Nutritional counseling improves quality of life and preserves body weight in systemic immunoglobulin light-chain (AL) amyloidosis

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 31; no. 10; pp. 1228 - 1234
• Main Authors: Caccialanza, Riccardo, M.D, Palladini, Giovanni, M.D., Ph.D, Cereda, Emanuele, M.D., Ph.D, Bonardi, Chiara, R.D, Milani, Paolo, M.D, Cameletti, Barbara, R.D, Quarleri, Lara, R.D, Cappello, Silvia, R.D, Foli, Andrea, M.D, Lavatelli, Francesca, M.D., Ph.D, Klersy, Catherine, M.D., M.Sc, Merlini, Giampaolo, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015; Elsevier Limited
• Subjects: Aged; AL amyloidosis; Amyloidosis - immunology; Amyloidosis - mortality; Amyloidosis - psychology; Amyloidosis - therapy; Body mass index; Body Weight; Chemotherapy; Confidence intervals; Counseling; Dietary supplements; Dietitians; Directive Counseling - methods; Energy Intake; Female; Gastroenterology and Hepatology; Hospitals; Humans; Immunoglobulin Light Chains; Immunoglobulins; Intervention; Light; Male; Malnutrition; Medical prognosis; Middle Aged; Mortality; Nutrition; Nutrition Therapy - methods; Nutritional counseling; Proportional Hazards Models; Proteins; Quality of Life; Studies; Survival; Weight control; Weight Loss; AL amyloidosis; Survival; Nutritional counseling; Quality of life
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2015.04.011

Abstract Objective Malnutrition is associated with mortality and impaired quality of life (QoL) in systemic immunoglobulin light-chain (AL) amyloidosis. The aim of this study was to determine whether nutritional counseling is beneficial to patients with AL. Methods In this intervention study ( ClinicalTrials.gov Identifier: NCT02055534 ), 144 treatment-naïve outpatients with AL were randomized to usual care (UC; n = 72) and nutritional counseling (NC; n = 72). Results In the randomized population, although patients in the NC group maintained a stable body weight (weight loss [WL] = 0.6 kg; 95% confidence interval [CI], −1.0 to 2.1; P  = 0.214), those in the UC group demonstrated a significant decrease (WL = 2.1 kg; 95% CI, 0.2–4.1; P  = 0.003). However, the difference in weight between groups was not significant (mean WL difference = 1.6 kg; 95% CI, −0.7 to 3.9; P  = 0.179). Patients in the NC group demonstrated more satisfactory energy intake (≥75% of estimated requirements, odds ratio, 2.18; 95% CI, 1.04–4.57; P  = 0.048) and a significant increase in the mental component summary of QoL (Short form-36) at 12 mo (mean difference, 8.1; 95% CI, 2.3–13.9; P  = 0.007), which was restored to a mean score of 53 (95% CI, 50–53), over the healthy population norms. NC was also associated with better survival (crude hazard ratio, 0.57; 95% CI, 0.35–0.94; P  = 0.028). Conclusions In outpatients with AL, NC was helpful in preserving body weight, effective in improving mental QoL, and associated with better survival.