Relationship between Access to Nutrition and Visceral Adiposity in Stable Long-Term Inner City Kidney Transplant Recipients (KTRs)

Abstract

Objectives: Higher % body fat has been associated with increased risk for multiple diseases especially if it has a visceral distribution. We studied body fat patterns in a population of inner-city KTRs at risk for food scarcity to explore access to nutrition and its relationship to % body fat. Methods: A random sample of 16 stable long-term pts from kidney transplant clinic were studied using the InBody S10 body composition analyzer at a regularly scheduled appointment. Pts were seated and electrodes were attached to the middle fingers, thumbs and below each ankle. Food scarcity was assessed by a standardized survey. Results: 63% (10) pts had body fat >25% (HIFAT). They did not differ from pts with body fat <25% (6 pts, LOFAT) in time since transplant (mean 10.6 ± 4.0 yrs), race, education, or annual income. 12 (75%) pts identified as black, 2 (12.5%) white and 2 (12.5%) other. The majority (56.3%) had an annual income < $20 k. HIFAT pts had higher visceral fat (14.0 ± 1.3 vs 5.1 ± 1.3, p < 0.001), higher BMI (34.8 ± 1.25 vs 27.7 ± 1.7, p = 0.002), and body weight (227.1 ± 12.6 vs 180.5 ± 12.1, p = 0.01), but no difference in skeletal muscle mass. HIFAT pts were more likely to be male (70% vs 30%, p = 0.039) and were older (53.9 ± 2.7 vs 43.5 ± 2.5 yrs, p = 0.01). Pts with diabetes were more likely to be HIFAT than those without (100% vs 50%, p = 0.037). 50% of pts in the LOFAT group reported they had cut down or skipped meals because there wasn't enough money for food vs none of the HIFAT pts (p = 0.018). Additionally, 100% of pts who received food from a bank, church or pantry in the last year were LOFAT (p = 0.004). There was no difference in SNAP use between the two groups. Conclusions: In our population of long-term inner-city KTRs a majority of patients had high total body fat, meeting the definition of obesity by BMI and pts with higher body fat weighed more overall with more visceral fat but not higher skeletal muscle mass. Patients with lower body fat reported more food scarcity and reliance on food pantries. Lower body fat in this population may not be related to better dietary habits and education regarding nutritional lifestyle changes that might improve body composition is important in this population at high risk for cardiovascular disease and diabetes.