Applied nutritional investigationAssociation of food cravings with weight gain, overweight, and obesity in patients after liver transplantation
Introduction
Patients undergoing liver transplantation (LTx) commonly present excessive weight gain after surgery [1], [2]. This weight gain becomes a worrisome factor as excess weight is associated with the development of comorbidities and an increase in long-term mortality [3].
In general, weight gain is associated with the individual's eating habits [4], [5] and an increased intake of high-calorie foods [6], [7]. However, authors who have evaluated food intake in the LTx population did not find a connection between consumption and weight gain [8], [9], [10]. Therefore, there is a gap between overweight and its determinants.
Studies on eating behavior have gained strength [11], [12], demonstrating that several factors can influence food intake and weight gain.
Food craving (FC) is a phenomenon characterized as the intense desire to consume a specific food or the difficulty of resisting it [13]. This behavior has been related to an increase in body mass index (BMI) and an increase in the intake of highly palatable foods [11].
FC can occur even in the absence of hunger [14] and a large portion of the population has experienced it. About 66% to 97% of the adult population has reported this behavior [15], [16]. This phenomenon is of interest due to the high prevalence and nutritional effects in several groups of individuals [17] and, in particular, because it could have strong implications on obesity and related health problems [13], [18], [19].
In individuals with obesity, the frequency and intensity of FCs seem to be more prevalent and intense [20], [21]. It has been suggested that there is a relationship with excessive energy intake and weight gain [22], unsuccessful weight loss [23], and early dropout from obesity treatment programs [24].
Considering the known association between FC and weight gain or obesity in the general population, it is important to investigate this aspect in the population undergoing LTx. The aim of this study was to evaluate the FC and its association with weight gain, excessive weight, and obesity after LTx.
Section snippets
Participants and design
A convenient sample of patients who underwent LTx, >18 y of age at the Alfa Institute of Gastroenterology – Transplant Outpatient Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil, were included in this cross-sectional study. Pregnant or nursing women were excluded. Patients were interviewed once either in the outpatient clinic or by completing the online questionnaire, from August 2016 to February 2017. The Ethics Committee of the Universidade Federal de Minas Gerais
Characteristics of population
The present study included 301 patients (median age 57 y, ranging from 20 to 77 y; time post-LTx 6.6 ± 4.4 y; 64.1% men). Their most frequent indications for LTx were ethanolic cirrhosis (29.2%) and hepatitis C virus (26.2%). The observed weight variation was 8 kg (ranging from –16 to +41 kg), with 17.6% of the patients (n = 53) having lost weight; 78.1% (n = 235) having gained weight, and 4.3% (n = 13) presenting with no weight change. At the evaluation, 62.5% (n = 188) presented with
Discussion
The present study evaluated FC in patients who underwent LTx and the influence of these factors on weight gain and obesity. The lack of data on similar populations made comparisons difficult, but compared with other studies with distinct populations, the average score on the FCQ-S of 33.4 ± 9.4 and FCQ-T median of 68 (30–163) in our sample, was lower than that reported by other authors discussed.
In a study carried out in Brazil, Medeiros et al. [25] evaluated 611 healthy adults and reported the
Conclusion
These findings suggest that, after liver transplantation, patients present with FC for different foods, which might be explained by the restrictions made before and after the transplantation.
The FCQ-T dimensions of lack of control, preoccupation, emotion, environmental triggers, and guilt were correlated with weight gain. The desire dimension in FCQ-S was associated with presence of overweight, and the dimensions of negative reinforcement, lack of control, emotion, environmental triggers, and
Acknowledgment
The authors acknowledge Pró-Reitoria de Pesquisa da Universidade Federal de Minas Gerais for their support in publication.
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This study was funded by Funding Agencies in Brazil: Coordination for the Improvement of Higher Education Personnel–Capes. (Scholarship to SCF); National Council for Scientific and Technological Development–CNPq (grant no. 301593/2016-7 scholarship to MITDC); and Minas Gerais Research Foundation–FAPEMIG (grant no, APQ-01582-14 scholarship to MITDC). The authors have no conflicts of interest to declare.