Survey of current enteral nutrition practices in treatment of amyotrophic lateral sclerosis

Published:December 26, 2012DOI:


      Background and aims

      Enteral nutrition (EN) is commonly prescribed for dysphagia and weight loss in amyotrophic lateral sclerosis (ALS), but there are currently no ALS-specific EN guidelines. We aimed to survey current practices prescribing EN to ALS patients.


      An online survey was distributed using list servers administered by the Academy of Nutrition and Dietetics (AND), Muscular Dystrophy Association (MDA), and ALS Association (ALSA).


      A total of 148 dietitians, nurses, and physicians participated in the survey, of whom 50% were dietitians and 68% were associated with an ALS clinic. Only 47% of respondents reported their patients to be fully compliant with EN recommendations. Side effects (fullness, diarrhea, constipation, and bloating) were the most important reason for patient noncompliance, followed by dependence on caregivers. By contrast, only 3% of providers rated depression/hopelessness as the most important reason for non-compliance. Half of those surveyed reported that more than 25% of patients continued to lose weight after starting EN.


      Our survey results show a high frequency of gastrointestinal side effects and weight loss in ALS patients receiving EN. These findings may be limited by sampling error and non-response bias. Prospective studies are needed to help establish EN guidelines for ALS.



      AND (Academy of Nutrition and Dietetics), ALS (amyotrophic lateral sclerosis), ALSA (Amyotrophic Lateral Sclerosis Association), BMI (body mass index), EN (enteral nutrition), MDA (Muscular Dystrophy Association), PEG (percutaneous endoscopic gastrostomy), RIG (radiologically inserted gastrostomy)
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