Successful kidney transplantation is associated with weight gain from truncal obesity and insulin resistance

Authors: WORKENEH, BIRUH - Md Anderson Cancer Center; MOORE, LINDA - Methodist Hospital; FONG, JOY V. NOLTE - Methodist Hospital; SHYPAILO, ROMAN - Children'S Nutrition Research Center (CNRC); GABER, A. OSAMA - Methodist Hospital; MITCH, WILLIAM - Baylor College Of Medicine

Submitted to: Journal of Renal Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/1/2019
Publication Date: 11/1/2019
Citation: Workeneh, B., Moore, L.W., Fong, J., Shypailo, R., Gaber, A., Mitch, W.E. 2019. Successful kidney transplantation is associated with weight gain from truncal obesity and insulin resistance. Journal of Renal Nutrition. 29(6):548-555. https://doi.org/10.1053/j.jrn.2019.01.009.
DOI: https://doi.org/10.1053/j.jrn.2019.01.009

Interpretive Summary: Weight gain after kidney transplantation (KT) is common, yet not all the weight gained is necessarily beneficial. In some cases, this weight gain can lead to obesity and to insulin resistance. This in turn may then be associated with diabetes and heart disease and in increased mortality. We studied 31 patients with end stage renal disease. We measured body composition, diet, blood glucose levels, and physical activity before KT and 3 and 12 months after KT. The patients gained weight after KT despite increasing their physical activity – 2.2 kg after 3 months, on average, and 6.6 kg after 12 months. The extra weight was predominantly body fat, and most of the body fat accumulated in the trunk region. There were no significant changes in the amounts of lean body, bone mineral or in muscle. The amount of physical activity did not seem related to the weight gain. Blood glucose tests showed increasing levels of insulin resistance in the group. This was most closely related to increases in the amount of fat accumulating in the visceral region, a region strongly associated with cardiovascular risk. It is important to develop methods to limit the increase of adipose tissue after KT. Limiting dietary fat intake and increasing energy expenditure through physical activity are reasonable targets in preventing insulin resistance in these patients. Additional work is needed to better understand the mechanisms involved, and to explore diet and behavioral interventions.

Technical Abstract: The objective of this study is to compare changes in body composition, lifestyle factors, and metabolic responses occurring in living kidney transplant recipient patients after transplantation.The study was a single-site, prospective, observational study. To identify metabolic responses during the initial years after transplantation, we obtained state-of-the-art, high-resolution measurements of body composition from a 4-compartment model using dual-energy X-ray absorptiometry, air displacement plethysmography, and total body potassium and nitrogen counters. We also assessed dietary recalls and actigraphy before transplantation and 3- and 12-month after transplantation. The study was conducted at a quaternary care hospital outpatient transplant center and a United States Department of Agriculture Agricultural Research Service center. Thirty-one adults receiving a living donor kidney allograft were studied. The main outcome measures were change in body composition at 3 months and 1 year after transplantation, and this was correlated with the occurrence of insulin resistance. In patients receiving a successful kidney transplant from living donors treated with standard immunosuppression, significant increases in body weight were detected at 3 and 12 months after transplantation (2.2 kg, P = .03 and 6.6 kg, P<.0001, respectively). Weight gain was principally due to adipose tissue accumulation in the truncal region. There was no increase in muscle mass or fluid accumulation. Weight gain was not associated with changes in resting energy expenditure or physical activity. Notably, increases in visceral and subcutaneous adipose tissue were positively correlated with insulin resistance. Successful transplantation was associated with increased insulin resistance and weight gain without increases in muscle or fluid. This metabolic pattern suggests potential interventions that could prevent or mitigate the consequences of adipose tissue accumulation in transplant recipients.