Gender-Specific Lipid and Hypermetabolism Risk Profiles for Amyotrophic Lateral Sclerosis

Diagnostic form with diagnosis Amyotrophic lateral sclerosis (ALS) and pills.
In a retrospective study, researchers assessed the predictive value or serum lipid profiles on the basis of gender and hypermetabolism in patients with ALS.

Among patients with amyotrophic lateral sclerosis (ALS), gender was observed to have differing influences on the prognostic predictive values of serum lipid profiles. These findings were published in Scientific Reports.

ALS is a neurodegenerative disease affecting motor neurons which leads to respiratory failure and death within a few years. Previous studies have found that hypermetabolism was prognostic of poorer outcomes. The objective of the current study was to assess the predictive value of serum lipid profiles on the basis of gender and hypermetabolism in patients with ALS.

This single-center, retrospective study recruited 78 patients with ALS from the Shiga University of Medical Science Hospital in Japan between 2016 and 2021. The baseline serum lipid profile was associated with outcomes and survival. Hypermetabolism was defined as the measured resting energy expenditure to lean soft tissue mass ratio ³ 38.

Patients were aged median 71 (interquartile range [IQR], 66-75) years, 38 were men, body mass index (BMI) was 21.7 (IQR, 18.7-24.1) kg/m2, 33% had bulbar type ALS, and 47% had hypermetabolism. Women had significantly higher low-density lipoprotein cholesterol (LDL) at baseline (median, 129 vs 111 mg/dL; P =.008).

High-density lipoprotein cholesterol (HDL) was correlated with triglycerides among men (r, -0.57; P <.001) and women (r, -0.39; P =.015) and LDL with triglycerides among men (r, 0.40; P =.030). At follow-up HDL decreased among men (P =.010) and women (P =.023) and LDL decreased among women (P =.030).

Stratified by high and low lipid levels, survival differed significantly for men on the basis of HDL (P =.001) and for women on the basis of LDL (P =.002), in which survival was decreased among individuals with high and low levels, respectively. The cutoff levels were 55 mg/dL for HDL, 100 mg/dL for LDL, and 70 mg/dL for triglycerides.

Among patients with hypermetabolism, patients with high HDL had significantly shorter survival than those with low levels (P =.005).

Stratifying patients on the basis of measured resting energy expenditure and lean soft tissue mass led the researchers to find that patients with high values of either index tended to be associated with poorer survival (all P £.084).

Significant predictors of poor prognosis included HDL among men (adjusted hazard ratio [aHR], 8.43; 95% CI, 1.67-42.5; P =.010) and HDL (aHR, 16.2; 95% CI, 2.15-121.4; P =.007) and LDL (aHR, 6.59; 95% CI, 1.41-30.7; P =.017) among women.

This study was limited by the fact that most blood tests were administered without fasting.

The researchers concluded, “”high HDL predicts poor prognosis in all patients, whereas low LDL, only in women.” In general, all patients with hypermetabolism tended to have poorer prognosis.


Nakamura R, Kurihara M, Ogawa N, et al. Investigation of the prognostic predictive value of serum lipid profiles in amyotrophic lateral sclerosis: roles of sex and hypermetabolism. Sci Rep. Published online February 3, 2022. doi:10.1038/s41598-022-05714-w