Reduced metabolic flexibility is a predictor of weight gain among liver transplant recipients.
Reduced metabolic flexibility is a predictor of weight gain among liver transplant recipients.
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代谢灵活性降低是肝移植受者体重增加的预测因素。
DOI：
10.1097/lvt.0000000000000169
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Siddiqui,MohammadShadab
中科院分区：
文献类型：
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作者：
Bui,AnhT;Chaudhari,Rahul;Bhati,Chandra;Wolver,Susan;Patel,Samarth;Boyett,Sherry;Evans,MarieClaire;Kamal,Hiba;Patel,Vaishali;Forsgren,Mikael;Sanyal,ArunJ;Kirkman,Danielle;Siddiqui,MohammadShadab
代谢灵活性是将生物燃料的可用性与利用率相匹配的能力，并且与肝移植（LT）受者的代谢负担增加呈负相关。本研究评估了代谢灵活性对LT后体重增加的影响。前瞻性招募LT受者（n= 47），并随访6个月。使用全室量热法测量代谢灵活性，并表示为呼吸商（RQ）。峰值RQ代表最大碳水化合物代谢并且发生在餐后状态，而谷RQ代表发生在禁食状态的最大脂肪酸代谢。体重减轻（n= 14）和体重增加（n= 33）研究队列的临床、代谢和实验室特征在基线时相似。体重减轻的患者更有可能早期达到最大RQ（最大碳水化合物氧化），并迅速过渡到RQ谷值（最大脂肪酸氧化）。相比之下，体重增加的患者延迟了RQ峰值和RQ谷值的时间。在多变量建模中，至RQ峰值的时间（β系数0.509，p= 0.01）、从RQ峰值至RQ谷值的时间（β系数0.634，p= 0.006）以及至RQ峰值至RQ谷值的时间与空腹RQ之间的相互作用（β系数0.447，p= 0.02）与体重增加的严重程度直接相关。RQ峰值、RQ谷值和体重变化之间无统计学显著性关系。生物燃料（碳水化合物和脂肪酸）之间的低效转换与LT接受者的体重增加相关，而与临床代谢风险无关。这些数据为LT后肥胖的生理学提供了新的见解，具有开发新的诊断和治疗方法的潜力。
Metabolic flexibility is the ability to match biofuel availability to utilization and is inversely associated with increased metabolic burden among liver transplant (LT) recipients. The present study evaluated the impact of metabolic flexibility on weight gain following LT. LT recipients were enrolled prospectively (n= 47) and followed for 6 months. Metabolic flexibility was measured using whole-room calorimetry and is expressed as a respiratory quotient (RQ). Peak RQ represents maximal carbohydrate metabolism and occurs in the post-prandial state, while trough RQ represents maximal fatty acid metabolism occurring in the fasted state. The clinical, metabolic, and laboratory characteristics of the study cohort of lost weight (n= 14) and gained weight (n= 33) were similar at baseline. Patients who lost weight were more likely to reach maximal RQ (maximal carbohydrate oxidation) early and rapidly transitioned to trough RQ (maximal fatty acid oxidation). In contrast, patients who gained weight had delayed time to peak RQ and trough RQ. In multivariate modeling, time to peak RQ (β-coefficient 0.509, p= 0.01), time from peak RQ to trough RQ (β-coefficient 0.634, p= 0.006), and interaction between time to peak RQ to trough RQ and fasting RQ (β-coefficient 0.447, p= 0.02) directly correlated with the severity of weight gain. No statistically significant relationship between peak RQ, trough RQ, and weight change was demonstrated. Inefficient transition between biofuels (carbohydrates and fatty acids) is associated with weight gain in LT recipients that is independent of clinical metabolic risk. These data offer novel insight into the physiology of obesity after LT with the potential to develop new diagnostics and therapeutics.