Promoting energy balance related behavior after liver transplantation

Sonja Beckmann

Sonja Beckmann
Sabina De Geest
Kris Denhaerynck
Lynn Leppla
Oliver Mauthner

Externe Projektpartner
Swiss Transplant Cohort Study (STCS)

Ort der Datenerhebung
– Universitätsspital Basel
– UniversitätsSpital Zürich
– Inselspital Universitätsspital Bern

2013 bis 2020

Obesity has become a global health concern not only in the general population but also among liver transplant recipients. For more than two decades, rates of obesity in liver transplant candidates have been rising; and weight gain after transplantation is contributing to a further increase of obesity in the post-transplant course.

Weight gain and subsequent obesity is the result of an imbalance between energy intake and energy expenditure. The mechanisms behind weight gain, however, are far more complex and depend on a multitude of interrelated factors such as genetic, sociodemographic, behavioral, biomedical, psychological, and environmental factors. Despite the multifaceted dynamics, energy balance related behaviors, such as physical activity and healthy diet, are among the most influential factors and can be targeted via behavioral interventions.

In general, obesity is associated with increased risk of all-cause mortality as well as metabolic and cardiovascular comorbidities. Due to the immunosuppressive drugs, liver transplant recipients are already at a higher risk for cardiovascular and metabolic diseases compared to the general population. Maintenance of a healthy lifestyle and the promotion of energy balance related behaviors, i.e., healthy diet and physical activity is therefore highly relevant after transplantation. However, in the transplant population, there is a lack of evidence on: factors related to weight gain and obesity after transplantation; the impact of post-transplant weight gain and obesity on patient outcomes; and behavioral interventions to support effective weight management.

The overall aim of this project is to facilitate the development of a behavioral intervention focusing on physical activity and diet to support effective weight management after transplantation.
1. To summarize and synthesize in liver transplantation the evidence in view of: (a) What pre- and post-transplant risk factors are associated with post-transplant body weight parameters such as weight gain and obesity? (b) What post-transplant patient outcomes and comorbidities are associated with pre- and post-transplant body weight parameters?
2. To examine the evolution of body weight parameters up to 3 years after transplantation within and among adult kidney, liver, lung, and heart transplant patients in the Swiss Transplant Cohort Study (STCS).
3. To examine weight gain in the first year after solid organ transplantation in the STCS from a genomic perspective.
4. To determine clinical and psychosocial risk factors for post-liver transplantation new-onset obesity and examine its impact on outcomes including patient survival and cardiovascular events in the STCS.
5. To explore energy balance related behavior (diet and physical activity) and its correlates (beliefs, perceptions, knowledge, attitudes, perceived barriers and preferences) after liver transplantation.
6. To develop a complex intervention integrating eHealth technology to achieve and maintain energy balance for weight management after transplantation

The BALANCE project was designed as a multiphase mixed method research project including two systematic literature reviews with meta-analyses, three quantitative data analyses of the prospective nationwide STCS, and a study with qualitative interviews to explore the patients’ perspectives. The results will inform the development of a weight management intervention based on behavior change, diet and physical activity. The systematic development of the intervention will be guided by the behavior change wheel.

Erwarteter Nutzen / Relevanz
We expect that this scientific rigorous approach will provide essential knowledge to the so far limited body of evidence concerning energy balance related behavior and weight management after transplantation. A behavioral intervention integrating eHealth technology might have the potential to positively impact energy balance related behaviors, decrease comorbidities, and hopefully improve long-term patient outcomes after transplantation.