Nutritional Status of Liver Transplantation Recipients and Factors Influencing Nutritional Status

SinYoung Hwang; Smi Choi-Kwon

doi:10.4040/jkan.2019.49.3.340

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Hwang and Choi-Kwon: Nutritional Status of Liver Transplantation Recipients and Factors Influencing Nutritional Status

Original Article

J Korean Acad Nurs 2019;49(3):340-348.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.3.340

Nutritional Status of Liver Transplantation Recipients and Factors Influencing Nutritional Status

SinYoung Hwang, Smi Choi-Kwon

College of Nursing, Seoul National University, Seoul, Korea

Address reprint requests to : Choi-Kwon, Smi College of Nursing, The Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8830 Fax: +82-2-765-4103 E-mail: smi@snu.ac.kr

Received 24 December 2018 Revised 8 May 2019 Accepted 8 May 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study aimed to investigate the nutritional status of liver transplantation (LT) recipients and explore certain factors that influence nutritional status, including dietary patterns and physical activities.

Methods

This was a cross-sectional, descriptive study. The subjects included 211 LT recipients at a medical center outpatient clinic located in Seoul, Korea. The nutritional status, dietary patterns, and physical activities of each subject were measured using the body mass index (BMI), Mini Dietary Assessment (MDA), and Global Physical Activity Questionnaire. Independent t-test, one-way analysis of variance, and multiple linear regression analysis were used to analyze the data.

Results

The percentages of living and deceased donor LTs were 81.0% and 19.0%, respectively. The mean BMIs pre- and post-LT were 23.88 and 23.16 kg/m², respectively, and the average MDA score was 36.55. More than 60.0% of the subjects had a moderate or high level of physical activity. In multivariate analysis, a higher BMI before LT (β=.72, p<.001), a lower Model for End-stage Liver Disease (MELD) score (β=-.18, p<.001), and being male (β=-.10, p=.024) contributed to better nutritional status post-LT. Patients within six months of LT were less engaged in muscle exercises than those post six months of LT (p=.020).

Conclusion

LT recipients in Korea have good nutritional status and a good level of physical activity. To improve recipients’ post-LT nutritional status, the pre-LT nutritional status should be considered, particularly in those with a higher MELD score. In addition, physical activity including muscle-strengthening exercises should be encouraged from an earlier stage.

Keywords: Liver Transplantation, Transplant Recipients, Nutritional Status, Feeding Behavior, Exercise

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Figure 1.

Flow diagram of patient's participants.

Table 1.

MDA, GPAQ and Post-LT BMI according to General and Clinical Characteristics of the Subjects (N=211)

Variables	Categories	n (%)	MDA			GPAQ			Post-LT BMI
Variables	Categories	n (%)	M±SD	t or F	(p)	M±SD	t or F	(p)	M±SD	t or F	(p)
Age (yr)		54.26±9.11^†
Gender	Men	155 (73.5)	36.52±5.86	-0.14	(.886)	2342.84±1625.89	1.78	(.077)	23.46±2.89	1.07	(.290)
	Women	56 (26.5)	36.64±5.08			1625.89±1803.55			22.77±4.33
Employment	Employed	134 (63.5)	36.78±5.85	0.47	(.637)	2608.29±3059.44	2.04	(.042)	23.46±2.71	0.62	(.538)
(current)	Unemployed	77 (36.5)	36.40±5.54			1862.87±2231.65			23.15±3.69
Marital status	Single	38 (18.0)	36.21±5.32	-0.41	(.684)	2727.63±3285.35	1.51	(.133)	22.14±2.96	-2.34	(.020)
	Married	173 (82.0)	36.62±5.73			2026.24±2421.82			23.55±3.40
Method of	LDLT	171 (81.0)	36.74±5.75	0.99	(.321)	2293.27±2758.10	1.63	(.105)	23.56±3.07	3.86	(<.001)
transplantation	DDLT	40 (19.0)	35.75±5.19			1551.00±1697.90			21.45±3.29
Diagnosis^††	Hepatitis virus	123 (58.3)	37.20±5.74	2.04	(.043)	2120.08±2447.09	-0.08	(.935)	23.32±2.93	0.03	(.975)
	Alcoholic	54 (25.6)	35.30±5.70			2154.44±2889.11			23.31±3.65
	Cryptogenic	19 (9.0)
	Biliary problem	9 (4.3)
	Etc^§	6 (2.8)
HCC	Yes	102 (48.3)	37.43±5.56	2.21	(.028)	2304.80±2674.28	0.82	(.413)	23.53±2.98	1.65	(.100)
	No	109 (51.7)	35.72±5.63			2010.09±2539.68			22.81±3.40
Months after transplantation		5.73±3.25^†
MELD score (pre-LT)		17.81±10.90^†
	<20	139 (66.2)	37.22±5.56	2.33	(.021)	2447.27±2859.66	2.60	(.010)	23.77±2.77	3.65	(<.001)
	≥20	71 (33.8)	35.32±5.64			1580.56±1925.61			21.96±3.69
CTP	A^a	67 (31.9)	36.39±5.85	0.58	(.564)	2414.33±2642.46	1.24	(.291)	24.08±2.86	8.83	(<.001)
	B^b	77 (36.7)	37.12±5.82			2280.13±2976.00			23.45±2.98	a>c,	b>c^\|\|
	C^c	66 (31.4)	36.15±5.25			1743.33±2047.63			21.88±3.47

BMI=Body Mass Index; CTP=Child-Turcotte-Pugh; DDLT=Deceased Donor Liver Transplantation; GPAQ=Global Physical Activity Questionnaire; HCC=Hepatocellular carcinoma; LDLT=Living Donor Liver Transplantation; MDA=Mini Dietary Assessment; MELD=Model for End-stage Liver Disease; M=mean; SD=Standard Deviation.

^† M±SD;

^†† Because the normality assumption of ANOVA was not satisfied, the kruskal-wallis test was performed, but it was not significant. Thus, independent t-test was used between only two groups of Hepatitis virus and Alcoholic;

^§ Autoimmune Hepatitis: 1, Nonalcoholic steatohepatitis: 2, Wilson disease: 1, Budd-chiari syndrome: 1, Toxic hepatitis: 1;

^|| Scheffé test.

Table 2.

Nutritional Status, Diet Patterns and Physical Activities of LT Recipients (N=211)

Variables	Categories	n (%)
MDA		36.55±5.65^†
	<30	19 (9.0)
	≥30	192 (91.0)
GPAQ (MET·min·wk)		2152.56±2603.57^†
	High	47 (22.3)
	Moderate	81 (38.4)
	Low	83 (39.3)
Taking a walk	Yes	112 (53.1)
	No	99 (46.9)
Sitting or lying down (hr)		8.60±4.51^†
Muscle strength exercise	Yes	51 (24.2)
	No	160 (75.8)
Pre-LT BMI (Kg/m²)		23.88±3.62^†
	Low weight	12 (5.7)
	Normal	68 (32.4)
	Overweight	59 (28.1)
	Obesity	71 (33.8)
Post-LT BMI (Kg/m²)		23.16±3.22^†
	Low weight	15 (7.1)
	Normal	87 (41.2)
	Overweight	48 (22.7)
	Obesity	61 (29.0)
Pre-LT BMI & post-LT BMI: t=4.22, p<.001^††, r=.74, p<.001^§

BMI=Body Mass Index; GPAQ=Global Physical Activity Questionnaire; LT=Liver Transplantation; MDA=Mini Dietary Assessment; MET= Metabolic Equivalent Task.

^† M±SD;

^†† Paired t-test;

^§ Pearson’s correlation.

Table 3.

Factors Influencing Post-LT BMI (N=210)

Variables	B	SE	β	t	p
(constant)	9.88	1.08		9.04	<.001
Pre-LT BMI	0.64	0.01	.72	15.76	<.001
Pre-LT MELD score	-0.05	0.01	-.18	-4.07	<.001
Gender^†	-0.74	0.33	-.10	-2.28	.024
R²=.77, Adjusted R²=.60, F=102.34, p<.001

BMI=Body Mass Index; LT=Liver Transplantation; MELD=Model for End-stage Liver Disease; SE=Standard Errors.

^† Dummy variable (Men: 0, Women: 1).

Table 4.

BMI Change Rate, Diet Patterns, Physical Activities according to Elapsed Time (N=210)

Variables	Before 3 months (N=66)	After 3 months (N=144)	t	p
BMI change rate	-5.73	-0.77	3.93	<.001
MDA	38.24±4.89	35.78±5.82	2.99	.003
High intensity leisure activity (MET·min·wk)	123.64±834.83	285.79±868.91	1.27	.199
Sitting and lying time (hr)	9.42±4.81	8.25±4.33	1.69	.095
Muscle exercise (per wk)	0.67±1.47	1.11±1.78	1.77	.078

Variables	Before 6 months (N=124)	After 6 months (N=86)	t	p

BMI change rate	-3.70	-0.35	2.23	.027
MDA	36.58±5.36	36.51±6.08	0.08	.935
High intensity leisure activity (MET·min·wk)	112.64±674.56	413.02±1052.69	2.34	.021
Sitting and lying time (hr)	9.18±4.72	7.80±4.07	2.26	.025
Muscle exercise (per wk)	0.74±1.47	1.31±1.94	2.34	.020

BMI=Body Mass Index; MDA=Mini Dietary Assessment; MET=Metabolic Equivalent Task.

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