Reduction rate of body mass index predicts prognosis for survival in amyotrophic lateral sclerosis: A multicenter study in Japan

Abstract

Malnutrition in the early stage has been reported as an independent predictor of survival in amyotrophic lateral sclerosis (ALS). We analyzed retrospectively the effect of variation of body mass index (BMI) on survival in ALS patients. In total, 77 consecutive ALS patients were enrolled from nine hospitals in Japan. Reduction rate of BMI was calculated from BMI before the disease onset and at the time of the first visit to each hospital. We analyzed the correlation between BMI reduction rate and total disease duration. Results showed that the median BMI reduction rate was 2.5 per year (interquartile range 1.3-3.8). The BMI reduction rate was significantly correlated with survival length (p <0.0001). There was also a significant difference in survival between ALS patients with a BMI reduction rate ≥ and < 2.5 (Kaplan-Meier survival analysis and the log-rank test, p < 0.0001; hazard ratio by the Cox model, 2.9816). In conclusion, faster reduction of BMI at the initial stage before the first visit to hospital predicts shorter survival length also in Japanese ALS patients.

Assessment and nutrition education in patients with amyotrophic lateral sclerosis

“…Another reason could be the inclusion of patients in the early stages of the disease where the respiratory functions were not affected; a fact that would help the preservation of body fat reserves. The importance of multidisciplinary assessment in the literature is well described, including early nutritional counseling as a positive factor for maintaining the nutritional status with a preventive approach in the treatment of ALS 14,15,16,19 . Although there was a variation in BMI, it was not enough to change the classification of nutritional status, stressing that as an isolated measure, the BMI is not sensitive enough to detect body alteration in the course of the disease 16 .…”

“…The importance of multidisciplinary assessment in the literature is well described, including early nutritional counseling as a positive factor for maintaining the nutritional status with a preventive approach in the treatment of ALS 14,15,16,19 . Although there was a variation in BMI, it was not enough to change the classification of nutritional status, stressing that as an isolated measure, the BMI is not sensitive enough to detect body alteration in the course of the disease 16 . Muscle atrophy is itself the triggering factor of changes, justifying the periodic anthropometric evaluation, with a recommendation for the anthropometry of the arm 20 .…”

“…The same applies to nutritional matters. The ALSFRS has been associated with objective measures of muscle strength and lung function, however, few studies were found that assess the scale items with nutritional parameters 16,17,18 . Unlike studies that observed low body weight as a symptom in the early stages of the disease, the same was not found in this study.…”

“…The change in body weight for values above the recommended, according to the age group and stature of the Brazilian population, has been growing in recent decades. When degenerative diseases affect individuals older than 45 years of age, being overweight and obese are commonlyobserved symptoms 16,19 . Another reason could be the inclusion of patients in the early stages of the disease where the respiratory functions were not affected; a fact that would help the preservation of body fat reserves.…”

Multidisciplinary Care Improves Survival of Patients with Amyotrophic Lateral Sclerosis in the Unique Health System (SUS) in Brazil

“…One reason for this finding is malnutrition [12,23], and as shown in this study, the BMI was significantly lower in bulbar onset patients (Table 1). Additionally, it has been observed that these patients have an increased risk of aspiration and earlier respiratory distress [21].…”