Early weight loss in amyotrophic lateral sclerosis: outcome relevance and clinical correlates in a population-based cohort. Issue 6 (10th January 2019)

• Record Type: Journal Article
• Authors: Moglia, Cristina; Calvo, Andrea; Grassano, Maurizio; Canosa, Antonio; Manera, Umberto; D'Ovidio, Fabrizio; Bombaci, Alessandro; Bersano, Enrica; Mazzini, Letizia; Mora, Gabriele; Chiò, Adriano
• Other Names: author non-byline.; Cammarosano Stefania author non-byline.; Vasta Rosario author non-byline.; Claudia Torrieri Maria author non-byline.; Solero Luca author non-byline.; Clerico Marinella author non-byline.; De Mercanti Stefania author non-byline.; Mauro Alessandro author non-byline.; Pradotto Luca author non-byline.; De Marchi Fabiola author non-byline.; Sosso Luisa author non-byline.; Leotta Daniela author non-byline.; Appendino Lucia author non-byline.; Imperiale Daniele author non-byline.; Cavallo Roberto author non-byline.; Geda Claudio author non-byline.; Poglio Fabio author non-byline.; Santimaria Paola author non-byline.; Massazza Umberto author non-byline.; Villani Antonio author non-byline.; Conti Roberto author non-byline.; Ruiz Luigi C author non-byline.; Palermo Mario author non-byline.; Vergnano Franco author non-byline.; Rota Eugenia author non-byline.; Teresa Penza Maria author non-byline.; Aguggia Marco author non-byline.; Meineri Piero author non-byline.; Ghiglione Paolo author non-byline.; Launaro Nicola author non-byline.; Astegiano Giuseppe author non-byline.; Corso Giovanni author non-byline.;
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 90:Issue 6(2019)
• Page Start: 666
• Page End: 673
• Publication Date: 2019-01-10
• Subjects: amyotrophic lateral sclerosis -- body mass index -- weight loss -- dysphagia -- respiratory function; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2018-319611
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objectives: To assess the role of body mass index (BMI) and of the rate of weight loss as prognostic factors in amyotrophic lateral sclerosis (ALS) and to explore the clinical correlates of weight loss in the early phases of the disease. Methods: The study cohort included all ALS patients in Piemonte/Valle d'Aosta in the 2007–2011 period. Overall survival and the probability of death/tracheostomy at 18 months (logistic regression model) were calculated. Results: Of the 712 patients, 620 (87.1%) were included in the study. Patients ' survival was related to the mean monthly percentage of weight loss at diagnosis (p<0.0001), but not to pre-morbid BMI or BMI at diagnosis. Spinal onset patients with dysphagia at diagnosis had a median survival similar to bulbar onset patients. About 20% of spinal onset patients without dysphagia at diagnosis had severe weight loss and initial respiratory impairment, and had a median survival time similar to bulbar onset patients. Conclusions: The rate of weight loss from onset to diagnosis was found to be a strong and independent prognostic factor in ALS. Weight loss was mainly due to the reduction of nutritional intake related to dysphagia, but a subgroup of spinal onset patients without dysphagia at diagnosis had a severe weight loss and an outcome similar to bulbar patients. According to our findings, we recommend that in clinical trials patients should be stratified according to the presence of dysphagia at the time of enrolment and not by site of onset of symptoms.