engleski

Factors affecting nutritional status in chronic GVHD

Background: Multiple factors such as disease activity and severity, therapy and/or dietary habits can cause changes in nutritional status independently or by interacting with each other. Presence of malnutrition or significant weight loss in chronic GVHD (cGVHD) patients was reported in literature up to 43%. The aim of this cross-sectional study was to identify factors that affect nutritional status in cGVHD patients. Methods: Nutritional status in patients with cGVHD treated at the University Hospital Center Zagreb, Croatia from 2015 to 2018 was assessed. Anthropometric measurements (height, body weight (BW), body mass index (BMI)) and clinical validated tool patient- generated subjective global assessment (PG-SGA) (where patients were categorized as well- nourished (PG-SGA A), moderately malnourished (PG-SGA B) or severely malnourished (PG-SGA C)) were used. All patients were evaluated according to 2005 NIH criteria for cGVHD diagnosis. Descriptive and correlation analysis were preformed. Results: In total, 44 adult cGVHD patients were included in the study, 23 women (52.3%), median age 47 (18-65) years, with mild cGVHD in 6 (13.64%), moderate in 24 (54.55%) and severe in 13 (29.55%) patients. According to the PG-SGA rating 19 (43.18 %) patients had PG-SGA A, 19 (43.18 %) PG-SGA B and 6 (13.64%) had PG-SGA C, giving a total malnutrition or risk of malnutrition prevalence of 56.82%. The mean BMI was 23.83±4.3 kg/m2 with correlation to PG-SGA rating (r=0.446, p=0.0024). Malnutrition according to the BMI (defined as BMI< 21 kg/m2) was found in 8 patients (18.18%). BW changes (10% or more in 6 months) were significant in 14 patients (31.82%). According to the PG-SGA assessment tool, oral symptoms reported by 31 patient (70.45%) and decreased appetite reported by 12 patients (27.27%) were associated with oral cGVHD NIH score (r=0.536, p=0.0002 ; r=0.441, p=0.0027) but not with BW or BMI. Gastrointestinal (GI) symptoms assessed with SGA, were generally mild with no correlation to GI cGVHD NIH score. No significant association was found between nutritional status and other NIH cGVHD scores. Corticosteroid therapy present in 12 (27.27%) correlated with PG-SGA rating (r=0.494, p=0.0006) but not with BW, BMI or appetite changes. In 23 patients (52.7%) with altered PG-SGA rating, BMI, appetite and body weight changes, dietary counseling and oral nutritional supplementation were initiated. Conclusions: Oral symptoms, decreased appetite and corticosteroid therapy in our cGVHD patients were associated with altered nutritional status according to the PG- SGA, but not with BMI. Therefore, PG-SGA might be a more sensitive tool in assessment of changes of the nutritional status and detection of patients at risk of malnutrition than BMI since it includes different factors like physical examination, presence of GI symptoms and corticosteroid therapy in its scoring system. Nutritional counseling and support are important in cGVHD patients especially in presence of oral symptoms. Disclosure: Nothing to declare

nutritional status ; chronic GVHD

kongresno priopćenje u CC časopisu - u procesu objavljivanja