Lucilene Rezende Anastácio

Metabolic syndrome after liver transplantation: prevalence and predictive factors

OBJECTIVES Metabolic syndrome (MetS) is a disorder in which obesity, insulin resistance, high blood pressure and dyslipidemia coexist. This study assessed the prevalence of MetS and its associated factors in patients who underwent orthotopic liver transplantation (OLTx). METHODS Post-OLTx patients were assessed for the presence of MetS according to the diagnostic criteria proposed by the International Diabetes Federation (IDF) and National Heart, Lung, and Blood Institute/American Heart Association (NHLBI/AHA). Demographic, socioeconomic, lifestyle, clinical, anthropometric, and dietary variables were collected to identify predictors for MetS using logistic regression analysis. RESULTS Among the 148 patients assessed, the prevalence of MetS was 50% (IDF criteria) and 38.5% (NHLBI/AHA criteria). For both the IDF and the NHLBI/AHA classifications, the independent factors associated with MetS were older age, shorter time since transplantation, and history of excessive weight prior to OLTx. Other predictors for MetS by IDF criteria were alcohol abuse as the indication for OLTx, physical activity reduction as the cause of weight gain after transplantation, and calcium intake below recommended levels. The presence of MetS (NHLBI/AHA) was also associated with decreased intake of potassium, fiber, and folic acid. CONCLUSIONS MetS is highly prevalent among post-OLTx patients and it is predicted by older age, shorter time since transplantation, alcohol abuse as the cause of cirrhosis, excessive weight prior to OLTx, and some potentially modifiable factors such as physical activity reduction after OLTx and low intake of calcium, potassium, fiber, and folic acid.

Assessment of nutritional status of patients waiting for liver transplantation

Ferreira LG, Anastácio LR, Lima AS, Correia MITD. Assessment of nutritional status of patients waiting for liver transplantation. 
Clin Transplant 2011: 25: 248–254.

Body composition and overweight of liver transplant recipients.

Background. Overweight is often used as a description after liver transplantation (LTx), but studies on body composition of patients submitted to LTx have only been devoted to early postoperative periods; there is little information regarding abdominal obesity after LTx. The aim of this study was to assess body composition, body mass index (BMI), and waist circumference and verify the prevalence and risk factors for excessive weight, obesity, and abdominal obesity in long-term survivors of LTx. Methods. Post-LTx patients with at least 1 year post-LTx were assessed for their body composition (by bioimpedance), BMI, and waist circumference. Demographic, socioeconomic, lifestyle, and clinical and dietetic variables were collected to assess risk factors using linear and logistic regression analyses. Results. We evaluated 143 patients (51±13 years; 59.4% male; median time since LTx: 4 years). The majority of patients had excessive weight, considering BMI, (58.1%). Considering body composition, 69.9% of patients were overweight and 37.8% obese. Some degree of abdominal obesity was seen in 88% of patients. Independent risk factors for overweight, obesity, and abdominal obesity after LTx included greater BMI before liver disease, weight gain since LTx, family history of overweight, smoking, working, being married, having less time since transplantation, a lower calcium intake, and less sleeping hours. Conclusions. The majority of patients are overweight or obese after LTx, and many of the associated risk factors are modifiable. Thus, patients, especially those who already have identified risk factors for overweight and obesity, undergoing LTx should be encouraged to engage in lifestyle changes early.

Resting energy expenditure, body composition, and dietary intake: a longitudinal study before and after liver transplantation.

Background The loss of hepatic innervations after liver transplantation (LTx) might affect the energy metabolism of the patients. The aim of this study was to assess the resting energy expenditure (REE), body composition, and dietary intake before and during the first year after the LTx. Methods The REE was measured by indirect calorimetry. Nutritional status was assessed by anthropometric assessment, bioimpedance, handgrip strength, and dietary intake (before and 30, 90, 180, 270, and 370 days after LTx). Social, clinical, and nutritional variables were assessed as being potentially associated with REE or hypermetabolism and hypometabolism after LTx. Results Seventeen patients were included. REE was elevated at 30 days and reduced at the end of the study (P<0.05). Hypermetabolism/hypometabolism were low but present at the end of the study (11.8% of each). Increases in body weight and fat mass were observed (P<0.05). Handgrip strength and phase angle improved after LTx (P<0.05). Energy balance was positive at all times after LTx, and an increase in fat intake occurred (P<0.05). After multivariate analyses (P<0.05), the REE before transplantation and triceps skinfold thickness were positively associated and the cumulative dose of prednisone was negatively associated with REE after LTx. The presence of hypermetabolism was significantly associated with the presence of hypermetabolism before LTx and the cumulative dose of prednisone. Percentage of fat intake and fat mass before LTx was associated with hypometabolism. Conclusion Some potential modifiable factors are related to resting energy metabolism in patients undergoing LTx. Adequate and individualized nutritional guidance should be started before LTx.

Metabolic syndrome and its components after liver transplantation: Incidence, prevalence, risk factors, and implications

Metabolic syndrome is defined as the mutual existence of obesity, impaired fasting glucose levels, insulin resistance, hypertension, and dyslipidemia. After liver transplantation, patients typically develop these disorders, and even though there has been minimal research focused on the chronic impact of this syndrome on post-liver transplant patients, studies point to an association with major vascular events and fibrosis. The aim of the current work is to review data on the incidence, prevalence, risk factors, and implications of metabolic syndrome and its components in patients who have undergone liver transplantation.

Negative energy balance secondary to inadequate dietary intake of patients on the waiting list for liver transplantation

OBJECTIVES The aim of this study was to evaluate the energy balance (EB) of patients on the waiting list for liver transplantation, using total energy expenditure (TEE) assessment and total caloric intake (TCI). METHODS We analyzed nutrient adequacy and factors associated with it. EB was obtained by subtracting the TCI (obtained by 3-d food record) from TEE, which was measured as resting energy expenditure and physical activity factor calculation. Socioeconomic and clinical data also were evaluated. Univariate and multiple linear regressions were used (P < 0.05). Seventy-three patients were included. RESULTS The TEE was 2318.5 kcal, and the TCI was 1485.1 kcal, with 81.6% of patients presenting with negative EB. There was no significant association between TCI and socioeconomic variables, medications, and encephalopathy (P > 0.05). Women, less-educated patients, those with ascites, and those who were malnourished presented with lower TCI (P < 0.05). Severity of disease, by Child-Pugh and Model for End-Stage Liver Disease scores were associated with EB (P < 0.05). Child-Pugh remained significant after multivariate analyses. Energy inadequacy was observed in 91.8% of patients, and protein inadequacy in 72.6% of patients. Polyunsaturated fatty acid (64.4%) and monounsaturated fatty acid (91.8%) and fiber (94.5%) inadequacies also were high. The percentage of adequate intake was less than 10% for vitamins B5 and D, calcium, folic acid, and potassium, and higher percentages of adequate intake (>80%) were found for iron and vitamins B1 and B12. Moreover, 54.8% and 16.4% of the patients had excessive sodium and cholesterol intakes, respectively. CONCLUSION Negative EB was highly prevalent among patients on the waiting list for liver transplantation, and was associated with the severity of liver disease. Negative EB was primarily affected by low food intake. The food intake data were characterized by low overall energy and protein intake and inadequate composition of the patients diet plan, which tended to be characterized by specific nutrient deficiencies and excesses.

Prospective evaluation of metabolic syndrome and its components among long‐term liver recipients

Survival after liver transplantation (LTx) has increased. Metabolic syndrome (MS) is widely reported in patients in the early years after LTx; few studies have researched this condition in relatively long‐term liver recipients. To describe, prospectively, the prevalence of MS, its components and its associated factors in relatively long‐term liver recipients.

Predictors of mortality in patients on the waiting list for liver transplantation

BACKGROUND AND AIM The demand for liver transplantation (LTx) increases every year, which is in contrast to the stagnation in the number of donors. This phenomenon has given rise to longer waiting times, which results in higher pre-transplantation mortality. Thus, our aim for this study was to identify risk factors, including nutritional variables, for mortality for patients who are on the waiting list for LTx. METHODS Patients on the waiting list were assessed to identify risk factors for mortality. Data related to demographic, socioeconomic, and etiologic factors, liver disease severity, complications, medications, and biochemical tests related to disease, nutritional status, diet intake, and physical activity were collected. RESULTS There were 159 patients followed, and 47.8% (76) were transplanted. The mortality rate while on the waiting list was 25.7% patient-years, and 40 patients died (28.0%). Variables associated with mortality during this period (p < 0.05) were the following: severe malnutrition (OR 2.5/CI: 1.2-5.3), low serum sodium values (OR: 1.1/CI: 1.01-1.2), and cryptogenic cirrhosis (OR: 2.2/CI: 1.1-4.6). CONCLUSIONS Special attention should be given to patients with low serum sodium, those who are diagnosed with cryptogenic cirrhosis and the severely malnourished. An early diagnosis of malnutrition and an appropriate nutritional intervention is mandatory in such patients.

Excesso de peso em pacientes submetidos ao transplante hepático

This review aims to describe the incidence and prevalence of overweight and obesity after liver transplantation and the consequences associated with it. Literature review consultation was conducted in Medline / PubMed, SciELO, EMBASE and LILACS, with the combination of the following keywords: liver transplantation, overweight, obesity, weight gain. Overweight is incident on more than 60% of patients undergoing liver transplantation and obesity rates exceed 20% in the first year after surgery, during which occurs the largest relative weight gain. Studies have shown that between 60% and 70% of patients undergoing liver transplantation are overweight after the third year, 90% with abdominal obesity. Associated factors are, among others, advanced age, family history of overweight and excess weight prior to liver disease. The contribution of immunosuppressive medication remains controversial. Some of the consequences of overweight are liver steatosis, steatohepatitis, diabetes mellitus, hypertension, dyslipidemia, cardiovascular disease and death.

INCIDENCE AND RISK FACTORS FOR DIABETES, HYPERTENSION AND OBESITY AFTER LIVER TRANSPLANTATION

AIM Metabolic disorders are widely described in patients after liver transplantation (LTx). MATERIAL AND METHODS Arterial hypertension, diabetes mellitus and obesity incidence and risk factors were assessed in 144 post-LTx patients at least one year after transplantation (59% male; median age 54 y; median time since transplantation 4 y). Risk factors were assessed using logistic regression analysis according to demographic, socioeconomic, lifestyle, clinical, anthropometric and dietetic variables. RESULTS The incidence of hypertension was 18.9%; diabetes, 14.0% and obesity, 15.9%. Risk factors for the incidence of hypertension were abdominal obesity (OR: 2.36; CI: 1.02-5.43), family history of hypertension (OR: 2.75; CI: 1.06-7.19) and cyclosporine use (OR: 3.92; CI: 1.05-14.70). Risk factor for incidence of diabetes were greater fasting glucose levels (mg/dL) pre-LTx (OR: 1.04; CI: 1.01-1.06) and on the diagnosis of alcoholic cirrhosis as an indication of LTx (OR: 2.54; CI: 0.84-7.72). The incidence of obesity after LTx was related to lower milk consumption (mL) (OR: 1.01; CI: 1.001-1.01; P < 0.05), greater donor BMI (kg/m(2)) (OR: 1.34; CI: 1.04-1.74; P < 0.05), greater BMI prior to liver disease (kg/m(2)) (OR: 1.79; CI: 1.36-2.36; P < 0.01) and a per capita income twice the minimum wage (OR: 5.71; CI: 4.51-6.86; P < 0.05). CONCLUSION LTx was associated with significantly increased rates of hypertension, diabetes and obesity. Furthermore, the incidences of these disorders were related to immunosuppressive therapy and have risk factors that are common in the general population.