Dietary modification associated with slower decline, longer survival for those with ALS

Key takeaways:

• Researchers examined 304 participants for dietary and health status, then followed up at 3 months.
• A higher glycemic index was associated with slower functional decline and longer survival.

PHILADELPHIA — A higher dietary glycemic index through diet modification was associated with both slower functional decline and longer survival in a cohort of individuals with ALS, according to a poster presentation.

“We don’t know which diet is most beneficial with patients of ALS and we tried to address which nutrients were most important in their diet,” Ikjae Lee, MD, MSc, an assistant professor of neurology in the division of neuromuscular medicine at Columbia University Irving Medical Center, told Healio at the American Neurological Association annual meeting.

Lee and colleagues examined whether dietary alteration with certain macronutrient (carbohydrate, protein, and fat) content as well as glycemic load and index are associated with disease progression and survival rate for individuals within the ALS Multicenter Cohort Study of Oxidative Stress (COSMOS).

Their analysis included 304 participants (mean age 61.6 years; 59% male) from the study, which was conducted across 16 centers in the United States. Participants were evaluated with a self-administered food frequency questionnaire that assessed eating habits over the previous 6 months and by macronutrient intake. The primary outcome for the study was chance in baseline to 3 months in the revised ALS functional rating scale (ALSFRS-r), and tracheostomy-free survival using linear regression and Cox proportional hazard models. Baseline age, sex, disease duration, diagnostic certainty, BMI, ALSFRS-r, ALSFRS-r bulbar sub-score and forced vital capacity were included as covariates.

Results showed that neither total calories nor macronutrient intake were significantly associated with ALSFRS-r change at 3 months. Conversely, baseline higher glycemic index (GI) was associated with slower progression of ALSFRS-r at 3 months where one unit of GI increase was associated with 0.19 less decline of ALSFRS-r (= -0.19, 95% CI, -0.3 to -0.07).

Researchers additionally found higher baseline glycemic load was associated with slower progression of ALSFRS-r at 3-month follow-up but associations were weaker than GI and not statistically significant (= -0.012, 95% CI, -0.02 to 0.0002). In a multivariable Cox proportional hazard model, higher GI was associated with longer tracheostomy-free survival (HR = 0.96; 95% CI, 0.93 to 0.99) after adjusting for age, sex, diagnostic certainty, disease duration, bulbar onset, baseline ALSFRS-r total score and FVC.

“(Diet alterations) can be translated to slower progression and longer survival,” Lee told Healio. “And this is very difficult to achieve with medicine, trying to achieve that with diet modification.”