diabetes in liver transplant recipients.
- These patients also experienced increased all-cause and cardiovascular disease mortality.
PHILADELPHIA — Liver transplant recipients who lived in counties with limited access to healthy food were at higher risk for developing diabetes following transplantation, according to data presented at the ACG Annual Scientific Meeting.
“We undertook this research to explore how food insecurity, a modifiable social determinant of health, might be associated with liver transplant outcomes,” Ashley H. Jowell, MD, MS, an internal medicine resident at Duke University School of Medicine, told Healio. “We specifically focused on the development of new-onset post-transplant diabetes mellitus, which impacts around 20% of transplant recipients and has been associated with inferior post-transplant outcomes.”
She continued: “We were hopeful that the results of our research could have implications for improving post-transplant outcomes and in addressing associated disparities.”
Using United Network for Organ Sharing and the Scientific Registry of Transplant Recipients database, Jowell and colleagues identified 68,273 first-time LT recipients between July 2004 and December 2022 who did not have diabetes at transplant and had at least 1 year of follow-up. The researchers also collected data from USDA Food Environment Atlas and County Health Rankings to determine patients’ access to healthy food, measured via the proportion experiencing food insecurity, the proportion living in food deserts and the presence of food swamps, or areas with high availability of unhealthy rather than healthy food options.
According to the researchers, 15.5% of recipients developed post-transplant diabetes, with 72.1% of cases occurring within 1 year. The majority were aged 40 to 59 years, and nearly two-thirds (65.3%) were men.
The researchers also reported that the proportion of LT recipients who developed diabetes was “nearly twice as high” in counties with the highest food insecurity vs. the lowest (21% vs. 11%; P < .001). Likewise, patients in counties with a high proportion in food deserts were more likely to develop diabetes (19% vs. 13%; P < .001), as were those in food swamps (18% vs. 14%; P < .001). These findings persisted after adjusting for risk factors (highest vs. lowest quartile food insecurity: subHR = 1.58; 95% CI, 1.46-1.71).
“We found that liver transplant recipients living in counties with decreased access to healthy food were more likely to develop new onset post-transplant diabetes, independent of other sociodemographic and transplant-related factors,” Jowell told Healio.
In addition, post-transplant diabetes was linked to higher risk for all-cause mortality (sHR = 1.18; 95% CI 1.13-1.22), cardiovascular disease mortality (sHR = 1.18; 95% CI 1.04-1.35), and mortality as a result of infection (sHR = 1.29; 95% CI 1.13-1.48) and graft loss (sHR = 1.39; 95% CI, 1.22-1.59).
“Improving access to healthy food could therefore decrease the risk of post-transplant diabetes and these associated outcomes,” Jowell told Healio. “Liver transplant recipients may benefit from screening for food insecurity and from interventions to improve access to healthy foods. Possible interventions could include providing information on local resources, partnering with community organizations and offering nutritional education.”
She added: “Future research is needed to evaluate interventions to identify and address food insecurity in the post liver-transplant setting and their impact on the development of new-onset post-transplant diabetes mellitus and other post-transplant outcomes.”
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Jowell AH, et al. Increased rates of post-transplant diabetes among liver transplant recipients with food insecurity. Presented at: ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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