To evaluate nutritional predictive factors of survival in bulbar ALS and to identify early factors for gastrostomy (PEG) indication.

A low body mass index (BMI) has been associated with poor prognosis in ALS patients. Moreover, bulbar onset ALS patients are exposed to early malnutrition because of the presence of dysphagia.

Patients with bulbar onset ALS and gastrostomy indication were prospectively included. We collected data on: 1) BMI and ALSFRSR both at diagnosis (Dx) and PEG indication, 2) rate of progression (RP=ALSFRSR at PEG-at Dx/time), 3) rate of BMI loss (RB=difference in BMI/time) from onset to Dx (RB1), from Dx to PEG (RB2) and from onset to PEG (RB3), 4) time from onset to Dx (TOD), from Dx to PEG and from onset to PEG in months, 5) non-invasive-ventilation (NIV) indication, and 6) survival. Two groups were defined: short (≤35 months) and long (>35) survival. Multivariate and Kaplan-Meier (KM) analyses were performed.

37 patients were included, 25 accepted and 12 refused PEG placement. Among patients who accepted PEG they were: mostly men (p<0.05), of younger age (p<0.05), shorter TOD (p<0.05) better functional status and slower RP (p<0.05), but >BMI loss (NS). Logistic regression between survival groups demonstrated that >RB1 increased risk of short survival [OR 0.003, 95%CI 0.00-0.81, p<0.05], with no influence of NIV, RP and PEG. By KM, PEG placement (yes/no) also did not modify survival; whereas RB1 (≤ or >0.36 points/month) modified survival curves (Log-rank p=0.02).

In this cohort of bulbar onset ALS patients, we observed: 1-Greater acceptance of PEG in younger men with a tendency to lose more BMI. 2-The RP and PEG placement did not influence survival; while the rate of BMI loss at Dx yielded significant results in this parameter. These findings could impact initial evaluation of patients with bulbar ALS and PEG indication.