Determinants of Overweight and Obesity in Lung Transplant Recipients

Abstract

Background: Obesity-related diseases have been shown to affect post-lung transplantation survival. An estimated 30% of lung transplant recipients develop overweight. Objective: The aim of this study was to examine the possible determinants of large increases in weight after lung transplantation. The contribution of physical activity, food intake, and resting energy expenditure was examined in lung transplant recipients. Methods: In this cross-sectional study 21 overweight lung transplant recipients (11 men, mean age 57 ± 7 years; BMI 30 ± 3) and 21 normal-weight lung transplant recipients (11 men, mean age 56 ± 5 years; BMI 22 ± 3) were matched for disease, gender, age, prescribed medication, and time since lung transplantation. Physical activity was measured by a pedometer and a questionnaire; resting energy expenditure was measured by the ventilated-hood technique, and daily food intake by a dietician. Additionally, fat-free mass, lower-body strength, and fatigue were measured. Results: The overweight lung transplant recipients had a significantly lower number of steps per day (4,686 ± 3,266 vs. 7,524 ± 3,448 steps/day, p = 0.01) and a lower fat-free mass (64 ± 9 vs. 75 ± 6%, p < 0.05) compared to normal-weight recipients. Obese subjects had a lower percentage of predicted resting energy expenditure level compared to normal-weight recipients (90 ± 14 vs. 100 ± 14% predicted, p = 0.04). Conclusion: Our data suggest that overweight in lung transplant recipients is associated with a lower fat-free mass and lower levels of physical activity and resting energy expenditure compared to normal-weight recipients.

Predictors of Long-Term Exercise Capacity in Patients Who Have Had Lung Transplantation

“…This effect has been reported previously, with overweight and obese transplant recipients being less active than those of ideal weight. 18 The current study identified several factors related to improved 6MWD, including male sex, pulmonary diagnosis, younger age, and type of graft. Males' 6MWD were significantly higher than that of females at both 6 months and 1 year after transplantation.…”

Sarcopenia of thoracic muscle mass is not a risk factor for survival in lung transplant recipients

“…with poor post-transplantation outcomes in liver and renal transplant recipients (6,7), therefore, we hypothesize that it may negatively impact survival following LTx. Previous studies on sarcopenia have focused on physical activity and rehabilitation in LTx patients, and the quadriceps muscle is mainly used in the context of skeletal muscle assessment (3,(30)(31)(32). Thoracic muscles and major respiratory muscles have been surgically dissected; nevertheless, sarcopenia of thoracic muscles in LTx patients has not been fully evaluated.…”

Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach

“…A research study conducted in our center demonstrated that lung transplant candidates with ILD had increased physical activity levels on days they participated in pulmonary rehabilitation, and the 90 min rehabilitation session accounted for 58% of the total daily steps[ 33 ]. Levels of daily physical activity improve following lung transplant however remain below predicted levels in terms of daily steps, walking time and movement intensity compared to healthy controls; and show great variability[ 23 , 24 , 34 - 37 ].…”

“…Daily physical activity has been reported to be significantly reduced one year following transplantation as compared to healthy controls[ 35 ]. Physical activity levels varied in long-term recipients and have been found to be inversely associated with body weight[ 37 ].…”