Life course body mass index and risk and prognosis of amyotrophic lateral sclerosis: results from the ALS registry Swabia
Life course body mass index and risk and prognosis of amyotrophic lateral sclerosis: results from the ALS registry Swabia
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DOI：
10.1007/s10654-017-0318-z
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发表时间：
2017-10-01
影响因子：
13.6
通讯作者：
Ludolph, Albert Christian
中科院分区：
文献类型：
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作者：
Peter, Raphael Simon;Rosenbohm, Angela;Ludolph, Albert Christian
体重减轻似乎是肌萎缩侧索硬化症患者生存的一个强有力的预测因素，但目前还没有数据可以描述这些患者诊断前体重指数(BMI)的生活史。对393例ALS患者(平均年龄：65.8岁，其中57.3%为男性)和791例按年龄和性别匹配的对照进行了分析，该研究来自于一项基于人群的病例对照研究。使用多水平相加模型模拟病例和对照的BMI随时间变化的差异。此外，通过BMI变化对ALS患者的存活率进行了建模，模型中使用了根据预后因素进行调整的加速失效时间模型。在ALS病例中，在采访前的20-70年里，BMI一直高于对照组。条件Logistic回归分析显示，访问前35~45年，体重指数每增加1 kg/m(2)，优势比为1·05(95%可信区间为1·00~1·11，P=0.041)。然而，肌萎缩侧索硬化症患者的BMI在发病前约10年明显下降。此外，体重减轻与肌萎缩侧索硬化症患者的生存期缩短密切相关。说明这一点，体重稳定的患者的中位生存期为22.1(95%-CI 19.2-25.0)个月，而在访谈前的最后3个月，体重减轻2.5 kg/m(2)的患者的中位生存期为13.4(95%-CI 10.5-16.3)个月。因此，ALS患者的体重变化早在ALS临床表现的几十年前就已经存在，而体重减轻早于几年的运动症状，并与不良预后相关。
Weight loss appears as a strong predictor of survival of patients with amyotrophic lateral sclerosis, yet no data are currently available to describe the life course history of pre-diagnostic body mass index (BMI) in these patients. 393 ALS cases (mean age: 65.8 years, 57.3% men) and 791 controls matched by age and sex from a population-based case-control study of the ALS Registry Swabia were analyzed. Differences of BMI change in cases and controls over time were modeled using a multilevel additive model. In addition, survival in ALS cases by BMI change was modeled using an accelerated failure time model adjusted for prognostic factors. In ALS cases, BMI was consistently higher than in controls in the 20-70 years before the interview. Conditional logistic regression revealed an odds ratio of 1.05 (95% confidence interval (CI) 1.00-1.11, p = 0.041) per 1 kg/m(2) higher BMI 35-45 years before interview. However, a sharp decrease was evident in the BMI of ALS cases about 10 years before disease onset. Moreover, weight loss was strongly associated with shorter survival in ALS patients. Illustrating this, patients with stable weight showed a median survival time of 22.1 (95%-CI 19.2-25.0) months, as compared to 13.4 (95%-CI 10.5-16.3) months for patients with weight loss of 2.5 kg/m(2) over the last 3 months before the interview. Thus, alterations in body weight are present in ALS patients already decades before clinical manifestation of ALS, while weight loss precedes motor symptoms of several years and is associated with poor prognosis.