**5. Conclusions**

606 Amyotrophic Lateral Sclerosis

Nutritional support may delay the weight loss and muscle atrophy. Researchers have shown the weight loss associated with bulbar changes (dysphagia and breathing) require early and

Constant muscle atrophy, characteristic of progressive diseases, may mask the increased metabolic demand. The increased baseline energy expenditure of patients with ALS occurs since the energies are focused on the maintenance of pulmonary ventilation (Stanich *et al*.,

In a study of ALS patients, under the oral nutritional supplementation program, there was a progressive decrease in body mass index (BMI) in patients with progressive bulbar palsy and preservation of such variables in ALS patients. The lean mass/fat mass ratio was maintained during the study for both groups. The nutritional status classification has not changed for 70% of the patients. The results showed that supplementation prevented the worsening of nutritional status, but was unable to correct the overall averages of adequacy

In clinical practice, the use of supplements of vitamins, especially vitamin E, is common. The supplementation of this vitamin, with quantity still not defined, is expected to improve the nutritional profile of subjects with ALS (Borasio; Voltz, 1997). Oral supplementation with creatine monohydrate at 3g/day showed no improvement of nutritional status in ALS. However, the energy and protein supplementation is used by many professionals, and has proven to be efficient in the nutritional status of subjects with ALS (Rio; Cawadias, 2007;

Silva et al., (2010) evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70%WPI:30%MS), on nutritional and functional parameters of patients with ALS. Sixteen patients were randomized to two groups, treatment (70%WPI:30%MS) and control (maltodextrin). They underwent prospective nutritional, respiratory and functional assessment for 4 months. Patients in the treatment group presented weight gain, increased BMI, increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced creatine-kinase, aspartate aminotransferase and alanine aminotransferase. In the control group, biochemical measures did not change, but weight and BMI declined. The results indicate that the agglomerate 70%WPI:30%MS

Different authors report the need for alternative routes of nutrition from the following criteria: vital capacity of approximately 50% of the expected value, presence of moderate to severe dysphagia and 10% reduction in body weight over the past three months. (Stanich *et al*., 2004; Mitsumoto *et al*., 2003; Albert *et al*., 2001; Silani; Kasarskis; Yanagisawa, 1998;

Percutaneous endoscopic gastrostomy (PEG) is an option for the symptomatic treatment of

When comparing the use of enteral nutrition via nasogastric tube and percutaneous endoscopic gastrostomy (PEG) in patients with ALS, there is a significant difference in the body mass index (BMI) of patients with PEG compared to those with a nasogastric tube, as well as a better social acceptance and, consequently, quality of life of the patients studied, supporting the use of this technique when oral intake is not safe (Mazzini et al., 1995).

specific nutritional support (Kasarskis *et al*., 1996; Slowie *et al*., 1983).

may be useful in the nutritional therapy of patients with ALS.

2004; Kasarskis *et al*., 1996; Nau *et al*., 1995; Shimizu; Hayashi; Tanabe, 1991).

**4.1 Nutritional support** 

(Stanich et al., 2004).

Heffernan et al., 2004).

**4.2 Alternative feeding in ALS** 

patients with ALS (Miller et al., 1999).

Lisbeth et al., 1994).

This chapter was conducted to support the hypothesis of the thesis and gathers scientific information listing the main practices for assessment, from the nutritional point of view, in patients with ALS. The relevant literature available for consultation is limited. Studies on food intake, specific techniques for assessment of nutritional status, and the use of supplements are scarce. However, the follow-up of nutritional status by monitoring the anthropometric evolution, body composition and clinical signs, such as dysphagia, may improve the quality of life of subjects with ALS.
