Do patients with amyotrophic lateral sclerosis (ALS) have increased energy needs?
OBJECTIVE
Nutritional status is a prognostic factor for survival in amyotrophic lateral sclerosis (ALS) patients. We investigated the contribution of some of the components contributing to resting energy expenditure (REE) in order to determine whether potentially higher energy needs should be considered for these patients.


METHODS
Thirty three ALS patients and 33 age- and gender-matched healthy controls participated. REE was measured by an open-circuit indirect calorimeter, body composition by dual energy X-ray absorptiometry, and estimated caloric intake by 7-day food records.


RESULTS
Patients had lower body mass indices and lower lean body mass (LBM) than healthy controls. REE values (as a percentage of predicted) was similar but increased when normalized by LBM (P<0.001). LBM and REE decreased while REE/LBM increased in ten patients who were reassessed 6 months later. A model for predicting measured REE was constructed based on the different components, with 86% prediction of its variability.


CONCLUSIONS
ALS is associated with increased REE. Various factors, such as poor caloric intake and mechanical ventilation, may mask this tendency. All the above parameters need to be considered during nutritional intervention to prevent additional muscle loss.
Vaisman
Nachum
N
Clinical Nutrition Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. vaisman@tasmc.health.gov.il
Lusaus
Michal
M
Nefussy
Beatrice
B
Niv
Eva
E
Comaneshter
Doron
D
Hallack
Ron
R
Drory
Vivian E
VE
D015502:Absorptiometry, Photon; D000690:Amyotrophic Lateral Sclerosis / Q000378:metabolism*; D001823:Body Composition; D015992:Body Mass Index; D002153:Calorimetry, Indirect; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged