Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment

Abstract

-Objective:To establish correlations between nutritional, functional and respiratory indices of patients with amyotrophic lateral sclerosis (ALS). Method: Twenty patients (13 appendicular -GA and 7 bulbar -GB) were included in the multidisciplinary study at the Neurological Clinic Ambulatory of the University of Campinas Hospital. Results: Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r= -0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss (%WL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with %WL. With regard to the GB, correlation was found between MEP and body mass index (BMI) (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat (%), arm and wrist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm 2 ). Conclusion: It is suggested that the application of simple anthropometric measurements could be useful in routine monitoring of patients with ALS.KEY WORDS: amyotrophic lateral sclerosis, nutritional support, respiratory tests, ALSFRS scale. esclerose lateral amiotrófica: correlações dos indicadores da avaliação nutricional, funcional e respiratóriaResumo -Objetivo: Correlacionar os indicadores utilizados na avaliação nutricional, funcional e respiratória de indivíduos com esclerose lateral amiotrófica (ELA). Método: Vinte pacientes (13 apendiculares -GA e 7 bulbares -GB) foram incluídos no estudo usando parâmetros nutricionais, respiratórios e escala funcional (ALSFRS-R). Resultados: Entre os pacientes do GA, as correlações observadas foram: pressão inspiratória máxima (PI max ) e expiratória máxima (PE max ) (r= -0,76); PE max e oximetria de pulso (r=0,58); PI max e porcentagem de perda de peso (%PP) (r=0,59); e entre PI max , escore ALSFRS-R com %PP. No GB, houve correlação entre MEP e índice de massa corporal (IMC) (r=0,97). Em GA e GB, observaram-se correlação entre IMC e as variáveis: massa, gordura (%), circunferência braquial e punho, pregas cutâneas tricipital, subescapular e supra-ilíaca, circunferência muscular do braço (cm), área muscular gordurosa do braço (mm 2 ). Conclusão: Sugere-se a aplicação deste conjunto de medidas durante a evolução clínica de indivíduos com ELA. PALAVRAS-CHAVE: esclerose lateral amiotrófica, suporte nutricional, testes respiratórios, escala ALSFRS-R.

Amyotrophic lateral sclerosis: prospective study on respiratory parameters

“…The results found in this study corroborate those obtained by Silva et al 19 who also found correlation between BMI and FVC and between BMI and MEP in patients who presented with bulbar ALS. The correlation was strong, even considering MIP and MEP indicators are not a sensitive measure in the evaluation of the respiratory function in these patients, due to oro-pharyngeal weakness, as described by Fitting et al 20 .…”

Effect of nutritional supplementation with milk whey proteins in amyotrophic lateral sclerosis patients

“…ALSFRS-R is a reliable tool useful to predict survival in ALS 30,31 , survival after mechanical non-invasive ventilation, and to estimate overall functioning of patients with ALS 32 . ALSFRS-R scores did not change among supplemented patients (p=0.173), but significantly declined in the control group (p=0.003).…”

Nutritional Care in Amyotrophic Lateral Sclerosis: An Alternative for the Maximization of the Nutritional State

“…Anthropometry involves obtaining measures of body size, their proportions and the relationship with standards that reflect the development of adult subjects. The most used measures are weight, height, circumferences and skinfolds (Almeida et al, 2010;Silva et al, 2008b;Silva et al, 2008c;Stanich et al, 2004;Kasarskis et al, 1996;Slowie et al, 1983).…”

“…Prior to patient's weighing, the wheelchairs are weighted and their weight is deducted at the time of calibration of the scale. In patients able to walk, the body weight is measured standing on platform type or digital scales (Silva et al, 2008b;Stanich et al, 2004). The weight can also be measured in chair scales, available in the market.…”