Efecto de la dieta mediterránea suplementada con los antioxidantes nicotinamida ribósido y pterostilbeno y/o con aceite de coco sobre variables antropométricas en esclerosis lateral amiotróficaestudio piloto

Resum

INTRODUCTION: Amyotrophic Lateral Sclerosis (ALS) is a chronic, progressive, neurodegenerative disease that results in the selective death of motor neurons. It increases the risk of alterations in body composition through hypermetabolism, weight loss and loss of muscle mass. On the one hand, it has been determined that the characteristics of the usual nutritional intake is a factor that conditions the prognosis and progression of the pathology. On the other hand, it has been identified that certain pathogenic mechanisms involved in the development of this disease are oxidative stress and mitochondrial dysfunction. Nutritional supplementation with the antioxidants nicotinamide riboside and pterostilbene has therefore been proposed as a therapeutic strategy to replenish nicotinamide adenine dinucleotide levels and reduce the risk of redox homeostasis breakdown. The administration of coconut oil is considered an alternative energy substrate in the face of the inefficiency of the glycolytic pathway. Therefore, the objectives of this research were: to identify nutritional deficiencies or excesses and to analyse the nutritional adequacy of the average intake of ALS patients. To design a healthy eating plan based on the Mediterranean Diet in order to guarantee an optimal supply of energy and nutrients. To evaluate the effect of the Mediterranean Diet supplemented with the antioxidants nicotinamide riboside and pterostilbene and/or coconut oil on anthropometric variables in patients affected by this disease. MATERIAL AND METHODS: Pilot study in humans, prospective, mixed, randomised, analytical and experimental, by a clinical trial with pre- and post-intervention assessment. The sample consisted of 40 subjects who were randomised to form the 4 study groups. The control group (GControl) continued with their usual routines. The antioxidant group (GAx) followed a Mediterranean dietary plan supplemented with nicotinamide riboside and pterostilbene. The coconut oil group (GCoco) and the antioxidants + coconut oil group (GAx+coco) followed a ketogenic Mediterranean diet plan. The first group received coconut oil and the second received coconut oil as well as nicotinamide riboside and pterostilbene. In all groups a pre-test clinical and dietary-nutritional anamnesis with Food Frequency Intake Questionnaire and dietary record was performed. Nutritional intake before the intervention was analysed using Nutrition and Health® 2.0 software (University of Granada, Spain) and compared with the nutritional objectives of the Spanish Society of Community Nutrition (SENC) and the Dietary Reference Intakes (DRI). The following variables were considered: energy, macronutrients, lipid profile, fibre, water-soluble vitamins, fat-soluble vitamins, minerals and trace elements. A pre- and post-test anthropometric assessment was made (after 4 months) following the method of the International Society for the Advancement of Kineanthropometry (ISAK). The following variables were assessed: weight, percentage of fat mass, percentage of muscle mass, skinfolds, body perimeters, Body Mass Index, Waist to Height Ratio and Waist to Hip Ratio. To determine the effect of the diets on the anthropometric variables, the ANOVA test was applied to the post - pre differences. Normality was analysed with the Saphiro Wilk test and QQ plots. Homoscedasticity was tested using Levene's test. A Tukey Post-Hoc Analysis was applied to identify groups with statistically significant differences. Effects were considered significant when a p ≤ 0.05 was obtained. Effect size (n2p) and Cohen's f were calculated. RESULTS: Before the intervention, the study sample (n=40) presented a deficient nutritional intake in carbohydrates, fibre, biotin and iodine, compared to the DRI. The lipid profile did not fulfil nutritional objectives. It was characterised by an intake of total lipids higher than the recommended maximum and an excess of polyunsaturated and saturated fatty acids. Intakes of niacin, cyanocobalamin, sodium, phosphorus and selenium were higher than the DRI. Significant changes were identified when analysing the time x group interaction at post-intervention time: percentage fat mass (p = 0.0049), percentage muscle mass (p = 0.0001), triceps skinfold (p = 0.0073), iliac crest skinfold (p = 0.0354) and abdominal skinfold (p = 0.0003). Compared to the GControl, the GAx presented a statistically significant increase in the percentage of muscle mass (p = 0.0002), decrease in the percentage of fat mass (p = 0.0045) and in skinfolds: triceps (p = 0.0077), iliac crest (p = 0.0331) and abdominal (p = 0.0004). Compared to the GControl, it was determined that the GCoco had a significant increase in the percentage of muscle mass (p = 0.0011) and reduction in the percentage of fat mass (p = 0.0216), subscapular skinfold (p = 0.0439) and abdominal skinfold (p = 0.0015). Compared to the GControl, the GAx+coco showed a statistically significant increase in the percentage of muscle mass (p = 0.0060) and decrease in the abdominal skinfold (p = 0.0115). CONCLUSIONS: Nutritional analysis of the diet before the intervention identified an unbalanced diet, characterised by low intake of carbohydrates, fibre, vitamin B8 and iodine, with an excessive intake of saturated fatty acids, sodium and phosphorus. It is recommended to increase the consumption of healthy foods: vegetables, fruit, legumes, whole grains, nuts and fish. Also reduce consumption of ultra-processed products rich in saturated fats and sodium: pastries, cold meats, snacks and soft drinks. The Mediterranean Diet supplemented with nicotinamide riboside and pterostilbene and/or coconut oil produces a decrease in the percentage of fat mass and an increase in the percentage of muscle mass, resulting in an improvement in body composition. The Mediterranean diet supplemented with antioxidants and the ketogenic Mediterranean diet supplemented with coconut oil are the two nutritional interventions that have reported the greatest benefits on the anthropometric variables of the study sample.