Disturbed energy metabolism after lung and heart transplantation.

Overweight, in combination with other cardiovascular risk factors, reduces survival after transplantation. The aim of this prospective study was to observe leptin, adiponectin, and energy intake as predictors of body mass index (BMI) and body composition and as risk factors associated with metabolic syndrome after lung and heart transplantation. After pre-operative baseline investigations, 35 lung and 59 heart recipients were followed and re-investigated two, six, and 12 months after transplantation. Linear regressions were performed to predict BMI and body composition. The lung recipients had a substantial weight gain after transplantation. Leptin increased, especially in the lung recipients and positively predicted BMI. Energy intake predicted BMI before and at two months after transplantation, but not after 12 months. Percentage trunk fat increased and lean mass decreased. Before transplantation, the dominant determinant of lean mass was adiponectin (positively associated), while after it was leptin (negatively associated), controlled for possible confounding variables (including prednisolone). Metabolic syndrome 12 months after transplantation was associated with higher leptin, greater weight gain without increased energy intake. After transplantation, a disturbed energy metabolism is indicated, where adiponectin and especially leptin are involved and a disadvantageous body composition is favored with increased body fat and decreased lean mass.

Dietary vitamin K2 supplement improves bone status after lung and heart transplantation.

BACKGROUND: Osteoporosis is a problem after transplantation. Studies since the last year indicate that vitamin K plays a role in optimal bone health. The aim of this randomized, double blind, prospective longitudinal study was to investigate the effect of a dietary supplement with vitamin K2 (180 microg menakinon-7) on bone mass, the first year after lung and heart transplantation. METHODS: After preoperative baseline investigation of bone mass and bone-related biochemistry, 35 lung and 59 heart recipients were postoperatively randomized to vitamin K2 or placebo and reinvestigated the following year. RESULTS: In all recipients, 1 year after solid organ transplantation, the difference between vitamin K2 and placebo for the lumbar spine (L2-L4) bone mineral density (BMD) was 0.028 (SE 0.014) g/cm(2), P=0.055 and for L2 to L4 bone mineral content was 1.33 (SE 1.91) g/cm(2) (P=0.5). In lung recipients separately, the difference for bone mineral content was 3.39 g (SE 1.65), P=0.048 and in heart recipients 0.45 (SE 0.02) g, P=0.9 after controlling for baseline measures. In a forward stepwise linear regression analysis fitted to model differences in the L2 to L4 BMD, controlled for possible confounding variables (including use of bisphosphonate), and the only significant predictors were organ (B=-0.065 g/cm(2), P<0.001) and vitamin K2 (B=0.034 g/cm(2), P=0.019). Insufficient vitamin D status was common, and the parathyroid hormone was highest in the K2 group indicating a higher need for vitamin D. CONCLUSIONS: One year of vitamin K2 supplement suggest a favorable effect on lumbar spine BMD with different response in lung and heart recipients. Vitamin D status should receive more attention.

The influence of underweight and dietary support on well-being in lung transplant candidates.

BACKGROUND: Quality of life has been found to be a significant predictor of survival in lung transplantation candidates. The aim of this study was to investigate associations between underweight, dietary support and well-being. METHODS: A self-administered questionnaire for perceived well-being was administered to underweight (n=42) and normal-weight (n=29) candidates for lung transplantation before and after dietary intervention in which the underweight patients received dietary support for weight gain. RESULTS: Underweight compared with normal-weight, independent of lung function, was associated with low well-being in several of the measured dimensions. Improvements were observed after dietary intervention compared with baseline in the underweight patients, for scores in the dimension of tiredness 29.2 (4.2) vs. 26.2 (6.0), P<0.01; general satisfaction 4.7 (1.5) vs. 4.0 (1.4), P=0.01; social life 16.7 (3.9) vs. 15.0 (4.4), P=0.02) (mean (sd) before and after dietary intervention respectively), but not in the normal-weight patients. The underweight patients achieved the goal for energy intake and protein intake and experienced a significant weight gain. Regression analyses showed that none of the well-being improvements was associated with weight gain or change in body composition. However, an association between less tiredness and an increase in protein intake was indicated (b=-0.305, P=0.055). CONCLUSION: Underweight compared with normal-weight was associated with more impaired quality of life in candidates for lung transplantation and some benefit from dietary support in terms of well-being was indicated.

Vitamins A and E in serum in relation to weight and lung function in patients with advanced pulmonary disease.

The objective of the study was to examine whether serum concentrations of retinol (vitamin A) and alpha-, beta-, and gamma-tocopherols (vitamin E) are affected by underweight and weight gain. The analysis was carried out in underweight (n = 42, of whom 24 had chronic obstructive pulmonary disease) and normal-weight (n = 29, of whom 16 had chronic obstructive pulmonary disease) candidates for lung transplantation before and after dietary intervention for weight gain. In all the patients, serum concentrations of retinol at baseline and changes in retinol were positively associated with body mass index (unstandardized regression coefficient, b = 0.03; p = 0.05) and an increase in weight (b = 0.09, p = 0.02) after dietary intervention, respectively. At baseline, serum retinol concentrations were positively correlated with forced vital capacity (b = 0.24, p < 0.05) and forced expiratory volume in one second (b = 0.17, p < 0.05). In patients with chronic obstructive pulmonary disease (COPD), tocopherols were higher in the underweight patients than in the normal-weight ones, while it was an opposite tendency in patients with other lung diseases. Only in patients with lung diseases other than COPD was there found a positive association between tocopherols and lung gas diffusion. In patients with other diagnoses compared with patients with COPD, a positive change in serum tocopherol status after weight gain was suggested.