Correlating factors in the recommendation of feeding tubes in the nutritional management of amyotrophic lateral sclerosis

Abstract

Amyotrophic lateral sclerosis (ALS) is associated with nutritional deficits. Gastrostomy tubes are often inserted in patients with ALS to supplement or replace oral intake. The aim of this study was to better understand the practices of gastrostomy tube insertion in patients with ALS. Pre-collected de-identified data were obtained from the Canadian Neuromuscular Disease Registry (CNDR). Feeding tube status was compared with markers of dysphagia, respiratory compromise, and weight status in both univariate and multivariate analysis by employing odds ratios. Results showed that abnormal ALSFRS-R dysphagia scores were associated with higher rates of feeding tube referrals. The use of non-invasive ventilation also increased the likelihood that a tube was recommended. A higher FVC was found to decrease the likelihood of recommendation. BMI and ALSFRS-R dyspnoea scores were not found to be independently associated. In conclusion, our findings demonstrate that symptoms of dysphagia and respiratory status are associated with higher rates of recommendation for feeding tubes. While not independently significant, individuals with a lower BMI had more feeding tube referrals compared to individuals with a normal or elevated BMI. A similar trend was noted for ALSFRS-R dyspnoea scores. Further research is required to determine if these represent optimal criteria for placement.

Keywords:

• Nutrition
• dysphagia
• forced vital capacity (FVC)
• body mass index (BMI)
• feeding tubes

Acknowledgements

The data used in this paper were provided by the Canadian Neuromuscular Disease Registry (CNDR) with permission from the University of Calgary and the CNDR National Principal Investigators including: Hannah Briemberg of the University of British Columbia, Lawrence Korngut of the University of Calgary, Wendy Johnston of the University of Alberta, Sanjay Kalra of the University of Alberta, Walter Hader of the University of Saskatchewan, Gary Linassi of the University of Saskatchewan, Lorne Zinman of the University of Toronto, Angela Genge of the Montreal Neurological Institute, Rami Massi of the Montreal Neurological Institute, Michel Melanson of Queen’s University, Sean Taylor of Queen’s University, Karen Smith of Queen’s University, Colleen O’Connell of the Stan Cassidy Centre for Rehabilitation, Scott Worley the Stan Cassidy Centre for Rehabilitation, Christen Shoesmith of Western University, Timothy Benstead of Dalhousie University, and Ian Grant of Dalhousie University.

Declaration of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.