Theme 12 Respiratory and nutritional management

IF 2.5 4区医学 Q2 CLINICAL NEUROLOGY

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration Pub Date : 2019-10-31 DOI:10.1080/21678421.2019.1647001

Q. Wei, R. Ou, Yongping Chen, Xueping Chen, B. Cao, Yanbing Hou, Lingyu Zhang, H. Shang

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引用次数: 3

Abstract

Background: Previous studies explored the associations between body weight index (BMI) at diagnosis, weight change after diagnosis and survival in amyotrophic lateral sclerosis (ALS). But significance of weight stability before diagnosis remains to be established.Objective: The aim of this study is to clarify the weight loss from baseline (6 months before diagnosis) to diagnostic and the effect on disease prognosis.Methods: Total of 911 patients were enrolled from 2014 to 2018 in West China Hospital of Sichuan University. BMI is divided into four subgroups: lean, normal, overweight, and obese. The formula for calculating the rate of weight change = (weight at baseline - weight at diagnosis)/weight at baseline * 100%. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazard models.Results: The mean age of onset was 55.4 ± 11.1 years. The percentage of overweight and obesity in ALS at baseline were significantly lower than healthy controls. The median of weight loss was 2.9%. 36.9% patients had weight loss more than 5%, and 16.5% of them lose weight more than 10%. Patients with bulbar onset, bulbar impairment, lower ALS functional rating scale-revised score had more serious weight loss. The Kaplan-Meier curve showed that, compared to other patients, patients with weight loss more than 10% had a shorter survival time (30.5 months vs. 48.8 months, log-rank p < 0.001). Cox analysis showed that the weight loss was found to be an independent predictor of survival after adjusting for other survival factors (HR= 1.165, p trend <0.001). Each additional increased class of weight loss was associated with a 16.5% (95% CI: 7.3%-26.5%) increased risk of mortality and worse survival.Discussion and conclusion: Our study suggested that the weight variation is associated with survival in ALS patients. This has strong implications for management of nutritional issues in ALS, that the patient education and therapy recommendation should be earlier and standardize to promote the nutritional support and prognosis.

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主题12呼吸和营养管理

背景:既往研究探讨了肌萎缩性侧索硬化症(ALS)患者诊断时体重指数(BMI)、诊断后体重变化与生存之间的关系。但诊断前体重稳定性的意义仍有待确定。目的:本研究的目的是明确从基线(诊断前6个月)到诊断的体重减轻及其对疾病预后的影响。方法:选取四川大学华西医院2014 - 2018年收治的患者911例。BMI分为四个亚组:瘦、正常、超重和肥胖。体重变化率计算公式=(基线体重-诊断时体重)/基线体重* 100%。生存率分析采用Kaplan-Meier曲线和Cox比例风险模型。结果:平均发病年龄为55.4±11.1岁。肌萎缩侧索硬化症患者超重和肥胖的比例在基线时明显低于健康对照组。体重减轻的中位数为2.9%。36.9%的患者体重减轻5%以上，16.5%的患者体重减轻10%以上。有球发病、球损伤、ALS功能评定量表修订评分较低的患者体重下降更严重。Kaplan-Meier曲线显示，与其他患者相比，体重减轻超过10%的患者生存时间更短(30.5个月vs 48.8个月，log-rank p < 0.001)。Cox分析显示，在调整其他生存因素后，体重减轻是独立的生存预测因子(HR= 1.165, p趋势<0.001)。体重每增加一级，死亡风险增加16.5% (95% CI: 7.3%-26.5%)，生存率降低。讨论与结论:我们的研究表明，体重变化与ALS患者的生存有关。这对肌萎缩侧索硬化症营养问题的管理具有重要意义，应尽早对患者进行教育和推荐治疗，以促进营养支持和预后。

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来源期刊

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration CLINICAL NEUROLOGY-

CiteScore

5.40

自引率

10.70%

发文量

期刊介绍： Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration is an exciting new initiative. It represents a timely expansion of the journal Amyotrophic Lateral Sclerosis in response to the clinical, imaging pathological and genetic overlap between ALS and frontotemporal dementia. The expanded journal provides outstanding coverage of research in a wide range of issues related to motor neuron diseases, especially ALS (Lou Gehrig’s disease) and cognitive decline associated with frontotemporal degeneration. The journal also covers related disorders of the neuroaxis when relevant to these core conditions.