Original article Energy expenditure, spontaneous physical activity and with weight gain in kidney transplant recipients q Anne-Elisabeth Heng a, b, c, * , Christophe Montaurier b, c , Noël Cano b, c, d , Nicolas Caillot e , A. Blot b, c , Nathalie Meunier b, c , Bruno Pereira f , Geoffroy Marceau g , Vincent Sapin g , Christelle Jouve b, c , Yves Boirie b, c, d , Patrice Deteix a, c , Beatrice Morio b a CHU Clermont-Ferrand, Service de Néphrologie, Pôle REUNNIRH, F-63003 Clermont-Ferrand, France b INRA, UMR 1019, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand, France c Clermont Université, Université d’Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000 Clermont-Ferrand, France d CHU Clermont-Ferrand, Service de Nutrition Clinique, Pôle REUNNIRH, F-63003 Clermont-Ferrand, France e NRC Medical, F-63450 Saint Saturnin, France f CHU Clermont-Ferrand, Biostatistics Unit, Délégation Recherche Clinique et Innovation, F-63000 Clermont-Ferrand, France g CHU Clermont-Ferrand, Laboratoire de Biochimie, F-63003 Clermont-Ferrand, France article info Article history: Received 2 April 2013 Accepted 1 May 2014 Keywords: Metabolism Nutrition Obesity Transplant outcome summary Background & aims: Alterations in energy metabolism could trigger weight gain after renal transplantation. Methods: Nineteen transplanted non-diabetic men, 53  1.6 years old, receiving calcineurin inhibitors but no corticosteroids were studied. They were compared with nine healthy men matched for height, age and lean body mass. Daily energy expenditure and its components (sleeping, basal and absorptive metabolic rates) were analyzed for 24 h in calorimetric chambers and for 4 days in free living conditions using calibrated accelerometry. Other variables known to influence energy expenditure were assessed: body composition, physical activity, 4-day food intake, drug consumption, serum C-reactive protein, interleukin-6, thyroid and parathyroid hormones, and epinephrine. Transplant recipients who gained more than 5% body weight after transplantation (n ¼ 11, þ11.0  1.5 kg) were compared with those who did not (n ¼ 8) and with the controls. Results: Weight gain compared with non-weight gain patients and controls exhibited higher fat mass without change in lean body mass. Daily, sleeping and resting energy expenditure adjusted for lean body mass was significantly higher in non-weight gain (167.1  4.2 kJ/kg/lean body mass/24 h, P < 0.05) compared with weight gain patients (147.4  3.6) and controls (146.1  4.6). Weight gain compared with controls and non-weight gain subjects had lower free living physical activity and a higher consumption of antihypertensive drugs and b-blockers. Conclusions: After kidney transplantation, weight gain patients were characterized by lower adjusted energy expenditure, reduced spontaneous physical activity but a more sedentary life style and a trend toward a higher energy intake explaining the reason they gained weight. The nWG KTR had increased resting and sleeping EE which protected them from weight gain. Such hypermetabolism was also observed in 24-h EE measurements. By comparison with the nWG patients, the WG transplant recipients were characterized by higher b-blocker consumption. These data could be helpful in the prevention of weight gain in kidney transplant recipients. Ó 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Non-standard abbreviations: ESRD, end-stage renal disease; KTRs, kidney transplant recipients; CKD, chronic kidney disease; EE, Energy expenditure; WG patients, patients who gained weight; nWG patients, patients who did not gain weight; LBM, lean body mass; DEXA, dual energy X-ray absorptiometry. q Conference presentation: This study was presented in part at the 16th International Congress on Renal Nutrition and Metabolism (ICRNM), Hawaii, USA, 2012. * Corresponding author. Department of Nephrology, CHU G. Montpied, 58 rue Montalembert, 63000 Clermont-Ferrand, France. Tel.: þ33 473 752 375; fax: þ33 473 752 362. E-mail address: aheng@chu-clermontferrand.fr (A.-E. Heng). Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu http://dx.doi.org/10.1016/j.clnu.2014.05.003 0261-5614/Ó 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Clinical Nutrition xxx (2014) 1e8 Please cite this article in press as: Heng A-E, et al., Energy expenditure, spontaneous physical activity and with weight gain in kidney transplant recipients, Clinical Nutrition (2014), http://dx.doi.org/10.1016/j.clnu.2014.05.003