School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Saint Lucia, Australia.
Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Australia.
Eur J Neurol. 2023 Jan;30(1):57-68. doi: 10.1111/ene.15589. Epub 2022 Nov 8.
Weight loss in patients with amyotrophic lateral sclerosis (ALS) is associated with faster disease progression and shorter survival. Decreased hypothalamic volume is proposed to contribute to weight loss due to loss of appetite and/or hypermetabolism. We aimed to investigate the relationship between hypothalamic volume and body mass index (BMI) in ALS and Alzheimer's disease (AD), and the associations of hypothalamic volume with weight loss, appetite, metabolism and survival in patients with ALS.
We compared hypothalamic volumes from magnetic resonance imaging scans with BMI for patients with ALS (n = 42), patients with AD (n = 167) and non-neurodegenerative disease controls (n = 527). Hypothalamic volumes from patients with ALS were correlated with measures of appetite and metabolism, and change in anthropomorphic measures and disease outcomes.
Lower hypothalamic volume was associated with lower and higher BMI in ALS (quadratic association; probability of direction = 0.96). This was not observed in AD patients or controls. Hypothalamic volume was not associated with loss of appetite (p = 0.58) or hypermetabolism (p = 0.49). Patients with lower BMI and lower hypothalamic volume tended to lose weight (p = 0.08) and fat mass (p = 0.06) over the course of their disease, and presented with an increased risk of earlier death (hazard ratio [HR] 3.16, p = 0.03). Lower hypothalamic volume alone trended for greater risk of earlier death (HR 2.61, p = 0.07).
These observations suggest that lower hypothalamic volume in ALS contributes to positive and negative energy balance, and is not universally associated with loss of appetite or hypermetabolism. Critically, lower hypothalamic volume with lower BMI was associated with weight loss and earlier death.
肌萎缩侧索硬化症（ALS）患者的体重减轻与疾病进展更快和生存时间更短有关。由于食欲下降和/或代谢亢进，下丘脑体积减少被认为是导致体重减轻的原因。我们旨在研究 ALS 和阿尔茨海默病（AD）患者的下丘脑体积与体重指数（BMI）之间的关系，以及下丘脑体积与 ALS 患者体重减轻、食欲、代谢和生存的相关性。
我们比较了 ALS 患者（n=42）、AD 患者（n=167）和非神经退行性疾病对照组（n=527）的磁共振成像扫描的下丘脑体积与 BMI。ALS 患者的下丘脑体积与食欲和代谢的测量值以及人体测量学指标和疾病结局的变化相关。
较低的下丘脑体积与 ALS 患者较低和较高的 BMI 相关（二次关联；概率方向=0.96）。在 AD 患者或对照组中未观察到这种情况。下丘脑体积与食欲减退（p=0.58）或代谢亢进（p=0.49）无关。BMI 和下丘脑体积较低的患者在疾病过程中往往会减轻体重（p=0.08）和脂肪量（p=0.06），并且死亡风险增加（风险比[HR]3.16，p=0.03）。单独较低的下丘脑体积也有更早死亡的更大风险（HR 2.61，p=0.07）。
这些观察结果表明，ALS 中的下丘脑体积较低有助于正能和负能量平衡，并不普遍与食欲减退或代谢亢进相关。至关重要的是，BMI 较低且下丘脑体积较低与体重减轻和更早死亡相关。
