Challenging Weight Gain and Obesity: An Opportunity for Dietary Management after Successful Kidney Transplantation

Abstract

Several factors contributing to post-transplant weight gain and obesity may occur during pre-, peri-, and/or post-transplant periods. The main factors are summarized in Figure 1. Pre-transplant periodDuring the pre-transplant period, there are several factors related to advanced CKD and ESRD that potentially increase the risk for post-transplant weight gain and obesity. These main risk factors include:Pre-transplant obesity: Data from a single kidney transplant center revealed that around one-third of ESRD patients were AbstractWeight gain and obesity are common after kidney transplantation. Several known risk factors for obesity in non-transplant population remain to be the important determining factors for obesity in kidney transplant recipients. In addition, some factors related to kidney transplantation contribute to post-transplant weight gain and obesity. These factors can occur during pre-, peri-, and/or post-transplant periods. During pre-transplant period, underlying conditions such as metabolic syndrome place the patients at risk for obesity after kidney transplantation. Positive fluid balance during peri-transplant period transiently causes posttransplant weight gain. Post-operative pain from surgical wounds limits physical activities and prevents weight loss especially in patients with pre-transplant obesity. Immunologic and non-immunologic factors during post-transplant period can become barriers to lose weight or even perpetuate obesity. Among of these factors, inappropriate dietary and nutrition management plays an important role in post-transplant weight gain and obesity. Apart from the dietary aspect, there are other factors contributing to post-transplant weight gain and obesity and these include the individual patient and their family, kidney transplant team through education and social aspects. Therefore, a multidisciplinary approach is required to prevent post-transplant weight gain and obesity.

Changes in Dietary Nutrient Intake and Estimated Glomerular Filtration Rate over a 5-Year Period in Renal Transplant Recipients

“…Furthermore, the number of RTRs meeting the 70% DRI recommendation for vitamins A, C, and B12 and iron decreased within the 5-year period. This trend might be associated with the RTRs continuing a dietary pattern from their dialysis days [ 33 ], resulting in low consumption of dairy products, dark green vegetables, nuts, and other foods rich in these vitamins and minerals. Cianciolo et al suggested that the insufficient intake of folic acid and vitamin B12 in patients with CKD resulted in an elevated blood homocysteine level, potentially increasing the risks of CVD and CKD progression [ 34 ].…”

Nutritional and dietary interventions to prolong renal allograft survival after kidney transplantation

“…Implementation science between additional research with strong evidence and clinical practice should assist to close to knowledge-practice gap to improve transplant outcomes by dietary interventions. complications such as obesity [14,15]. We focus our review on macronutrients and dietary patterns.…”

“…Appropriate dietary management posttransplant needs to be modified by period posttransplant to improve allograft outcomes and avoid complications such as obesity [14,15]. We focus our review on macronutrients and dietary patterns.…”