title: Effects of preventive versus "on-demand" nutritional support on paid labour productivity, physical exercise and performance status during PEG-interferon-containing treatment for hepatitis C.
abstract: OBJECTIVE
  Deterioration of nutritional status during PEG-interferon containing therapy for chronic hepatitis C can be ameliorated by preventive nutritional support. We aimed to explore whether such support also affects paid labour productivity, physical exercise and performance status.
  
  
  METHODS
  In this prospective randomized controlled trial (J Hepatol 2012;57:1069-75), 53 patients with chronic hepatitis C had been 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) during PEG-interferon-containing therapy. Paid labour productivity, physical exercise and performance status were evaluated at baseline, after 24 and (if applicable) after 48 weeks of treatment.
  
  
  RESULTS
  At baseline, 46% of patients performed paid labour and 62% performed some kind of physical exercise. Furthermore, most patients were able to carry out normal activity with only minor symptoms of disease (mean Karnofsky performance score: 94). Decreases of paid labour productivity (-21% vs. -70%, P=0.003), physical exercise activity (-43% vs. -87%, P=0.005) and Karnofsky performance scores (-12% vs. -24%, P<0.001) were less in the preventive than in "on demand" group after 24 weeks of treatment. Effects of preventive nutritional support were even more pronounced after 48 weeks.
  
  
  CONCLUSIONS
  Preventive nutritional support markedly ameliorates decreases of paid labour productivity, physical exercise and performance status during PEG-interferon-containing treatment for chronic hepatitis C.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Huisman
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: van Meer
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Leiden, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: van Hoek
authors.affiliation: Department of Gastroenterology and Hepatology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Hanneke
authors.initials: H
authors.lastname: van Soest
authors.affiliation: Department of Gastroenterology and Hepatology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Karin M J
authors.initials: KM
authors.lastname: van Nieuwkerk
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Center, Utrecht, The Netherlands.
authors.forename: Joop E
authors.initials: JE
authors.lastname: Arends
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands. Electronic address: k.j.vanerpecum@umcutrecht.nl.
authors.forename: Karel J
authors.initials: KJ
authors.lastname: van Erpecum
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004526:Efficiency; D015444:Exercise; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000139:chemically induced / Q000628:therapy*; D018529:Nutritional Support; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; C417083:peginterferon alfa-2b