Obesity and Metabolic Syndrome in Kidney Transplantation: The Role of Dietary Fructose and Systemic Endotoxemia

Background The concepts that obesity is merely a consequence of overeating, and that metabolic health then reflects obesity, may be insufficient and potentially flawed. The role of fructose intake and metabolic endotoxemia have gained attention recently, but data in kidney transplantation are lacking. This study evaluated the risk factors for metabolic syndrome (MS), its components, and other associated markers in kidney transplant recipients (KTRs), focussing particularly on fructose intake and systemic endotoxemia. Methods This cross-sectional observational study enrolled 128 KTRs>1-year posttransplantation. Clinical, biochemical, anthropometric, and questionnaire assessments were undertaken. Results Obesity (body mass index≥30kg/m2) and MS (International Diabetes Federation Definition) were found in 36.7% and 50% of KTRs respectively. Both increased fructose intake (p=0.01) and endotoxin level (p=0.02) were independently associated with MS; and higher fructose intake was independently associated with obesity (p0.6), as well as relationships between increased fructose intake, inflammation and blood glucose (r>0.6). Conclusions Dietary modifications through decreasing fructose intake and addressing systemic endotoxemia are plausible targets for improving metabolic health of KTRs. Corresponding Author: Dr Richard Borrows, Department of Nephrology & Kidney Transplantation, Area 5, Level 7, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK. Tel: +44 (0) 121 371 6099, Fax: +44 (0) 121 371 5858. Email: Richard.Borrows@uhb.nhs.uk Author Contributions Winnie Chan and Richard Borrows designed the research. Winnie Chan, Byron Smith, Mark Stegall, and Richard Borrows wrote the manuscript. Winnie Chan and Richard Borrows conducted the research. Winnie Chan, Byron Smith, and Richard Borrows analysed the data and performed the statistical analysis. Richard Borrows had primary responsibility for the final content. Disclosure: The authors declare no conflict of interest. Funding Winnie Chan received a research grant from the British Renal Society and was awarded a PhD research training fellowship from the National Health Service West Midlands Strategic Healthy Authority. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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