Comportamento alimentar, food craving e relação com ganho de peso e obesidade em pacientes submetidos ao transplante hepático

Abstract

Excessive weight gain and obesity are frequent in patients who undergoing liver transplantation (LTx). Traditional methods of assessment food intake have failed to demonstrate an association among dietary intake and weight gain as well as obesity. Eating behavior and food craving are unknown in these patients. The aim of this study was to evaluate the eating behavior, the food craving and the relationship with weight gain, excessive weight and obesity after LTx. This is a cross-sectional study. Post-LTx patients, age 18y were evaluated about their eating behavior [Three Factor Eating Questionnaire R21 (TFEQ-R21]) and food craving [Food Craving Questionnaires State (FCQ-S) and Trait (FCQ-T) and the Brazilian Inventory of Foods Related to Craving (FCIBr)]. Weight gain was assessed by the difference between the current weight and the post-LTx weight, assessed at the first outpatient visit. Excessive weight (overweight and obesity) was classified as body mass index (BMI) 25kg/m² and obesity 30kg/m². The data were evaluated using SPSS 17.0. The correlation between post-LTx weight gain and the different eating behaviors and food craving was assessed by the Pearson or Spearman tests. The association between eating behavior, food craving, overweight and obesity was assessed by Student's t-test or Mann-Whitney test. Variables independently associated with post-LTx weight gain and obesity were investigated using linear regression and multiple logistic tests, respectively. The level of significance was 5%. A total of 301 patients (median age 57.0, ranging from 20 to 77 years old, time post LTx 6.6±4.4 years, 64.1% men), the most frequent indications for LTx were ethanolic cirrhosis (29.2%) and by hepatitis C virus (26.2%). The observed weight gain was 8.0kg (ranging from -16.0 to +41.0kg); 62.5% (n=188) of the patients presented with excessive weight and 22.3% (n=67), with obesity. The highest food score was the cognitive restriction (CR) 53.5±27.5, followed by uncontrolled eating (UE) 14.0 (16.0-56.0) and emotional eating (EE) 11.0 (0100.0). Post-LTx weight gain was significantly correlated with the UE behaviors (r=0.261, p<0.001) and EE (r=0.233, p<0.001). Overweight patients had significantly higher scores than non-overweight individuals for CR (57.1±26.3 vs. 47.6±28.6, p = 0.004) and EE [11.0 (0-100.0) vs. 0.0 (0-100.0) p=0.047]. Patients with obesity had significantly higher scores than non-obese individuals for all eating behaviors of UE [22.0 (0-77.0) vs. 14.0 (0-85.0); p=0.011], CR (60.2±23.3 vs. 51.6±28.4, p=0.014), and EE [16.0 (0-100.0) vs. 5.0 (0-100.0); p<0.01]. Uncontrolled eating was independently associated with weight gain. In general, the median total score for FCQ-T was 68.0 points, ranging from 39.0 to 163.0 and for the FCQ-S the total average score was 33.4±9.0. There was no statistical difference in the total scores of FCQ-T and FCQ-S among excessive weight and obese patients or correlation of these scores and weight gain. Among the participants, 90.0% (n=271) presented food craving for at least one food, most had a specific desire for food in the Home Intake dimension [263 (87.4%)], followed by High Fat [108 35.9%)] and the dimension with the lowest percentage was Sweet Food [101 (33.5%)]. The most frequently mentioned desired foods were beans/feijoada, with 129 (42.9%), followed by steak (n=126; 41.9%) and cheese (n=113; 37.5%). In conclusion, post-LTx weight gain was related to the behaviors of uncontrolled eating and emotional eating. Overweight and obese patients had higher eating behavior scores than the other patients. Uncontrolled eating was independently associated with weight gain. Food craving was not related to weight gain, excessive weight and obesity in patients undergoing LTx, in this study