Nutritional factors associated with survival following enteral tube feeding in patients with motor neurone disease.
BACKGROUND
Motor neurone disease (MND) is a progressive neurodegenerative disease leading to limb weakness, wasting and respiratory failure. Prolonged poor nutritional intake causes fatigue, weight loss and malnutrition. Consequently, disease progression requires decisions to be made regarding enteral tube feeding. The present study aimed to investigate the survival, nutritional status and complications in patients with MND treated with enteral tube feeding.


METHODS
A retrospective case note review was performed to identify patients diagnosed with MND who were treated with enteral tube feeding. A total of 159 consecutive cases were identified suitable for analysis. Patients were treated with percutaneous endoscopic gastrostomy (PEG), radiologically inserted gastrostomy (RIG) or nasogastric feeding tube (NGT). Nutritional status was assessed by body mass index (BMI) and % weight loss (% WL). Serious complications arising from tube insertion and prescribed daily energy intake were both recorded.


RESULTS
Median survival from disease onset was 842 days [interquartile range (IQR) 573-1263]. Median time from disease onset to feeding tube was PEG 521 days (IQR 443-1032), RIG 633 days (IQR 496-1039) and NGT 427 days (IQR 77-781) (P = 0.28). Median survival from tube placement was PEG 200 (IQR 106-546) days, RIG 216 (IQR 83-383) days and NGT 28 (IQR 14-107) days. Survival between gastrostomy and NGT treated patients was significant (P < or = 0.001). Analysis of serious complications by nutritional status was BMI (P = 0.347) and % WL (P = 0.489).


CONCLUSIONS
Nutritional factors associated with reduced survival were weight loss, malnutrition and severe dysphagia. Serious complications were not related to nutritional status but to method of tube insertion. There was no difference in survival between PEG and RIG treated patients.
Rio
A
A
Department of Nutrition & Dietetics, King's College Hospital, London SE5 9RS, UK. a.rio@nhs.net
Ellis
C
C
Shaw
C
C
Willey
E
E
Ampong
M-A
MA
Wijesekera
L
L
Rittman
T
T
Nigel Leigh
P
P
Sidhu
P S
PS
Al-Chalabi
A
A
D000368:Aged; D015992:Body Mass Index; D015984:Causality; D015897:Comorbidity; D003680:Deglutition Disorders / Q000453:epidemiology; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D044342:Malnutrition / Q000401:mortality* / Q000517:prevention & control*; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000453:epidemiology* / Q000628:therapy*; D015596:Nutrition Assessment; D009752:Nutritional Status; D012189:Retrospective Studies; D015431:Weight Loss