Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Spain; Instituto de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Spain.
Complejo Asistencial Universitario de León, Universidad de Valladolid, Spain; Instituto de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Spain.
Clin Nutr. 2021 Jan;40(1):237-244. doi: 10.1016/j.clnu.2020.05.014. Epub 2020 May 21.
Malnutrition is a prognostic factor in Amyotrophic Lateral Sclerosis (ALS). Sometimes, this condition is underdiagnosed, and it might influence on disease progression.
To evaluate a) nutritional status at the beginning of specialized nutritional treatment and b) the influence of initial nutritional status on disease evolution and survival in a group of patients with amyotrophic lateral sclerosis (ALS).
An interhospital registry of patients with motor neuron disease treated at the Clinical Nutrition Clinics of six hospitals in the region of Castilla y León in Spain was created. The study was developed from January 2015 to December 2017. An anamnesis, affiliation data, past medical history, disease evolution, nutritional history and an anthropometry and bioelectrical impedance analysis were performed at baseline. The mortality rate was compared among those patients with worse nutritional status at the beginning of the follow-up against those with a better nutritional situation using two tools: The Subjective Global Assessment (SGA) and the criteria of the Global Leadership Initiative for Malnutrition (GLIM).
A total of 93 patients were analysed. The median age of the patients was 67 (57.5-75.5) years. The median Body Mass Index was 24.4 (21.7-25.9) kg/m and the median percentage of weight loss was 9.32 (2.7-17.6)% without differences between the onset type. According to the SGA, 27 (29%) patients were in grade A; 43 (46.3%) patients were in grade B and 23 (24.7%) were in grade C. According to the new GLIM malnutrition criteria, 45 patients (48.4%) had malnutrition. Patients with worse nutritional status had a lower survival median with both SGA (SGA A: 20.5 (10.2-35) months vs SGA B-C: 12 (5.2-23.7) months (p = 0.03)) or the new GLIM criteria according to severity (severe malnutrition: 18 (5-24) months vs. no severe malnutrition: 20 (12-33) months (p = 0.01)). In the multivariate analysis, malnutrition measured by SGA was an independent risk factor (HR: 4.6 (1.5-13.9) p = 0.007) for survival over 15 months when adjusted for age, sex and type of onset of ALS.
Patients with ALS have a severe deterioration in nutritional status when analysed using a classical malnutrition test (SGA) or a new one (GLIM criteria). Patients with a better nutritional situation according to SGA and GLIM severity classification were associated with a longer survival time.
营养不良是肌萎缩侧索硬化症（ALS）的预后因素。有时，这种情况被漏诊，可能会影响疾病的进展。
评估 a）在接受专门的营养治疗开始时的营养状况，以及 b）在一组肌萎缩侧索硬化症（ALS）患者中，初始营养状况对疾病进展和生存的影响。
创建了一个在西班牙卡斯蒂利亚-莱昂地区六家医院的临床营养诊所接受治疗的运动神经元疾病患者的医院间登记处。该研究于 2015 年 1 月至 2017 年 12 月进行。在基线时进行了病史、归属数据、既往病史、疾病进展、营养史以及人体测量和生物电阻抗分析。使用两种工具比较了随访开始时营养状况较差的患者与营养状况较好的患者的死亡率：主观全面评估（SGA）和全球营养不良倡议（GLIM）标准。
共分析了 93 名患者。患者的中位年龄为 67（57.5-75.5）岁。中位体重指数为 24.4（21.7-25.9）kg/m，体重减轻的中位百分比为 9.32（2.7-17.6）%，在起始类型之间无差异。根据 SGA，27（29%）名患者为 A 级；43（46.3%）名患者为 B 级，23（24.7%）名患者为 C 级。根据新的 GLIM 营养不良标准，45 名患者（48.4%）有营养不良。根据 SGA（SGA A：20.5（10.2-35）个月 vs SGA B-C：12（5.2-23.7）个月（p=0.03））或新的 GLIM 严重程度标准（严重营养不良：18（5-24）个月 vs. 无严重营养不良：20（12-33）个月（p=0.01）），营养状况较差的患者中位生存率较低。在多变量分析中，根据 SGA 测量的营养不良是生存超过 15 个月的独立危险因素（HR：4.6（1.5-13.9）p=0.007），调整年龄、性别和 ALS 起始类型后。
使用经典营养不良测试（SGA）或新测试（GLIM 标准）分析时，肌萎缩侧索硬化症患者的营养状况严重恶化。根据 SGA 和 GLIM 严重程度分类，营养状况较好的患者与较长的生存时间相关。
