Dietary intake and zinc status in amyotrophic lateral sclerosis patients / Ingesta dietética y estado de zinc en pacientes con esclerosis lateral amiotrófica

Background: There is considerable evidence that abnormal zinc homeostasis is related to amyotrophic lateral sclerosis (ALS) pathogenesis, and malnutrition is an independent prognostic factor for worsened survival of ALS patients. Objective: To evaluate the dietary intake and zinc status in patients with ALS, treated in a specialized outpatient facility in Natal, Brazil. Methods: Twenty patients with ALS (case group) and 37 healthy subjects (control group) were included. Clinical and anthropometric assessments were carried out and dietary intake was obtained from two 24-hour recalls. Plasma and urinary zinc concentrations were determined by atomic absorption spectrophotometry. Results: Most of the participants were eutrophic. Mean energy, protein, carbohydrate and fat intake was significantly lower for the case group. There was greater prevalence of inadequate zinc intake in the case group (35%) compared to controls (27%). Mean plasma zinc was significantly lower in the case group than in controls (77.13 ± 22.21 vs 87.84 ± 17.44 μgZn/dl). Urinary zinc did not differ significantly between cases and controls. In the case group, plasma and urinary zinc concentrations were below reference values in 50.0% and 52.6% of patients, respectively. Conclusion: A large portion of patients with ALS exhibited poor dietary intake and changes in body zinc status. The zinc deficiency found in half of the ALS patients may contribute to a worsened prognosis and should be the target of nutritional intervention that aims to correct this deficiency (AU)

Introducción: hay pruebas considerables de que los cambios en la homeostasis del zinc están relacionados con la patogénesis de la esclerosis lateral amiotrófica (ELA) y que la malnutrición es un factor pronóstico capaz de reducir la supervivencia de los pacientes con ELA. Objetivo: evaluar la ingesta dietética y el estado de zinc en pacientes con ELA, tratados en un centro de atención ambulatoria especializado en Natal, Brasil. Métodos: se incluyeron 20 pacientes con ELA (grupo de casos) y 37 sujetos sanos (grupo control). Se realizaron evaluaciones clínicas y antropométricas y se obtuvo la ingesta dietética en dos recordatorios de 24 horas. Las concentraciones plasmáticas y urinarias de zinc se determinaron por espectrofotometría de absorción atómica. Resultados: la mayoría de los participantes fueron eutróficos. El consumo medio de energía, proteínas, carbohidratos y grasas fue significativamente menor en el grupo de casos. Hubo una mayor prevalencia de ingesta inadecuada de zinc en el grupo de casos (35%) en comparación con los controles (27%). El zinc plasmático medio fue significativamente menor en el grupo de casos que en los controles (77,13 ± 22,21 frente a 87,84 ± 17,44 μgZn/dl). El zinc urinario no difirió significativamente entre los casos y los controles. En el grupo de casos, las concentraciones de zinc plasmático y urinario fueron inferiores a los valores de referencia en el 50,0% y 52,6% de los pacientes, respectivamente. Conclusión: gran parte de los pacientes con ELA exhibieron una ingesta dietética pobre y modificación en el estatus de zinc corporal. La deficiencia de zinc encontrada en la mitad de los pacientes con ELA puede contribuir a un empeoramiento del pronóstico y debe ser el objetivo de la intervención nutricional que apunta a corregir esta deficiencia (AU)

Protocolo diferenciado para terapia nutricional na esclerose lateral amiotrófica / Special protocol to nutritional therapy in amyotrophic lateral sclerosis

OBJETIVO: Discutir a terapia nutricional na Esclerose Lateral Amiotrófica (ELA), compartilhando um protocolo elaborado e utilizado em ambulatório especializado. MATERIAL E MÉTODOS: A fundamentação teórica desse artigo foi baseada na literatura científica publicada nas bases de dados PubMed e ISI Web of Science, utilizando os descritores "amyrotrophic lateral sclerosis" and "nutrition". RESULTADOS E DISCUSSÃO: Em síntese, a ELA é uma doença neurodegenerativa rara, com prognóstico desfavorável e tratamento paliativo. A desnutrição é bastante frequente nessa doença e aumenta o risco de morte dos pacientes. Assim, a terapia nutricional é imprescindível e deve estar integrada a uma assistência multidisciplinar. O monitoramento nutricional é recomendado pelo menos a cada três meses, incluindo avaliação nutricional e prescrição de dieta hipercalórica e hiperproteica, com adequada quantidade hídrica e de fibras. Em adição, os micronutrientes, sobretudo os antioxidantes, devem atingir a Ingestão Diária Recomendada. Modificações na consistência da dieta para tratar a disfagia são indicadas e a nutrição enteral deve ser desmistificada entre os pacientes e cuidadores. Esses pacientes são candidatos potenciais para uso da nutrição enteral, a qual deve ser indicada em casos de disfagia significativa ou prejuízo da função respiratória associada com baixa ingestão alimentar, índice de massa corporal menor que 18,5 ou 22,0 kg/m2 (para adultos e idosos, respectivamente) e/ou perda de peso acima de 10%. CONCLUSÃO: Sugere-se a padronização da terapia nutricional na ELA e a instituição de protocolo diferenciado na prática clínica. Com isso, a desnutrição pode ser evitada ou minimizada, contribuindo para melhor qualidade de vida e sobrevida desses pacientes

OBJECTIVE: To discuss the nutritional therapy in Amyotrophic Lateral Sclerosis (ALS), sharing a protocol performed and used by a specialized ambulatory care service. MATERIAL AND METHODS: The theoretical foundation of this paper was based on the literature published in both PubMed and ISI Web of Science, using "amyrotrophic lateral sclerosis" and "nutrition" as keywords. RESULTS AND DISCUSSION: In brief, ALS is a rare neurodegenerative disease with poor prognosis and palliative treatment. Malnutrition is very common in these patients and increases the risk of death among them. Nutritional therapy is essential and must be integrated into a multidisciplinary care. Nutritional monitoring is recommended at least once every three months. Nutritional assessment, high-calorie and highprotein diet with an adequate amount of water and fiber are recommended. In addition, micronutrients, especially antioxidants, must reach the Recommended Dietary Allowances. A diet texture modification for dysphagia is indicated and enteral nutrition should be demystified to patients and care givers during the follow-up care. ALS patients are potential candidates to use enteral nutrition, which should be indicated in cases of significant dysphagia or impaired respiratory function associated with low food intake, body mass index less than 18.5 or 22.0 kg/m² (for adults or elderlies, respectively), and/or body weight loss above 10%. CONCLUSION: We suggest the standardization of nutritional therapy in ALS and the establishment of a distinct protocol in clinical practice. Thus, malnutrition can be avoided or minimized, contributing to a better quality of life and survival of these patients