Department of Emergency and Organ Transplantation, Gastroenterology Unit, University of Bari , Bari , Italy.
Neurological ALS Tertiary Centre, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari , Bari , Italy.
Amyotroph Lateral Scler Frontotemporal Degener. 2019 Nov;20(7-8):490-496. doi: 10.1080/21678421.2019.1643374. Epub 2019 Jul 26.
There are conflicting data on nutritional factors influencing survival in amyotrophic lateral sclerosis (ALS) patients after percutaneous endoscopic gastrostomy (PEG) placement. We performed an observational cross-sectional study evaluating body mass index (BMI) categories and cholesterol levels as prognostic factors for survival after PEG. Moreover, we assessed body composition in a subgroup of patients to better explain the influence of BMI on survival. Neurological and nutritional parameters were evaluated at the time of PEG implantation in 47 consecutive patients. Moreover, body composition was evaluated in a subgroup of 22 patients by bioelectrical impedance analysis. Survival was calculated as the time from the PEG placement to death. Underweight patients had a significantly increased risk of death as compared to normal-weight patients using Cox regression analysis [HR = 3.37 (1.29-8.81); = 0.04]. Similarly, older age at the onset of symptoms significantly increased the risk of death [HR = 1.07 (1.02-1.12); = 0.001]. Neither overweight/obesity nor hypercholesterolemia affected survival. All ALS patients showed an altered body composition compared to the general population. In addition, a BMI <18.5 kg/m identified patients with a significant reduction of body cell mass (BCM) and phase angle (PhA) compared to patients with normal BMI taken as the reference value. In the later stages of the disease, only a BMI < 18.5 kg/m and older age at symptom onset had a prognostic value on survival. Dyslipidemia did not affect survival. The low BCM and PhA characterizing underweight patients support the role of BMI as a predictor of survival.
经皮内镜胃造口术 (PEG) 后影响肌萎缩侧索硬化症 (ALS) 患者生存的营养因素存在争议。我们进行了一项观察性横断面研究，评估体重指数 (BMI) 类别和胆固醇水平作为 PEG 后生存的预后因素。此外，我们评估了一组患者的身体成分，以更好地解释 BMI 对生存的影响。在 47 例连续患者进行 PEG 植入时评估了神经和营养参数。此外，在 22 例患者亚组中通过生物电阻抗分析评估了身体成分。生存时间从 PEG 放置到死亡计算。使用 Cox 回归分析，与正常体重患者相比，体重不足患者的死亡风险显著增加[HR=3.37（1.29-8.81）；=0.04]。同样，症状发作时的年龄较大也显著增加了死亡风险[HR=1.07（1.02-1.12）；=0.001]。超重/肥胖或高胆固醇血症均不影响生存。与一般人群相比，所有 ALS 患者的身体成分均发生改变。此外，与正常 BMI 作为参考值的患者相比，BMI<18.5 kg/m2 确定了患者的身体细胞质量 (BCM) 和相位角 (PhA) 显著减少。在疾病的后期，只有 BMI<18.5 kg/m2 和症状发作时的年龄较大对生存有预后价值。血脂异常不影响生存。体重不足患者的低 BCM 和低 PhA 支持 BMI 作为生存预测因子的作用。
