Nutritional Counseling May Delay Loss of Muscle and Fat in ALS Patients

The nutritional status of patients with amyotrophic lateral sclerosis (ALS) tends to decrease with disease progression, which further increases their fragility and low energy. A new study shows that nutritional counseling may increase food consumption in ALS patients and delay the loss of muscle and fat.

The study, “Assessment And Nutrition Education In Patients With Amyotrophic Lateral Sclerosis,” was published in the Brazilian journal Arquivos de Neuro-Psiquiatria.

ALS patients often experience worsening nutritional status, which accompanies disease progression. At rest, these patients use more energy to maintain body functions, and for that reason, their nutritional status should be monitored to guarantee patients have enough energy and survive longer.

To analyze the benefits of nutrition education to the nutritional status and food intake in ALS patients, researchers followed 53 Brazilian patients with a median age of 57 at an early stage of the disease who were assigned to the intervention or control group.

At the start of the study, the team performed a clinical evaluation, nutritional assessment, analysis of food intake and functional evaluation using the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) — the lower the score, the more advanced the disease status.

Nutritional status was analyzed by measuring body mass index (BMI), weight, height, arm circumference, triceps, biceps, suprailiac and subscapular skinfold (estimates of body fat), arm muscle circumference, arm muscle area, arm fat area, and calf circumference in people older than 60.

Food intake was assessed with a questionnaire on frequency of food consumption adapted to the Brazilian population. These analyses were repeated three months after the nutritional education.

Nutritional education consisted of food counseling to ALS patients. Those in the intervention group received guidance on the food pyramid, whereas patients in the control group received general advice, including changes in food consistency and dividing up the components of meals.

At the study’s start, the average score on the ALSFRS was 33 points (scores greater than or equal to 30 points may correspond with longer survival) and only 3.8 percent had a low body weight. After three months, half the ALS patients showed a significant variation in measures related to muscle mass and body fat.

According to the authors, a reduction in body fat is a negative prognostic factor and “the delay in nutritional intervention negatively influences the loss of muscle mass, demonstrating the importance of early intervention.”

They also found that in both groups, there was low frequency in eating legumes, cereals, tubers, vegetables, and fruits — especially cereals, tubers, and vegetables. ALS patients in the intervention group frequently consumed dairy products, meats, eggs, oils and fats.

The qualitative nutritional guidance of the diet seemed to be more effective for the consumption of dairy products and fruit groups — dairy foods, where consumption increased significantly.

“Determining the components of the meals was not an instrument of analysis of this study, however we observed an inadequacy related to the number of meals per day, with consumption of just three meals (breakfast, lunch and dinner), a fact that can combine with the non-intake of other groups recommended by the food guide,” the authors wrote.

“We observed that food from the dairy group, meats, eggs, oils and fats were found to have a higher intake frequency, explaining in part the low intake of other food groups, since the former kinds of food are often consumed during the main meals.

“After nutritional counseling for both [intervention] and [control] patients, an increase in the frequency of intake of all food groups, especially dairy products, was observed,” they wrote

The authors believe patients adhered to the nutritional guidelines so well because “this service differs by providing preventive guidance to patients and caregivers, preparing them for the implications that will arise with disease progression.”

“The multidisciplinary team aims for the ultimate goal of improving the quality of life of these individuals,” they added. “The results of this study reinforce the importance of early nutrition counseling as part of the treatment of patients with ALS.”