Índice inflamatório da dieta em pacientes submetidos ao transplante hepático: caracterização, fatores associados e impacto em desfechos 10 anos depois da avaliação inicial.

Abstract

The liver transplant (LTx) has been the alternative to increase the survival and quality of life of patients with decompensated advanced liver disease. However, metabolic and cardiovascular complications can contribute to increasing these patients’ morbidity and mortality rates in the long term. In this context, the association between the development of diseases, such as cardiovascular diseases and cancer and the presence of low-grade chronic inflammation has been discussed. The inflammatory markers can be affected by the diet, which can reduce or increase inflammation. This study aimed to assess the dietary inflammatory index (DII), its characterization, associated factors, and the association with clinical outcomes up to 10 years of followup in patients who underwent LTx, as well as identify the factors independently associated with the occurrence of steatosis, cardiovascular events, neoplasm, and death in these patients. This is a prospective study including 108 patients aged≥18 years, followed at the LTx outpatient clinic (HC/UFMG). The patients were initially assessed in 2011/2012, and the outcomes were registered up to 10 years after the initial assessment (2021). Sociodemographic, clinical, biochemical, dietetic, and anthropometric data were registered at the initial assessment, and the clinical outcomes were obtained from the electronic medical records in 2021. The prevalence of steatosis was estimated by the hepatic steatosis index (HSI). The scores from the DII were calculated using the data on 21 food parameters from the 24h dietary recall, according to the method developed by Shivappa et al. (2014). The normality of the numerical variables was assessed by the Shapiro-Wilk test, and variables were described as mean and standard deviation (SD) or as median (interquartile range – IQR). The DII was categorized as negative or positive, as well as higher or lower than the highest quartile (higher DII indicates a pro-inflammatory diet). The T-Student and Mann-Whitney tests were used to assess the variables associated with the DII, and the factors associated with the outcomes were assessed by univariate and multivariate logistic regression (Hosmer Lemeshow>0.05). 108 patients were assessed, with a mean age of 54.4±12.8, 59.3% male, and with an average follow-up post-LTx of seven years (IQR: 5-9). The median DII score was 0.80 (IQR: -0.12-1.59). Patients with the DII above the highest quartile were significantly had higher total serum cholesterol (182.16±41.02 mg/dL; p=0.048) and LDL (median: 108 mg/dL; IQR: 87.50-132.50; p=0.016) levels, in comparison with the remaining patients (total serum cholesterol: 164.60±33.09; LDL: median: 85.00, IQR: 64.50-109.00). The prevalence of the studied clinical outcomes was 41.0% for steatosis, 12.4% for cardiovascular events, 16.2% for cancer and 12.0% for death. The DII values were not significantly different regarding the occurrence of steatosis, cardiovascular events, and death up to 10 years after the initial assessment. Age proved to be a predictor of the incidence of neoplasia (OR: 1.055; CI95%: 1.004-1.109; p=0.033) in the long term in patients undergoing LTx evaluated. A higher BMI at the first assessment (OR: 1.513; CI95%: 1.290-1.775; p<0.001) were independently associated with the hepatic steatosis. The cardiovascular events occurrence was independently associated with previous smoking (OR: 7.714; CI95% 1.534-38.799; p=0.013). In conclusion, the proinflammatory diet was associated with higher total cholesterol and LDL. Age was a predictor of cancer incidence. A higher BMI at the first assessment were predictor for the development of steatosis, and previous smoking for cardiovascular events occurrence during the 10 years of follow-up