Body Shape Index Predicts Metabolic Syndrome and Insulin Resistance in Renal Transplant Recipients

Prevalence of metabolic syndrome in patients with end-stage renal disease: a systematic review and meta-analysis

BACKGROUND

Metabolic syndrome, a significant risk factor for cardiovascular mortality in patients with end-stage renal disease, profoundly impacts patient prognosis and survival. Despite its clinical importance, the prevalence of metabolic syndrome remains unexplored in this population. Therefore, the objective of this study was to systematically assess the prevalence of metabolic syndrome among patients with end-stage renal disease and raise awareness among healthcare professionals.

METHODS

We conducted a comprehensive search in CNKI, WANFANG, WeiPu, CBM, PubMed, Web of Science, EMBASE, and The Cochrane Library databases. The search time was until August 21, 2023. Standardized tables were employed for data extraction and imported into Stata 16.0 software for subsequent meta-analysis. A random-effects model was employed to estimate combined prevalence and 95% confidence intervals. Subgroup and sensitivity analyses were conducted to explore potential sources of heterogeneity, while publication bias was evaluated using a funnel plot and Egger's test. This study has been registered with PROSPERO under the registration number CRD42023456284.

RESULTS

This meta-analysis comprised 35 studies involving a total of 14,202 participants. The pooled prevalence estimate for metabolic syndrome was 49.0% [95% CI (46.0,53.0)]. We conducted subgroup analyses based on participant characteristics, gender distribution, publication year, national economic status, diagnostic criteria employed, and components of metabolic syndrome.

CONCLUSIONS

The prevalence of metabolic syndrome is higher among patients with end-stage renal disease, necessitating early prevention and control measures to reduce its incidence and delay the progression of the disease, thereby improving patient life expectancy.

Obesity- and lipid-related indices as a predictor of obesity metabolic syndrome in a national cohort study

Objective

Metabolic syndrome is a common condition among middle-aged and elderly people. Recent studies have reported the association between obesity- and lipid-related indices and metabolic syndrome, but whether those conditions could predict metabolic syndrome is still inconsistent in a few longitudinal studies. In our study, we aimed to predict metabolic syndrome by obesity- and lipid-related indices in middle-aged and elderly Chinese adults.

Method

A national cohort study that consisted of 3,640 adults (≥45 years) was conducted. A total of 13 obesity- and lipid-related indices, including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), conicity index (CI), visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), and triglyceride glucose index (TyG-index) and its correlation index (TyG-BMI, TyG-WC, and TyG-WHtR), were recorded. Metabolic syndrome (MetS) was defined based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III (2005). Participants were categorized into two groups according to the different sex. Binary logistic regression analyses were used to evaluate the associations between the 13 obesity- and lipid-related indices and MetS. Receiver operating characteristic (ROC) curve studies were used to identify the best predictor of MetS.

Results

A total of 13 obesity- and lipid-related indices were independently associated with MetS risk, even after adjustment for age, sex, educational status, marital status, current residence, history of drinking, history of smoking, taking activities, having regular exercises, and chronic diseases. The ROC analysis revealed that the 12 obesity- and lipid-related indices included in the study were able to discriminate MetS [area under the ROC curves (AUC > 0.6, P < 0.05)] and ABSI was not able to discriminate MetS [area under the ROC curves (AUC < 0.6, P > 0.05)]. The AUC of TyG-BMI was the highest in men, and that of CVAI was the highest in women. The cutoff values for men and women were 187.919 and 86.785, respectively. The AUCs of TyG-BMI, CVAI, TyG-WC, LAP, TyG-WHtR, BMI, WC, WHtR, BRI, VAI, TyG index, CI, and ABSI were 0.755, 0.752, 0.749, 0.745, 0.735, 0.732, 0.730, 0.710, 0.710, 0.674, 0.646, 0.622, and 0.537 for men, respectively. The AUCs of CVAI, LAP, TyG-WC, TyG-WHtR, TyG-BMI, WC, WHtR, BRI, BMI, VAI, TyG-index, CI, and ABSI were 0.687, 0.674, 0.674, 0.663, 0.656, 0.654, 0.645, 0.645, 0.638, 0.632, 0.607, 0.596, and 0.543 for women, respectively. The AUC value for WHtR was equal to that for BRI in predicting MetS. The AUC value for LAP was equal to that for TyG-WC in predicting MetS for women.

Conclusion

Among middle-aged and older adults, all obesity- and lipid-related indices, except ABSI, were able to predict MetS. In addition, in men, TyG-BMI is the best indicator to indicate MetS, and in women, CVAI is considered the best hand to indicate MetS. At the same time, TyG-BMI, TyG-WC, and TyG-WHtR performed better than BMI, WC, and WHtR in predicting MetS in both men and women. Therefore, the lipid-related index outperforms the obesity-related index in predicting MetS. In addition to CVAI, LAP showed a good predictive correlation, even more closely than lipid-related factors in predicting MetS in women. It is worth noting that ABSI performed poorly, was not statistically significant in either men or women, and was not predictive of MetS.

Body Fat Distribution, Adipocytokines Levels and Variability in Associated Genes and Kidney Transplant Outcomes

Introduction: Body fat distribution is known to contribute to a variety of pathologies. Research Questions: We aimed to assess whether this distribution is associated with clinical outcomes in renal transplant recipients (RTR) and to examine its relationship with leptin and adiponectin gene variants and plasma concentrations. Design: Bioelectrical impedance analyses were performed in 236 RTR. Leptin/adiponectin levels were measured by immunoassay and relevant polymorphisms in the leptin receptor (LEPR) and adiponectin (ADIPOQ) genes were identified. Associations were assessed by logistic regression modeling. Results: The waist-to-height ratio (WHr) displayed a significant association with delayed graft function, acute rejection and post-transplant diabetes mellitus, with OR values of 2.04 (1.02-4.08) p = 0.045; 3.08 (1.22-7.79) p = 0.017 and 2.79 (1.16-6.74) p = 0.022, respectively. Waist circumference was linked to delayed graft function [OR = 1.03 (1.01-1.05), p = 0.025] and AR [OR = 1.041 (1.01-1.07), p = 0.009]. Leptin levels were significantly higher in patients who experienced rejection [19.91 ± 23.72 versus 11.22 ± 16.42 ng/ml; OR = 1.021 (1.01-1.04), p = 0.017]. The ADIPOQ rs1501299TT genotype showed a significant association with higher WHr (0.63 ± 0.11 vs 0.59 ± 0.87 for GG/GT genotypes; p = 0.015) and WC values (102.3 ± 14.12 vs 96.38 ± 14.65 for GG/GT genotypes; p = 0.021). Conclusion: WC, and especially WHr, are associated with adverse outcomes in renal transplantation and are affected by variability in the ADIPOQ gene.

Nutritional Parameters in Early and Late Kidney Transplantation

BACKGROUND

Kidney transplantation (KT) has the advantage of providing a better quality of life and freedom for the patient. However, nutritional changes can occur, with clinical repercussions. The aim of the study was to compare the nutritional status in the initial and late post-KT period.

METHODS

A cross-sectional study was conducted involving 169 outpatients post-KT. Clinical, demographic, biochemical, food intake, handgrip strength (HGS), and anthropometric data were collected from medical records for the first nutritional care after KT. Statistical tests were performed to compare the groups according to the time of KT: early (≤1 year) and late (>1 year). The level of significance adopted was 5%.

RESULTS

The median age of the patients was 46 years (range, 38-57), 50.3% were men, and it was observed that 66.9% underwent KT with a deceased donor. There was a higher prevalence of diabetes mellitus (42.6% vs 23.5%; P = .011), and higher body mass index (28.80 ± 7.26 vs 26.51 ± 6.62 kg/m²; P = .046), arm muscle circumference (25.84 ± 4.63 vs 24.09 ± 3.36 cm; P = .019), and HGS (26.97 ± 10.70 vs 20.21 ± 10.83 kg; P = .010) in patients with late KT. Linear regression analysis showed that at each log of time, there was an increase of 1.90 kg in HGS (P = .045) and 0.48 cm (P = .036) in mid-arm muscle circumference.

CONCLUSION

The present study demonstrated that late kidney transplantation was associated with higher values of body mass index, mid-arm muscle circumference, and HGS.