title: Free fatty acids are associated with obesity, insulin resistance, and atherosclerosis in renal transplant recipients.
abstract: BACKGROUND
  Insulin resistance (IR) may be implicated in the pathogenesis of atherosclerosis in renal transplant recipients (RTRs) and be contributed to, in part, by free fatty acids (FFAs), produced in excess in centrally obese individuals. The aim of this study was to determine the prevalence of IR and the relationships between FFAs, central obesity, and atherosclerosis in a cohort of prevalent RTRs.
  
  
  METHODS
  Observational data were collected on 85 RTRs (mean age 54 years; 49% male, 87% Caucasian). Fasting serum was analyzed for FFAs, glucose, and insulin; IR was calculated using the homeostasis model assessment (HOMA-IR) score. Vascular structure was assessed by carotid intima-media thickness (IMT) measurement. Linear regression analyses were performed to determine the factors associated with IR and atherosclerosis.
  
  
  RESULTS
  IR occurred in 75% of RTRs, and FFA levels were independently associated with its occurrence (beta: -0.55, 95% CI: -1.02 to -0.07, P = 0.02). Other variables independently associated with IR were male sex, body mass index, central obesity, diabetes, systolic blood pressure and corticosteroid use. There was a significant correlation between FFA levels and IMT (r = 0.3, P=0.01). On multivariate analysis, IMT correlated with elevated FFA (beta: 0.07, 95% CI: 0.02-0.12, P = 0.007), diabetes mellitus (P = 0.05), older age (P < 0.002), and a body mass index >25 kg/m (P = 0.002).
  
  
  CONCLUSIONS
  FFAs are associated with the development of IR and may be involved in the pathogenesis of atherosclerosis in RTRs. Additional studies are required to explore these associations further before considering whether an interventional trial aimed at lowering FFA would be a worthwhile undertaking.
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia. kirsty@ascom.net
authors.forename: Kirsten A
authors.initials: KA
authors.lastname: Armstrong
authors.forename: Balaji
authors.initials: B
authors.lastname: Hiremagalur
authors.forename: Brian A
authors.initials: BA
authors.lastname: Haluska
authors.forename: Scott B
authors.initials: SB
authors.lastname: Campbell
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.forename: Lisa
authors.initials: L
authors.lastname: Marks
authors.forename: Johannes
authors.initials: J
authors.lastname: Prins
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Isbel
mesh_terms: D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D005230:Fatty Acids, Nonesterified / Q000097:blood*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012737:Sex Factors; D017539:Tunica Intima / Q000473:pathology
chemical_list: D005230:Fatty Acids, Nonesterified