title: Nutritional counseling improves quality of life and preserves body weight in systemic immunoglobulin light-chain (AL) amyloidosis.
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.
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: R.caccialanza@smatteo.pv.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Caccialanza
authors.affiliation: Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palladini
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cereda
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bonardi
authors.affiliation: Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Milani
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cameletti
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Quarleri
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cappello
authors.affiliation: Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Foli
authors.affiliation: Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lavatelli
authors.affiliation: Biometry and Statistics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Merlini
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000276:immunology / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D001835:Body Weight; D037001:Directive Counseling / Q000379:methods*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains; D008297:Male; D008875:Middle Aged; D044623:Nutrition Therapy / Q000379:methods*; D016016:Proportional Hazards Models; D011788:Quality of Life; D015431:Weight Loss
chemical_list: D007147:Immunoglobulin Light Chains
keywords: AL amyloidosis; Nutritional counseling; Quality of life; Survival