Influence of a multidisciplinary protocol on nutritional status at diagnosis in amyotrophic lateral sclerosis

Gómez, Juan José López; Torres-Torres, Beatriz; Gómez-Hoyos, Emilia; Fernández-Buey, Nieves; Ortolá-Buigues, Ana; Castro-Lozano, Ángeles; Arenillas-Lara, Juan Francisco; Luis-Román, Daniel Antonio De

doi:10.1016/j.nut.2017.11.010

Cited by 12 publications

(10 citation statements)

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“…The mean age of the patients was 64.63 (17.68) years; 57 (58.2%) were men and 41 (41.8%) were women. The median follow-up at the nutrition clinics was 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) months. Of the total number of patients, 73 patients (78%) developed dysphagia during the study.…”

Section: Resultsmentioning

confidence: 99%

“…The disease duration was 26 (16-42) months (Patients who died: 28 (17-41) months and patients who did not die: 25 (15-43.5) months). Of the total number of patients, 38 (37.8%) died during the follow-up period, the median time between diagnosis and death was 16 When evaluating survival based on early PEG implantation (less than 10 months after diagnosis), a longer survival was observed, although not significant in those patients in whom a PEG was implanted later (PEG (>10 months), 27 (21-62) months; PEG (<10 months), 15.5 (6-24.25) months; p = 0.06) (Figure 4). When performing the multivariate analysis, it was observed that the probability of survival above 12 months from the start of nutrition follow-up was independently related to gastrostomy implantation (OR, 6.8; 95% CI (2.05-22.68)) adjusting for the type of onset of ALS, age and nutritional status.…”

Section: Resultsmentioning

confidence: 99%

“…The patients were referred at the diagnosis of ALS, despite the nutritional symptoms. This protocol allows us to initiate nutritional support at an early phase and patients can have a better nutritional status [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of Disease in Patients with Amyotrophic Lateral Sclerosis (ALS)

et al. 2021

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Dysphagia is a highly prevalent symptom in Amyotrophic Lateral Sclerosis (ALS), and the implantation of a percutaneous endoscopic gastrostomy (PEG) is a very frequent event. The aim of this study was to evaluate the influence of PEG implantation on survival and complications in ALS. An interhospital registry of patients with ALS of six hospitals in the Castilla-León region (Spain) was created between January 2015 and December 2017. The data were compared for those in whom a PEG was implanted and those who it was not. A total of 93 patients were analyzed. The mean age of the patients was 64.63 (17.67) years. A total of 38 patients (38.8%) had a PEG implantation. An improvement in the anthropometric parameters was observed among patients who had a PEG from the beginning of nutritional follow-up compared to those who did not, both in BMI (kg/m2) (PEG: 0 months, 22.06; 6 months, 23.04; p < 0.01; NoPEG: 0 months, 24.59–23.87; p > 0.05). Among the deceased patients, 38 (40.4%) those who had an implanted PEG (20 patients (52.6%) had a longer survival time (PEG: 23 (15–35.5) months; NoPEG 11 (4.75–18.5) months; p = 0.01). A PEG showed a survival benefit among ALS patients. Early implantation of a PEG produced a reduction in admissions associated with complications derived from it.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of Disease in Patients with Amyotrophic Lateral Sclerosis (ALS)

et al. 2021

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“…Instead, we chose to study the effects of nutritional counseling on dietary intake, weight, and disease progression. Nutritional counseling has been studied in one non-randomized [16] and one small randomized trial of limited nutritional counseling [17], with no difference in the rate of BMI decline over 3 months. Nutrition-based mHealth applications are easy to use, commonly available, and can facilitate frequent reminders and measurements [18, 19].…”

Section: Introductionmentioning

confidence: 99%

Nutritional counseling with or without mobile health technology: a randomized open-label standard-of-care-controlled trial in ALS

et al. 2019

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Background Nutritional status is an important prognostic factor in Amyotrophic Lateral Sclerosis (ALS). We wished to study the safety, tolerability and efficacy of nutritional counseling with or without an mHealth application to maintain or increase body weight in ALS, compared to standard care. Methods In this randomized open-label, standard-of-care-controlled, single-center clinical trial, we randomly assigned adults with ALS to one of three nutritional interventions: counseling by their physician or nurse (“standard care”), counseling by a registered dietitian (RD) (“in-person”), or counseling supported by a mHealth app (“mHealth”). Both intervention arms received tailored nutrition recommendations and recorded dietary intake and weight biweekly (mHealth) or monthly (in-person). The primary outcome of weight and secondary and tertiary outcomes of calorie intake, ALSFRS-R, and quality of life (QOL) were recorded at each clinic visit and analyzed in an ITT mixed model analysis. Results A total of 88 participants were enrolled of whom 78 were included in this analysis. The three arms were well-balanced except for excess males in the mHealth arm and greater weight lost at baseline in the in-person arm. Participants in the mHealth arm increased their calorie intake at month 3 to an average of 94% (95% CI: 85, 103) of recommended calories, compared to 81% (95% CI: 72, 91, p = 0.06 vs. mHealth) in the standard care arm. After 6 months, calorie intake was not different among the three arms. Overall weight was stable across all three groups. QOL scores in the mHealth arm were stable over 3 months (0.3 points, 95% CI: − 1.7, 2.2) compared to worsening in standard care (− 2.1 points, 95% CI: − 4.0, − 0.2, p = 0.09 vs. mHealth), but all scores declined by 6 months. ALSFRS-R total scores declined by an average of − 2.6 points (95% CI: − 5.1, − 0.1) over 6 months in the mHealth arm ( p = 0.13 vs. standard care) compared to − 5.8 points (95% CI: − 8.2, − 3.4, p = 0.74 vs. standard care) in the in-person and − 5.2 points (95% CI: − 7.6, − 2.9) in the standard care arm. Conclusions Nutritional counseling by a registered dietitian (with or without support by an mHealth app) is safe but did not maintain weight significantly better than standard care in ALS patients. Trial registration https://clinicaltrials.gov/ identifier NCT02418546. Registered April 16, 2015. Electronic supplementary material The online version of this article (10.1186/s12883-019-1330-6) contains supplementary material, which is available to authorized users.

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“…Instead, we chose to study the effects of nutritional counseling on dietary intake, weight, and disease progression. Nutritional counseling has been studied in one non-randomized [ 16] and one small randomized trial of limited nutritional counseling [ 17], with no difference in the rate of BMI decline over 3 months. Nutrition-based mHealth applications are easy to use, commonly available, and can facilitate frequent reminders and measurements [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Nutritional counseling with or without mobile health technology: a randomized open-label standard-of-care-controlled trial in ALS

Wills

Garry

Hubbard

et al. 2019

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Influence of a multidisciplinary protocol on nutritional status at diagnosis in amyotrophic lateral sclerosis

Cited by 12 publications

References 24 publications

Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of Disease in Patients with Amyotrophic Lateral Sclerosis (ALS)

Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of Disease in Patients with Amyotrophic Lateral Sclerosis (ALS)

Nutritional counseling with or without mobile health technology: a randomized open-label standard-of-care-controlled trial in ALS

Nutritional counseling with or without mobile health technology: a randomized open-label standard-of-care-controlled trial in ALS

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