Omega-3 Fatty Acids Linked to Slower ALS Progression

Polyunsaturated fatty acids (PUFA) may have a favorable effect on disease progression and survival in patients with amyotrophic lateral sclerosis (YEAH).

Among more than 400 ALS patients who were followed for more than 18 months, higher levels of the omega-3 fatty acid alpha-linolenic acid (ALA) were associated with longer survival and slower functional decline.

Higher levels of the n-3 fatty acid eicosapentaenoic acid (EPA) and the n-6 fatty acid linoleic acid (LA) were also associated with a lower risk of death during follow-up.

The results suggest that specific PUFAs, ALA in particular, “may have neuroprotective properties that could benefit people with ALS,” said Kjetil Bjornevik, MD, PhD, of Harvard University in Boston, Massachusetts. Medscape Medical News.

the study was posted online June 21 in Neurology.

new data

Previous studies have shown that a diet high in ALA and elevated levels of this fatty acid in the blood can lower the risk of ALS, but less is known about how PUFAs affect disease progression.

To investigate, Bjornevik and colleagues studied 449 adults with ALS (mean age, 58; 65% male) who enrolled in the EMPOWER study. Plasma samples were collected from participants at the time of randomization and were available for fatty acid analysis.

Endpoints included death within 18 months and a pooled rating test reflecting both functional decline and change from baseline to month 12 in ALS Functional Rating Scale-Revised (ALSFRS-R) score. and survival up to 12 months.

During the 18-month follow-up period, 126 (28%) patients died.

Fewer patients in the top quartile of ALA (n = 21, 19%) died during follow-up than their peers in quartile 1 (n = 37, 33%), quartile 2 (n = 31, 27%), and quartile 3 (n = 37, 33%).

After adjusting for age and sex, higher plasma ALA levels were associated with a lower risk of death (hazard ratio(HR)), 0.50 for the highest vs. lowest quartile; 95% CI, 0.29 – 0.86; P = 0.041), as well as a higher score on the joint classification test consistent with slower functional decline (score difference per 1 SD increase: 10.7; 95% CI, 0.2 – 21, 1; P = .045).

Results were similar when adjusted for body mass index, race/ethnicity, duration of symptoms, site of onset, use of reluctancefamily history of ALS, predicted vertical slow vital capacity, and treatment group.

Higher levels of EPA and LA were also associated with a lower risk of death during follow-up.

For EPA, the multivariate adjusted HR comparing the upper and lower quartile was 0.45 (95% CI, 0.26 – 0.79; P = .008); for LA, it was 0.54 (95% CI, 0.31 – 0.93; P = .048).

The results suggest that specific PUFAs may have a beneficial effect for ALS patients, but further study is needed, Bjornevik said.

“There are no immediate clinical implications. We need to conduct a randomized trial to assess whether ALA is beneficial in people with ALS before we can recommend supplements to patients,” he added.

potentially beneficial

Commenting on this research for Medscape Medical NewsStephen Scelsa, MD, director of the ALS Center, Mount Sinai Downtown Union Square, New York, said that when it comes to nutrition in ALS, “we don’t have big data.

“The only thing we know historically about ALS is that there is good evidence that weight loss is harmful, but we don’t know what the optimal diet is,” said Scelsa, a professor of neurology at the Icahn School of Medicine at Mount Sinai.

“We need more nutritional information, so I think anything in this area is important, and I think the paper makes a good case that alpha-linolenic acid could be beneficial,” he noted.

Scelsa also noted that data on statins in ALS is also needed. Some studies suggest that higher levels of cholesterol or triglycerides are associated with a better course of the disease.

“If statins, which lower cholesterol and triglyceridesare detrimental to ALS patients, we really don’t know the answer to that,” Scelsa said.

The study was funded by a grant from the ALS Association. Bjornevik and Scelsa have disclosed no relevant financial relationships.

Neurology. Published online June 21, 2023. Abstract

For more Neurology news from Medscape, join us at Facebook and Twitter.