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

BACKGROUND & AIMS: 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. METHODS: A total of 117 patients were evaluated in 2008 (median of 3 years after LTx, range 0-13 years) and in 2012 (median of 7 years after LTx, range 3-17 years) for the presence of MS [using modified NCEP Adult Treatment Panel III and International Diabetes Federation (IDF) criteria]; its components; and its associated factors, including demographic, socioeconomic, lifestyle, clinical, body composition (measured using bioelectric impedance) and dietetic factors. RESULTS: MS increased over the years (IDF, 43.1-53.3%, P=0.12; and NCEP, 34.3-44.8%, P=0.03). Blood glucose increased over the years (98.8±24.7 to 109.2±33.3 mg/dl, P<0.01), which resulted in an increased prevalence of glucose intolerance (34.2-48.6%, P<0.01). Waist circumference (93.3±14.3 to 99.4±14.9 cm, P<0.01) and body fat (30.3±8.9 to 31.8±10.3%, P=0.03) also increased. The MS associated factors (P<0.05) were age [Odds ratio (OR) 1.05, confidence interval (CI) 1.02-1.11], family history of diabetes (OR 3.38, CI 1.19-9.61), body mass index (BMI) prior to liver disease (OR 1.39, CI 1.19-1.63) and body fat (OR 1.09, CI 1.03-1.14). The MS components were associated (P<0.05) with greater age, family history of diabetes, current and previous BMI, body fat, current corticosteroid use, lack of exercise and greater carbohydrate and fat intakes. CONCLUSION: MS prevalence increased over the years after LTx because of the increases in waist circumference and blood glucose. MS and its components are associated with modifiable factors, such as greater BMI, body fat and carbohydrate and fat intake.

Energy expenditure and balance among long term liver recipients.

BACKGROUND: Excessive weight gain in patients undergoing liver transplantation has been well documented. The etiology for this complication is not well defined, although it has a high prevalence in post-transplant patients. Reduced energy expenditure may be related to excessive weight gain. Thus, the assessment of the resting energy expenditure (REE) in this patient population is of utmost importance. METHODS: Therefore, patients who underwent liver transplantation had their REEs measured by indirect calorimetry (IC). These results were compared with the demographic, socioeconomic, clinical, anthropometric, dietary and lifestyle variables assessed by uni- and multivariate statistical analyses. The REEs were also compared to estimates using the Harris-Benedict formula, and the patients were classified as hypo-, normo- and hypermetabolic. RESULTS: We evaluated 42 patients with an average of 6.5 years post-transplant and an REE of 1449.7 kcal/day (measured by IC) or 1404.5 kcal/day (predicted by the HB formula). There was great correlation between the methods, and the best predictors of REE were age, weight, amount of lean mass and amount of total body water. Excessive weight was observed in 57% of patients, and obesity was observed in 26.2%. Underreporting of energy intake was observed in 65.8% of patients, and most patients (92.7%) were classified as sedentary or less active. No patient was classified as hypometabolic. CONCLUSIONS: These results indicate that hypometabolism should be discarded as cause of the high prevalence of overweight and obese patients in the population undergoing LT. However, energy consumption and low levels of physical activity may be risk factors.