title: Prevalence of malnutrition in adult patients previously treated with allogeneic hematopoietic stem-cell transplantation.
abstract: Malnutrition is common after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and is a well-known prognostic factor for survival. The nutritional status of patients in a long term after allo-HSCT is less well documented. The main objective of this study was to evaluate the prevalence of malnutrition in adult patients who underwent allo-HSCT more than one year ago. Secondary objectives were to assess body composition, muscle strength, and factors associated with malnutrition.
  
  
  
  All allo-HSCT patients admitted into the University Hospital of Clermont-Ferrand between 1st January 1985 and 31st December 2012 were screened. Clinical and biological nutritional assessments included anthropometric measurements, serum nutritional proteins, body composition assessed by bioelectrical impedance, and upper-limb muscle strength (MS) measured by dynamometry. Hematological and nutritional data during and after hospital stay for allo-HSCT were retrospectively collected.
  
  
  
  Eighty four allo-HSCT patients (52% men; mean age 54.4 ± 12.5 years) were enrolled. Average follow-up after allo-HSCT was 56.4 ± 47.5 months. Prevalence of malnutrition at the end of follow-up was 20%. Compared to well-nourished patients (WN group), undernourished patients (UN group) at the end of follow-up were significantly more likely to be undernourished (50% vs. 21%, p = 0.04) at hospital admission, and to have a Nutritional Risk Index of <97.5 (47% vs. 20%, p = 0.004). Compared to a reference population, mid-arm muscle circumference and MS were significantly more likely to be decreased in the UN group than in the WN group (35.3% vs. 8.9%, p = 0.017; 24% vs. 3%, p = 0.005, respectively); fat-free mass index and appendicular skeletal muscle mass index were decreased in 30.5% and 36.6% of all patients, respectively, with no difference between UN and WN groups. Chronic graft-versus-host disease was more frequent, although not significantly in the UN group (76% vs. 52%, p = 0.071). In multivariate analyses, the presence of malnutrition at hospital admission for allo-HSCT trended towards an increased risk of longer-term malnutrition (OR = 3.60 [0.95; 13.67], p = 0.06).
  
  
  
  Malnutrition is a frequent consequence of allo-HSCT, and may occur several months or years after allo-HSCT, particularly if malnutrition existed before allo-HSCT. Our findings support the need for specialized nutritional care for both before and after allo-HSCT. Furthermore, assessment of muscle mass may be a pertinent parameter of malnutrition in this instance.
authors.affiliation: CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, EA7283, CIC501, F-63000 Clermont-Ferrand, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Brotelle
authors.affiliation: CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, EA7283, CIC501, F-63000 Clermont-Ferrand, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Lemal
authors.affiliation: CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, EA7283, CIC501, F-63000 Clermont-Ferrand, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Cabrespine
authors.affiliation: CHU Clermont-Ferrand, Service Nutrition Clinique, F-63000 Clermont-Ferrand, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Combal
authors.affiliation: CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, EA7283, CIC501, F-63000 Clermont-Ferrand, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Hermet
authors.affiliation: CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, EA7283, CIC501, F-63000 Clermont-Ferrand, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Ravinet
authors.affiliation: CHU Clermont-Ferrand, Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, EA7283, CIC501, F-63000 Clermont-Ferrand, France.
authors.forename: Jacques-Olivier
authors.initials: JO
authors.lastname: Bay
authors.affiliation: CHU Clermont-Ferrand, Service Médecine Digestive et Hépatobiliaire, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, F-63000 Clermont-Ferrand, France. Electronic address: cbouteloup@chu-clermontferrand.fr.
authors.forename: Corinne
authors.initials: C
authors.lastname: Bouteloup
mesh_terms: D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence
keywords: Body composition; Hemato-oncology; Muscle mass; Muscle strength; Nutritional status