title: Association between nutritional status and disease severity using the amyotrophic lateral sclerosis (ALS) functional rating scale in ALS patients.
abstract: OBJECTIVE
  The 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).
  
  
  METHODS
  One 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).
  
  
  RESULTS
  BMI 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.
  
  
  CONCLUSIONS
  Nutritional 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.
authors.affiliation: Department of Food and Nutrition, Hanyang University, Seoul, Korea. Electronic address: yongsoon@hanyang.ac.kr.
authors.forename: Yongsoon
authors.initials: Y
authors.lastname: Park
authors.affiliation: Department of Food and Nutrition, Hanyang University, Seoul, Korea.
authors.forename: Jinhee
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Food and Nutrition, Hanyang University, Seoul, Korea.
authors.forename: Yeonsun
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Food and Nutrition Services, Hanyang University Hospital, Seoul, Korea.
authors.forename: Heejoon
authors.initials: H
authors.lastname: Baek
authors.affiliation: Department of Neurology, Hanyang University Hospital, Seoul, Korea. Electronic address: kimsh1@hanyang.ac.kr.
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000367:Age Factors; D000418:Albumins / Q000378:metabolism; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000401:mortality; D015992:Body Mass Index; D004032:Diet; D015930:Diet Records; D018450:Disease Progression; D002149:Energy Intake; D015444:Exercise; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D056910:Republic of Korea / Q000453:epidemiology; D012720:Severity of Illness Index; D013472:Sunlight; D013851:Thinness / Q000150:complications* / Q000453:epidemiology
chemical_list: D000418:Albumins
keywords: Amyotrophic lateral sclerosis; Body mass index; Dietary intake; Geriatric nutritional risk index; Revised ALS functional rating scale