Effect of the type of specialized nutrition support on the course of the patient with amyotrophic lateral sclerosis (ALS). Interhospital registry SCLEDyN

Abstract

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease in which specialized nutritional support is essential. The objectives of our study were to describe nutritional support at the beginning of follow-up and its impact on anthropometry and survival.

Methods: An interhospital registry was created for the hospitals of Castilla-León through a web platform designed for this purpose. An anamnesis was carried out on the evolution and nutritional history of the disease; and classical anthropometry was determined. The prescribed nutritional treatment was recorded. The parameters were measured at the beginning, at six and twelve months of nutritional follow-up.

Results: A total of 93 patients [49 (52.7%) spinal; 44 (47.3%) bulbar)] were analyzed. The nutritional support route at the beginning was oral diet in 36 (38.7%) patients; oral nutritional supplementation (SON) in 46 (49.5%) patients; and in 11 (11.8%) patients percutaneous endoscopic gastrostomy (PEG). A decrease in the body mass index (BMI) was observed between the first and second visit [Start: 24.18 (3.29) kg/m²; 6 months: 23.69 (4.12) kg/m²; P < .05]. Less weight loss was observed at 6 months compared to the start of nutritional follow-up [Start: 8.09 (8.72)%; 6 months: 1.4 (6.29)%; P < .01]. 36 (38.7%) patients died but with no differences according to when nutritional support was started. Survival from the onset of symptoms was higher in the group of patients with artificial nutrition, although without reaching statistical significance [Oral: 28 (20.25) months; SON: 30 (16.75-48.25) months; PEG: 39 (27-52) months; P = .90].

Conclusions: Patients with ALS present a severe deterioration in nutritional status before the start of nutritional support. After the nutritional intervention, a slowdown in weight loss and nutritional deterioration was observed.

Keywords: Amyotrophic lateral sclerosis; Esclerosis lateral amiotrófica; Gastrostomía endoscópica percutánea; Nutritional support; Oral nutritional supplementation; Percutaneous endoscopic gastrostomy; Soporte nutricional; Suplementación oral nutricional.