Alteration of nutritional status at diagnosis is a prognostic factor for survival of amyotrophic lateral sclerosis patients

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 82; no. 6; pp. 628 - 634
• Main Authors: Marin, B, Desport, J C, Kajeu, P, Jesus, P, Nicolaud, B, Nicol, M, Preux, P M, Couratier, P
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.06.2011; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Age; Aged; Amyotrophic Lateral Sclerosis; Amyotrophic Lateral Sclerosis - diagnosis; Amyotrophic Lateral Sclerosis - mortality; Amyotrophic Lateral Sclerosis - physiopathology; Body Composition; Body Composition - physiology; Body mass index; cohort studies; Data collection; Disease Progression; Electric Impedance; epidemiology; Female; Humans; Life Sciences; Male; Malnutrition; Middle Aged; Nutritional Status; Nutritional Status - physiology; Ostomy; Prognosis; Proportional Hazards Models; Santé publique et épidémiologie; Survival Analysis; weight loss
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2010.211474

ObjectivesThe aims were to analyse changes in nutritional parameters from diagnosis of amyotrophic lateral sclerosis (ALS) to death and to assess their relationships with survival at the time of diagnosis and during follow-up.Methods92 ALS patients were included and clinically assessed every 3 months (ALS functional rating scale, manual muscular testing, forced vital capacity, weight, BMI, percentage weight loss). Bioimpedance was performed to evaluate body composition (fat-free mass, fat mass and hydration status) and phase angle. Survival analyses were performed from diagnosis to death or censoring date using a Cox model.ResultsThe evolution of nutritional parameters in ALS patients was marked by significant decreases in weight, BMI, fat-free mass and phase angle, and increased fat mass. The authors identified an adjusted 30% increased risk of death for a 5% decrease from usual weight at time of diagnosis (RR 1.30; 95% CI 1.08 to 1.56). During follow-up, the authors identified adjusted 34% (95% CI 18% to 51%) and 24% (95% CI 13% to 36%) increased risks of death associated with each 5% decrease in usual weight and each unit decrease in usual BMI, respectively (p<0.0001). Malnutrition during the course was related to a shorter survival (p=0.01), and fat mass level was associated with a better outcome (RR 0.90 for each 2.5 kg fat mass increment).ConclusionsNutritional parameters of ALS patients worsened during evolution of the disease, and worse nutritional status (at time of diagnosis or during the course) was associated with a higher mortality. This study offers some justification for studying the use of therapeutic nutritional intervention to modify the survival of ALS patients.