Endocrine Abstracts

Introduction: A high percentage of patients diagnosed with Amyotrophic Lateral Sclerosis (ALS) have malnutrition. The nutritional treatment in ALS is essential, affecting muscle strength, quality of life and survival.

Objective: To describe the nutritional characteristics of patients evaluated in a specific nutritional Unit in patients with ALS during 3 years.

Material and methods: A descriptive study of all patients diagnosed with ALS and evaluated in this specific consultation since October 2013. The nutritional status is assessed by anamnesis, 24-h ingestión count, physical examination (BMI, % lost weight, Plicometry, dynamometry), evaluation of dysphagia by EAT-10 (if positive, volume viscosity test) and analytical tests.

Results: Data were obtained from 60 patients. Mean age at diagnosis: 57.5 years (26–79 years), 65% male. Bulbar: 28.6%, spinal: 61.2%. The mean time until the evaluation in nutrition Unit was 22.1 month (12.6 in bulbar vs 24.7 in spinal, P<0.05). The initial BMI: 26.4 (18.1 to 36.2), in 78.3%> 25. The nutritional status in the first consultation was (VSG): 23% of patients with moderate malnutrition, 17.1% of severe malnutrition (30.8% of bulbars vs 5.9% of spinal, P<0.05). The most frequent analytical alterations were vitamin D insufficiency/deficiency (58.3%) and hypercholesterolemia (50%). The most frequent analytical disorders were vitamin D deficiency/insufficiency (58.3%) and hypercholesterolemia (22.5%). Nutritional intervention at the first visit was only diet in 46% (7.1% bulbar vs 69% in spinal, P<0.05), thickening prescription in 34%, nutritional supplements in seven patients, gastrostomy in three patients (all of them bulbar). Of the patients who were offered gastrostomy during follow-up (56.8%), 68.4% accepted. The main reason for this was weight loss (83%). The FVC (Forced vital capacity) at this time was: 58% (23 to 97%) and 100% were endoscopic. As complications of gastrostomy: three patients had accidental withdrawal. The mean survival time after gastrostomy was 14 months (2–25 months).

Conclusions: – 40.1% of patients with ALS present moderate/severe malnutrition in the first assessment.

– BMI and analytical parameters are not early markers of malnutrition, being weight loss the best marker.

– Patients with bulbar ALS present malnutrition more frequently than spinal forms and require an earlier and more aggressive nutritional intervention.