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

Abstract

Objective: We evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70%WPI:30%MS), on nutritional and functional parameters of patients with ALS. Method: A prospective randomized double-blind study was performed with 16 ALS patients, divided in two groups, the treatment group received (70%WPI:30%MS) and the control group received (maltodextrin). They underwent prospective nutritional and functional assessment for 4 months. Results: Patients in the treatment group presented weight gain, increased body mass index (BMI), increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced creatine-kinase, aspartate aminotransferase and alanine aminotransferase. In the control group, biochemical parameters did not change, but weight and BMI declined. Conclusion: Our results indicate that the agglomerate 70%WPI:30%MS may be useful in the nutritional therapy of patients with ALS. Key words: amyotrophic lateral sclerosis, nutrition status, anthropometry.Efeito da suplementação nutricional com proteínas do soro de leite em pacientes com esclerose lateral amiotrófica RESUMO Objetivo: Avaliar a eficácia da suplementação nutricional oral com proteínas do soro do leite e amido modificado (70%WPI:30%MS), nos parâmetros nutricionais e funcionais de pacientes com esclerose lateral amiotrófica (ELA). Método: Foi realizado estudo randomizado duplo-cego, com 16 pacientes com ELA, divididos em dois grupos, um que recebeu 70%WPI:30%MS e um controle que recebeu maltodextrina. Os pacientes foram submetidos a avaliação nutricional e funcional durante quatro meses. Resultados: Nos pacientes que receberam o suplemento 70%WPI:30%MS, foi observado ganho de peso, aumento na contagem de linfócitos e redução de creatina kinase, aspartato aminotransferase and alanina aminotransferase. No grupo controle, os parâmetros bioquímicos não sofreram modificações; no entanto, peso e índice de massa corporal diminuíram. Conclusão: Nossos resultados indicam que o aglomerado 70%WPI:30%MS pode ser útil na terapia de pacientes com ALS. Palavras-chave: esclerose lateral amiotrófica, estado nutricional, antropometria.

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).…”

“…Viscosity influences many aspects of the assessment and management of dysphagia. It can be defined as the fluid resistance to the flow and is measured in Centipoise (ctps or cPs) (Silva et al, 2010). There are different types of viscosity that can be easily achieved using commercial thickeners.…”

“…When diagnosing the cause and severity of dysphagia, healthcare professionals can determine the texture of foods and the thickness of fluids for a safer swallowing by dysphagic patients, since the consistency of the diet should be individualized according to the type and extent of dysfunction. In case the recipe is not followed, the subject may face serious consequences for health (Silva et al, 2010;Macedo & Furquim, 2000). Table 1 shows an example of a modified diet with restriction of "thin liquids" (1-50 cP) and solids for subjects with dysphagia and swallowing impairment.…”

“…The choice of thickening agent is critical to achieve a homogeneous and lasting consistency. The thickeners should interfere as little as possible with the sensory properties of liquids (Silva et al, 2010) Several agents can be used as food thickeners. Such thickeners are mostly composed of polysaccharides (carbohydrates), such as gums and starches, in addition to pectins and cellulose derivatives.…”

“…However, the energy and protein supplementation is used by many professionals, and has proven to be efficient in the nutritional status of subjects with ALS Cawadias, 2007;Heffernan et al, 2004). Silva et al, (2010) evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70%WPI:30%MS), on nutritional and functional parameters of patients with ALS. Sixteen patients were randomized to two groups, treatment (70%WPI:30%MS) and control (maltodextrin).…”