Increased prevalence of malnutrition and reduced lean body mass in overweight/obese kidney transplant recipients

Abstract

Overweight and obesity are common in subjects after kidney transplantation. On the other hand, features of malnutrition are also frequently recognized in this group of patients. The aim of the study was to evaluate the prevalence of both abnormalities in a cohort of stable kidney recipients and to assess whether obesity precludes malnutrition in transplanted patients. We also investigated associations between the nutritional status, graft function and adipokines concentrations. The study was performed in 80 prevalent kidney transplant patients and in a control group which consisted of 23 healthy volunteers. Body composition (% of fat, lean body mass (LBM), water content) was measured by multifrequency bioelectrical impedance (Body Composition Manager). Nutritional status was determined by a 7–point Subjective Global Assessment (SGA), anthropometric measurements and s-albumin concentration. C–reactive protein (CRP), Il–6 and plasminogen activator inhibitor–1 (PAI–1) were used as markers of inflammatory status. Concentration of leptin, adiponectin and visfatin were measured by ELISA. Results: Mean age was 52.4±13.9 years (45 men and 35 women). Diabetes mellitus was present in 29% (n=23) of them. Mean time after transplantation (transplantation vintage) was 82.5±56.5 months (median=73 months). Mean eGFR was 41.7±14.9 ml/min (4 points MDRD), BMI was 25.7±4.2. Overweight was present in 41% of the patients and obesity in 14%. On the basis of SGA evaluation, signs of malnutrition were observed in 48% of the subjects. Malnutrition was present in 64% (21/33) of the overweight patients and in 91% (10/11) of the obese patients. Transplantation vintage was directly associated with fat mass and inversely associated with LBM. Malnourished patients (SGA) had a longer transplantation vintage. Adiponectin levels were significantly lower in transplanted patients as compared to controls. In multivariate analysis, leptin was an independent predictor of serum creatinine level and of eGFR.. The prevalence of concurrent signs of overweight/obesity and malnutrition in the kidney transplant recipients is high