Conservative Management of Obesity in Kidney Transplant Candidates.

OBJECTIVE: Obesity is prevalent in patients with chronic kidney disease and is associated with increased complications after kidney transplantation (KT). A body mass index limit is used in most transplant programs, though few studies have focused on conservative weight loss in KT candidates. The objective of this retrospective study is to evaluate the efficacy of a basic conservative weight management program in morbidly obese KT candidates and to perform a comprehensive nutritional evaluation. METHODS: This retrospective study included patients with a body mass index (BMI) >35 kg/m2, with grade IV or V chronic kidney disease. The conservative weight loss program consisted of anthropometric measurements every 3 months, consultation with a nutritionist, daily exercise, and counseling for healthier eating habits. Overall and quarterly BMI targets were defined. A subset of patients further underwent a comprehensive nutritional evaluation to measure socioeconomic characteristics, food intake behavior, motivation for change, and a 4-day food diary. RESULTS: Eighty patients were observed for a mean of 24 months. Successful weight loss (BMI < 35 kg/m2) was achieved in 26.3%, associated with women and those already close to the limit. The mean 1-year excess body weight loss was 8.4%. No patient with a BMI >40 kg/m2 was successful. The comprehensive nutritional evaluation was performed with 44 patients and found that only 14.6% had previously received nutritional counseling for weight loss. Cognitive restraint scored highest in the food-intake behavior. Most patients were motivated to lose weight with 66% in the action phase. There was little evidence of overeating with a recommended mean calculated daily caloric intake of 82.9%. CONCLUSION: The conservative weight loss program can have limited but non-negligible, success. Future successful nutritional interventions should take into consideration this surprising comprehensive profile of morbidly obese KT candidates.

Predicting functional linkages from gene fusions with confidence.

Pairs of genes that function together in a pathway or cellular system can sometimes be found fused together in another organism as a Rosetta Stone protein--a fusion protein whose separate domains are homologous to the two functionally-related proteins. The finding of such a Rosetta Stone protein allows the prediction of a functional linkage between the component proteins. The significance of these deduced functional linkages, however, varies depending on the prevalence of each of the two domains. Here, we develop a statistical measure for the significance of predicted functional linkages, and test this measure for proteins of E. coli on a functional benchmark based on the KEGG database. By applying this statistical measure, proteins can be linked with over 70% accuracy. Using the Rosetta Stone method and this scoring scheme, we find all significant functional linkages for proteins of E. coli, P. horikshii and S. cerevisiae, and measure the extent of the resulting protein networks.