Nutritional disorders as a predictor of rapid diagnosis and disease progression in patients with amyotrophic lateral sclerosis
Authors:   RSBHI Regional Clinical Hospital, Ermilov Е. А. ,   FSBEI HE Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky of the Ministry of Health of the Russian Federation, Isaeva N. V. ,   RSBHI Regional Clinical Hospital; FSBEI HE Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky of the Ministry of Health of the Russian Federation, Khramchenko М. А. ,   RSBHI Regional Clinical Hospital; FSBEI HE Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky of the Ministry of Health of the Russian Federation
Published: October 2024

Background: One of the symptoms of amyotrophic lateral sclerosis (ALS) is progressive loss of body weight. Moreover, in various forms of ALS, regardless of the presence of dysphagia at the onset of the disease, there are similar changes in nutritional status. The problem of nutritional support in patients with ALS, as well as monitoring nutritional status over time in this group of patients remains relevant. Purpose: to evaluate the severity and rate of increase in nutritional disorders in patients with ALS and their relationship with the rate of disease progression, as well as the life expectancy of these patients. Materials and methods: The study included 49 patients diagnosed with ALS who died from 2018 to 2023. All participants underwent a neurological examination, measurement of anthropometric parameters, and laboratory blood tests; 61 % (n=30) of the patients underwent bioimpedance analysis of body composition over time. Results: The highest rate of body weight loss was recorded in the group of patients with quickly diagnosed ALS: it accounted for 1.9 (1.6; 2.2) kg/month. The highest rate of loss of skeletal muscle mass was noted in the same group of patients at 0.4 (0.38;0.46) kg/month. In the group with a quickly diagnosed disease, only 20 % of the patients underwent gastrostomy insertion; in the group with a slow diagnosis rate, 25 % of the patients underwent gastrostomy; only 50 % of the patients received special therapeutic nutrition. Conclusions: Patients with rapid disease progression have a short period of ALS diagnosis and rapidly increasing nutritional disorders, reflected in higher rates of losing weight and skeletal muscle mass. However, patients with rapid diagnosis of the disease had the lowest level of nutritional support. Lack of time to make the difficult decision to insert a gastrostomy tube and perform the necessary preoperative examination is the main reason for the low rate of gastrostomy tube placement in patients with rapidly progressing disease. In this regard, the development of new measures and algorithms for dynamic monitoring of the nutritional status of patients with ALS, as well as increasing awareness of the need for timely gastrostomy, is required. Bioimpedance analysis of body composition can be one of the methods for monitoring the patient’s nutritional status, allowing one to assess the dynamics of decrease in skeletal muscle mass as the most labile component of body composition in patients with ALS.