Contenuto dell'articolo principale
Abstract
INTRODUZIONE E SCOPO: L'incremento di peso si osserva frequentemente nei pazienti sotto- posti a Trapianto di Fegato. Questa condizione è spesso associata allo sviluppo di altre compli- canze che potrebbero influenzare la sopravvivenza a lungo termine. Tuttavia, i fattori di rischio non sono stati ancora chiarificati. Lo scopo dello studio è di rilevare la prevalenza di sovrappeso e obesitaÌ€, e la variazione del BMI nei tre anni successivi al trapianto, e di identificare i fattori di rischio associati.
METODO: Sono stati retrospettivamente reclutati i soggetti sottoposti a Trapianto di Fegato, presso la Fondazione IRCCS " CaÌ€ Granda – Ospedale Maggiore Policlinico" di Milano dal 1° Gennaio 2005 al 30 Giugno 2014.Sono stati reperiti parametri clinici, biochimici e farmaco- logici, alla dimissione e ad 1,2,3 anni dal trapianto di fegato.
RISULTATI: Sono stati inclusi 145 soggetti, 95(66%) uomini, 53 anni (44-59), 48(33%) affetti da Cirrosi HBV+HDV correlata, 30(21%) da Cirrosi Etiltossica. Alla dimissione il BMI dei soggetti era 21.9 Kg/m2 e la prevalenza di sovrappeso era del 14%; gli stessi parametri dopo 1,2 e 3 anni di follow-up erano, rispettivamente, 25.6 Kg/m2 e 40%, 25.5 Kg/m2 e 41%, 25.4 Kg/m2 e 37%. L'incremento medio di peso corporeo, durane il primo anni, è stato di 9.8 Kg(p<0.001) mentre solamente di 0.9 Kg e 0.5 Kg durante il secondo e terzo anno. Nessuna correlazione tra l'aumento ponderale e i parametri considerati.
CONCLUSIONI: L'incremento ponderale e lo sviluppo di obesitaÌ€ sono preponderanti nel primo anno post trapianto; cioÌ€ è probabilmente dovuto alla dieta inadeguata e all'inattivitaÌ€ fisica.
PAROLE CHIAVE: Obesità, sovrappeso, Indice di Massa Corporea, Incremento ponderale, trapianto di fegato
ABSTRACT
BACKGROUND AND AIM: Weight gain is frequently observed among liver transplanted patients. This condition is often associated to the development of other post LT morbidities which might influence the long-term post-transplant survival. However, the risk factors asso- ciated have not yet been identified. The aim of this study was to assess the prevalence of over- weight and obesity, to notice Body Mass Index changes and associated risk factors, within three years after LT.
METHODS: All the patients consecutively transplanted at the Liver Transplantation Unit of Fondazione IRCCS "Cà-Granda Ospedale Maggiore Policlinico", Milan between January 2005 and June 2014 were retrospectively evaluated for inclusion. Clinical, Biochemical and pharmaco- logical data were collected at hospital discharge and at 1st,2nd and 3rd years post-LT. RESULTS: 145 patients, 95(66%) male, 53 years (44-59 yr), 48(33%) HBV+HDV positive and 30(21%)alcohol abusers pre LT, were enrolled. At hospital discharge patients' BMI was 21.9 Kg/m2 (IQR: 20.1-24.1 Kg/m2) and the prevalence of overweight was 14%. The same para- meters after 1,2 and 3 years of follow-up were 25.6 Kg/m2 and 40%, 25.5 Kg/m2 and 41%, 25.4 Kg/m2 and 37%. The main weight gain was 9.8 Kg(p<0.001) during the 1st year after LT while only 0.9 Kg and 0.5 Kg during the 2nd and 3rd year, respectively, No correlation between weight gain and any clinical, biochemical and pharmacological parameters considered was observed.
DISCUSSION: The weight gain and the development of obesity are predominant during the first year after LT; this is probably due to an improper diet and lack of physical activity.
KEYWORDS: Obesity, Overweight, Body Mass Index, Weight gain, liver transplantation
Dettagli dell'articolo
Riferimenti
- Anastácio, L. R., Lima, A. S., & Toulson Davisson Correia, M. I. (2010). Metabolic syndrome and its components after liver transplantation: Incidence, prevalence, risk factors, and implications. Clinical Nutrition, 29(2), 175–179. https://doi.org/10.1016/j.clnu.2009.08.008
- Anastácio, L. R., Pereira, M. C. de A., Vilela, E. G., Lima, A. S., & Correia, M. I. T. D. (2013). Excesso de peso em pacientes submetidos ao transplante hepático. Revista Do Colégio Brasileiro de Cirurgiíµes, 40(6), 502–507. https://doi.org/10.1590/S0100-69912013000600014
- Da Silva Alves, V. (2014). Estado Nutricional, Perfil Lipídico Y Homa-Ir En El Postransplante Hepatico. Nutricion Hospitalaria, (5), 1154–1162. https://doi.org/10.3305 /nh.2014.29.5.6861
- Fussner, L. A., Heimbach, J. K., Fan, C., Dierkhising, R., Coss, E., Leise, M. D., & Watt, K. D. (2015). Cardiovascular disease after liver transplantation: When, What, and Who Is at Risk. Liver Transplantation: Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 21(7), 889–896. https://doi.org/10.1002/lt.24137
- Gebhardt, S., Jara, M., Malinowski, M., Seehofer, D., Puhl, G., Pratschke, J., & Stockmann, M. (2015). Risk factors of metabolic disorders after liver transplantation: an analysis of data from fasted patients. Transplantation, 99(6), 1243–1249. https://doi.org/10.1097/TP. 0000000000000499
- Giusto, M. (2014). Changes in nutritional status after liver transplantation. World Journal of Gastroenterology, 20(31), 10682. https://doi.org/10.3748/wjg.v20. i31.10682
- Kouz, J., Vincent, C., Leong, A., Dorais, M., & Räkel, A. (2014). Weight gain after orthotopic liver transplantation: Is nonalcoholic fatty liver disease cirrhosis a risk factor for greater weight gain?: Weight Gain After Liver Transplantation. Liver Transplantation, 20(10), 1266–1274. https://doi.org/10.1002/lt.23951
- L. Rezende Anastácio, L. G. F. (2012). Sobrepeso, Obesidad Y Aumento De Peso Hacia Tres Años Después Del Trasplante Hepático. Nutricion Hospitalaria, (4), 1351–1356. https://doi.org/10.3305/nh.2012.27.4.5768
- Lucilena Rezende Anastácio, H. de S. R. (2013). Incidencia Y Factores De Riesgo Para La Diabetes, La Hipertensión Y La. Nutricion Hospitalaria, (3), 643–648. https://doi.org/10.3305/nh.2013.28.3.6193
- Lunati, M. E., Grancini, V., Agnelli, F., Gatti, S., Masserini, B., Zimbalatti, D., ... Orsi, E. (2013). Metabolic syndrome after liver transplantation: short-term prevalence and pre- and post-operative risk factors. Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 45(10), 833–839. https://doi.org/10.1016/j.dld.2013.03.009
- Mesut, A., Yasin, B., Sedat, K., Tarkan, U., Aylin, B., & Ibrahim, A. (2013). Prevalence and Risk Factors for Obesity After Liver Transplantation: A Single-Center Experience. Hepatitis Monthly, 13(8). https://doi.org/10.5812/hepatmon.7569
- Ribeiro, H. S., Anastácio, L. R., Ferreira, L. G., Lima, A. S., & Correia, M. I. T. D. (2014). Energy expenditure and balance among long term liver recipients. Clinical Nutrition, 33(6), 1147–1152. https://doi.org/10.1016/ j.clnu.2013.12.015
- Ruiz-Rebollo, M. L., Sánchez-Antolín, G., García-Pajares, F., Fernández-Orcajo, P., González-Sagrado, M., Cítores-Pascual, M. A., ... Caro-Patón, A. (2010). Risk of Development of the Metabolic Syndrome After Orthotopic Liver Transplantation. Transplantation Proceedings, 42(2), 663–665. https://doi.org/10.1016/ j.transproceed.2010.02.018
- Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2010). Infermieristica medico-chirurgica. (4th ed., Vol. 1). Milano: CEA.
- Song, A. T. W. (2014). Liver transplantation: Fifty years of experience. World Journal of Gastroenterology, 20(18), 5363. https://doi.org/10.3748/wjg.v20.i18.536
Riferimenti
Anastácio, L. R., Lima, A. S., & Toulson Davisson Correia, M. I. (2010). Metabolic syndrome and its components after liver transplantation: Incidence, prevalence, risk factors, and implications. Clinical Nutrition, 29(2), 175–179. https://doi.org/10.1016/j.clnu.2009.08.008
Anastácio, L. R., Pereira, M. C. de A., Vilela, E. G., Lima, A. S., & Correia, M. I. T. D. (2013). Excesso de peso em pacientes submetidos ao transplante hepático. Revista Do Colégio Brasileiro de Cirurgiíµes, 40(6), 502–507. https://doi.org/10.1590/S0100-69912013000600014
Da Silva Alves, V. (2014). Estado Nutricional, Perfil Lipídico Y Homa-Ir En El Postransplante Hepatico. Nutricion Hospitalaria, (5), 1154–1162. https://doi.org/10.3305 /nh.2014.29.5.6861
Fussner, L. A., Heimbach, J. K., Fan, C., Dierkhising, R., Coss, E., Leise, M. D., & Watt, K. D. (2015). Cardiovascular disease after liver transplantation: When, What, and Who Is at Risk. Liver Transplantation: Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 21(7), 889–896. https://doi.org/10.1002/lt.24137
Gebhardt, S., Jara, M., Malinowski, M., Seehofer, D., Puhl, G., Pratschke, J., & Stockmann, M. (2015). Risk factors of metabolic disorders after liver transplantation: an analysis of data from fasted patients. Transplantation, 99(6), 1243–1249. https://doi.org/10.1097/TP. 0000000000000499
Giusto, M. (2014). Changes in nutritional status after liver transplantation. World Journal of Gastroenterology, 20(31), 10682. https://doi.org/10.3748/wjg.v20. i31.10682
Kouz, J., Vincent, C., Leong, A., Dorais, M., & Räkel, A. (2014). Weight gain after orthotopic liver transplantation: Is nonalcoholic fatty liver disease cirrhosis a risk factor for greater weight gain?: Weight Gain After Liver Transplantation. Liver Transplantation, 20(10), 1266–1274. https://doi.org/10.1002/lt.23951
L. Rezende Anastácio, L. G. F. (2012). Sobrepeso, Obesidad Y Aumento De Peso Hacia Tres Años Después Del Trasplante Hepático. Nutricion Hospitalaria, (4), 1351–1356. https://doi.org/10.3305/nh.2012.27.4.5768
Lucilena Rezende Anastácio, H. de S. R. (2013). Incidencia Y Factores De Riesgo Para La Diabetes, La Hipertensión Y La. Nutricion Hospitalaria, (3), 643–648. https://doi.org/10.3305/nh.2013.28.3.6193
Lunati, M. E., Grancini, V., Agnelli, F., Gatti, S., Masserini, B., Zimbalatti, D., ... Orsi, E. (2013). Metabolic syndrome after liver transplantation: short-term prevalence and pre- and post-operative risk factors. Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 45(10), 833–839. https://doi.org/10.1016/j.dld.2013.03.009
Mesut, A., Yasin, B., Sedat, K., Tarkan, U., Aylin, B., & Ibrahim, A. (2013). Prevalence and Risk Factors for Obesity After Liver Transplantation: A Single-Center Experience. Hepatitis Monthly, 13(8). https://doi.org/10.5812/hepatmon.7569
Ribeiro, H. S., Anastácio, L. R., Ferreira, L. G., Lima, A. S., & Correia, M. I. T. D. (2014). Energy expenditure and balance among long term liver recipients. Clinical Nutrition, 33(6), 1147–1152. https://doi.org/10.1016/ j.clnu.2013.12.015
Ruiz-Rebollo, M. L., Sánchez-Antolín, G., García-Pajares, F., Fernández-Orcajo, P., González-Sagrado, M., Cítores-Pascual, M. A., ... Caro-Patón, A. (2010). Risk of Development of the Metabolic Syndrome After Orthotopic Liver Transplantation. Transplantation Proceedings, 42(2), 663–665. https://doi.org/10.1016/ j.transproceed.2010.02.018
Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2010). Infermieristica medico-chirurgica. (4th ed., Vol. 1). Milano: CEA.
Song, A. T. W. (2014). Liver transplantation: Fifty years of experience. World Journal of Gastroenterology, 20(18), 5363. https://doi.org/10.3748/wjg.v20.i18.536