Frontiers in nutrition · 2026
Caregiver burden and malnutrition in patients with HIV-associated lymphoma: indirect pathways via symptom distress and family closeness, and a test of resilience as a mediator.
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Liu Tingting, Lv Jing, Xu Luxiang, Peng Yu, Wang Chaoyu, Zhang Xiaomei, Xiao Qing, Li Jun, Zhang Zhaoli, Liu Yao
Аннотация
BACKGROUND AND OBJECTIVE: Malnutrition is a frequent and clinically significant complication in patients with HIV-associated lymphoma, adversely affecting treatment tolerance, prognosis, and quality of life. Although disease-related and immunological determinants of malnutrition have been widely reported, the potential psychosocial pathways-particularly the role of caregiver burden-in patients with HIV-associated lymphoma remain insufficiently characterized. This study aimed to identify key determinants of malnutrition and to examine whether caregiver burden exerts indirect effects through symptom distress and psychosocial factors.
METHODS: This single-center cross-sectional study included 200 patients with HIV-associated lymphoma and their family caregivers. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), with the total score analyzed as a continuous outcome. Symptom burden, caregiver burden, psychological resilience, and family closeness were assessed using standardized instruments. Univariable and multivariable linear regression analyses were conducted using HC3 heteroscedasticity-consistent inference. Indirect statistical associations were examined using bootstrap analyses, followed by exploratory subgroup and sensitivity analyses.
RESULTS: Higher symptom burden and IPI risk were associated with higher PG-SGA total scores, whereas higher CD4 + T-cell counts and serum albumin concentrations were associated with lower scores (all p ≤ 0.005). Age, sex, and caregiver burden were not independently associated with PG-SGA score. Exploratory analyses provided no statistically supported evidence of an indirect association through symptom burden or of differences by age, sex, or CD4 + T-cell count. Sensitivity analyses produced consistent conclusions.
CONCLUSION: Nutritional status in patients with HIV-associated lymphoma was associated mainly with symptom burden, immune status, serum albumin, and lymphoma prognostic risk. Caregiver burden showed neither an independent association with PG-SGA score nor a confirmed indirect association through symptom burden. Larger multicenter longitudinal studies are needed to clarify the temporal relationships among caregiver burden, psychosocial factors, and nutritional status.
METHODS: This single-center cross-sectional study included 200 patients with HIV-associated lymphoma and their family caregivers. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), with the total score analyzed as a continuous outcome. Symptom burden, caregiver burden, psychological resilience, and family closeness were assessed using standardized instruments. Univariable and multivariable linear regression analyses were conducted using HC3 heteroscedasticity-consistent inference. Indirect statistical associations were examined using bootstrap analyses, followed by exploratory subgroup and sensitivity analyses.
RESULTS: Higher symptom burden and IPI risk were associated with higher PG-SGA total scores, whereas higher CD4 + T-cell counts and serum albumin concentrations were associated with lower scores (all p ≤ 0.005). Age, sex, and caregiver burden were not independently associated with PG-SGA score. Exploratory analyses provided no statistically supported evidence of an indirect association through symptom burden or of differences by age, sex, or CD4 + T-cell count. Sensitivity analyses produced consistent conclusions.
CONCLUSION: Nutritional status in patients with HIV-associated lymphoma was associated mainly with symptom burden, immune status, serum albumin, and lymphoma prognostic risk. Caregiver burden showed neither an independent association with PG-SGA score nor a confirmed indirect association through symptom burden. Larger multicenter longitudinal studies are needed to clarify the temporal relationships among caregiver burden, psychosocial factors, and nutritional status.