Cognitive function, self-management, and outcomes among liver transplant recipients: LivCog, a multicenter, prospective study.

Liver transplantation is a life-saving option for decompensated cirrhosis. Liver transplant recipients require advanced self-management skills, intact cognitive skills, and care partner support to improve long-term outcomes. Gaps remain in understanding post-liver transplant cognitive and health trajectories, and patient factors such as self-management skills, care partner support, and sleep. Our aims are to (1) assess pre-liver transplant to post-liver transplant cognitive trajectories and identify risk factors for persistent cognitive impairment; (2) evaluate associations between cognitive function and self-management skills, health behaviors, functional health status, and post-transplant outcomes; and (3) investigate potential mediators and moderators of associations between cognitive function and post-liver transplant outcomes. LivCog is a longitudinal, prospective observational study that will enroll 450 adult liver transplant recipients and their caregivers/care partners. The duration of the study is 5 years with 24 additional months of patient follow-up. Data will be collected from participants at 1, 3, 12, and 24 months post-transplant. Limited pre-liver transplant data will also be collected from waitlisted candidates. Data collection methods include interviews, surveys, cognitive assessments, and actigraphy/sleep diary measures. Patient measurements include sociodemographic characteristics, pretransplant health status, cognitive function, physical function, perioperative measures, medical history, transplant history, self-management skills, patient-reported outcomes, health behaviors, and clinical outcomes. Caregiver measures assess sociodemographic variables, health literacy, health care navigation skills, self-efficacy, care partner preparedness, nature and intensity of care, care partner burden, and community participation. By elucidating various health trajectories from pre-liver transplant to 2 years post-liver transplant, LivCog will be able to better characterize recipients at higher risk of cognitive impairment and compromised self-management. Findings will inform interventions targeting health behaviors, self-management, and caregiver supports to optimize outcomes.

Moderate compared to low dietary intake of trans-fatty acids impairs strength of old and aerobic capacity of young SAMP8 mice in both sexes.

The senescence accelerated SAMP8 mouse is a model for sarcopenia and provides an opportunity to study the effects of lifelong dietary composition on the loss of physical function with age. We studied the effects of trans-fatty acids (2 % of total energy, TFA diet) on the loss of strength and aerobic exercise capacity (VO2peak) with age. SAMP8 mice were studied at two ages (young, 25 weeks; old, 60 weeks) and on two diets (control vs TFA). Body composition, grip strength, VO2peak, blood metabolites, and biochemical parameters were assessed. Body weight, fat mass, and body fat percentage all increased with age (p < 0.05) but were not significantly impacted by diet. There was a significant age-related decline in total grip strength as well as that normalized to fat-free mass (FFM) (p < 0.05) with a further decrease at old age in these metrics of strength on the TFA diet vs control diet (p < 0.05). Total VO2peak exhibited no change with age or diet, but when normalized to FFM, VO2peak exhibited age and TFA-related declines (p < 0.05). Intramuscular triacylglycerol (p < 0.05) and collagen content (p < 0.05) significantly increased with age, while blood triacylglycerol was increased by the TFA diet (p < 0.05). These data further characterize the SAMP8 mouse as a model for sarcopenia and indicate that dietary fatty acid composition can impact the degree of this age-related loss of physical function.