Higher Glycemic Index and Glycemic Load Diet Is Associated with Slower Disease Progression in Amyotrophic Lateral Sclerosis.

Objective: High‐caloric diets may slow the progression of amyotrophic lateral sclerosis; however, key macronutrients have not been identified. We examined whether dietary macronutrients are associated with the rate of progression and length of survival among the prospective cohort study participants. Methods: Participants with a confirmed diagnosis of sporadic amyotrophic lateral sclerosis enrolled in the Multicenter Cohort Study of Oxidative Stress were included (n = 304). We evaluated baseline macronutrient intake assessed by food frequency questionnaire in relation to change in revised amyotrophic lateral sclerosis functional rating scale total‐score, and tracheostomy‐free survival using linear regression and Cox proportional hazard models. Baseline age, sex, disease duration, diagnostic certainty, body mass index, bulbar onset, revised amyotrophic lateral sclerosis functional rating scale total‐score, and forced vital capacity were included as covariates. Results: Baseline higher glycemic index and load were associated with less decline of revised amyotrophic lateral sclerosis functional rating scale total score at 3‐month follow‐up (β = −0.13, 95% CI −0.2, −0.01, p = 0.03) and (β = −0.01, 95% CI −0.03, −0.0007, p = 0.04), respectively. Glycemic index second‐quartile, third‐quartile, and fourth‐quartile groups were associated with less decline at 3 months by 1.9 (95% CI −3.3, −0.5, p = 0.008), 2.0 (95% CI −3.3, −0.6, p = 0.006), and 1.6 (95% CI −3.0, −0.2, p = 0.03) points compared with the first‐quartile group; the glycemic load fourth‐quartile group had 1.4 points less decline compared with the first‐quartile group (95% CI −2.8, 0.1, p = 0.07). Higher glycemic index was associated with a trend toward longer tracheostomy‐free survival (HR 0.97, 95% CI 0.93, 1.00, p = 0.07). Interpretation: Higher dietary glycemic index and load are associated with slower disease progression in amyotrophic lateral sclerosis. ANN NEUROL 2024;95:217–229 [ABSTRACT FROM AUTHOR]