Hypermetabolism is a reality in amyotrophic lateral sclerosis compared to healthy subjects

Abstract

Hypermetabolism (HM) in Amyotrophic lateral sclerosis (ALS) is the reflection of a high energy metabolic level, but this alteration seems controversial. The main objective of the study was to confirm the existence of HM during ALS compared to healthy subjects. Methods: A cohort of ALS patients was compared to a control group without metabolic disorder. The assessment included anthropometric criteria measurements, body composition by bioelectric impedance analysis and resting energy expenditure (REE) by indirect calorimetry. HM was defined as a variation > +10% between measured and calculated REE. Statistical analysis used Mann-Withney and Chi2 tests. Multivariate analysis included logistic regression. Results: 287 patients and 75 controls were included. The metabolic level was higher in ALS patients (1500 kcal/ 24 h vs. 1230 kcal/24 h [1000-1455], p < 0.0001) as well as the REE/fat free mass ratio (33.5 kcal/kg/24 h [30.4-37.8] vs. 28.3 kcal/kg/24 h [26.1-33.6], p < 0.0001). 55.0% of ALS patients had HM vs. 13.3% of controls (p < 0.0001). HM was strongly and positively associated with ALS (OR = 9. 50 [4.49-20.10], p < 0.0001). Conclusions: HM in ALS is a reality, which affects more than half of the patients and is associated with ALS. This work confirms a very frequent metabolic deterioration during ALS. The identification of HM can allow a better adaptation of the patients' nutritional intake.

Skeletal Muscle Metabolism: Origin or Prognostic Factor for Amyotrophic Lateral Sclerosis (ALS) Development?

“…Defined as hypermetabolism, this phenomenon was subsequently confirmed, in a larger study, and was shown to be significantly increased by 14% and affected 62.3% of the 168 ALS patients (sex ratio M/F = 0.97) [105]. Data from the literature report that hypermetabolism affects up to 66% of ALS patients [104][105][106][107][108][109] and is an early event that persists throughout the course of disease [108,110,111]. Weight loss [112], hypermetabolism, and dyslipidemia are now considered as three major risk factors for ALS [107,109,113,114], and are associated with the severity of disease [108] (Figure 1).…”

Repurposing of Trimetazidine for amyotrophic lateral sclerosis: A study in SOD1G93Amice

“…Despite a growing body of evidence linking metabolic alterations to disease outcome in ALS, interest in targeting metabolic dysfunction as a therapeutic approach has only grown in recent times (Fayemendy et al, 2021 ; Ferri & Coccurello, 2017 ; Ngo & Steyn, 2015 ). In this context, we aimed to evaluate the therapeutic potential of trimetazidine in the SOD1 G93A mouse model of ALS.…”

Metabolic Dysfunction in Motor Neuron Disease: Shedding Light through the Lens of Autophagy

“…There is expanding evidence of multitudes of metabolic abnormalities in ALS (reviewed in [ 53 ]). Weight loss, which is not always attributable to dysphagia, is a common observation in patients [ 54 , 55 ], as is hypermetabolism, characterized by an increased basal metabolic rate [ 56 , 57 ]. It has been suggested that weight loss could occur if the increased energy expenditure in hypermetabolic patients is not balanced by an increase in dietary intake [ 58 ].…”