Investigação do perfil antropométrico, composição corporal, hábitos e comportamento alimentar de pacientes transplantados de fígado com e sem doença hepática esteatótica associada à disfunção metabólica pós-transplante

Abstract

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) is recognized as the hepatic manifestation of metabolic syndrome and can occur in patients undergoing liver transplantation (LT), associated with inadequate lifestyle habits, which can result in visceral obesity and insulin resistance. In this context, there are evidences that highlight the importance of diet in both the pathogenesis and management of MASLD, with eating behavior being a factor with relevant impact due to its relationship with weight gain and obesity. OBJECTIVES: To investigate and compare eating behavior, anthropometric profile, body composition, muscle strength, eating habits and physical activity in post-LT patients with and without MASLD. METHODS: This is a cross-sectional study which included liver transplant patients aged 18 years or older, at least 12 months after LT, with alcohol intake < 20g of ethanol/day or 140g/week for women and < 30g/day or 210g/week for men; and the exclusion criteria were HIV infection, recurrent hepatocellular carcinoma, diagnosis of non-skin neoplasms and pregnancy. The anthropometric profile, body composition, and muscle strength were assessed by weight, height, body mass index (BMI), waist (WC), upper arm (AC), and calf (CA) circumferences in addition to triceps skinfold thickness (TSF), electrical bioimpedance, and dynamometry. The level of physical activity was based on the International Physical Activity Questionnaire (IPAQ), and food consumption was assessed by the 24-h Food Recall (R24h). The Three Factor Eating Questionnaire–R21 (TFEQ-R21) was used to analyze eating behavior to assess dimensions such as cognitive restraint (CR), emotional eating (EA), and eating disorders (ED). RESULTS: A total of 138 participants were evaluated, the majority of whom were male (59.4%, n = 82), with a median age of 60 (46-80) years and a mean follow-up time after LT of 11.3 ± 6.4 years. The prevalence of MASLD observed after LT was 26.1%. Patients with MASLD had higher BMI (29.5 ± 5.8 vs. 25.6 ± 4.9 kg/m², p = 0.001); WC (101.3 ± 13.1 vs. 91.0 ± 14.4 cm, p = 0.001); AC (33.7±5.0 vs. 30.2±4.3 cm, p<0.001); CC [36.0 (34.1-40.0) vs. 35.0 (33.0-37.0) cm, p=0.01]; DCT [22.2 (15.3-30.3) vs. 19.7 (14.3-24.9) mm, p=0.035]; arm muscle circumference [26.1 (24.0-27.6) vs. 24.0 (22.0-25.6) cm, p<0.001] and body fat (BF) [41.5±11.4 vs. 34.6±10.3%, p=0.001], in addition to a lower percentage of lean mass (LM) (58.5±11.4 vs. 65.4±10.3%, p=0.003). There were no differences between energy, macro and micronutrient consumption between the groups, as well as between the percentage of energy ingested according to the food processing category. Regarding eating behavior, in the univariate analysis, the highest CR score [44.4 (22.2-70.8) vs. 27.8 (16.7-44.4), p=0.009] was associated with MASLD. In the multiple logistic regression analysis, a higher percentage of GC (OR: 1.072; 95% CI: 1.017-1.129; p=0.009); higher AE score (OR: 1.027; 95% CI: 1.005-1.050; p=0.018); lower adjusted caloric intake per kg of corrected weight (OR: 0.911; 95% CI: 0.841-0.986; p=0.021); higher caloric intake of proteins (OR: 1.007; 95% CI: 1.002-1.011; p=0.008) and energy from culinary ingredients (OR: 1.084; 95% CI: 1.008-1.166; p=0.030) were associated with MASLD. CONCLUSIONS: The MASLD post-HT group presented significantly higher values of markers related to body fat. BF (%) was independently associated with MASLD, as well as protein intake (kcal) and energy from culinary ingredients. In contrast, adjusted calorie intake per kg of corrected weight was inversely associated with the prevalence of MASLD post-LT. Regarding eating behavior, the CR and AE domains were associated with MASLD post-LT.