Prevalence and factors associated with dyslipidemia after
               liver transplantation

Ribeiro, Hélem de Sena; Anastácio, Lucilene Rezende; Ferreira, Lívia Garcia; Lagares, Érika Barbosa; Lima, Agnaldo Soares; Correia, Maria Isabel Toulson Davisson

doi:10.1590/1806-9282.60.04.016

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Revista da Associação Médica Brasileira

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ORIGINAL ARTICLES • Rev. Assoc. Med. Bras. 60 (4) • Jul-Aug 2014 • https://doi.org/10.1590/1806-9282.60.04.016 copy

Prevalence and factors associated with dyslipidemia after liver transplantation

Prevalência e fatores associados às dislipidemias pós-transplante hepático

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to determine the prevalence of abnormal total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides in patients undergoing liver transplantation (LTx) and to identify predictors of these disorders.

Methods:

cross-sectional study to assess the prevalence of dyslipidemia in patients undergoing LTx. Demographic, socioeconomic, clinical, anthropometric and dietetic data were collected to determine the association with dyslipidemia using univariate and multivariate statistical analysis.

Results:

136 patients were evaluated, 68.1% of which had at least one type of dyslipidemia. The triglyceride level was high in 32.4% of cases, with low HDL in 49.3% of patients and high LDL levels in only 8.8%. High total cholesterol was observed in 16.2% of the study population and was associated with the recommendation for transplantation due to ethanolic cirrhosis (OR = 2.7) and a greater number of hours slept per night (OR = 1.5).

Conclusion:

many patients presented dyslipidemia after transplantation, demonstrating the need for interventions in relation to modifiable factors associated with dyslipidemias that can mitigate or prevent these disorders.

dyslipidemia; lipoprotein; prevalence; liver transplantation

Categorical variables		%	N	Numerical variables	Mean / Median	± Standard deviation / Minimum-maximum
Marital status - married		30	42	Per capita income (BR$)	499	83 - 6,000
Unemployed/retired/homemaker		69.1	94	Hours of sleep (per day)	7.7	1.4
Smokers		11.4	15	Physical activity factor (MET/24)	1.3	0.2
Former smokers		39.8	47	Glucose (mg/dL)	96	61 - 346
Use of tacrolimus		89	121	Total cholesterol (mg/dL)	163.9	43.5
Use of cyclosporine		11	15	LDL (mg/dL)	88.8	34.3
Hypertension before transplantation		19.3	26	HDL (mg/dL)	44	18 - 162
Current hypertension		41.2	56	Triglycerides (mg/dL)	124	28 - 659
Diabetes mellitus before transplantation		5.9	8	Systolic blood pressure (mmHg)	120	90 - 180
Current diabetes mellitus		21.3	29	Diastolic blood pressure (mmHg)	80	50 - 110
Indicated for transplantation				Time using prednisone (months)	4	1.5 - 140
	VHC cirrhosis	30.9	42	Accumulated prednisone dose (g)	2.5	0.5 - 39.4
	Ethanolic cirrhosis	30.9	42	BMI before liver disease	25.4	4.7
	Autoimmune hepatitis	12.5	17	Current BMI	26.5	4.7
	Cryptogenic cirrhosis	11	15	Waist circumference	95	14.4
	Cirrhosis and hepatocellular carcinoma	8.8	12	Hip circumference	102.3	10.4
	Primary biliary cirrhosis	5	5	Waist-hip ratio	0.93	0.08
	Secondary biliary cirrhosis	3.7	2

Nutrient	Median intake	Minimum intake	Maximum intake	Nutrient		Median intake	Minimum intake	Maximum intake
Kilocalories (kcal)	1,933.4	476.8	3,998.1	Vitamin B12 (mcg)		3.8	0	19.3
Carbohydrates (g)	229.3	65.8	519.4	Folic acid (mcg)		179.7	24.5	536.6
Proteins (g)	70	14.8	187.4	Calcium (mg)		536.5	140.2	1577
Lipids (g)	61.9	12.4	552	Iron (mg)		13.1	1.4	52.9
Polyunsaturated lipids (g)	18	1.7	51.5	Magnesium (mg)		210.7	62.7	907.3
Monounsaturated lipids (g)	15.6	2.3	59.8	Potassium (mg)		2,287.9	646.9	9,411.4
Saturated lipids (g)	18.7	3	63	Sodium (mg)		2,201.6	287.9	5,425.8
Carbohydrates %	51.7	32.7	78.3	Zinc (mg)		9.2	1	33
Proteins %	15.8	7.3	44.4	Per group
Lipids %	32.1	9.5	52		Breads, cereals, tubers (g)	390	89	1,680
Polyunsaturated lipids %	8.9	3.2	17.2		Wholegrain cereals (g)	0	0	190
Monounsaturated lipids %	8.3	3	17		Greenery (g)	110	0	521
Saturated lipids %	9.4	2	22.2		Fruits (g)	123.4	0	717
Cholesterol (mg)	175.4	0	750		Vegetables (g)	140	0	600
Total fibers (g)	16.6	2	72		Meat (g)	127	0	500
Vitamin A (RE)	890.6	57.9	4,590		Sugar-sweetened beverages (g)	200	0	2,000
Vitamin C (mg)	72.5	4.1	740		Sweets (g)	0	0	500
Vitamin D (mcg)	1.8	0	18.7		Fats (g)	11	0	100
Vitamin E (mg)	17.4	2	17	Dairy
Vitamin B1 (mg)	1.5	0.2	3.3		Milk (mL)	150	0	720
Vitamin B2 (mg)	1.3	0.4	3.8		Whole milk (mL)	37.5	0	720
Niacin (mg)	17.2	2.8	272.4		Skim milk (mL)	0	0	480
Vitamin B5 (mg)	3.3	0.8	9.1		Yogurt (mL)	0	0	150
Vitamin B6 (mg)	1.5	0.3	4.9		Cheese (g)	0	0	92

Associated independent factors	OR	CI	p Value
High TG
Older age (years)	1.07	1.03 - 1.01	0.01
Indicated due to cryptogenic cirrhosis	1.03	1.00 - 1.06	0.05
Higher consumption of whole milk (mL)	1.00	1.00 - 1.004	0.05
Hosmer-Lemeshow test			0.98
Low HDL
Waist circumference > 88/102 cm	3.22	1.47 - 7.05	<0,01
Triglycerides ≥ 150 mg/dL	1.005	0.99 - 1.01	0.08
Lower vegetable intake (g)	1.01	1.001 - 1.002	0.01
Hosmer-Lemeshow test			0.77
High LDL
Higher folic acid intake (mg)	1.02	1.007 - 1.035	<0,01
Lower potassium intake (mg)	1.01	1.01 - 1.001	0.01
Higher fruit intake (g)	1.01	1.001 - 1.011	0.02
Higher meat intake (g)	1.01	1.002 - 1.023	0.02
Unemployed/retired/homemaker	16.60	1.26 - 219.68	0.03
Presence of diabetes prior to transplantation	10.49	1.16 - 95.19	0.04
Hosmer-Lemeshow test			0.77
High TC
More hours of sleep per night	1.45	1.02 - 2.07	0.04
Indicated due to ethanolic cirrhosis	2.66	0.99 - 7.11	0.05
Hosmer-Lemeshow test			0.41

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