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Obesity and Metabolic Syndrome in Kidney Transplantation: The Role of Dietary Fructose and Systemic Endotoxemia
Abstract
Background The concepts that obesity is merely a consequence of overeating, and that metabolic health then reflects obesity, may be insufficient and potentially flawed. The role of fructose intake and metabolic endotoxemia have gained attention recently, but data in kidney transplantation are lacking. This study evaluated the risk factors for metabolic syndrome (MS), its components, and other associated markers in kidney transplant recipients (KTRs), focussing particularly on fructose intake and systemic endotoxemia.
Methods This cross-sectional observational study enrolled 128 KTRs>1-year posttransplantation. Clinical, biochemical, anthropometric, and questionnaire assessments were undertaken.
Results Obesity (body mass index≥30kg/m2) and MS (International Diabetes Federation Definition) were found in 36.7% and 50% of KTRs respectively. Both increased fructose intake (p=0.01) and endotoxin level (p=0.02) were independently associated with MS; and higher fructose intake was independently associated with obesity (p<0.001). Specifically, increased fructose intake was associated with the central obesity (p=0.01) and hyperglycaemia (p<0.001) criteria of MS; whereas higher endotoxin level was associated with the hypertriglyceridemia (p=0.003) and low high-density lipoprotein cholesterol concentration (p=0.002) criteria of MS. Neither saturated fat nor total caloric intakes were independently associated with obesity and MS; and neither obesity nor central obesity were independently associated with the dyslipidaemia and hyperglycaemia criteria of MS. Principal component analysis demonstrated relationships between higher levels of endotoxin, sE-selectin, triglycerides and insulin resistance (r>0.6), as well as relationships between increased fructose intake, inflammation and blood glucose (r>0.6).
Conclusions Dietary modifications through decreasing fructose intake and addressing systemic endotoxemia are plausible targets for improving metabolic health of KTRs.
https://journals.lww.com/transplantjournal/Abstract/onlinefirst/Obesity_and_Metabolic_Syndrome_in_Kidney.96405.aspx
"Neither saturated fat nor total caloric intakes were independently associated with obesity and MS; and neither obesity nor central obesity were independently associated with the dyslipidaemia and hyperglycaemia criteria of MS."
Abstract
Background The concepts that obesity is merely a consequence of overeating, and that metabolic health then reflects obesity, may be insufficient and potentially flawed. The role of fructose intake and metabolic endotoxemia have gained attention recently, but data in kidney transplantation are lacking. This study evaluated the risk factors for metabolic syndrome (MS), its components, and other associated markers in kidney transplant recipients (KTRs), focussing particularly on fructose intake and systemic endotoxemia.
Methods This cross-sectional observational study enrolled 128 KTRs>1-year posttransplantation. Clinical, biochemical, anthropometric, and questionnaire assessments were undertaken.
Results Obesity (body mass index≥30kg/m2) and MS (International Diabetes Federation Definition) were found in 36.7% and 50% of KTRs respectively. Both increased fructose intake (p=0.01) and endotoxin level (p=0.02) were independently associated with MS; and higher fructose intake was independently associated with obesity (p<0.001). Specifically, increased fructose intake was associated with the central obesity (p=0.01) and hyperglycaemia (p<0.001) criteria of MS; whereas higher endotoxin level was associated with the hypertriglyceridemia (p=0.003) and low high-density lipoprotein cholesterol concentration (p=0.002) criteria of MS. Neither saturated fat nor total caloric intakes were independently associated with obesity and MS; and neither obesity nor central obesity were independently associated with the dyslipidaemia and hyperglycaemia criteria of MS. Principal component analysis demonstrated relationships between higher levels of endotoxin, sE-selectin, triglycerides and insulin resistance (r>0.6), as well as relationships between increased fructose intake, inflammation and blood glucose (r>0.6).
Conclusions Dietary modifications through decreasing fructose intake and addressing systemic endotoxemia are plausible targets for improving metabolic health of KTRs.
https://journals.lww.com/transplantjournal/Abstract/onlinefirst/Obesity_and_Metabolic_Syndrome_in_Kidney.96405.aspx
"Neither saturated fat nor total caloric intakes were independently associated with obesity and MS; and neither obesity nor central obesity were independently associated with the dyslipidaemia and hyperglycaemia criteria of MS."
