Nutritional status of outpatients with systemic immunoglobulin light-chain amyloidosis 1.
BACKGROUND
Maintenance of a good nutritional status is associated with prolonged survival in many chronic diseases. To date, the nutritional status of outpatients with immunoglobulin light-chain (AL) amyloidosis has not been evaluated.


OBJECTIVE
The aims of this study were to obtain information regarding the nutritional status of AL amyloidosis outpatients and to investigate its prognostic role.


METHODS
One hundred six consecutive patients with histologically confirmed AL amyloidosis were enrolled. Anthropometric, biochemical, and clinical variables were measured. The Kaplan-Meier method was used to calculate survival. A Cox proportional hazard model was constructed to evaluate the prognostic effect of the nutritional variables.


RESULTS
Unintentional weight loss (median: 11.3%; range: 2.6-34% of usual nonedematous body weight) was documented in 58 subjects (54.7%). Body mass index (BMI; in kg/m2) was <22 in 25 subjects (23.6%). Serum prealbumin was <200 mg/L (lower reference limit) in 26 patients (24.5%). A multivariate analysis showed that the percentage weight loss was significantly greater in patients with than in those without cardiac involvement (P = 0.03), and it also differed significantly by New York Heart Association class (P = 0.02) and Eastern Cooperative Oncology Group performance status (P = 0.001). Cardiac involvement (P = 0.008), hematologic response to therapy (P = 0.013), BMI (P = 0.001) and serum prealbumin (P = 0.001) were independent predictors of survival.


CONCLUSIONS
Malnutrition is a prominent clinical feature of patients with AL amyloidosis. Appropriate nutritional evaluation that comprises the easily measurable nutritional variables associated with survival should be an integral part of the clinical assessment of AL amyloidosis outpatients.
Nutrition and Dietetics Service and the Department of Health Sciences, Section of Human Nutrition and Dietetics, University of Pavia, Pavia, Italy. r.caccialanza@smatteo.pv.it
Riccardo
R
Caccialanza
Giovanni
G
Palladini
Catherine
C
Klersy
Hellas
H
Cena
Christina
C
Vagia
Barbara
B
Cameletti
Paola
P
Russo
Francesca
F
Lavatelli
Giampaolo
G
Merlini
D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000378:metabolism / Q000401:mortality*; D000886:Anthropometry; D002318:Cardiovascular Diseases / Q000150:complications / Q000378:metabolism / Q000401:mortality; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000150:complications* / Q000209:etiology / Q000378:metabolism / Q000401:mortality; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D015431:Weight Loss
D007147:Immunoglobulin Light Chains