Night Eating Syndrome (NES) was identified in 5% of liver transplant recipients with type 2 diabetes and/or overweight/obesity, and obesity was significantly associated with nocturnal awakenings unrelated to urination (p = 0.008).
Key Findings
Results
NES was identified in 5% of liver transplant recipients with type 2 diabetes and/or overweight or obesity.
The Night Eating Questionnaire (NEQ) was administered to 101 LT recipients attending a nutritional-metabolic outpatient clinic.
Inclusion criteria were age >18 years, liver transplantation, and presence of type 2 diabetes and/or BMI >25 kg/m².
Patients with recent psychiatric diagnoses or unstable psychotropic medication were excluded.
This is the first study to assess NES prevalence in a liver transplant population according to the abstract.
Results
Obesity was significantly associated with nocturnal awakenings unrelated to urination in liver transplant recipients.
The association between obesity and nocturnal awakenings unrelated to urination reached statistical significance at p = 0.008.
This finding suggests a link between excess body weight and disrupted sleep patterns in this population.
Nocturnal awakenings unrelated to urination is a core symptom component assessed by the Night Eating Questionnaire (NEQ).
Results
A substantial subset of liver transplant recipients reported NES-related symptoms including insomnia, evening eating urges, and depressive mood, even without meeting full NES criteria.
These symptoms were reported by patients beyond the 5% who met full NES criteria.
Insomnia, evening hyperphagia urges, and depressive mood are recognized components of the NES symptom spectrum.
The presence of these subthreshold symptoms suggests broader psycho-nutritional vulnerability in this population.
Discussion
NES appears more prevalent in liver transplant recipients with obesity and disrupted sleep patterns compared to those without these features.
The study was cross-sectional in design, limiting causal inference.
The studied cohort was specifically selected for metabolic risk factors (type 2 diabetes and/or BMI >25 kg/m²), which may influence prevalence estimates.
The authors note NES may represent an 'under recognized barrier to optimal post-transplant care' in this metabolically and psychologically vulnerable population.
Conclusions
The authors concluded that psycho-nutritional screening tools should be incorporated into transplant follow-up protocols.
The Night Eating Questionnaire (NEQ) was used as the screening instrument in this study.
The recommendation is based on the metabolic and psychological vulnerability of the liver transplant population.
The study population consisted of 101 LT recipients seen at a nutritional-metabolic outpatient clinic.
Prior to this study, NES had been extensively studied in obese and psychiatric populations but remained unexplored in liver transplant recipients.
What This Means
This research suggests that Night Eating Syndrome (NES) — a condition where people eat excessively in the evenings or wake up at night to eat — exists among liver transplant patients who also have type 2 diabetes or are overweight or obese. The researchers gave a standardized questionnaire to 101 liver transplant recipients at a nutrition clinic and found that about 1 in 20 (5%) met the criteria for NES. Additionally, obesity was strongly linked to waking up at night for reasons other than needing to urinate, and many patients reported related symptoms like trouble sleeping, urges to eat in the evening, and low mood, even if they didn't fully meet NES criteria.
This matters because liver transplant recipients already face significant health challenges, including managing weight, blood sugar, and psychological well-being after their transplant. NES can make these challenges harder by disrupting sleep and promoting unhealthy eating patterns, yet it is rarely screened for in transplant care settings. The study highlights that this eating disorder may be going undetected in a population that is particularly vulnerable to its metabolic and psychological consequences.
This research suggests that transplant follow-up programs should consider routinely using screening tools like the Night Eating Questionnaire to identify patients who might benefit from nutritional and psychological support. Catching NES early could help improve long-term health outcomes for liver transplant recipients dealing with weight and metabolic issues.
Stecchi M, Albanese M, Nardi E, Simonetti G, Baldo C, Sciatta M, et al.. (2026). Night eating syndrome in liver transplant recipients with diabetes or excess-weight: a cross-sectional study.. Nutrition, metabolism, and cardiovascular diseases : NMCD. https://doi.org/10.1016/j.numecd.2025.104519