Loss of appetite in patients with amyotrophic lateral sclerosis is associated with weight loss and anxiety/depression

Abstract

Weight loss is common in patients with Amyotrophic lateral sclerosis (ALS), and associated with disease progression. Loss of appetite has been shown to be a contributor to weight loss in patients with amyotrophic lateral sclerosis (ALS). However, the reason of loss of appetite is not clear. The Council on Nutrition appetite questionnaire (CNAQ) and the simplified nutritional appetite questionnaire (SNAQ) are short and simple appetite assessment tools, which were using in ALS patients. In our study, the CNAQ and SNAQ were translated into Chinese, and their reliability and validity were tested. The Chinese version of the CNAQ (CNAQ-C) presented more appropriate reliability and validity than the SNAQ. Among the 94 ALS patients, 50 patients (53.2%) had loss of appetite, and we found that anxiety and/or depression contributed to the loss of appetite in the ALS patients. We reconfirmed that loss of appetite was associated with greater weight loss but not with clinical features of ALS. The loss of appetite caused by emotional problems in ALS patients should be taken seriously, and early intervention should be implemented to reduce weight loss.

Appetite and quality of life in amyotrophic lateral sclerosis: A scoping review

“…Given that weight loss is affected by physical functions such as swallowing, ability to cut food, ability to feed oneself, and respiratory insufficiency, we expected this relationship for pALS. In this study, functional loss, as measured by the ALSFRS‐R, was not uniformly identified as a risk factor for appetite loss across all studies 3,5,9,21,22 . Earlier studies demonstrated a similar relationship between mood and physical function, such that decreased mood is not directly correlated with decreased function 29,30 .…”

“…The median sample size in the included studies was 56, ranging from 7 to 94. The prevalence of appetite loss in this population, when reported, varied from 18.0% to 53.2% 3,5,9,20,21,25 …”

“…After full‐text review, five articles were excluded (Figure 1). The remaining ten articles met the inclusion criteria and were eligible for data synthesis 3,5,9,19–25 . The earliest publication date was 2010, 19 with most articles (n = 7, 70%) published in 2019 or more recently (Table 1).…”

“…1,8 The symptom of appetite loss has been identified as one cause of weight loss and reported in up to two thirds of pALS. 3,5 This effect on caloric intake and weight loss has been shown to be independent of dysphagia. 9 Appetite contributes to overall quality of life (QoL) not only in ALS, but also in other life-limiting diseases.…”

Dietary-Derived Essential Nutrients and Amyotrophic Lateral Sclerosis: A Two-Sample Mendelian Randomization Study

“…This inconsistency is largely because most of this evidence came from observational studies, which are plagued by selection bias and unmeasured confounders. In addition, we previously found that most ALS patients showed a loss of appetite [ 18 ] and the presence of metabolic disorders [ 19 ], which may affect the absorption and consumption of dietary nutrients, making the true relationship between essential nutrients and ALS elusive. Randomized controlled trials (RCTs) are recognized to overcome the limitations of observational studies and provide the highest level of evidence [ 20 ].…”