饮食和呼吸，可能会共同作用，互相影响

菡萏尘雾

Eating and breathing: A possible 'synergistic' effect in ALS

Initial results of a multicenter pilot study to evaluate nutritional requirements and early intervention for breathing problems in ALS
are helping scientists determine how physical factors such as body mass, diet and activity affect the total daily energy expenditure of people with ALS at different stages of the disease.

Neurologist Edward Kasarskis, professor of neurology, toxicology and nutrition at the University of Kentucky in Lexington, and colleagues, reported preliminary results in the January issue of Amyotrophic Lateral Sclerosis.

The study is designed to determine factors contributing to energy; evaluate nutrition in ALS; and investigate the effects of noninvasive positive pressure ventilation (NIPPV) used for respiratory support in ALS.

Although optimal nutrition and ventilatory function in ALS may appear to be unrelated issues, the investigators noted that each may affect the other and provide “synergistic” benefits overall.

For example, NIPPV used through the night might reduce the number of calories burned during the day. Also, lack of energy translates to muscle weakness and fatigue, and a poor diet can adversely affect the structure and function of the diaphragm (a major respiratory muscle located under the ribcage).

Further analysis of the initial findings will enable the research team to:

• develop two approaches for pinpointing the best time for people with ALS to begin using a feeding tube, based on specific knowledge of each individual’s actual energy needs, rather than on general estimates of indicators such as bulbar function and weight change; and

• design a clinical trial to test NIPPV prior to the onset of respiratory symptoms.
• 原文链接：http://alsn.mda.org/article/als-research-roundup-july-august-2011

菡萏尘雾

一个旨在评估ALS病人营养需求量和早期介入呼吸问题治疗的研究公布了初步结果，这有助于科学家确定物理因素，比如体重、饮食、活动，是怎样影响不同阶段ALS病人每日能量总消耗量的。

莱克星顿市肯塔基大学神经病学、毒理及营养学教授，神经病学专家Edward Kasarskis及其同事，在ALS月刊上发表了初步的研究成果。

研究的目的是为了确定能量因子（对营养、能量有好处的因素）；评估ALS病人的营养状况；同时研究ALS常用的呼吸支持方法（无创正压通气）的效果。

好的营养状况和通气功能看起来好像是没有关联的两个方面，然而，研究者宣称：良好的营养和呼吸功能可能会互相影响、互相促进，对整个身体状况有好处。

举个例子：夜间（彻夜）使用无创正压通气，可能会减少身体白天的卡路里消耗量。同时，能量的缺乏会转化为肌肉虚弱和乏力，糟糕的饮食会对膈膜（位于胸腔下方的主要呼吸肌）的结构和功能产生不利的影响。

对初步结果的进一步分析可以在以下两个方面给研究者启示：

1、发展出两种方法，以确定ALS病人使用饲管的最佳时间。这应该是基于对个体实际能量需求量的特殊研究，而不是粗略地用其他指标，比如延髓功能、体重变化等进行估计。

      2、设计临床实验以测试在出现呼吸症状前使用无创正压通气的效果。