Impact of dysphagia on nutritional status in amyotrophic lateral sclerosis

Patients diagnosed as having amyotrophic lateral sclerosis (ALS) can suffer from a combined form of protein calorie malnutrition, marasmic kwashiorkor, resulting in atrophy and wasting of skeletal muscles along with dysfunction of voluntary muscles and components of the central nervous system. The bulbar musculature is eventually affected resulting in varying degrees of dysphagia, dysphonia, and dysarthria. The direct impact of dysphagia on oral intake and nutritional status in this patient population has yet to be clearly defined. Intake records, lab data, and weight records were collected on thirty-six patients diagnosed with ALS who were part of a concurrent study at Baylor College of Medicine. No differences were found between the dysphagic and the non-dysphagic group in terms of gender, age, serum albumin, serum cholesterol, initial weight, ending weight, percent ideal body weight, or percent of weight change. However, significant weight loss was found within the dysphagic subjects. Mean intake of calories, protein, and fat were significantly greater in the dysphagic group compared to the non-dysphagic group. The possibility of errors in data collection and analysis of food records may partially explain what appear to be inconsistent results.