Departments of Gastroenterology and Hepatology, University Medical Center Utrecht, Free University Medical Center Amsterdam, The Netherlands; University Medical Center Leiden, Free University Medical Center Amsterdam, The Netherlands.
BACKGROUND AND AIMS:
Although antiviral treatment for hepatitis C (HCV) is highly effective, side effects often occur, including weight loss, digestive symptoms and impaired quality of life. We aimed to explore beneficial effects of preventive nutritional support.
In a randomized controlled trial, 53 HCV patients were allocated to "on demand" support (n=26: nutritional intervention if weight loss >5%) or preventive support (n=27: regular dietary advice plus energy- and protein- rich evening snack). Nutritional state (including validated Jamar Hand Grip Strength), digestive symptoms (visual analog score) and quality of life (SF-36 survey) were evaluated at baseline, after 24 and 48 weeks peginterferon α-2b and ribavirin.
The primary endpoint (weight loss at 24 weeks) was reached in 22 patients in both groups. Weight decreased markedly in the "on demand" group (decrease at 24 weeks: 5.4 kg or 6.9%, P<0.001), but not in the preventive group (decrease 0.3 kg or 0.3%, P=NS). Jamar Hand Grip Strength deteriorated in the "on demand" group (from 40.3±15.5 kg to 32.0±13.1 kg, p<0.001) but not in the preventive group (from 40.7±10.4 kg to 39.7±8.9 kg, P=NS). Intake of energy, proteins and fat decreased markedly in the "on demand" group but increased in the preventive group. Although digestive symptoms and quality of life deteriorated, impairment was significantly less in the preventive group.
Preventive nutritional advice plus supplementation prevents weight loss and catabolic state during antiviral therapy for HCV, with improved digestive symptoms and quality of life.