Steyn FJ, et al. - The researchers ascertained the prevalence of hypermetabolism, relative to body composition, in amyotrophic lateral sclerosis (ALS) and its relationship with clinical features of disease and survival. They noted a greater level of lower motor neuron involvement, faster rate of functional decline and shorter survival among hypermetabolic patients with ALS. Findings suggested the prognostic significance of the metabolic index in ALS.

Methods

• Assessment of energy expenditure was performed on 58 patients with clinically definite or probable ALS (as defined by El Escorial criteria) and 58 age and sex-matched control participants.
• The prevalence of hypermetabolism in cases and controls was the primary outcome.
• Researchers determined longitudinal changes in clinical parameters between hypermetabolic and normometabolic patients with ALS for up to 12 months after metabolic assessment.
• They monitored survival over a 30-month period after metabolic assessment.

Results

• Patients with ALS had a higher incidence of hypermetabolism compared to controls (41% vs 12%, adjusted OR=5.4; p < 0.01).
• Normometabolic and hypermetabolic patients with ALS were comparable in terms of change in body weight, body mass index and fat mass (%).
• Hypermetabolic patients showed greater mean lower motor neuron score (SD) when compared with normometabolic patients (4 [0.3] vs 3 [0.7]; p=0.04).
• In the 12 months following metabolic assessment, hypermetabolic patients demonstrated greater change in Revised ALS Functional Rating Scale score vs normometabolic patients (-0.68 points/month vs -0.39 points/month; p=0.01).
• Inverse association of hypermetabolism with survival was noted.
• During follow-up, hypermetabolism increased the overall risk of death to 220% (HR 3.2, 95% CI 1.1 to 9.4, p=0.03).