Nutrição e Esclerose Lateral Amiotrófica: síntese de evidências e recomendações

Abstract

Amyotrophic Lateral Sclerosis (ALS) is a multisystem neurological disease characterized by the degeneration of motor neurons. Malnutrition is common in ALS and evidence-based nutritional interventions promote the optimization of nutritional status, contributing to improved quality of life and survival of patients with ALS. The general objective of this dissertation was to identify and synthesize scientific evidence and recommendations aimed at nutritional interventions in ALS. Thus, three products were developed: 1) a narrative review (article 1); a protocol of systematic reviews (article 2); and a systematic review (article 3). Each article was developed according to the required methodological specificity. The narrative review (article 1) synthesized relevant information, extracted from several relevant studies published in PubMed/MEDLINE, on intestinal microbiota and neurodegenerative diseases, with an emphasis on ALS. The data extracted in this narrative review were arranged in topics covering “intestinal microbiota and human microbiome”, “intestinal microbiota and neuro-immuno-endocrine system”, “intestinal microbiota and ALS”, and “modulation of intestinal microbiota in ALS”. The systematic review protocol (article 2) was registered in the PROSPERO database on April 12, 2021 (CRD42021233088) and was developed according to the Preferred reporting items for systematic review and metaanalysis protocols (PRISMA-P). It encompassed the planning of more than one systematic review to answer three research questions: RQ1- “What are the evidencebased nutritional recommendations to maintain or restore the nutritional status of patients with ALS?”; RQ2 - “What is the effect of a diet rich in energy and protein in people with ALS?”; and RQ3 - “What are the effects of supplementation of isolated micronutrients or bioactive compounds in people with ALS?”. The answer to RQ1 gave rise to the systematic review produced in this dissertation (article 3). This systematic review (article 3) followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and used the following electronic libraries and databases: PubMed/MEDLINE, EMBASE, Scopus, SciELO, Web of Science, LILACS, CENTRAL, ScienceDirect, ProQuest, and Google Scholar. Of a total of 837 records identified, 11 were included, all of which were guidelines. The quality of the evidence was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Due to the heterogeneity of the studies, it was not possible to perform a meta-analysis. The summary of nutritional recommendations was organized into five topics: “dysphagia”, “nutritional evaluation”, “energy”, “protein”, “supplementation”, and “percutaneous endoscopic gastrostomy”. According to the products developed, it was concluded that the intestinal microbiota can modulate several physiological and behavioral activities based on the microbiota-gut-brain axis. The study of the intestinal microbiota in ALS is an important field of research and its modulation is considered an important therapeutic target for affected patients, since intestinal dysbiosis is related to complications and worse prognoses. The developed protocol demonstrated the importance of adequate planning to prepare the systematic review and highlighted the relevance of using evidence-based nutrition in decision-making related to nutritional therapy in ALS. The evidence and recommendations summarized in the systematic review covered several aspects of nutritional management of patients with ALS. Furthermore, it was found that there are gaps in the literature regarding specific micronutrient needs and recommendations for nutritional supplements in ALS. Finally, the scientific information gathered in this dissertation is relevant for directing safe and effective nutritional interventions in ALS, optimizing the nutritional status and prognosis of affected patients.