Nutritional Intake of Patients affected by amyotrophic lateral sclerosis in an ambulatory artificial nutrition clinic in Portugal
DOI:
https://doi.org/10.14306/renhyd.25.4.1308Keywords:
Amyotrophic Lateral Sclerosis, Eating, Nutritional Status, Antioxidants, PortugalAbstract
Introduction: Amyotrophic Lateral Sclerosis (ALS) is a chronic and progressive neurodegenerative pathology, which causes motor neuron death. It results in weight loss, loss of muscle mass and increased nutritional deficiencies. There is a link between nutritional intake and the pathogenesis of ALS. The aim of this analysis was to describe the sociodemographic, anthropometric and clinic characteristics as well as the nutritional intake in a sample of Portuguese ALS patients.
Material and Methods: A brief clinical history was taken. Body weight was measured according to the protocol of the International Society for the Advancement of Kinanthropometry (ISAK) and height was taken from the patient's clinical record. A dietary-nutritional anamnesis and a dietary record were performed. Nutritional intake was analysed with the Nutrition and Health® software and compared with the Dietary Reference Intakes (DRI). The nutritional adequacy index was considered below recommendations when it was ≤ 80%.
Results: 13 patients (7 men) aged 53-83 years were analysed. 69.20% presented bulbar ALS. 54% were normal weight. All patients had dysphagia and dysarthria and 84.62% had constipation. Compared to the DRI, in both sexes, nutritional deficiency of fiber, vitamin D, E, B8, B9, calcium, magnesium and iodine was identified, accompanied by a nutritional excess of protein, lipids, saturated fatty acids and sodium.
Conclusions: The finding of these nutritional deficiencies is relevant because the nutrients involved influence pathogenic mechanisms of ALS, because they are antioxidant, anti-inflammatory and contribute to normal motor neuron function. Identified nutritional excesses are associated with oxidative stress, inflammation, and increased risk of ALS. Further research in larger sample sizes is needed to contribute to the understanding of the associations between nutritional excess and deficiencies and risk of ALS development and/or progression.
References
Sorarù G, Ermani M, Logroscino G, Palmieri A, D’ Ascenzo C, Orsetti V, et al. Natural history of upper motor neuron-dominant ALS. Amyotroph Lateral Scler. 2010;11(5):424-9, doi: 10.3109/17482960903300867.
Costa J, Swash M, de Carvalho M. Awaji criteria for the diagnosis of amyotrophic lateral sclerosis:a systematic review. Arch Neurol. 2012;69(11):1410-6, doi: 10.1001/archneurol.2012.254.
Yunusova Y, Plowman EK, Green JR, Barnett C, Bede P. Clinical Measures of Bulbar Dysfunction in ALS. Front Neurol. 2019;10:106, doi: 10.3389/fneur.2019.00106.
Chiò A, Logroscino G, Traynor BJ, Collins J, Simeone JC, Goldstein LA, et al. Global epidemiology of amyotrophic lateral sclerosis: a systematic review of the published literature. Neuroepidemiology. 2013;41(2):118-30, doi: 10.1159/000351153.
Conde B, Winck JC, Azevedo LF. Estimating Amyotrophic Lateral Sclerosis and Motor Neuron Disease Prevalence in Portugal Using a Pharmaco-Epidemiological Approach and a Bayesian Multiparameter Evidence Synthesis Model. Neuroepidemiology. 2019;53(1-2):73-83, doi: 10.1159/000499485.
Andersen PM, Borasio GD, Dengler R, Hardiman O, Kollewe K, Leigh PN, et al. Good practice in the management of amyotrophic lateral sclerosis: clinical guidelines. An evidence-based review with good practice points. EALSC Working Group. Amyotroph Lateral Scler. 2007;8(4):195-213, doi: 10.1080/17482960701262376.
Carrera-Juliá S, Moreno ML, Barrios C, de la Rubia Ortí JE, Drehmer E. Antioxidant Alternatives in the Treatment of Amyotrophic Lateral Sclerosis: A Comprehensive Review. Front Physiol. 2020;11:63, doi: 10.3389/fphys.2020.00063.
Caplliure-Llopis J, Peralta-Chamba T, Carrera-Juliá S, Cuerda-Ballester M, Drehmer-Rieger E, López-Rodriguez MM, et al. Therapeutic alternative of the ketogenic Mediterranean diet to improve mitochondrial activity in Amyotrophic Lateral Sclerosis (ALS): A Comprehensive Review. Food Sci Nutr. 2020;8(1):23-35, doi: 10.1002/fsn3.1324.
Adibhatla RM, Hatcher JF. Role of Lipids in Brain Injury and Diseases. Future Lipidol. 2007;2(4):403-22, doi: 10.2217/17460875.2.4.403.
Kennedy DO. B Vitamins and the Brain: Mechanisms, Dose and Efficacy--A Review. Nutrients. 2016;8(2):68, doi: 10.3390/nu8020068.
Marin B, Arcuti S, Jesus P, Logroscino G, Copetti M, Fontana A, et al. Population-Based Evidence that Survival in Amyotrophic Lateral Sclerosis is Related to Weight Loss at Diagnosis. Neurodegener Dis. 2016;16(3-4):225-34, doi: 10.1159/000442444.
Soriani M-H, Desnuelle C. Care management in amyotrophic lateral sclerosis. Rev Neurol (Paris). 2017;173(5):288-99, doi: 10.1016/j.neurol.2017.03.031.
Riccio P, Rossano R. Nutrition facts in multiple sclerosis. ASN Neuro. 2015;7(1):1759091414568185, doi: 10.1177/1759091414568185.
Okamoto K, Kihira T, Kondo T, Kobashi G, Washio M, Sasaki S, et al. Nutritional status and risk of amyotrophic lateral sclerosis in Japan. Amyotroph Lateral Scler. 2007;8(5):300-4, doi: 10.1080/17482960701472249.
Wang M, Liu Z, Sun W, Yuan Y, Jiao B, Zhang X, et al. Association Between Vitamins and Amyotrophic Lateral Sclerosis: A Center-Based Survey in Mainland China. Front Neurol. 2020;11:488, doi: 10.3389/fneur.2020.00488.
Yu H, Kim SH, Noh M-Y, Lee S, Park Y. Relationship between Dietary Fiber Intake and the Prognosis of Amytrophic Lateral Sclerosis in Korea. Nutrients. 2020;12(11):E3420, doi: 10.3390/nu12113420.
Alvero Cruz JR, Cabañas Armesilla MD, Herrero de Lucas A, Martínez Riaza L, Moreno Pascual C, Porta Manzañido J, et al. Protocolo de valoración de la composición corporal para el reconocimiento médico-deportivo. Documento de consenso del grupo español de cineantropometría de la Federación Española de Medicina del Deporte. Arch Med Deporte. 2009;24(14):166-79.
Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutr Today. 2015;50(3):117-28, doi: 10.1097/NT.0000000000000092.
Ortega RM, Pérez-Rodrigo C, López-Sobaler AM. Métodos de evaluación de la ingesta actual: registro o diario diétetico. Rev esp nutr comunitaria. 2015;21(Supl.1):34-41.
Nazareth M, Rêgo C, Lopes C, Pinto E. Recomendações nutricionais em idade pediátrica: o estado da arte. Acta Portuguesa de Nutrição. 2016;7:18-33.
Otten JJ, Hellwig JP, Meyers LD. DRI, dietary reference intakes: the essential guide to nutrient requirements. Washington, D.C: National Academies Press; 2006.
Román-Viñas B, Serra-Majem L, Ribas-Barba L, Ngo J, García-Alvarez A, Wijnhoven TMA, et al. Overview of methods used to evaluate the adequacy of nutrient intakes for individuals and populations. Br J Nutr. 2009;101 Suppl 2:S6-11, doi: 10.1017/S0007114509990535.
Marshall TA, Stumbo PJ, Warren JJ, Xie XJ. Inadequate nutrient intakes are common and are associated with low diet variety in rural, community-dwelling elderly. J Nutr. 2001;131(8):2192-6, doi: 10.1093/jn/131.8.2192.
Institute of Medicine (US) Subcommittee on Interpretation and Uses of Dietary Reference Intakes, Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes DRI Dietary Reference Intakes: Applications in Dietary Assessment. Washington (DC): National Academies Press (US); 2000.
Nieves JW, Gennings C, Factor-Litvak P, Hupf J, Singleton J, Sharf V, et al. Association Between Dietary Intake and Function in Amyotrophic Lateral Sclerosis. JAMA Neurol. 2016;73(12):1425-32, doi: 10.1001/jamaneurol.2016.3401.
Pupillo E, Bianchi E, Chiò A, Casale F, Zecca C, Tortelli R, et al. Amyotrophic lateral sclerosis and food intake. Amyotroph Lateral Scler Frontotemporal Degener. 2018;19(3-4):267-74, doi: 10.1080/21678421.2017.1418002.
Okamoto K, Kihira T, Kobashi G, Washio M, Sasaki S, Yokoyama T, et al. Fruit and vegetable intake and risk of amyotrophic lateral sclerosis in Japan. Neuroepidemiology. 2009;32(4):251-6, doi: 10.1159/000201563.
González De Aguilar J-L. Lipid Biomarkers for Amyotrophic Lateral Sclerosis. Front Neurol. 2019;10:284, doi: 10.3389/fneur.2019.00284.
Drehmer E, Navarro-Moreno MÁ, Carrera S, Villar VM, Moreno ML. Oxygenic metabolism in nutritional obesity induced by olive oil. The influence of vitamin C. Food Funct. 2019;10(6):3567-80, doi: 10.1039/c8fo02550a.
Winge K, Rasmussen D, Werdelin LM. Constipation in neurological diseases. J Neurol Neurosurg Psychiatry. 2003;74(1):13-9, doi: 10.1136/jnnp.74.1.13.
Roy Sarkar S, Banerjee S. Gut microbiota in neurodegenerative disorders. J Neuroimmunol. 2019;328:98-104, doi: 10.1016/j.jneuroim.2019.01.004.
Fondell E, O’Reilly EJ, Fitzgerald KC, Falcone GJ, Kolonel LN, Park Y, et al. Dietary fiber and amyotrophic lateral sclerosis: results from 5 large cohort studies. Am J Epidemiol. 2014;179(12):1442-9, doi: 10.1093/aje/kwu089.
de la Rubia JE, Drehmer E, Platero JL, Benlloch M, Caplliure-Llopis J, Villaron-Casales C, et al. Efficacy and tolerability of EH301 for amyotrophic lateral sclerosis: a randomized, double-blind, placebo-controlled human pilot study. Amyotroph Lateral Scler Frontotemporal Degener. 2019;20(1-2):115-22, doi: 10.1080/21678421.2018.1536152.
Fitzgerald KC, O’Reilly ÉJ, Fondell E, Falcone GJ, McCullough ML, Park Y, et al. Intakes of vitamin C and carotenoids and risk of amyotrophic lateral sclerosis: pooled results from 5 cohort studies. Ann Neurol. 2013;73(2):236-45, doi: 10.1002/ana.23820.
Veldink JH, Kalmijn S, Groeneveld G-J, Wunderink W, Koster A, de Vries JHM, et al. Intake of polyunsaturated fatty acids and vitamin E reduces the risk of developing amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry. 2007;78(4):367-71, doi: 10.1136/jnnp.2005.083378.
Camu W, Tremblier B, Plassot C, Alphandery S, Salsac C, Pageot N, et al. Vitamin D confers protection to motoneurons and is a prognostic factor of amyotrophic lateral sclerosis. Neurobiol Aging. 2014;35(5):1198-205, doi: 10.1016/j.neurobiolaging.2013.11.005.
Long K vinh quốc, Nguyễn LTH. Roles of vitamin D in amyotrophic lateral sclerosis: possible genetic and cellular signaling mechanisms. Mol Brain. 2013;6:16, doi: 10.1186/1756-6606-6-16.
Saraff V, Shaw N. Sunshine and vitamin D. Arch Dis Child. 2016;101(2):190-2, doi: 10.1136/archdischild-2014-307214.
Sedel F, Papeix C, Bellanger A, Touitou V, Lebrun-Frenay C, Galanaud D, et al. High doses of biotin in chronic progressive multiple sclerosis: a pilot study. Mult Scler Relat Disord. 2015;4(2):159-69, doi: 10.1016/j.msard.2015.01.005.
Tong L. Structure and function of biotin-dependent carboxylases. Cell Mol Life Sci. 2013;70(5):863-91, doi: 10.1007/s00018-012-1096-0.
Sechi G, Sechi E, Fois C, Kumar N. Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutr Rev. 2016;74(5):281-300, doi: 10.1093/nutrit/nuv107.
Zhang X, Chen S, Li L, Wang Q, Le W. Folic acid protects motor neurons against the increased homocysteine, inflammation and apoptosis in SOD1 G93A transgenic mice. Neuropharmacology. 2008;54(7):1112-9, doi: 10.1016/j.neuropharm.2008.02.020.
Michal Freedman D, Kuncl RW, Weinstein SJ, Malila N, Virtamo J, Albanes D. Vitamin E serum levels and controlled supplementation and risk of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2013;14(4):246-51, doi: 10.3109/21678421.2012.745570.
Grillo A, Salvi L, Coruzzi P, Salvi P, Parati G. Sodium Intake and Hypertension. Nutrients. 2019;11(9):E1970, doi: 10.3390/nu11091970.
Farquhar WB, Edwards DG, Jurkovitz CT, Weintraub WS. Dietary sodium and health: more than just blood pressure. J Am Coll Cardiol. 2015;65(10):1042-50, doi: 10.1016/j.jacc.2014.12.039.
Yase Y. The pathogenesis of amyotrophic lateral sclerosis. Lancet. 1972;2(7772):292-6, doi: 10.1016/s0140-6736(72)92903-0.
Longnecker MP, Kamel F, Umbach DM, Munsat TL, Shefner JM, Lansdell LW, et al. Dietary intake of calcium, magnesium and antioxidants in relation to risk of amyotrophic lateral sclerosis. Neuroepidemiology. 2000;19(4):210-6, doi: 10.1159/000026258.
Yasui M, Ota K, Yoshida M, Effects of low calcium and magnesium dietary intake on the central nervous system tissues of rats and calcium-magnesium related disorders in the amyotrophic lateral sclerosis focus in the Kii Peninsula of Japan. Magnes Res. 1997;10(1):39-50.
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Sandra Carrera Juliá, Ana Catarina-Moreira, Carla Adriana-Santos, Jorge Fonseca, Eraci Drehmer
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This journal 