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American Journal of Clinical Nutrition, Vol. 83, No. 2, 350-354, February 2006
© 2006 American Society for Clinical Nutrition

ORIGINAL RESEARCH COMMUNICATION

Nutritional status of outpatients with systemic immunoglobulin light-chain amyloidosis 1 ,2 ,3

Riccardo Caccialanza, Giovanni Palladini, Catherine Klersy, Hellas Cena, Christina Vagia, Barbara Cameletti, Paola Russo, Francesca Lavatelli and Giampaolo Merlini

1 From the Nutrition and Dietetics Service (RC and BC), the Biometry and Clinical Epidemiology Service (CK), and the Center for Amyloidosis (GP, PR, FL, and GM), IRCCS Policlinico San Matteo, Pavia, Italy; and the Department of Biochemistry (GP, PR, FL, and GM) and the Department of Health Sciences, Section of Human Nutrition and Dietetics (HC and CV), University of Pavia, Pavia, Italy

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.

Design: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.

Key Words: Amyloidosis • outpatients • nutritional status • weight loss • prognosis • survival






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