Association between nutritional status and disease severity using the amyotrophic lateral sclerosis (ALS) functional rating scale in ALS patients

• Nutritional status, evaluated by BMI and GNRI, was worst in the lower score of amyotrophic lateral sclerosis functional rating scale (ALSFRS-R) in Korean ALS patients.
• Nutritional status correlated with ALSFRS-R, bulbar score, albumin, total lymphocyte count, and total daily energy expenditure in Korean ALS patients.
• Intakes of total energy and most nutrients were decreased in Korean ALS patients with lower score of ALSFRS-R.

ObjectiveThe nutritional status of patients with amyotrophic lateral sclerosis (ALS) has been shown to be associated with mortality. However, there have not been, to our knowledge, any studies on the association between nutritional status and disease severity. The present study investigated the hypothesis that nutritional status was negatively associated with disease severity using the ALS functional rating scale (ALSFRS-R).MethodsOne hundred ninety-three Korean ALS patients were divided into tertiles based on their ALSFRS-R score. Dietary intake was measured using 24 h recall and nutritional status was determined by body mass index (BMI) and geriatric nutritional risk index (GNRI).ResultsBMI and GNRI were significantly lower in patients in the lowest tertile of ALSFRS-R. BMI and GNRI also correlated with ALSFRS-R score, bulbar score, albumin levels, total lymphocyte count, and total daily energy expenditure. Intakes of energy and most nutrients were significantly lower in patients in the lowest tertiles of ALSFRS-R, but significances disappeared after adjusting for energy intake. Intakes of vegetables, grains, seasonings, and oils were also significantly lower in patients in the lowest tertile of ALSFRS-R. In addition, patients in the lowest tertile of ALSFRS-R were significantly younger at disease onset, had a longer duration of ALS, less regular exercise, and less sun exposure.ConclusionNutritional status, as assessed by BMI and GNRI, was negatively associated with disease severity using ALSFRS-R. The present study suggested that intake of nutrients decreases with disease progression in ALS patients.