Summary:
In this study, the researchers investigated the potential impact of polyunsaturated fatty acids (PUFAs), particularly alpha-linolenic acid (ALA), on the prognosis and physical decline in patients with amyotrophic lateral sclerosis (ALS). Previous epidemiological studies have suggested that higher dietary intake of certain PUFAs, including ALA, might be associated with a decreased risk of ALS. However, there’s limited data on how PUFAs influence disease progression in ALS patients. The data for this study was provided from a previous clinical trial whereby 449 patients provided information for fatty acid analysis. The findings were that higher levels of ALA were linked to a reduced risk of death among ALS patients. Elevated ALA levels were also associated with a slower rate of physical decline. Higher levels of other fatty acids such as eicosapentaenoic acid (also known as EPA) and linoleic acid were also linked to a reduced risk of death.
Abstract:
Background and Objectives: Polyunsaturated fatty acids (PUFAs) have neuroprotective and anti-inflammatory effects and could be beneficial in amyotrophic lateral sclerosis (ALS). Higher dietary intake and plasma levels of PUFAs, in particular alpha-linolenic acid (ALA), have been associated with a lower risk of ALS in large epidemiological cohort studies, but data on disease progression in ALS patients is sparse. We examined whether plasma levels of ALA and other PUFAs contributed to predicting survival time and functional decline in ALS patients. Methods: We conducted a study among participants in the EMPOWER clinical trial who had plasma samples collected at the time of randomization that were available for fatty acid analyses. Plasma fatty acids were measured using gas chromatography. We used Cox proportional hazards models and linear regression to evaluate the association of individual fatty acids with risk of death and joint-rank test score of functional decline and survival. Results: Fatty acid analyses were conducted in 449 participants. The mean (SD) age of these participants at baseline was 57.5 (10.7) years and 293 (65.3%) were men; 126 (28.1%) died during follow-up. Higher ALA levels were associated with lower risk of death (age and sex-adjusted hazard ratio [HR] comparing highest vs. lowest quartile: 0.50, 95% CI: 0.29 to 0.86, p-trend: 0.041) and higher joint-rank test score (difference in score according to 1 SD increase: 10.7, 95% CI: 0.2 to 21.1, p = 0.045), consistent with a slower functional decline. The estimates remained similar in analyses adjusted for BMI, race/ethnicity, symptom duration, site of onset, riluzole use, family history of ALS, predicted upright slow vital capacity, and treatment group. Higher levels of the n-3 fatty acid eicosapentaenoic acid (EPA) and the n-6 fatty acid linoleic acid (LA) were associated with a lower risk of death during follow-up. Conclusions: Higher levels of ALA were associated with longer survival and slower functional decline in ALS patients. These results suggest that ALA may have a favorable effect on disease progression in ALS patients.
Article Publication Date: 21/06/2023
DOI: 10.1212/WNL.0000000000207485
