Body composition in amyotrophic lateral sclerosis subjects and its effect on disease progression and survival

Rup Tandan, Evan A. Levy, Diantha B. Howard, John Hiser, Nathan Kokinda, Swatee Dey, Edward J. Kasarskis

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Motor neuron degeneration and malnutrition alter body composition in amyotrophic lateral sclerosis (ALS). Resulting losses of weight, fat mass (FM), and fat-free mass (FFM) shorten survival. Nutritional management relies on body weight or BMI; neither reliably indicates malnutrition nor differentiates body compartments. Objectives: We aimed to 1) develop an equation to compute FM and FFM using clinical data, validated against DXA; and 2) examine the effect of computed FM and FFM on disease course and survival. Methods: We studied 364 ALS patients from 3 cohorts. In Cohort #1 we used logistic regression on clinical and demographic data to create an equation (test cohort). In Cohort #2 we validated FM and FFM computed using this equation against DXA (validation cohort). In Cohort #3, we examined the effect of computed body composition on disease course and survival. Results: In Cohort #1 (n = 29) the model incorporated sex, age, BMI, and bulbar-onset to create an equation to estimate body fat: % body fat = 1.73 - [19.80∗gender (1 if male or 0 if female)] + [0.25∗weight (kg)] + [0.95∗BMI (kg/m2)] - (5.20∗1 if bulbar-onset or ∗0 if limb-onset). In Cohort #2 (n = 104), body composition using this equation, compared to other published equations, showed the least variance from DXA values. In Cohort #3 (n = 314), loss of body composition over 6 mo was greater in males. Adjusted survival was predicted by low baseline FM (HR: 1.39; 95% CI: 1.07, 1.80), and loss of FM (HR: 1.87; 95% CI: 1.30, 2.69) and FFM (HR: 1.73; 95% CI: 1.20, 2.49) over 6 mo. Conclusions: Our equation broadens the traditional nutritional evaluation in clinics and reliably estimates body composition. Measuring body composition could target FM as a focus for nutritional management to ensure adequate energy intake and complement measures, such as the ALS functional rating scale-revised score and forced vital capacity, currently used.

Original languageEnglish
Pages (from-to)1378-1392
Number of pages15
JournalAmerican Journal of Clinical Nutrition
Issue number5
StatePublished - May 1 2022

Bibliographical note

Publisher Copyright:
© 2022 The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.


  • amyotrophic lateral sclerosis
  • body composition
  • body mass index
  • disease progression
  • dual energy X-ray absorptiometry
  • fat mass
  • fat-free mass
  • nutrition
  • survival

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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