SDC, Materials and Methods

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SDC, Materials and Methods

Measurement of Blood Pressure

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured

semirecumbent with a fully automatic upper-arm digital blood pressure monitor (Spot Vital Signs LXi; Welch Allyn). Six readings over an 8- to 10- minute period were taken, with the first reading ignored, and the mean of the remaining 5 used for subsequent derivation of mean arterial pressure (MAP), calculated using the formula MAP=(2DBP+SBP)/3.

Measurement of Body Weight and Height, and Derivation of Body Mass Index

Body weight (kg) and height (m) were measured in a standardised procedure with participants wearing light clothing without shoes. Body weight was measured using a digital scale to the nearest 0.01kg. Body height was measured using a stadiometer with the participants standing without shoes and feet together, to the nearest 0.01m. Body mass index (kg/m

²

) was calculated as weight (kg) divided by height squared (m

²

).

Measurement of Waist and Neck Circumferences

Waist and neck circumferences (cm) were measured to the nearest 0.1cm with a nonstretchable

standard tape measure. Waist circumference was taken over the unclothed abdomen at the

midpoint of the lower thoracic cage and the iliac crest in the midaxillary line, as recommended

by the World Health Organisation. Neck circumference was measured below the laryngeal

prominence and perpendicular to the long axis of the neck.

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Measurement of Triceps Skinfold Thickness

Triceps skinfold thickness (mm), to the nearest 0.2mm, was measured using a skinfold caliper (Holtain, Crymych, UK), on the posterior surface of the upper arm, at the midpoint between the acromial process of the scapula and the tip of the olecranon process of the elbow.

Body Composition Measurement using Bio-impedance Analysis

Body composition was assessed by a well-validated multifrequency bio-impedance based body composition monitor (BCM, Fresenius Medical Care, Germany). Measurements were carried out in a standard manner while the patient was lying supine in a flat and nonconductive bed.

The inbuilt physiological body composition model measures whole-body bio-impedance spectroscopy at 50 frequencies (5-1000 kHz) via electrodes placed on the wrist (proximal to the transverse) and ankle (arch on the superior side of the foot). Body composition data focused on fat tissue and lean tissue mass were expressed as a percentage of body weight.

3-Day Food Diary

Dietary intakes of fructose, dietary fibre, total fat and saturated fat were estimated by a 3-day

food dairy, a widely accepted dietary assessment tool deemed to be valid, reliable and accurate

in estimating typical and habitual nutrient intake. Participants were given detailed written

instructions on completing an accurate dietary record for a 3-day period, which included 1

weekend day, within 1 week before attending the research visit. These instructions were

accompanied by verbal explanation from the researcher, which included training in portion

size estimation and documentation for both dinning in and eating out. The dietary records were

reviewed by the researcher for accuracy and completeness at the research visit. Data were

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entered into Dietplan 6 P3 (Forestfield Software Ltd) nutrition analysis program by the same researcher, avoiding interobserver variation. Total intakes of all nutrients were calculated by this program.

General Practice Physical Activity Questionnaire (GPPAQ)

Physical activity was evaluated using the General Practice Physical Activity Questionnaire

(GPPAQ), where participants were asked to estimate weekly number of hours spent on the

following activities: walking; jogging or running; swimming; cycling; exercise or dance

classes; housework; gardening; and other forms of physical activity. The number of hours

engaged in each form of physical activity was summed to provide the weekly total number of

hours spent on performing physical activity.

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Table S1: Univariate Associations of Covariates with Obesity (BMI criteria)

Logistic Regression Coefficient* p value Demographic and Social Parameters

Age (years) 0.0071 0.61

Male Gender 0.6680 0.01

Ethnicity:

Non-Caucasian (South Asian, African-Caribbean, and Others) 0.0542 0.84

Diabetes status:

Diabetic Pretransplant

Posttransplant Diabetes Mellitus

0.2782 0.1861

0.06 0.07

Time Posttransplantation (years) 0.0362 0.18

Immunosuppressive Medications:

Calcineurin Inhibitor

Adjunctive Antiproliferative Agent Prednisolone

0.2791 0.9842 0.4162

0.65 0.14 0.04

Total Calorie Intake (kcal/day) 0.4021 0.08

Saturated Fat intake (g/day) 0.0042 0.21

Total Fructose Intake (g/day) 0.0321 <0.001

Physical Activity Level (hours/week) -0.0741 0.09

Sleep Quality (PSQI score) 0.1021 0.03

Endotoxin Level (EU/mL) 0.5382 0.03

UACR (mg/mmol) 0.0162 0.04

*For continuously-distributed variables, coefficient reported per unit increase in predictor variable; for gender, coefficient shown for male versus female.

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Table S2: Univariate Associations of Covariates with Metabolic Syndrome

Age (years) 0.0662 0.004

Ethnicity:

Diabetes status:

0.6271 0.7821

0.03 0.04

1.2021 0.2312 0.1832

0.08 0.45 0.06

Total Fructose Intake (g/day) 0.0271 0.002

Physical Activity Level (hours/week) 0.0351 0.19

UACR (mg/mmol) 0.002 0.67

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Table S3: Univariate Associations of Covariates with Central Obesity

Age (years) 0.0471 0.003

Ethnicity:

Diabetes status:

0.0321 0.0632

0.18 0.09

0.3821 0.9212 0.0821

0.55 0.09 0.07

UACR (mg/mmol) 0.0042 0.55

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Table S4: Univariate Associations of Covariates with Raised Triglycerides

Age (years) 0.0072 0.60

Ethnicity:

Non-Caucasian (South Asian, African-Caribbean, and Others) 0.0591 0.38 Diabetes status:

0.6241 0.3215

0.12 0.10

0.1062 0.6852 0.0871

0.57 0.28 0.49

UACR (mg/mmol) 0.0091 0.26

Obesity (BMI≥30 kg/m²) 1.1411 0.02

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Table S5: Univariate Associations of Covariates with Reduced HDL Cholesterol

Age (years) 0.0032 0.83

Ethnicity:

Non-Caucasian (South Asian, African-Caribbean, and Others) 0.7211 0.18 Diabetes status:

0.3922 0.3416

0.51 0.43

0.7422 0.0441 0.0813

0.49 0.59 0.78

UACR (mg/mmol) 0.0031 0.67

Obesity (BMI≥30 kg/m²) 0.4412 0.19

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Table S6: Univariate Associations of Covariates with Raised Fasting Glucose

Age (years) 0.0126 0.35

Ethnicity:

0.9275 0.8797 0.1718

0.19 0.16 0.69

Total Fructose Intake (g/day) 0.0331 <0.001

UACR (mg/mmol) 0.0015 0.39

Obesity (BMI≥30 kg/m²) 1.1692 0.003

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Table S7: Univariate Associations of Covariates with Raised Systolic Blood Pressure

Age (years) 0.0521 0.004

Ethnicity:

Diabetes status:

0.6842 0.5431

0.11 0.13

0.8011 0.0826 0.6651

0.19 0.88 0.19

UACR (mg/mmol) 0.0116 0.36

Obesity (BMI≥30 kg/m²) 0.4472 0.28

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Table S8: Univariate Associations of Covariates with Raised Diastolic Blood Pressure

Age (years) 0.0246 0.07

Ethnicity:

Diabetes status:

0.8941 0.6549

0.07 0.08

1.8356 0.1321 0.3965

0.08 0.38 0.37

UACR (mg/mmol) 0.0107 0.17

Obesity (BMI≥30 kg/m²) 0.2891 0.46