title: Preventive versus "on-demand" nutritional support during antiviral treatment for hepatitis C: a randomized controlled trial.
abstract: OBJECTIVE
  Although antiviral treatment for hepatitis C (HCV) is highly effective, side effects often occur, including weight loss, digestive symptoms, and impaired quality of life. We aimed at exploring the beneficial effects of preventive nutritional support.
  
  
  METHODS
  In a randomized controlled trial, 53 HCV patients were allocated to "on demand" support (n=26: nutritional intervention if weight loss >5%) or preventive support (n=27: regular dietary advice plus energy- and protein-rich evening snack). Nutritional state (including validated Jamar Hand Grip Strength), digestive symptoms (visual analog score), and quality of life (SF-36 survey) were evaluated at baseline, and after 24 and 48 weeks of peginterferon α-2b and ribavirin treatment.
  
  
  RESULTS
  The primary end point (weight loss at 24 weeks) was reached in 22 patients in both groups. Weight decreased markedly in the "on demand" group (decrease at 24 weeks: 5.4 kg or 6.9%, p<0.001), but not in the preventive group (decrease 0.3 kg or 0.3%, p=n.s.). Jamar Hand Grip Strength deteriorated in the "on demand" group (from 40.3 ± 15.5 kg to 32.0 ± 13.1 kg, p<0.001) but not in the preventive group (from 40.7 ± 10.4 kg to 39.7 ± 8.9 kg, p=n.s.). Intake of energy, proteins, and fat decreased markedly in the "on demand" group but increased in the preventive group. Although digestive symptoms and quality of life deteriorated, impairment was significantly less in the preventive group.
  
  
  CONCLUSIONS
  Preventive nutritional advice plus supplementation prevents weight loss and catabolic state during HCV antiviral therapy, with improved digestive symptoms and quality of life.
authors: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors: Ellen J
authors: EJ
authors: Huisman
authors: Bart
authors: B
authors: van Hoek
authors: Hanneke
authors: H
authors: van Soest
authors: Karin M
authors: KM
authors: van Nieuwkerk
authors: Joop E
authors: JE
authors: Arends
authors: Peter D
authors: PD
authors: Siersema
authors: Karel J
authors: KJ
authors: van Erpecum
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D004064:Digestive System / Q000503:physiopathology; D004066:Digestive System Diseases / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006526:Hepatitis C / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D044623:Nutrition Therapy; D009752:Nutritional Status / Q000502:physiology; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011788:Quality of Life; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b