{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:56:12Z","timestamp":1790571372811,"version":"4.1.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>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\u2014particularly the role of caregiver burden\u2014in 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher symptom burden and IPI risk were associated with higher PG-SGA total scores, whereas higher CD4\u202f+\u202fT-cell counts and serum albumin concentrations were associated with lower scores (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f\u2264\u202f0.005). 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\u202f+\u202fT-cell count. Sensitivity analyses produced consistent conclusions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1921747","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:28:55Z","timestamp":1790569735000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"13","author":[{"given":"Tingting","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Hematology-Oncology, Hematologic Oncology Intelligent Diagnosis and Treatment Engineering Research Center of Chongqing Education Commission of China, Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Hematologic Oncology Intelligent Diagnosis and Treatment Engineering Research Center of Chongqing Education Commission of China, Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luxiang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Hematologic Oncology Intelligent Diagnosis and Treatment Engineering Research Center of Chongqing Education Commission of China, Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Hematologic Oncology Intelligent Diagnosis and Treatment Engineering Research Center of Chongqing Education Commission of China, Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Hematologic Oncology Intelligent Diagnosis and Treatment Engineering Research Center of Chongqing Education Commission of China, Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Hematologic Oncology Intelligent Diagnosis and Treatment Engineering Research Center of Chongqing Education Commission of China, Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Hematologic Oncology Intelligent Diagnosis and Treatment Engineering Research Center of Chongqing Education Commission of China, Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Hematologic Oncology Intelligent Diagnosis and Treatment Engineering Research Center of Chongqing Education Commission of China, Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoli","family":"Zhang","sequence":"additional","affiliation":[{"name":"Nursing Department, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Hematology-Oncology, Hematologic Oncology Intelligent Diagnosis and Treatment Engineering Research Center of Chongqing Education Commission of China, Chongqing University Cancer Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e641","DOI":"10.1016\/s2352-3018(20)30118-1","article-title":"Epidemiology of haematological malignancies in people living with HIV","volume":"7","author":"Kimani","year":"2020","journal-title":"The lancet HIV"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1097\/qad.0000000000003096","article-title":"HIV-associated wasting prevalence in the era of 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lymphoma","volume":"9","author":"Liu","year":"2022","journal-title":"Front Nutr"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e105","DOI":"10.1017\/s1368980024000788","article-title":"Association between risk of malnutrition defined by patient-generated subjective global assessment and adverse outcomes in patients with cancer: a systematic review and meta-analysis","volume":"27","author":"Zhang","year":"2024","journal-title":"Public Health Nutr"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2898","DOI":"10.1016\/j.clnu.2021.02.005","article-title":"ESPEN practical guideline: Clinical Nutrition in cancer","volume":"40","author":"Muscaritoli","year":"2021","journal-title":"Clin Nutr"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"100092","DOI":"10.1016\/j.esmoop.2021.100092","article-title":"Cancer cachexia in adult patients: ESMO clinical practice guidelines","volume":"6","author":"Arends","year":"2021","journal-title":"ESMO 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