Hydration measured by doubly labeled water in ALS and its effects on survival

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


We present a study of hydration in ALS patients and its effects on survival. This was a multicenter study over 48 weeks in 80 ALS patients who underwent 250 individual measurements using doubly labeled water (DLW). Total body water (TBW) and water turnover (a surrogate for water intake) were 3.4% and 8.6% lower, respectively, in patients compared to age- and gender-matched healthy controls, and both significantly decreased over study duration. In 20% of patients, water turnover measured over 10 d was 2 standard deviations below the mean value in healthy controls. In a separate clinic cohort of 208 patients, water intake estimated from a de novo equation created from common clinical endpoints was a prognostic indicator of survival. Regardless of nutritional state assessed by BMI, survival was two-fold longer in the group above the median for estimated water intake, suggesting that hydration may be a more important predictor of survival than malnutrition. Risk factors for poor hydration were identified. Water intake equations recommended by US Centers for Medicare and Medicaid Services in healthy elderly were inaccurate for use in ALS patients. We developed equations to estimate TBW and water intake in ALS patients for use in clinics to accurately estimate hydration and improve clinical care.

Original languageEnglish
Pages (from-to)220-231
Number of pages12
JournalAmyotrophic Lateral Sclerosis and Frontotemporal Degeneration
Issue number3-4
StatePublished - Apr 3 2018

Bibliographical note

Publisher Copyright:
© 2017 World Federation of Neurology on behalf of the Research Group on Motor Neuron Diseases.


  • ALS
  • doubly labeled water
  • hydration
  • survival
  • total body water
  • water intake
  • water turnover

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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