Metabolic Abnormalities, Dietary Risk Factors and Nutritional Management in Amyotrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis (ALS) is a devastating progressive neurodegenerative disease that affects motor neurons, leading to a relentless paralysis of skeletal muscles and eventual respiratory failure. Although a small percentage of patients may have a longer survival time (up to 10 years), in most cases, the median survival time is from 20 to 48 months. The pathogenesis and risk factors for ALS are still unclear: among the various aspects taken into consideration, metabolic abnormalities and nutritional factors have been the focus of recent interests. Although there are no consistent findings regarding prior type-2 diabetes, hypercholesterolemia and ALS incidence, abnormalities in lipid and glucose metabolism may be linked to disease progression, leading to a relatively longer survival (probably as a result of counteract malnutrition and cachexia in the advanced stages of the disease). Among potential dietary risk factors, a higher risk of ALS has been associated with an increased intake of glutamate, while the consumption of antioxidant and anti-inflammatory compounds, such as vitamin E, n-3 polyunsaturated fatty acids, and carotenoids, has been related to lower incidence. Poor nutritional status and weight loss in ALS resulting from poor oral intake, progressive muscle atrophy, and the potential hypermetabolic state have been associated with rapid disease progression. It seems important to routinely perform a nutritional assessment of ALS patients at the earliest referral: weight maintenance (if adequate) or gain (if underweight) is suggested from the scientific literature; evidence of improved diet quality (in terms of nutrients and limits for pro-inflammatory dietary factors) and glucose and lipid control is yet to be confirmed, but it is advised. Further research is warranted to better understand the role of nutrition and the underlying metabolic abnormalities in ALS, and their contribution to the pathogenic mechanisms leading to ALS initiation and progression.

Download Full-text

Abstract P060: Major Dietary Risk Factors for Chronic Diseases: A Systematic Review of the Current Evidence for Causal Effects and Effect Sizes

Circulation ◽

10.1161/circ.125.suppl_10.ap060 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Shahab Khatibzadeh ◽

Renata Micha ◽

Ashkan Afshin ◽

Mayuree Rao ◽

Mohammad Y Yakoob ◽

...

Keyword(s):

Risk Factors ◽

Dose Response ◽

Convincing Evidence ◽

Dietary Factors ◽

Causal Effects ◽

Effect Sizes ◽

Current Evidence ◽

Dietary Risk Factors ◽

Dietary Risk ◽

Meta Analyses

Background: Diet habits contribute to development of CVD and diabetes. Estimating the impact of diet on these diseases requires identification and quantification of causal effects of dietary factors. Objectives: To assess major dietary risk factors for CVD and diabetes, evaluate current evidence for causal effects, and identify the best unbiased effect estimates on risk. Methods: For multiple dietary risk factors, we evaluated WHO and similar criteria as part of the Global Burden of Diseases (GBD) study to assess probable or convincing evidence for causal effects, including consistency, dose-response, plausibility, and temporality. We performed systematic searches of online databases from 2008 to 2011, including hand-searches of references and author contacts, to identify systematic reviews and meta-analyses of well-designed observational or interventional studies. Meta-analyses were evaluated based on number of studies, design, definition of diet factors and outcomes, sample size, number of events, length of follow-up, statistical methods, evidence of bias, and control for confounders. Meta-analyses with largest numbers of studies and events and least evidence for bias were identified. Effect sizes and uncertainty were quantified per defined units of exposure, including pooling of categorical dose-response estimates using fixed-effects generalized least squares for trend estimation (GLST). Results: We identified 15 dietary risk factors having probable or convincing evidence of causal effects on CVD or diabetes. For 13, data were identified to provide the best pooled unbiased effect size on disease (Table). Conclusions: This systematic evaluation provides the best evidence-based quantitative estimates of the effects of major dietary factors on CVD and diabetes. These findings enable estimation of quantitative impacts on diseases burdens of suboptimal intakes of these factors in specific populations, and also highlight gaps in knowledge related to causality or effect sizes of other dietary factors.

Download Full-text

Contribution of specific dietary factors to CHD in US females

Public Health Nutrition ◽

10.1017/s1368980009990693 ◽

2009 ◽

Vol 13 (2) ◽

pp. 154-162 ◽

Cited By ~ 1

Author(s):

Nga Tran ◽

Leila Barraj

Keyword(s):

Risk Factors ◽

Risk Reduction ◽

Dietary Cholesterol ◽

Dietary Factors ◽

Health Study ◽

Relative Risks ◽

Dietary Risk Factors ◽

Dietary Risk ◽

Chd Risk ◽

Chd Risk Factors

AbstractObjectiveTo estimate dietary cholesterol contribution to CHD risk among US females, relative to other dietary risk factors.DesignA risk apportionment model was applied to apportion CHD risk shares among the lifestyle and dietary risk factors.SettingThe model was implemented using relative risks from the Nurses’ Health Study and data on CHD risk factors and consumption from the National Health and Nutrition Examination Survey 1999–2002.SubjectsUS females aged 25 years or older.ResultsOn average, poor diet contributes 20 % of the CHD risk relative to obesity, inactivity and smoking, of which trans fat intake contributes 2·9 %, dietary cholesterol 1·5 % and 16 % is due to low consumption of nutrients, i.e. MUFA (1·5 %), PUFA (1·7 %), marine n-3 fatty acids (2·7 %), α-linolenic acid (1·1 %), dietary fibre (2·4 %), vitamin B6 (4·1 %), vitamin C (0·5 %) and folate (1·8 %).ConclusionsReducing trans fat and dietary cholesterol intakes could lead to CHD reduction, but greater risk reduction may be achieved by improving intakes of heart-healthy nutrients currently deficient in US females’ diets. Total diet consideration is essential in any CHD risk reduction strategy.

Download Full-text

Relationship between Dietary Fiber Intake and the Prognosis of Amyotrophic Lateral Sclerosis

10.20944/preprints202010.0466.v1 ◽

2020 ◽

Author(s):

Haelim Yu ◽

Seung Hyun Kim ◽

Min-Young Noh ◽

Sang-Gon Lee ◽

Yongsoon Park

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Survival Time ◽

Disease Progression ◽

Dietary Fiber ◽

Progression Rate ◽

Fiber Intake ◽

Dietary Fiber Intake ◽

Disease Progression Rate ◽

Lateral Sclerosis ◽

Vegetable Fiber

The gut microbiota has been suggested as an important factor in the pathogenic mechanisms of amyotrophic lateral sclerosis (ALS). This study aimed to investigate whether the intake of different kinds of dietary fiber was related to the disease progression rate (∆FS) and survival time. In total, 272 sporadic ALS patients diagnosed according to the revised EI Escorial criteria were recruited from March 2011 and were followed-up until the occurrence of events or the end of September 2020. The events included percutaneous endoscopic gastrostomy, tracheostomy, and death. Dietary fiber intake was calculated based on a 24-hour dietary recall and classified according to five major fiber-rich foods: vegetables, fruits, grains, legumes, and nuts/seeds. Among the total participants, the group with ∆FS values lower than the mean ∆FS (0.75) was noted in the highest tertiles of total and vegetable fiber intake. Participants with the highest tertile of vegetable fiber intake showed longer survival in the Kaplan–Meier analysis (p = 0.033). Notably, vegetable fiber intake was negatively correlated with pro-inflammatory cytokine (interleukin [IL]-1β, IL-6, and monocyte chemoattractant protein-1) levels in the cerebrospinal fluid. This study showed that vegetable fiber intake could influence the disease progression rate and survival time. Further clinical trials are needed to confirm whether dietary fiber supplementation improves the prognosis of ALS.

Download Full-text

Dietary Risk-Related Colorectal Cancer Burden: Estimates From 1990 to 2019

Frontiers in Nutrition ◽

10.3389/fnut.2021.690663 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yujiao Deng ◽

Bajin Wei ◽

Zhen Zhai ◽

Yi Zheng ◽

Jia Yao ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Dietary Factors ◽

Cancer Death ◽

Dietary Factor ◽

Cancer Burden ◽

Targeted Interventions ◽

Dietary Risk Factors ◽

Dietary Risk ◽

Life Years

Background: Colorectal cancer remains a public health problem worldwide. Dietary risk factors play a key role in the carcinogenesis and progression of colorectal cancer. This study aimed to explore the geographical and temporal trends in various dietary factor-related colorectal cancers.Methods: Data were extracted from the Global Burden of Disease (GBD) 2019 study, including the deaths, disability-adjusted life-years (DALYs), age-standardized rate (ASR), and summary exposure value (SEV) among 4 world regions, 11 age groups, 21 regions, and 204 countries and territories between 1990 and 2019. The estimated annual percentage changes (EAPCs) were calculated to evaluate the variation trend of ASR.Results: Dietary factors were the leading cause of colorectal cancer death and DALY rate, regardless of age. Dietary factor-related deaths and DALYs accounted for 32 and 34% of global colorectal cancer, respectively. Further analysis showed that low whole grain intake remained the leading cause of cancer death and DALY rate, followed by milk and calcium. Diets that were low in whole grains, milk, and calcium accounted for 81.61% of deaths and 81.64% of DALYs. Deaths and DALYs of dietary factors related to colorectal cancer grew by half from 1990 to 2019. All ASRs remained higher for men than women. Asia carried the highest colorectal cancer burden attributed to dietary risks, especially for East Asia [age-standardized death rate (ASDR): EAPC = 1.15, 95% CI:0.88–1.42; DALY: EAPC = 1.08, 95% CI:0.82–1.34]. The heavy burden also existed in high-middle and middle socio-demographic index (SDI) quintiles. China has always had the highest deaths and DALYs of colorectal cancer attributable to dietary risks, followed by the USA, India, and Japan.Conclusions: Large variations existed in the dietary risk-related colorectal cancer burdens among sexes, regions, and countries. More targeted interventions to address modifiable dietary risk factors would save 32% of deaths and 34% of DALYs for colorectal cancer.

Download Full-text

Do MTHFR C677T Genetic Polymorphism Influence in the Pathogenesis of Amyotrophic Lateral Sclerosis?

10.21203/rs.3.rs-939291/v1 ◽

2021 ◽

Author(s):

Rômulo Morais Azevedo ◽

Kamilla de Faria Santos ◽

Rayana Pereira Dantas de Oliveira ◽

Júllia Costa Pereira ◽

Dhiogo da Cruz Pereira Bento ◽

...

Keyword(s):

Risk Factors ◽

Amyotrophic Lateral Sclerosis ◽

Neurodegenerative Disease ◽

Disease Progression ◽

Mutant Allele ◽

Control Group ◽

C677t Polymorphism ◽

Mutant Genotype ◽

Significant Difference ◽

Lateral Sclerosis

Abstract Amyotrophic Lateral Sclerosis (ALS) is a progressive and lethal neurodegenerative disease without a definitive diagnostic test and effective treatment. A plethora of studies suggest that genetic factors play an important role in ALS development, and potentially link folate pathway dysregulation to disease pathogenesis. This study aims to evaluate folate dysregulation due to MTHFR C677T polymorphism and other factors such as sociodemographic and clinical, to better elucidate the involvement of these factors in ALS pathogenesis, and to investigate possible biomarkers for use as disease diagnostics or prognostics. This hospital-based case-control study analyzed 101 patients diagnosed with ALS and 119 considered healthy, with no suspicion or diagnosis of neurodegenerative disease. Blood samples were collected, stored, and underwent DNA extraction. Clinical and sociodemographic data from patients were collected through a questionnaire, as well as consultation of medical records. Genotypic analyses were performed using PCR-RFLP, and statistical analysis of clinical and genotypic data was conducted with SPSS software, version 23. The results show a higher presence of the mutant genotype (p = 0.02) in the case group, and suggest that mutant allele (T) is a risk factor for ALS susceptibility (OR = 1.54; 95% CI = 1.05–2.29; p = 0.03). Mutant genotype (T/T) interacts with both demographics (White p = 0.005 / Brown p = 0,001) and clinical factors (Physical activity p = 0.006) as risk factors for ALS. Also, a significant difference in alcohol consumption (p = 0.001) between the case and control group was observed. Moreover, a statistical trend towards faster disease progression and death was observed for patients with the mutant allele (T) (p = 0.06). Thus, the results of this study suggest that folate deficiency due to MTHFR C677T polymorphism is implicated in ALS through pathogenic mechanisms and interaction with other risk factors, resulting in faster disease progression and early death.

Download Full-text

Therapeutic Nanocatalysis to Slow Disease Progression of Amyotrophic Lateral Sclerosis (ALS)

Case Medical Research ◽

10.31525/ct1-nct04098406 ◽

2019 ◽

Author(s):

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Disease Progression ◽

Slow Disease Progression ◽

Lateral Sclerosis

Download Full-text

Faculty Opinions recommendation of Dietary risk factors for nasopharyngeal carcinoma in Maghrebian countries.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1089507.544759 ◽

2007 ◽

Author(s):

Ellen Chang

Keyword(s):

Risk Factors ◽

Nasopharyngeal Carcinoma ◽

Dietary Risk Factors ◽

Dietary Risk

Download Full-text

Clinical Determinants of Disease Progression in Amyotrophic Lateral Sclerosis—A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10081623 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1623

Author(s):

Maria Viktoria Requardt ◽

Dennis Görlich ◽

Torsten Grehl ◽

Matthias Boentert

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Motor Neuron ◽

Disease Progression ◽

Rating Scale ◽

Rapid Decline ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Hazard Ratios ◽

Sum Score ◽

Lateral Sclerosis

Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that is ultimately fatal but characterized by substantial phenotypic heterogeneity, which is known to impact long-term course and survival. This study investigated clinical determinants of disease progression and outcome in a large cohort of patients with ALS. Methods: Retrospective analysis included comprehensive data from 625 patients who attended a tertiary ALS centre at least twice. Patients were stratified according to five distinct clinical phenotypes: classical ALS; bulbar ALS; ALS with frontotemporal dementia (ALS-FTD); upper motor neuron predominant (UMNP); and lower motor neuron predominant (LMNP). Results: This study confirmed higher age at symptom onset, shorter latency to diagnosis and more rapid decline in the revised ALS Functional Rating Scale sum score as predictors of poor prognosis. Hazard ratios for shorter survival were higher in patients with ALS-FTD versus classical ALS, and in patients with versus without chronic obstructive pulmonary disease (COPD). Mean survival was longest in the UMNP phenotype group. Conclusions: This study confirmed established predictors of shorter survival in ALS and showed that concomitant COPD in particular relates to poor outcome.

Download Full-text