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Life course body mass index and risk and prognosis of amyotrophic lateral sclerosis: results from the ALS registry Swabia

  • NEURO-EPIDEMIOLOGY
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Abstract

Weight loss appears as a strong predictor of survival of patients with amyotrophic lateral sclerosis, yet no data are currently available to describe the life course history of pre-diagnostic body mass index (BMI) in these patients. 393 ALS cases (mean age: 65.8 years, 57.3% men) and 791 controls matched by age and sex from a population-based case–control study of the ALS Registry Swabia were analyzed. Differences of BMI change in cases and controls over time were modeled using a multilevel additive model. In addition, survival in ALS cases by BMI change was modeled using an accelerated failure time model adjusted for prognostic factors. In ALS cases, BMI was consistently higher than in controls in the 20–70 years before the interview. Conditional logistic regression revealed an odds ratio of 1.05 (95% confidence interval (CI) 1.00–1.11, p = 0.041) per 1 kg/m2 higher BMI 35–45 years before interview. However, a sharp decrease was evident in the BMI of ALS cases about 10 years before disease onset. Moreover, weight loss was strongly associated with shorter survival in ALS patients. Illustrating this, patients with stable weight showed a median survival time of 22.1 (95%-CI 19.2–25.0) months, as compared to 13.4 (95%-CI 10.5–16.3) months for patients with weight loss of 2.5 kg/m2 over the last 3 months before the interview. Thus, alterations in body weight are present in ALS patients already decades before clinical manifestation of ALS, while weight loss precedes motor symptoms of several years and is associated with poor prognosis.

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Acknowledgements

We thank the Ilonka Kraft-Overbeck, Ines Dobias and Nicola Lämmle for their excellent field work, and Gertrud Feike, Sarah Enderle and Birgit Och for their excellent data management and technical support.

Members of the ALS registry study group: Andres F., Kreiskliniken Reutlingen, Department of Neurology; Arnold G., Klinikum Sindelfingen-Böblingen, Department of Neurology; Asshauer I., Klinikum Friedrichshafen, Department of Psychiatry and Psychotherapy; Baezner H., Bürgerhospital Stuttgart, Department of Neurology; Baier H., ZFP Südwürttemberg Weissenau, Department of Epileptology; Beattie J., Ostalb-Klinikum Aalen, Department of Neurology; Becker T., University of Ulm, Department of Psychiatry and Psychotherapy II; Behne F., ZFP Südwürttemberg Weissenau, Department of Epileptology; Bengel D., Oberschwabenklinik Ravensburg, Department of Neurology; Boertlein A., Bürgerhospital Stuttgart, Department of Neurology; Bracknies, V., Klinik Dietenbronn, Department of Neurology; Broer R., Klinikum am Weissenhof, Weinsberg, Department of Psychiatry and Psychotherapy; Burkhard, A., Klinikum Günzburg, Department of Neurology; Connemann B., University of Ulm, Department of Psychiatry and Psychotherapy III; Dempewolf S., Klinikum Ludwigsburg, Department of Neurology; Dettmers C., Schmieder Kliniken Konstanz, Department of Neurology; Dieterich M., LMU München, Department of Neurology; Etzersdorfer E., Furtbachkrankenhaus Stuttgart, Department of Psychiatry and Psychotherapy; Freund, W., Biberach; Gersner T., ZfP Zwiefalten, Department of Psychiatry and Psychotherapy; Gold H.-J., Klinikum am Gesundbrunnen Heilbronn, Department of Neurology; Hacke, W., University of Heidelberg, Department of Neurology; Hamann G., Klinikum Günzburg, Department of Neurology; Hecht M., Bezirkskrankenhaus Kaufbeuren, Department of Neurology; Heimbach B., University of Freiburg, Department of Neurology; Hemmer B., TU München, Department of Neurology; Hendrich C., Klinikum Friedrichshafen, Department of Neurology; Herting B., Diakonie-Klinikum Schwäbisch Hall, Department of Neurology; Huber R., Klinikum Friedrichshafen, Department of Neurology; Huber-Hartmann K., Kliniken Landkreis Heidenheim, Department of Neurology; Hülser P.-J., Fachklinik Wangen, Department of Neurology; Jüttler E., Ostalb-Klinikum Aalen, Department of Neurology; Kammerer-Ciernioch J., Klinikum am Weissenhof, Weinsberg, Department of Psychiatry and Psychotherapy; Kaspar A., Oberschwabenklinik Ravensburg, Department of Neurology; Kern R., Klinikum Kempten, Department of Neurology; Kimmig H., Kliniken Schwenningen, Department of Neurology; Klebe, S., University of Würzburg, Department of Neurology; Kloetzsch C., Schmieder Kliniken Allensbach, Department of Neurology; Klopstock, T., LMU München, Department of Neurology; Kohler, A., Klinikum am Gesundbrunnen Heilbronn, Department of Neurology; Kuethmann A., Bezirkskrankenhaus Memmingen, Department of Psychiatry and Psychotherapy; Lewis D., Marienhospital Stuttgart, Department of Neurology; Lichy C., Klinikum Memmingen, Department of Neurology; Lindner A., Marienhospital Stuttgart, Department of Neurology; Lulé D., University of Ulm, Department of Neurology; Mäurer M., Caritas Krankenhaus Bad Mergentheim, Department of Neurology; Maier-Janson W., Ravensburg; Metrikat J., Bundeswehrkrankenhaus Ulm, Department of Neurology; Meudt O., Klinikum Memmingen, Department of Neurology; Meyer A., Weissenau, Department of Neurology; Müller vom Hagen J., University of Tuebingen, Department of Neurology; Naegele A., Christophsbad Göppingen, Department of Neurology; Naumann M., Klinikum Augsburg, Department of Neurology; Neher K.-D., Vinzenz von Paul Hospital, Rottweil, Department of Neurology; Neuhaus O., Kliniken Landkreis Sigmaringen, Department of Neurology; Neusch C., Singen; Niehaus L., Klinikum Winnenden, Department of Neurology; Opherk C., Klinikum am Gesundbrunnen Heilbronn, Department of Neurology; Raape J., ZFP Südwürttemberg Weissenau, Department od Neurology; Ratzka P., Klinikum Augsburg, Department of Neurology; Rettenmayr C., Klinikum Esslingen, Department of Neurology; Riepe M.W., Klinikum Günzburg, Department of Gerontopsychiatry; Rothmeier J., ZFP Südwürttemberg Weissenau, Department of Neurology; Sabolek M., Klinik Biberach, Department of Neurology; Schabet M., Klinikum Ludwigsburg, Department of Neurology; Schell C., Kreiskliniken Reutlingen, Department of Neurology; Schlipf T., Klinikum Winnenden, Department of Psychiatry and Psychotherapy; Schmauss M., Bezirkskrankenhaus Augsburg, Department of Psychiatry and Psychotherapy; Schoels L., University of Tübingen, Department of Neurology; Schuetz K., Kliniken Schwenningen, Department of Neurology; Schweigert B., Caritas Krankenhaus Bad Mergentheim, Department of Neurology; Sommer N., Christophsbad Göppingen, Department of Neurology; Sperber W., Kliniken Esslingen, Department of Neurology; Steber C., Bezirkskrankenhaus Augsburg, Department of Psychiatry and Psychotherapy; Steber R., Bezirkskrankenhaus Memmingen, Department of Psychiatry and Psychotherapy; Stroick M., Klinikum Memmingen, Department of Neurology; Synofzik, M., University of Tübingen, Deartment of Neurology; Trottenberg T., Klinikum Winnenden, Department of Neurology; Tumani H., Klinikum Dietenbronn, Department of Neurology; Wahl C., Klinikum Kempten, Department of Neurology; Weber F., Bundeswehrkrankenhaus Ulm, Department of Neurology; Weiler M., University of Heidelberg, Department of Neurology; Weiller C., University of Freiburg, Department of Neurology; Wessig C., University of Würzburg, Department of Neurology; Winkler A., TU München, Department of Neurology.

Funding

The ALS registry Swabia and this study have been supported by the German Research Council (DFG, main Number 577 631).

Author’s contributions

ACL, DR, GN conventionalized the study, ACL; AR, GN, TB, RSP were involved in the data collection, DR, GN, TB, RSP analyzed the data, JK and LD provided valuable input for the interpretation of the data, RSP drafted and revised the manuscript, all authors were involved in the draft and revision of the manuscript.

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Authors and Affiliations

  1. Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany

    Raphael Simon Peter, Torben Brehme, Dietrich Rothenbacher & Gabriele Nagel

  2. Department of Neurology, Ulm University, Ulm, Germany

    Angela Rosenbohm, Jan Kassubek & Albert Christian Ludolph

  3. INSERM U1118, Université de Strasbourg, Strasbourg, France

    Luc Dupuis

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  1. Raphael Simon Peter
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  2. Angela Rosenbohm
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Correspondence to Raphael Simon Peter.

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Conflict of interest

DR reports personal fees from Novartis Pharma and Basilea Pharmaceutical, outside the submitted work. RSP, AR, LD, TB, JK, GN, ACL have nothing to disclose.

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Peter, R.S., Rosenbohm, A., Dupuis, L. et al. Life course body mass index and risk and prognosis of amyotrophic lateral sclerosis: results from the ALS registry Swabia. Eur J Epidemiol 32, 901–908 (2017). https://doi.org/10.1007/s10654-017-0318-z

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  • DOI: https://doi.org/10.1007/s10654-017-0318-z

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