Ann Hematol (2012) 91:399–406 DOI 10.1007/s00277-011-1309-x
ORIGINAL ARTICLE
Nutritional status independently affects quality of life of patients with systemic immunoglobulin light-chain (AL) amyloidosis Riccardo Caccialanza & Giovanni Palladini & Catherine Klersy & Emanuele Cereda & Chiara Bonardi & Barbara Cameletti & Elisabetta Montagna & Paola Russo & Andrea Foli & Paolo Milani & Francesca Lavatelli & Giampaolo Merlini
Received: 14 June 2011 / Accepted: 31 July 2011 / Published online: 9 August 2011 # Springer-Verlag 2011
Abstract Nutritional status is an independent prognostic factor in immunoglobulin light-chain amyloidosis (AL), but its influence on quality of life (QoL) is unknown. The aim of this cross-sectional study was to investigate the association between nutritional status and QoL in AL patients at diagnosis. One hundred and fifty consecutive patients with biopsy-proven AL were assessed for nutritional status by anthropometry [body mass index, unintentional weight loss (WL) in the previous 6 months and mid-arm muscle circumference (MAMC)], biochemistry (serum prealbumin), and semiquantitative food intake at referral. QoL was assessed by the Medical Outcomes Study 36-item Short Form General Health Survey. The composite physical component summary (PCS) and the mental component summary (MCS) for AL outpatients were 36.2±10.1 and 44.9±11.3, respectively (p< 0.001 for both vs the population norms of 50). In multivariate linear regression models adjusted for gender, R. Caccialanza (*) : E. Cereda : C. Bonardi : B. Cameletti : E. Montagna Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy e-mail:
[email protected] G. Palladini : C. Klersy : P. Russo : A. Foli : P. Milani : F. Lavatelli : G. Merlini Amyloidosis Research and Treatment Center, Biotechnology Research Laboratories, Department of Biochemistry, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy C. Klersy Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
age, Eastern Cooperative Oncology Group performance status, the number of organs involved, the severity of cardiac damage, C-reactive protein, energy intake, and WL, PCS was significantly lower for serum prealbumin 60% of the energy requirements estimated by the Harris Benedict equation [25] multiplied by a correction factor of 1.5. Protein intake was considered adequate if ≥1 g/kg of body weight/day. Statistical analysis All statistical analyses were performed using STATA 11.1 statistical software [26]. Data were described as counts and percent if categorical and mean and SD or median and quartiles (25th to 75th) if continuous. Differences between groups were assessed with the Student t test or the one-way
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analysis of variance (with Scheffé test for post hoc comparisons). The Pearson R was computed to measure correlation between continuous variables. For the purpose of the analyses, percentage weight loss was log transformed (skewed distribution). Multivariable general linear regression models were fitted to assess the association of relevant nutritional and clinical parameters with PCS and MCS, respectively. Collinearity between variables included in the models were assessed and excluded. Huber–White robust standard errors were computed to account for heteroscedasticity. A two-sided p level of
