Diet and Exercise in Pediatric Liver Transplant Recipients: Behaviors and Association with Metabolic Syndrome

Objective: To analyze the impact of physical activity and eating behaviors on precursors of cardiovascular disease—including overweight/obesity, hypertension, low HDL, and impaired glucose tolerance—in pediatric liver transplant (LT) recipients and matched controls. Method: Cross-sectional study of pediatric LT recipients 8–30 years, matched to controls from NHANES. Dietary intake assessed with 24-hour recall. Physical activity assessed by standardized questionnaires. LT recipients ≥12 years completed a confidential survey on alcohol consumption. Results: LT recipients (n = 90) were 0.9–24.7 years post-transplant. LT recipients and controls were equally likely to consume excess carbohydrates (32% vs 34%) and sugar, per age and gender-specific recommended dietary intake (RDA) guidelines. LT recipients spent more hours sedentary or on the computer daily and fewer days each week physically active for >60 minutes than controls. More overweight/obese LT recipients spent 3+ hours at the computer than non-overweight LT recipients (49% vs 27%; p = 0.02). Normal weight LT recipients spent more days doing vigorous activity each week (median 5 days, IQR 2–6) than did the overweight/obese LT recipients (median 3 days, IQR 2–4; p = 0.01). Among LT recipients, neither dietary intake nor physical activity were consistently associated with measures of hypertension, glucose intolerance, or dyslipidemia. Among LT adolescents and young adults (n = 38), 36% reported ever consuming alcohol; 38% of these reported significant alcohol consumption by frequency or quantity. Conclusions: Additional counseling during routine post-LT care on the importance of physical activity and healthy diet may be useful. However, it is unlikely that these factors alone explain the increased prevalence of metabolic syndrome components in pediatric LT recipients. Address correspondence and reprint requests to Emily R. Perito, MD, MAS, 550 16th Street, 5th Floor Box 0136, SF, CA 94143; E-mail: emily.perito@ucsf.edu; Julia H. Chambers, BS, University of California, San Francisco, San Francisco, United States; E-mail: julia.chambers@ucsf.edu Received 13 December, 2017 Accepted 29 August, 2018 Conflicts of interest disclosure: The authors have no relevant conflicts of interest to disclose. Funding Source: Supported by the NASPGHAN Mentored Summer Student Research Program (Ms. Chambers), an NIH-NIDDK K23 Career Development Award (K23 DK0990253-A101, Dr. Perito), AGA Emmet B. Keeffe Career Development Award in Clinical or Translational Research in Liver Disease (Dr. Perito), UCSF Liver Center Pilot Funding (Dr. Perito, P30 DK026743), and by the NIH-National Center for Advancing Translational Sciences (UCSF-CTSI Grant UL1 TR000004). Julia H. Chambers BS1 – Data analysis and interpretation, drafting manuscript, final approval for publishing Melissa Zerofsky, PhD2 – Data acquisition, Data analysis and interpretation, drafting manuscript, final approval for publishing Robert H. Lustig, MD, MSL2 – Project conception and design, data interpretation, manuscript revision, final approval for publishing Philip Rosenthal, MD2,3 – Project conception and design, data interpretation, manuscript revision, final approval for publishing Emily R. Perito, MD MAS2,4 – Project conception and design, data analysis and interpretation, manuscript drafting and revision, final approval for publishing © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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