Diet-related poor nutritional status as a major challenge in the treatment of patients with amyloidosis: A systematic review.

[INTRODUCTION] Amyloidoses are systemic diseases associated with organ function deterioration and severe management challenges. The most common types of systemic amyloidosis are AL (immunoglobulin light chain) and ATTR (transthyretin related) amyloidosis, which are increasingly diagnosed, and cause serious health problems and lead to significant present-substantial nutritional challenges.

[AIM] The present systematic review aimed to collect existing data on dietary intake and the dietary-related problems emerging in patients with AL or ATTR amyloidosis.

[DATA SOURCES] The review was conducted following PRISMA guidelines. A systematic search in the databases PubMed, Google Scholar, and Scopus was conducted until January 2025.

[DATA EXTRACTION] Nine articles were included, related to nutritional assessment of individuals with AL or ATTR amyloidosis. Six studies referred to AL and three to patients with ATTR amyloidosis.

[DATA ANALYSIS] According to the studies included, patients with AL amyloidosis presented with lower dietary intake compared to their daily needs. A high prevalence of WL, malnutrition, and an inverse association between body mass index and risk of death were also observed. In ATTR amyloidosis, a high prevalence of malnutrition, WL, sarcopenia, and cachexia were highlighted. There is no published study investigating dietary intake and its adequacy compared to patients' daily needs in ATTR amyloidosis.

[CONCLUSIONS] Patients living with AL or ATTR amyloidosis face important nutritional problems that are often undetected and therefore untreated. Future research should prioritize assessment of dietary intake, especially in ATTR amyloidosis, and detection of sarcopenia and cachexia in AL amyloidosis, and their possible association with patients' quality of life and disease prognosis. The importance of dietetic management in amyloidosis should be emphasized in order to implement nutritional assessment at time of diagnosis.