A decrease in body mass index is associated with faster progression of motor symptoms and shorter survival in ALS

Abstract

Our objective was to test the hypothesis that changes in body mass index (BMI) are associated with changes in the clinical course of ALS. We examined the relationships between BMI at first clinical visit and changes in BMI up to a two-year follow-up, and multiple clinical variables related to ALS: age of onset, rate of progression of motor symptoms, and survival. Baseline BMI was classified according to the World Health Organization (WHO) criteria. Changes in BMI were classified as a loss of >1 unit, no change, or a gain of >1 unit. Our results showed that baseline BMI was not associated with age of onset, rate of progression or survival. In contrast, a loss of BMI >1 over two years was associated with significantly shorter survival and a faster rate of progression. In a multiple regression model, these results were independent of gender, site of onset, history of diabetes mellitus and apolipoprotein (ApoE) genotype. In summary, a change in BMI after ALS diagnosis was significantly associated with rate of progression and survival. This raises the possibility that early changes in BMI may identify patients likely to have a more malignant course of the disease. However, further research is needed to clarify the relationship between BMI and ALS.

Should patients with ALS gain weight during their follow-up?

“…Several studies highlighted that weight loss increases the risk for mortality in patients with ALS [7][8][9][12][13][14]. As a corollary, interventions aiming at preventing weight loss, such as hypercaloric nutrition, should be beneficial.…”

“…Effect of obesity was not assessed. A larger study stratified 285 patients with ALS according to BMI categories at baseline [8]. BMI categories were not predictive of survival or rate of progression.…”

Energy metabolism in amyotrophic lateral sclerosis: assessment of body composition and energy expenditure

“…Increasing evidence suggests that altered metabolic homeostasis occurs in some ALS patients and could modify the course of ALS. Reduced body energy stores in the form of fat mass (FM) (Nau et al, 1995, Kasarskis et al, 1996, Desport et al, 1999, Desport et al, 2000, Jawaid et al, 2010a, Paganoni et al, 2011 and increased resting energy expenditure (REE) (Kasarskis et al, 1996, Desport et al, 2001, Desport et al, 2005, Bouteloup et al, 2009, Funalot et al, 2009, Kasarskis et al, 2014 appear to be of clinical importance in some ALS patients. The evidence that metabolic needs increase relative to disease severity and duration in ALS (Kasarskis et al, 1996) suggests that the pathological changes that occur with worsening disease could contribute to altered energy needs.…”

“…A decline in body mass and FM occurs throughout the course of ALS (Nau et al, 1995, Kasarskis et al, 1996, Desport et al, 1999, Desport et al, 2000, Jawaid et al, 2010a) and a more rapid rate of reduction in adiposity predicts a worse survival (Stambler et al, 1998, Shimizu et al, 2012. Furthermore, the observation of markedly reduced amounts of white adipose tissue in the SOD1 mouse (a widely studied preclinical model of ALS) in the asymptomatic phase of disease suggests that loss of FM could occur early in the disease process (Dupuis et al, 2004).…”

“…Hypermetabolism in ALS can be considered paradoxical because loss of FFM secondary to neurogenic muscle wasting (Nau et al, 1995, Kasarskis et al, 1996, Desport et al, 1999, Desport et al, 2000, Jawaid et al, 2010a would be expected to reduce REE (Johnstone et al, 2005).…”