SPECIAL PROTOCOL TO NUTRITIONAL THERAPY IN AMYOTROPHIC LATERAL SCLEROSIS

Abstract

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 key-words. 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 high-protein 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. DESCRIPTORS: Amyotrophic Lateral Sclerosis. Nutrition Therapy. Recommended Dietary Allowances.