Prognostic significance of body weight variation after diagnosis in ALS: a single-centre prospective cohort study
- 27 Downloads
Body weight reduction after disease onset is an independent predictor of survival in amyotrophic lateral sclerosis (ALS), but significance of weight variation after diagnosis remains to be established.
To investigate weight variation after diagnosis and its prognostic significance in patients with ALS as a prospective cohort study.
Seventy-nine patients with ALS were enrolled in this study. At the time of diagnosis and about 1 year later, we evaluated the following parameters: age, sex, onset age, onset region, body mass index (BMI) and premorbid BMI, forced vital capacity and the revised ALS functional rating scale. Annual BMI decline rates (∆BMI) from onset to diagnosis and from diagnosis to about 1 year later were calculated. Patients were followed to the endpoints (death or tracheostomy), and the relationships between ∆BMIs and survival were investigated.
Patients with post-diagnostic ∆BMI ≥ 2.0 kg/m2/year showed shorter survival length than those with < 2.0 kg/m2/year (log-rank test, p < 0.0001), and multivariate analysis using the Cox model revealed post-diagnostic ∆BMI as an independent prognostic factor. No correlation was identified between pre- and post-diagnostic ∆BMIs. Female patients with post-diagnostic ∆BMI < pre-diagnostic ∆BMI showed longer survival than those with the opposite ∆BMI trend (log-rank test, p = 0.0147). Female patients with post-diagnostic weight increase showed longer survival than those with weight decrease (log-rank test, p = 0.0228).
Body weight changes after diagnosis strongly predicts survival in ALS, and weight gain after diagnosis may improve survival prognosis, particularly in female ALS patients.
KeywordsAmyotrophic lateral sclerosis Body weight Survival Sex difference Nutritional intervention
Amyotrophic lateral sclerosis
Revised Amyotrophic Lateral Sclerosis Functional Rating Scale
Body mass index
Body mass index decline rate
Forced vital capacity
Percutaneous endoscopic gastrostomy
Progressive muscular atrophy
TAR DNA-binding protein-43
This study was supported by JSPS KAKENHI [Grant-in-Aid for Scientific Research (B) Nos. 25293449, 16H05583 and 16H03044] from the Ministry of Education, Culture, Sports, Science and Technology of Japan and by the Joint Program for ALS Research (2015–2018) from the Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
Compliance with ethical standards
Conflicts of interest
Dr. Shimizu reports speaker honoraria from Tanabe Mitsubishi Pharma. The other authors declare that they have no conflict of interest.
The study was approved by the ethics committee at Tokyo Metropolitan Neurological Hospital (TS-H29-048). All patients provided informed consent to participate in the study, in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
- 6.Shimizu T, Ishikawa-Takata K, Sakata A et al (2017) The measurement and estimation of total energy expenditure in Japanese patients with ALS: a doubly labelled water method study. Amyotroph Lateral Scler Frontotemporal Degener 18:37–45. https://doi.org/10.1080/21678421.2016.1245756 CrossRefGoogle Scholar
- 13.Miller RG, Jackson CE, Kasarskis EJ et al (2009) Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 73:1218–1226. https://doi.org/10.1212/WNL.0b013e3181bc0141 CrossRefGoogle Scholar
- 17.Fasano A, Fini N, Ferraro D et al (2017) Percutaneous endoscopic gastrostomy, body weight loss and survival in amyotrophic lateral sclerosis: a population-based registry study. Amyotroph Lateral Scler Frontotemporal Degener 18:233–242. https://doi.org/10.1080/21678421.2016.1270325 CrossRefGoogle Scholar
- 19.Kellogg J, Bottman L, Arra EJ et al (2018) Nutrition management methods effective in increasing weight, survival time and functional status in ALS patients: a systematic review. Amyotroph Lateral Scler Frontotemporal Degener 19:7–11. https://doi.org/10.1080/21678421.2017.1360355 CrossRefGoogle Scholar