Low socioeconomic status and associated stress contribute to weight gain in kidney transplant recipients

Akya Myrie

BOSTON — Kidney transplant recipients from underserved communities have limited access to healthy foods and high levels of stress and anxiety, which contribute to a likelihood of weight gain post-transplant, according to results of a poster presented at the National Kidney Foundation Spring Clinical Meetings.

“Many people have researched pre-transplant weight gain,” Akya Myrie, of SUNY Downstate Medical Center in Brooklyn, New York, told Healio/Nephrology. “However, how much weight people are gaining after their transplant, which affects the longevity of that transplant, has not been well-researched.”

To more fully examine the psychosocial and socioeconomic factors that may contribute to weight gain post-transplant, researchers interviewed 28 kidney transplant recipients from inner-city Brooklyn (mean age 55.6 years; 82% were black; 32% had completed college; 75% had household income less than $40,000/year; mean baseline BMI, 25.8 kg/m²). Researchers assessed stress and anxiety in participants using the perceived stress scale (PSS) and the patient health questionnaire-9 (PHQ9), and then analyzed diet as a 24-hour food recall using the healthy eating index (HEI). The average time since transplant was 6.6 years.

At 6 months, 50% of all patients had greater than a 10% increase in BMI, 60% had greater than 5% weight change and 53.6% gained seven pounds or more.

In addition, researchers found patients who used SNAP or EBT were more likely to gain weight than those who did not and that diabetes at the time of transplant and lower HEI scores correlated with weight gain at 6 months.

Compared with patients with a BMI of less than 25 kg/m², the 65% of patients with a BMI of greater than 25 kg/m²at last follow-up had higher stress and anxiety scores based on the PSS (11.4 vs. 5.6) and the PHQ9 (5.12 vs. 1.56).

Myrie commented that she is often asked if corticosteroids can contribute to this weight gain.

“Yes, absolutely, but the amount of weight that our patients were gaining could not solely be attributed to the use of corticosteroids,” she said.

Myrie emphasized that stress in this study population — coming from socioeconomic status — is intricately tied to the weight gain. For example, many of these patients used food stamps and had limited access to healthy food choices. Myrie said, “Many patients have more than four fast food restaurants within a 1-mile radius. That’s typically where they get their food, because it’s cheaper.”

She suggested interventions in which a nutritionist of a similar background/race be assigned to specific patients.

“A lot of patients, even when they were trying to eat healthy, were not aware of the actual carbohydrate or fat percentage in the foods they were eating,” Myrie said. “[So having] someone who understands what kind of foods that they’re eating, could make a big difference.” – by Melissa J. Webb

Reference:

Myrie A, et al. Abstract 415. Presented at: National Kidney Foundation Spring Clinical Meetings; May 8-12, 2019; Boston.

Disclosures: Myrie reports no relevant financial disclosures.