Severe Loss of Appetite in Amyotrophic Lateral Sclerosis Patients: Online Self-Assessment Study

AbstractWeight loss is common in patients with Amyotrophic lateral sclerosis (ALS), and associated with disease progression. Loss of appetite has been shown to be a contributor to weight loss in patients with amyotrophic lateral sclerosis (ALS). However, the reason of loss of appetite is not clear. The Council on Nutrition appetite questionnaire (CNAQ) and the simplified nutritional appetite questionnaire (SNAQ) are short and simple appetite assessment tools, which were using in ALS patients. In our study, the CNAQ and SNAQ were translated into Chinese, and their reliability and validity were tested. The Chinese version of the CNAQ (CNAQ-C) presented more appropriate reliability and validity than the SNAQ. Among the 94 ALS patients, 50 patients (53.2%) had loss of appetite, and we found that anxiety and/or depression contributed to the loss of appetite in the ALS patients. We reconfirmed that loss of appetite was associated with greater weight loss but not with clinical features of ALS. The loss of appetite caused by emotional problems in ALS patients should be taken seriously, and early intervention should be implemented to reduce weight loss.

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Nutritional and Metabolic Support in Adults With Amyotrophic Lateral Sclerosis

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd22.1.12 ◽

2013 ◽

Vol 22 (1) ◽

pp. 12-16

Author(s):

Michelle McDonagh

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

High Standard ◽

Nutrition Support ◽

Nutrition Status ◽

Team Approach ◽

Registered Dietitian ◽

Loss Of Appetite ◽

Evidence Based Guidelines ◽

Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is an incurable, degenerative, neuromuscular condition. Nutritional and metabolic support is an integral component of care for patients with ALS because those capable of maintaining a normal nutrition status exhibit a slower rate of disease progression. Although there are multiple barriers to maintaining a normal nutrition status, the multidisciplinary team approach can facilitate early identification of symptoms, early intervention, and better outcomes for these patients. Barriers that patients often encounter include dysphagia, hypermetabolism, hypometabolism, upper extremity weakness, early satiety, constipation, depression, and loss of appetite. The role of the registered dietitian in the multidisciplinary ALS clinic is to intervene by providing a high standard of nutrition support. Further research into other facets of nutrition for ALS could lead to new interventions to slow weight loss and provide evidence-based guidelines for nutrition professionals. Areas for further research include the use of appetite stimulants, dietary supplements, delayed gastric motility, diet composition, metabolic rate, and the development of a standard equation for estimation of caloric needs in ALS.

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Fat-rich versus carbohydrate-rich nutrition in ALS: a randomised controlled study

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2021-328331 ◽

2022 ◽

pp. jnnp-2021-328331

Author(s):

Johannes Dorst ◽

Judith Doenz ◽

Katharina Kandler ◽

Jens Dreyhaupt ◽

Hayrettin Tumani ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Body Weight ◽

Weight Gain ◽

Gastrointestinal Symptoms ◽

Food Supplements ◽

Controlled Study ◽

Randomised Controlled Study ◽

Loss Of Appetite ◽

Randomised Controlled ◽

Lateral Sclerosis

ObjectiveThere is growing evidence that the course of amyotrophic lateral sclerosis (ALS) may be influenced beneficially by applying high-caloric food supplements (HCSs). However, it is unknown which composition of nutrients offers optimal tolerability and weight gain.MethodsWe conducted a randomised controlled study (Safety and Tolerability of Ultra-high-caloric Food Supplements in Amyotrophic Lateral Sclerosis (ALS); TOLCAL-ALS study) in 64 patients with possible, probable or definite ALS according to El Escorial criteria. Patients were randomised into four groups: a high-caloric fatty supplement (HCFS; 405 kcal/day, 100% fat), an ultra-high-caloric fatty supplement (UHCFS; 810 kcal/day, 100% fat), an ultra-high-caloric, carbohydrate-rich supplement (UHCCS; 900 kcal/day, 49% carbohydrates) and an open control (OC) group without any supplement. The primary endpoint was tolerability. Patients were followed up over 4 weeks.ResultsGastrointestinal side effects were most frequent in the UHCFS group (75.0%), while loss of appetite was most frequent in the UHCCS group (35.3%). During intervention, patients gained +0.9 kg/month of body weight (IQR −0.9 to 1.5; p=0.03) in the HCFS group and +0.9 kg/month (IQR −0.8 to 2.0; p=0.05) in the UHCFS group. A non-significant trend for weight gain (+0.6 kg/month (IQR −0.3 to 1.9; p=0.08)) was observed in the UHCCS group. Patients in OC group continued to lose body weight (−0.5 kg/month, IQR −1.4 to 1.3; p=0.42).InterpretationThe findings suggest that HCSs frequently cause mild to moderate tolerability issues in patients with ALS, most notably gastrointestinal symptoms in high-fat supplements, and loss of appetite in high-carbohydrate supplements. All three HCSs tested are suited to increase body weight.

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Loss of appetite is associated with a loss of weight and fat mass in patients with amyotrophic lateral sclerosis

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration ◽

10.1080/21678421.2019.1621346 ◽

2019 ◽

Vol 20 (7-8) ◽

pp. 497-505 ◽

Cited By ~ 8

Author(s):

Shyuan T. Ngo ◽

Ruben P.A. van Eijk ◽

V. Chachay ◽

Leonard H. van den Berg ◽

Pamela A. McCombe ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Fat Mass ◽

Loss Of Weight ◽

Loss Of Appetite ◽

Lateral Sclerosis

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A Case Study on the Use of Megestrol Acetate and Korean Medical Treatment for the Loss of Appetite and Weight Loss in Patients with Amyotrophic Lateral Sclerosis(ALS)

The Acupuncture ◽

10.13045/acupunct.2013057 ◽

2013 ◽

Vol 30 (5) ◽

pp. 185-192 ◽

Cited By ~ 1

Author(s):

Ho Hyun Jeong ◽

Sang Mi Lee ◽

Jong Chul Lee ◽

Man Yong Park ◽

Bong Keun Song ◽

...

Keyword(s):

Weight Loss ◽

Amyotrophic Lateral Sclerosis ◽

Medical Treatment ◽

Megestrol Acetate ◽

Loss Of Appetite ◽

Lateral Sclerosis

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Automated Acoustic Analysis of Oral Diadochokinesis to Assess Bulbar Motor Involvement in Amyotrophic Lateral Sclerosis

Journal of Speech Language and Hearing Research ◽

10.1044/2019_jslhr-19-00178 ◽

2020 ◽

Vol 63 (1) ◽

pp. 59-73 ◽

Cited By ~ 3

Author(s):

Panying Rong

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Acoustic Analysis ◽

Speaking Rate ◽

Disease Stage ◽

Healthy Controls ◽

Tongue Movement ◽

Major Barrier ◽

Syllable Repetition ◽

Oral Diadochokinesis ◽

Lateral Sclerosis

Purpose The purpose of this article was to validate a novel acoustic analysis of oral diadochokinesis (DDK) in assessing bulbar motor involvement in amyotrophic lateral sclerosis (ALS). Method An automated acoustic DDK analysis was developed, which filtered out the voice features and extracted the envelope of the acoustic waveform reflecting the temporal pattern of syllable repetitions during an oral DDK task (i.e., repetitions of /tɑ/ at the maximum rate on 1 breath). Cycle-to-cycle temporal variability (cTV) of envelope fluctuations and syllable repetition rate (sylRate) were derived from the envelope and validated against 2 kinematic measures, which are tongue movement jitter (movJitter) and alternating tongue movement rate (AMR) during the DDK task, in 16 individuals with bulbar ALS and 18 healthy controls. After the validation, cTV, sylRate, movJitter, and AMR, along with an established clinical speech measure, that is, speaking rate (SR), were compared in their ability to (a) differentiate individuals with ALS from healthy controls and (b) detect early-stage bulbar declines in ALS. Results cTV and sylRate were significantly correlated with movJitter and AMR, respectively, across individuals with ALS and healthy controls, confirming the validity of the acoustic DDK analysis in extracting the temporal DDK pattern. Among all the acoustic and kinematic DDK measures, cTV showed the highest diagnostic accuracy (i.e., 0.87) with 80% sensitivity and 94% specificity in differentiating individuals with ALS from healthy controls, which outperformed the SR measure. Moreover, cTV showed a large increase during the early disease stage, which preceded the decline of SR. Conclusions This study provided preliminary validation of a novel automated acoustic DDK analysis in extracting a useful measure, namely, cTV, for early detection of bulbar ALS. This analysis overcame a major barrier in the existing acoustic DDK analysis, which is continuous voicing between syllables that interferes with syllable structures. This approach has potential clinical applications as a novel bulbar assessment.

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