1. In this prospective cohort study, higher blood levels of the polyunsaturated fatty acid (PUFA), alpha-linolenic acid (ALA), were associated with slower disease progression and lower risk of death in patients with amyotrophic lateral sclerosis (ALS).
2. However, higher levels of palmitic acid, a monounsaturated fatty acid, were associated with a higher risk of death in ALS patients.
Evidence Rating Level: 2 (Good)
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with no effective disease reversal or curative therapeutics. In large cohort studies, polyunsaturated fatty acids (PUFAs) have demonstrated a protective role in neuronal survival and neuroinflammation. However, whether individual PUFA levels are associated with ALS disease progression and risk of death has not been well studied. Therefore, the present study aimed to investigate the association between PUFAs and clinical progression in ALS patients.
This prospective cohort study included 449 adult ALS patients (65% men) from the EMPOWER randomized control trial that evaluated dexpramipexole treatment in ALS patients. Participants were adults from Australia, Belgium, Canada, France, Germany, Ireland, the Netherlands, Spain, Sweden, the UK, and the USA, with ALS symptom onset within 24 months of baseline. Patients with significant cognitive impairment, clinical dementia, psychiatric illness, other neurodegenerative diseases, or significant cardiac, hepatic, or renal disease were excluded. Patients’ blood levels of PUFAs were measured at the time of randomization. Death at 18 months and a joint-rank test that measured decline using the ALS Functional Rating Scale-Revised (ALSFRS-R) score and survival up to 12 months were used to determine clinical progression. The primary outcome was the association between PUFAs and ALS progression.
The results demonstrated that higher levels of one PUFA, alpha-linolenic acid (ALA), were associated with a slower functional decline in ALS patients, as evidenced by a lower risk of death and a higher joint-rank score. In contrast, higher levels of the monounsaturated fatty acid, palmitic acid, were associated with a higher risk of death. The study was limited by a lack of information regarding participants’ dietary patterns and whether blood levels of fatty acids accurately reflected dietary intake of fatty acids. Nonetheless, the results suggested that PUFAs may be beneficial in slowing clinical decline in people with ALS.
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