**2.2.1 Weight (W)**

596 Amyotrophic Lateral Sclerosis

experienced energy intake below the RDA and 84% of the patients experienced protein intake above the RDA. Slowie et al. (1983) found, as well as Kasarskis et al. (1996), 70% of inadequacy for energy, using the 24-hour recall in patients with ALS. Stanich et al. (2004),

Silva et al. (2007a and 2007b) analyzed the nutritional profile of patients treated in Dysphagia and Neuromuscular Outpatient Clinics of the Hospital das Clínicas of Unicamp – HC/UNICAMP. Interdisciplinary assessments were performed, revealing a low caloric intake of approximately 1600 kcal for men. In women, a low caloric intake (approximately

In another study conducted by Silva et al. (2008a) the food intake was quantitatively and qualitatively assessed in ALS patients regularly followed at the neuromuscular outpatient clinic of the HC-UNICAMP. The foods most consumed daily were oil, rice, beans, French bread and milk. The food was found to be inadequate regarding energy, fiber, calcium and vitamin E. A significant difference was observed between patients with ALS of bulbar and appendicular predominance, whereas, in patients with higher appendicular manifestation, a higher energy intake (p=0.02) of saturated fat (p=0.03), monounsaturated fat (p=0.04) and polyunsaturated fat (p=0.001), as well as cholesterol (p=0.001) and fibers (p=0.001) was observed when compared with the ALS of bulbar predominance. A higher swallowing impairment observed in patients with bulbar predominance may have influenced the qualitative and quantitative intake. While feeding is impacted by the disease features, the per capita income of patients seems to have influenced the low qualitative consumption of food. Based on the results obtained, the authors suggested that guidance regarding the consumption of foods and preparations with a higher content of high-biological proteins,

In ALS, as in most neuromuscular diseases, changes can also be observed, which increase the muscle catabolism, directly impacting protein synthesis and mineral excretion. In the initial stages of the disease, according to the study conducted in 94 patients with ALS, it was observed no deficiency of vitamins E and C, but upon disease progression, clinical and

To estimate the dietary intake, some countries in Europe and Canada use as main practices the 24-hour recall, 3-day and 7-day food record. To estimate the energy requirements, professionals have used the equations of Schofield (1985) and Harris and Benedict (1919). To estimate the adequacy of macronutrients, the researchers used the standards of the Recommended Dietary Allowances (NCR, 1989), Department of Health (1991) and the

To estimate the energy requirements, the most used equation was that of Harris and

Men: BMR\* = 66 + 13.7 x mass in kg + 5 x height in cm – 6.8 x age in years Women: BMR\* = 655 + 9.6 x mass in kg + 1.7 x height in cm – 4.7 x age in years

 

biochemical manifestations of such deficiency were observed (Ludolph, 2006).

Institute of Medicine (IOM, 2002; IOM, 2001; IOM 2000; IOM 1997).

Benedict (1919) modified by Long; Schaffel; Geiger (1979).

According to Harris and Benedict:

Modified by Long; Schaffel; Geiger (1979): VET\* = BMR x activity factor x injury factor

\*BMR = basal metabolic rate

\*TEV = total energy value

found values above the RDA for lipids in most ALS patients chosen in their study.

1700 kcal/day) was also observed.

fibers, calcium, and vitamin E is necessary.

For patients unable to walk, in the absence of a metabolic scale, the weight is measured using a wheelchair. Prior to patient's weighing, the wheelchairs are weighted and their weight is deducted at the time of calibration of the scale. In patients able to walk, the body weight is measured standing on platform type or digital scales (Silva et al., 2008b; Stanich et al., 2004). The weight can also be measured in chair scales, available in the market.
