Malnutrition in patients with chronic GVHD

Abstract

Malnutrition is a known complication of chronic GVHD (cGVHD), but has not been well described in the context of organ-specific manifestations and the recent National Institutes of Health (NIH) criteria. Here, 210 cGVHD patients were analyzed, in a cross-sectional study design, for demographics, transplant-related history, clinical assessments, symptoms, function, quality-of-life, laboratory values and survival in order to determine their associations with nutritional status. Most patients had long-standing, moderate or severe cGVHD and had failed many lines of therapy. Twenty-nine percent (60/210) of subjects were malnourished, using the subjective Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and evaluation. No demographic or transplant characteristics were associated with malnutrition; cGVHD of the lungs, gastrointestinal (GI) tract and mouth, NIH global score, cGVHD symptoms, worse functioning, low albumin, poorer survival and low BMI were associated with malnutrition. A predictive model was developed from all variables of significance: cGVHD of the lungs, GI tract, mouth and BMI accurately predicted 84.2% of malnourished patients as well as 87.2% of well-nourished patients. The PG-SGA questionnaire may be a useful tool in diagnosing nutritional deficits in cGVHD patients undergoing one-time evaluations. Longitudinal prospective studies should assess the utility of nutritional support interventions in cGVHD.

Assessing the relationship between oral chronic graft-versus-host disease and global measures of quality of life

“…6,27 Higher mouth NIH scores are associated with malnutrition and cGVHD-related salivary dysfunction is associated with significantly greater difficulty with swallowing solid foods. 14,28 With respect to the relationship between oral cGVHD and social/family well-being, oral cGVHD is associated with inferior social/family well-being. 16 Additionally, patients with chronic mucosal diseases may experience discomfort in social settings and reluctance to participate in social activities.…”

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report

“…Weight loss in patients with extensive chronic GVHD may also be caused by increased action of glucagon and norepinephrine, resulting in an increase in resting energy expenditure and alterations in fat and carbohydrate oxidation rates [61]. Nutritional support is very important as around 30% of adults [62,63] and up to 40% of children with chronic GVHD are malnourished [64]. The input of a nutritionist can be very helpful in addressing weight loss, as some patients will need total parenteral nutrition or tube feedings.…”

Biology of chronic graft-vs-host disease: Immune mechanisms and progress in biomarker discovery

“…In one recent study of 210 cGVHD patients, 29% of cases were classified as malnourished by measurement using the Patient-Generated Subjective Global Assessment tool. Malnutrition was correlated with a lower body-mass index and poorer overall survival[19]. Gingivitis and tooth decay also occur because of xerostomia and altered oral immunity related to immunosuppression and reduced salivary IgG production[20].…”