title: Sarcopenic obesity with metabolic syndrome: a newly recognized entity following living donor liver transplantation.
abstract: OBJECTIVE
  There are limited data about sarcopenic obesity in liver transplant recipients.
  
  
  METHODS
  Living donor liver transplant recipients with at least 12 months of follow-up were included. Metabolic syndrome (MS) was defined as ≥ 3 ATP III criteria. Body composition was assessed by bioelectrical impedance. Immunosuppression protocol included short-term steroids, mycophenolate and calcineurin inhibitors (mainly tacrolimus). Data are shown as percentage, mean ± SD, or median (25-75 IQR).
  
  
  RESULTS
  The study comprised 82 patients (males 69), aged 50.5 ± 10.65 yr, and follow-up 24 (12-38.5) months. Etiology for cirrhosis was alcohol 29%, hepatitis C 22%, hepatitis B 17%, cryptogenic 24%, and others 7%. Post-transplant sarcopenic obesity was present in 72 (88%), and MS was present in 43 (52%) of recipients with no significant difference among etiologies. There were significant differences between pre- and post-transplant body mass index, triglycerides, high-density lipoprotein, low-density lipoprotein (p = 0.000 for all), prevalence of hypertension (18% vs. 39%), and diabetes (20% vs. 56%). Patients with sarcopenic obesity had significantly higher body mass index, waist circumference, and MS (57% vs. 20%, p = 0.041) when compared to patients without sarcopenic obesity.
  
  
  CONCLUSIONS
  Despite resuming routine activities, the majority of liver transplant recipients develop sarcopenic obesity and MS. The importance and role of appropriate nutrition and exercise after transplantation merits further investigation.
authors.affiliation: Medanta Liver Institute, Medanta The Medicity, Gurgaon, Delhi NCR, India.
authors.forename: Narendra S
authors.initials: NS
authors.lastname: Choudhary
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Saigal
authors.forename: Neeraj
authors.initials: N
authors.lastname: Saraf
authors.forename: Ravi
authors.initials: R
authors.lastname: Mohanka
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Sanjay
authors.initials: S
authors.lastname: Goja
authors.forename: Palat B
authors.initials: PB
authors.lastname: Menon
authors.forename: Sunil
authors.initials: S
authors.lastname: Mishra
authors.forename: Ambrish
authors.initials: A
authors.lastname: Mittal
authors.forename: Arvinder S
authors.initials: AS
authors.lastname: Soin
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D055948:Sarcopenia / Q000175:diagnosis / Q000209:etiology*
keywords: diabetes; liver transplantation; metabolic syndrome; obesity; sarcopenia