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ABSTRACT
Year : 2018  |  Volume : 4  |  Issue : 4  |  Page : 106

Obesity in a patient after renal transplant: Its implications, prevention, and management


Professor, Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India

Date of Web Publication19-Sep-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrnm.jrnm_34_19

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How to cite this article:
Saxena A. Obesity in a patient after renal transplant: Its implications, prevention, and management. J Renal Nutr Metab 2018;4:106

How to cite this URL:
Saxena A. Obesity in a patient after renal transplant: Its implications, prevention, and management. J Renal Nutr Metab [serial online] 2018 [cited 2019 Oct 21];4:106. Available from: http://www.jrnm.in/text.asp?2018/4/4/106/267203



Changes in body composition after renal transplantation are due to increased appetite and reversal of the uremic state, as well as to the immunosuppressive treatment, in particular immediately after surgery. Therefore, two clearly distinct phases regarding nutritional changes are the early and late posttransplant phases. Obesity is associated with decreased graft and patient survival-surgical, metabolic, and cardiovascular complications. Risk factors for atherosclerosis are present in end-stage renal disease patients much before transplantation. Dyslipidemias and vascular calcifications are characterized by elevated triglycerides, low-density lipoprotein (LDL), and very LDL and lower high-density lipoprotein.[1]

Weight gain and obesity are common findings in transplant patients. The development of obesity after renal transplant may be due to several factors, such as (1) feeling of well-being after a successful transplant, with concomitant increase in food intake, (2) increased hemoglobin; (3) improved physical and psychological quality of life; (4) less food restrictions, especially compared to hemodialysis; (5) sedentary lifestyle; (6) greater calorie intake, usually prescribed immediately after transplant; (7) hyperphagia and higher body fat accumulation, related to corticosteroids; and (8) bone disease, which may limit physical activity and decrease energy expenditure. A retrospective study (unpublished observation) of 142 patients, spanning from immediately following to 4 years after transplant, confirmed a significant weight gain during the first year (initial body mass index 21.3 2.8; after 1 year 24.3 3.8 kg/m2; P = 0.01), with stabilization after this period. Despite this significant weight gain, most patients did not show obesity at the end of the observed period. Therefore, the magnitude of weight gain after transplantation seems to be directly correlated with the pretransplant body weight. Recent studies suggest little influence of moderate obesity on transplant outcomes; compared to dialysis, it may even be protective for patient survival. Gender, however, is one factor that possibly should be better explored on this issue. A study performed in a large number of patients demonstrated that obesity was a significant risk factor for mortality in men, but not in women, and for graft loss between both.

By 1 year of transplantation, 60% of the patients gain weight by 10% or more. Causes of weight gain are long-term use of glucocorticoid mediated by their inhibiting effect on lipid peroxidation, episodes of rejection and renal function, physical inactivity, increased appetite, and gluconeogenesis, leading to hyperglycemia and hyperinsulinemia. Hence, nutritional management involves (i) before transplantation, correction of obesity, diabetes, hypertension, and dyslipidemia; (ii) if severe malnutrition is present, artificial nutrition may be suggested; (iii) low carbohydrate diet for 6–12 months can help reduce weight and lipids; (iv) restriction of fat and energy intake to 25 kcal/kg/day; (v) adequate dietary protein to prevent muscle breakdown as a consequence of steroid therapy; and (vi) all obese kidney transplant recipients (KTRs) must be offered a weight reduction program according to the New South Wales Guidelines. Limit carbohydrate to control high glucose and/or triglyceride. Fifty percent of total energy should come from energy as carbohydrates. Limit fat intake to 30% (20 g/day visible fat is recommended), of total energy, advise polyunsaturated fatty acids for cooking and cholesterol <200 mg/day (avoid egg yolk).[2]



 
  References Top

1.
Martins C, Pecoits-Filho R, Riella MC. Nutrition for the post-renal transplant recipients. Transplant Proc 2004;36:1650-4.  Back to cited text no. 1
    
2.
Anita Saxena Hanbook of nutrition in kidney disease Oxford Clinical Practice Series, publishers Oxford University Press.  Back to cited text no. 2
    




 

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