Objective To determine the prevalence and prognostic value of weight loss (WL) prior to diagnosis in patients with amyotrophic lateral sclerosis (ALS).
Methods We enrolled patients diagnosed with ALS between 2010 and 2018 in a population-based setting. At diagnosis, detailed information was obtained regarding the patient’s disease characteristics, anthropological changes, ALS-related genotypes and cognitive functioning. Complete survival data were obtained. Cox proportional hazard models were used to assess the association between WL and the risk of death during follow-up.
Results The data set comprised 2420 patients of whom 67.5% reported WL at diagnosis. WL occurred in 71.8% of the bulbar-onset and in 64.2% of the spinal-onset patients; the mean loss of body weight was 6.9% (95% CI 6.8 to 6.9) and 5.5% (95% CI 5.5 to 5.6), respectively (p<0.001). WL occurred in 35.1% of the patients without any symptom of dysphagia. WL is a strong independent predictor of survival, with a dose response relationship between the amount of WL and the risk of death: the risk of death during follow-up increased by 23% for every 10% increase in WL relative to body weight (HR 1.23, 95% CI 1.13 to 1.51, p<0.001).
Conclusions This population-based study shows that two-thirds of the patients with ALS have WL at diagnosis, which also occurs independent of dysphagia, and is related to survival. Our results suggest that WL is a multifactorial process that may differ from patient to patient. Gaining further insight in its underlying factors could prove essential for future therapeutic measures.
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Contributors MRJvM: Design of the study, cleaned, analysed and interpreted the data, drafted and revised the manuscript for intellectual content. RPAvE: Design of the study, analysed and interpreted the data and revised the manuscript for intellectual content. HKvdB: Statistical support, support in cleaning the cognitive and behavioural data, revised the manuscript for intellectual content. HHGT: Statistical support. HJW: Revised the manuscript for intellectual content. MAvE and JHV: Acquisition of the data, revised the manuscript for intellectual content. LHvdB: Principal investigator; acquisition of the data, revised the manuscript for intellectual content.
Funding Funding was received from the Netherlands ALS Foundation.
Competing interests MAvE reports grants from the Netherlands Organization for Health Research and Development (Veni scheme), Joint Program Neurodegeneration (JPND), The Thierry Latran foundation and the Netherlands ALS foundation (Stichting ALS Nederland). He received travel grants from Shire (formerly Baxalta) and has consulted for Biogen. LHvdB reports grants from Netherlands ALS Foundation (Stichting ALS Nederland), The Netherlands Organization for Health Research and Development (Vici schema; and funded through the EU Joint Program – Neurodegenerative Disease Research, JPND (SOPHIA, STRENGTH, ALS-CarE projects)), personal fees from Shire, Biogen, Cytokinetics and Treeway, outside the submitted work.
Patient consent for publication Not required.
Ethics approval The medical ethics committee and institutional board of the University Medical Centre Utrecht approved the protocol of this study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. All protocol, analyses and anonymized data will be shared by request from any qualified investigator. We take full responsibility for the data, the analyses and interpretation and the conduct of the research.