Assessment and nutrition education in patients with amyotrophic lateral sclerosis

Almeida, Claudinéa. S.; Stanich, Patricia; Salvioni, Cristina C. S.; Diccini, Solange

doi:10.1590/0004-282X20160145

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ARTICLE • Arq. Neuro-Psiquiatr. 74 (11) • Nov 2016 • https://doi.org/10.1590/0004-282X20160145 copy

Assessment and nutrition education in patients with amyotrophic lateral sclerosis

Avaliação e educação nutricional em pacientes com esclerose lateral amiotrófica

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Neurological patients with amyotrophic lateral sclerosis (ALS)often deteriorate to a worsening nutritional status. The aim of this study was to compare the nutritional status and food intake after nutrition education in patients with ALS. Clinical, anthropometric and functional variables were analyzed. Fifty-three patients were monitored at an early stage of the disease. The average score on the functionality scale was 33 points. Initially only 3.8% were classified as low body weight. After three months, 50% showed significant variation in anthropometric measures related to muscle mass and body fat reserves without association with clinical variables. After nutritional guidance, there was an increase in the intake of all food groups, especially the dairy group (p <0.05).The change of the nutritional status occurs early in patients with amyotrophic lateral sclerosis, even in those previously eutrophic or over weight. There was an increase in food intake after nutritional guidance according to the food guide adapted to the Brazilian population.

amyotrophic lateral sclerosis; continuing education; body composition

Variable	n	%
Gender
Male	31	58,5
Female	22	41.5
Age (years)
Average (min – max)	57.0	(33 – 76)
< 60 years	34	64,2
≥ 60 years	19	35.8
Manifestation of thedisease
Appendicular	42	79.2
Bulbar	11	20.8
Symptom onset (days)
Average (min – max)	360	90 – 3270
ALSFRS score
Average (min – max)	33	13 – 44
Nutritional status according to BMI
Lowweight (< 18,9)	2	3,8
Eutrophy (19–24,9)	26	49.1
Overweight (≥ 25)	25	47.2
Nutritionalcounseling
Foodguide	35	66
Standard orientation	18	34

Variable	Min.	P25	Average	P75	Max.	p**
BMI (kg/m²)	-3.63	-0.53	-0.09	0.0	+1.47	0.02
AC (cm)	-3.0	-1.0	-0.75	0.0	+3.0	0.04
TSF (mm)	-5.0	-1.0	-0.90	0.0	+4.0	0.008
BSF (mm)	-6.0	-1.0	0.0	0.0	+2.0	0.001
SISF (mm)*	-8.0	-1.0	0.0	0.0	+3.0	0.003
SSF (mm)	-3.0	-1.0	0.0	0.0	+3.0	0.005
AMC (cm)	-3.0	-1.0	0.0	2.0	+4.0	0.69
AMA (cm²)	-8.0	-3.0	-2.0	0.0	+16.0	0.94

Variable	BMI decline		p

	< 0.53 Kg/m²	≥ 0.53 Kg/m²
Gender
Male	23 (76.7%)	7 (23.3%)	0.74
Female	16 (72.7%)	6 (27.3%)	0.74
Age group
< 60 years	25 (75.8%)	8 (24.2%)	0.86
≥ 60 years	14 (73.7%)	5 (26.3%)	0.86
Disease form
Appendicular	32 (78%)	9 (22%)	0.32
Bulbar	7 (63.6%)	4 (36.4%)	0.32
Symptom onset
≤ 360 days	24 (72.7%)	9 (27.3%)	0.61
> 360 days	15 (78.9%)	4 (21.1%)	0.61
ALSFRS
≥ 33 points	23 (79.3%)	6 (20.7%)	0.42
< 33 points	16 (69.6%)	7 (30.4%)	0.42
Prior nutritional status
Eutrophy/lowweight	22 (84.6%)	4 (15.4%)	0.08
Overweight	16 (64%)	9 (36%)	0.08
Nutritionalcounseling
FoodGuide	25 (71.4%)	10 (28.6%)	0.39
Standard orientation	14 (82.4%)	3 (17.6%)	0.39

Variable	Arm muscle area decline		p

	< 3.0 cm²	≥ 3.0 cm²
Gender
Male	20 (64.5%)	11 (35.5%)	0.31
Female	17 (77.3%)	5 (31.3%)	0.31
Age group
< 60 years	22 (64.7%)	12 (35.3%)	0.27
≥ 60 years	15 (78.9%)	4 (21.1%)	0.27
Disease form
Appendicular	29 (69%)	13 (31.%)	0.45
Bulbar	8 (72.7%)	3 (27.3%)	0.45
Symptom onset
≤ 360 days	24 (72.7%)	9 (27.3%)	0.55
> 360 days	13 (65%)	7 (35%)	0.55
ALSFRS
≥ 33 points	19 (65.5%)	10 (34.5%)	0.45
< 33 points	18 (75%)	6 (25%)	0.45
Prior nutritional status
Eutrophy/lowweight	19 (70.4%)	8 (29.6%)	0.85
Overweight	17 (68%)	8 (32%)	0.85
Nutritionalcounseling
FoodGuide	24 (68.6%)	11 (31.4%)	0.78
Standard orientation	13 (72.2%)	5 (27.8%)	0.78

Variable	TSF decline		p

	<1.0 mm	≥ 1.0 mm
Gender
Male	15 (50%)	15 (50%)	1.0
Female	11 (50%)	11 (50%)	1.0
Age group
< 60 years	18 (54.5%)	15 (45.5%)	0.38
≥ 60 years	8 (42.1%)	11 (57.9%)	0.38
Disease form
Appendicular	21 (51.2%)	20 (48.8%)	0.73
Bulbar	5 (45.5%)	6 (54.5%)	0.73
Symptom onset
≤ 360 days	18 (54.5%)	15 (45.5%)	0.38
> 360 days	8 (42.1%)	11 (57.9%)	0.38
ALSFRS
≥ 33 points	17 (58.6%)	12 (41.4%)	0.16
< 33 points	9 (39.1%)	14 (60.9%)	0.16
Prior nutritional status
Eutrophy/lowweight	14 (53.8%)	12 (46.2%)	0.48
Overweight	11 (44%)	14 (56%)	0.48
Nutritionalcounseling
FoodGuide	14 (40%)	21 (60%)	0.39
Standard orientation	12 (70.6%)	5 (29.4%)	0.39

Variable	Control	Intervention	p

	(n = 18)	(n = 35)
Age
Average ± DP	54 ±10.5	56.8 ±10.5	0.35
Gender
Male	13 (72.2%)	18 (51.4%)	0.14
Female	5 (27.8%)	17 (48.6%)	0.14
Disease form
Appendicular	16 (88.9%)	26 (74.3%)	0.21
Bulbar	2 (11.1%)	9 (25.7%)	0.21
Symptom onset
Average	315	360	0.62
Min – Max	150 - 1560	90 - 3270	0.62
ALSFRS
Average	37	33	0.23
Min – Max	18 - 44	13 - 45	0.23

Variable	Control	Intervention	p

	(n = 35)	(n = 18)
BMI*	%	%
Delta + orstable	9 (52.9)	17 (48.6)	0.76
Delta -	8 (47.1)	18 (51.4)	0.76
AMA
Delta < -10%	14 (77.8)	25 (71.4)	0.62
Delta ≥ -10%	4 (22.2)	10 (28.6)	0.62
AMC
Delta < -10%	17 (94.4)	34 (66.0)	0.62
Delta ≥ -10%	1 (5.6)	1 (2.9)	0.62
TSF
Delta <10%	13 (76.5)	24 (68.6)	0.55
Delta ≥10%	4 (23.5)	11 (31.4)	0.55
AC*
Delta <10%	17 (100)	34 (97.1)
Delta ≥10%	0 ( -- )	1 (2.9)
ALSFRS
Delta + orstable	10 (55.6)	9 (25.0)	0.03
Delta -	8 (44.4)	26 (74.3)	0.03

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[1] Correspondence: Claudinéia S. Almeida; Universidade Federal de São Paulo, Setor de Investigação em Doenças Neuromusculares, Rua Estado de Israel, 899; 04022-020 São Paulo Sp, Brasil. E-mail: claudineianutri@gmail. com.