Electronic App to Monitor Dietary Intake May Benefit ALS Patients, Trial Data Suggest

A diet monitoring app can help amyotrophic lateral sclerosis (ALS) patients to manage their calorie intake in order to maintain or even improve their weight, and achieve better outcomes, results from a clinical trial show.

The trial also found that nutritional counseling by a registered dietitian, with or without support of an electronic-health application, does not significantly improve the weight of ALS patients compared to standard care.

Results from the EAT MORE trial (NCT02418546) were reported in the study, “Nutritional counseling with or without mobile health technology: a randomized open-label standard-of-care-controlled trial in ALS,” which was published in the journal BMC Neurology.

ALS patients often can start losing weight even before the disease has been diagnosed because of several factors, including dysphagia (difficulty in swallowing), depression, loss of appetite, difficulty manipulating utensils, and increased energy expenditure.

It is unclear how body weight specifically contributes to the rate of disease progression in ALS patients. However, increasing evidence has demonstrated that an ALS patient’s long-term outcome is associated with their weight. Moderate obesity has been associated with slower disease progression and longer survival, while weight loss has been linked to more rapid disease progression.

Based on these findings, researchers have focused on finding ways to help ALS patients improve their weight, or at least prevent weight loss, in order to achieve better overall outcomes.

Researchers from the Massachusetts General Hospital, with the support of the ALS Association, conducted the EAT MORE Phase 2 trial to evaluate how nutritional counseling, with or without an electronic monitoring application, can help maintain or increase body weight in ALS patients.

The single-center study enrolled 80 adults diagnosed with ALS who were randomized to receive nutritional counseling by their physician and nurse (standard care), nutritional counseling by a registered dietitian at each clinic visit (in-person), or nutritional counseling by a registered dietitian supported by a monitoring-health (mHealth) application.

The goal of the interventions was for patients to consume an additional 117.5 to 235 kcal per day, depending on their initial body weight and weight history, with the ultimate goal of gaining approximately 0.5–1 kg (1.1–2.2 pounds) per month.

Participants in the mHealth group initially gained an average of 0.3 kg (0.7 pounds) at three months, which was followed by a loss of 0.2 kg (0.4 pounds) at six months. Participants in the in-person dietary counseling group lost on average 0.1 kg (0.2 pounds), and those receiving standard care lost approximately 1 kg (2.2 pounds) by six months. However, these differences between the groups were not considered significant.

Further analysis showed that, compared with patients receiving standard care, participants monitored with the mHealth app consumed 344 kcal more per day, and those in the in-person arm consumed on average 286 kcal more per day.

Although the trial had not been designed to determine disease progression, the team compared progression rates of patients according to the different interventions.

Overall, the participants monitored with and without the mHealth app showed an average decline of 2.6 and 5.8 points in the ALSFRS-R scale (which measures ALS progression) at six months, compared with a 5.2-point loss in standard care group.

Differences in ALSFRS-R scores between the groups were not statistically significant. Still, they were strongly correlated to weight changes, with “greater weight gain associated with slower rates of disease progression,” the researchers reported.

The team believes that “nutritional counseling with frequent reinforcement by a mobile health app” may help patients to increase their dietary intake and recommended calories.

“Using a mHealth app to increase calorie intake in ALS (…) should be made widely available to people with ALS to help maintain weight,” they stated.