Correlation between Total Daily Energy Expenditure and Progression of Amyotrophic Lateral Sclerosis in Men and Women
Authors: Lee Jihye , Kim Seung Hyun , Park Yongsoon 
Published: November 2023

Nutritional status is a major prognostic factor for survival of amyotrophic lateral sclerosis (ALS), a progressive neurodegeneration disease, suggesting the importance of estimating total daily energy expenditure (TDEE). The purpose of the present study was to investigate whether TDEEs were different with progression of disease in male and female ALS patients, and compared with actual intake (AI). ALS was diagnosed according to EI Escorial criteria and categorized into stage 2, 3 and 4 using clinical staging system. Resting energy expenditure (REE) was calculated according to Harris benedict and Mifflin St. Jeor. Physical activity was calculated using ALS functional rating scale, physical activity coefficient, or adding 30% of REE. TDEEs were calculated by adding REE and physical activity. This study was conducted according to the guidelines of the Declaration of Helsinki. Average TDEEs were significantly lower in male and female patients with stage 4 as compared with stage 2 and 3, and not significantly different between male and female. TDEE 1, 2 and 4 were significantly decreased, and negatively correlated with increasing clinical stages in male and female patients. However, TDEE 3 and 5 were increased and positively correlated with increasing stages. Ratio of AI and average TDEE was significantly lower in male and female with stage 3 than 2 and 4, and not different between male and female. Ratios of AI and TDEE 1, 2 and 4 were significantly increased with increasing clinical stages in male and female patients. In conclusion, the present study suggested that TDEE was decreased with progression of ALS, but not different between male and female. Ratio of AI and TDEE was lower in stage 3, suggesting nutrition support could be started at stage 3.Support or Funding InformationThis study was supported by a National Research Foundation of Korea grant funded by the Korean government

Total daily energy expenditure (TDEE) and ratio of actual intake (AI)TDEE between clinical stages in male and female patients with amyotrophic lateral sclerosis†

Males
Females

Stage 2 (n=84)
Stage 3 (n=67)
Stage 4 (n=51)
R¥
Stage 2 (n=64)
Stage 3 (n=42)
Stage 4 (n=33)
R¥

TDEE 1 (KJ/kg/d)‡,§
151.9 ± 14.4A,a,¶
139.3±17.8A,b,¶
122.9±21.9c
−0.513**
160.7±24.0A,a
155.1±21.4A,a
129.5±25.6A,b
−0.3.84**

TDEE 2 (KJ/kg/d)
127.6 ± 10.5B,a
123.3±12.2B,b
119.2±12.8c
−0.285**
128.9±15.3B,a
127.6±14.6B,ab
122.9±13.7A,b
−0.237*

TDEE 3 (KJ/kg/d)
118.1 ± 7.6C,b
119.1±9.3B,b
123.9±9.7a
0.248**
119.4±12.4C,b
122.9±12.8B,ab
124.4±9.9A,a
0.266**

TDEE 4 (KJ/kg/d)
129.0 ± 11.5B,a,¶
125.8±15.7B,ab,¶
124.8±13.8b,¶
−0.163*
116.6±12.8C,a
115.2±12.9C,a
109.1±12.3B,b
−0.206*

TDEE 5 (KJ/kg/d)
119.3 ± 8.5C,b,¶
121.2±11.2B,b,¶
129.9±12.4a,¶
0.370**
108.0±10.3D,b
111.0±11.8C,ab
113.2±9.5B,b
0.208**

AI/TDEE 1 (%)‡,§
70.4 ± 24.2B,b
67.4±21.4b
92.6±28.4a
0.275**
68.6±24.3B,b
64.6±19.7B,b
91.3±36.4a
0.239**

AI/TDEE 2 (%)
84.1 ± 29.9AB,ab
76.2±24.8b
93.5±24.4a
0.125
85.1±30.3AB,ab
78.0±22.3AB,b
94.5±34.4a
0.095

AI/TDEE 3 (%)
91.1 ± 32.7A,a
78.4±25.4b
89.8±23.9a
−0025
92.0±33.6A,a
81.6±25.1A,b
90.9±31.2ab
−0.014

AI/TDEE 4 (%)
83.1 ± 28.9AB,ab,¶
75.0±23.3b,¶
88.9±21.9a,¶
0.090
94.0±34.0A,ab
86.5±25.2A,b
106.4±38.3a
0.132

AI/TDEE 5 (%)
90.0 ± 31.5A,a,¶
77.2±23.9b,¶
85.3±21.4ab,¶
−0.070
102.4±35.1A,a
90.5±28.3A,b
101.6±37.8a
−0.011

Values are expressed as means ± standard deviations.
Values with different capital letters within a column are significantly different between TDEE 1–5 at P<0.05.
Values with different small letters within a row are significantly different between clinical stages at P<0.05.
Value are significantly different between male and female patients at P<0.05.
Spearman correlation coefficients between clinical stages and TDEEs,
P<0.05,
P<0.001