Abstract
To examine whether hypermetabolism could predict the prognosis of early amyotrophic lateral sclerosis (ALS) patients with differing nutritional profiles. This single-center, retrospective study examined the prognosis of ALS patients with hypermetabolism in relation to their nutritional status at hospitalization. The metabolic state was estimated by the ratio of measured resting energy expenditure (mREE) to lean soft tissue mass (LSTM) (mREE/LSTM), wherein patients with ratios ≥ 38 were defined as hypermetabolic. Malnutrition was defined as %ideal body weight < 0.9. Forty-eight patients were enrolled in this study. The hypermetabolic group had shorter survival in the normal-weight group but more prolonged survival in the malnutrition group. Multiplication of nutritional and metabolic factors, such as [(body mass index (BMI) − 19.8) × (mREE/LSTM − 38)], designated as BMI-muscle metabolism index (BMM index), successfully predicted the prognosis in the group with a high BMM index (≥ 1), which showed shorter survival and a faster rate of weight loss and functional decline. Multivariate analysis using the Cox model showed high BMM index was an independent poor prognostic factor (hazard ratio: 4.05; p = 0.025). Prognostic prediction by hypermetabolism varies depending on the nutritional status in ALS, and the BMM index is a consistent prognostic factor.
Highlights
To examine whether hypermetabolism could predict the prognosis of early amyotrophic lateral sclerosis (ALS) patients with differing nutritional profiles
Previous studies have shown that metabolism and nutritional status play an essential role in the progression of ALS. Hypermetabolism[9,10,11], low body fat percentage[12], and low fat-free mass[13] were poor prognostic factors, as confident as serum creatine phosphokinase (CPK), creatinine, albumin, and ferritin, as previously
In this study we explored the effect of hypermetabolism on survival relative to the nutritional status of patients with ALS, and found that hypermetabolic patients with a normal-weight had shorter survival, whereas survival was longer in hypermetabolic patients with malnutrition
Summary
We collected data on the resting energy expenditure (REE) and respiratory quotient (RQ), which were measured by indirect calorimetry (Aeromonitor AE310S, Minato Medical Science Co., Ltd.). We collected the data of lean soft tissue mass (LSTM; kg), body fat percentage (%), and skeletal muscle index (SMI; kg/m2), which were measured by bioelectrical impedance analysis with a body composition analyzer (InBody S10; InBody, Tokyo, Japan). We defined hypermetabolism as mREE/LSTM ≥ 38 kcal/kg, considering the percentage of patients with hypermetabolism. To estimate the absolute risks of hypermetabolism on survival depending on nutritional status, we used Kaplan–Meier curves and the log-rank test. Excess weight loss, body fat percentage, and LDL were assessed for stratification by using the Kaplan–Meier curves and the log-rank test. We used EZR and Microsoft Excel version 2016
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