Consumo alimentar em indivíduos com Esclerose Lateral Amiotrófica

Abstract

Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease, characterized by the degeneration of motor neurons and muscle atrophy. Impairment of swallowing muscles, reduced food intake, and hypermetabolism are the primary causes of malnutrition in this population. Malnutrition decreases both the survival rate and quality of life of individuals with ALS, making research on dietary intake across various dimensions crucial for improving nutritional care in this population. Evaluate the intake of micronutrients and its relationship with the severity of ALS, as well as investigate the applicability of a QFA in this population. To achieve this, the thesis presents three distinct studies. Study 1, an observational crosssectional study, assessed the prevalence of inadequate micronutrient, macronutrient, and energy intake among individuals with ALS and examined the association between nutrient intake and disease severity. Study 2, a scoping review, mapped the food frequency questionnaires (FFQs) developed and validated in Brazil. In Study 3, a cross-sectional study, the validity and reproducibility of a short semiquantitative FFQ designed to assess the energy and protein intake in individuals with ALS were developed and evaluated. Study 1 used medical record data from 69 individuals. The severity of ALS was determined using the revised ALS Functional Rating Scale (ALSFRS-R). The prevalence of inadequate micronutrient intake was estimated using the Estimated Average Requirements (EAR) as a cutoff. For the scoping review (Study 2), studies on the development and validation of FFQs conducted in Brazil were included. The review followed the methodology of the Joanna Briggs Institute for scoping reviews. The search was performed across databases including PubMed/MEDLINE, LILACS, Embase, Web of Science (ISI), Scopus, and Google Scholar. Study 3 utilized data from 24-hour dietary recalls (24hR) from the medical records of 69 individuals with ALS. The food items included in the FFQ were selected based on their contribution to 90% of total energy and protein intake. The validation and reproducibility analysis was conducted with 39 individuals with ALS, using 24hR as the reference method. Validity and reproducibility were assessed using correlation coefficients, mean comparisons, and Bland-Altman analysis. In Study 1, the prevalence of inadequate intake of vitamins D, E, riboflavin, pyridoxine, folate, cobalamin, calcium, zinc, and magnesium was found to be high. Individuals with lower ALSFRS-R scores had significantly lower intakes of vitamin E (p<0.001), niacin (p=0.033), pantothenic acid (p=0.037), pyridoxine (p=0.008), folate (p=0.009), and selenium (p=0.001). In Study 2, the scoping review identified 102 articles since the late 1990s, covering several regions of Brazil: Southeast (n=56), South (n=16), Northeast (n=14), Central-West (n=8), North (n=1), and two or more regions or populations (n=8). Over the past decade, 32 FFQ validation studies were identified, focusing on children and adolescents (n=8), adults (n=10), adults and elderly (n=7), and pregnant women (n=7). In Study 3, a short self-administered semiquantitative FFQ was developed and validated, consisting of 21 food items with a photographic guide for each. The FFQ included seven categories of intake frequency, assessing energy and protein intake over the previous month. The short FFQ was found to be reproducible for estimating energy intake (ICC=0.553), but not valid for estimating energy and protein intake in individuals with ALS. The findings from these studies highlight the importance of monitoring dietary intake in individuals with ALS. Given the absence of an FFQ specifically developed and validated for individuals with ALS, a new short self-administered FFQ was constructed and validated for assessing energy and protein intake in this population. After adjustments to this instrument aimed at improving validity indices, it may be used both for nutritional assessment and in scientific research.