Nutritional assessment and survival in ALS patients

Malnutrition, present in 16-50% of ALS patients, is an independent prognost ic factor for worsened survival. It is caused primarily by swallowing dysfu nction, resulting from involvement of the lower sets of cranial nerves, but hypermetabolism is also implicated. Malnutrition itself can produce neurom uscular weakness and adversely affect patients' quality of life, thereby cr eating a vicious circle. The nutritional status of ALS patients can be asse ssed with dietary review and measurements of weight (W) and height (H), A b ody mass index (BMI = W/H-2) below 18.5-20 kg/m(2) indicates a state of mal nutrition. Dietary counselling is important, but rapidly becomes insufficie nt, particularly in bulbar-onset ALS, where enteral nutritional support is then necessary. Percutaneous endoscopic gastrostomy tube placement is well tolerated, and provides more efficient enteral nutrition than nasogastric t ube feeding. Enteral nutrition support can improve the respiratory status o f ALS patients. The effect on survival remains to be confirmed.