Optimizing Nutritional Support for Patients with Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness. It predominantly affects males and presents challenges across various aspects of life, including nutrition.

As physicians caring for patients with DMD, it’s imperative to understand the nuanced nutritional needs and challenges these individuals face, which is what we’ll be reviewing below.

Understanding the Nutritional Challenges

Individuals with DMD often experience difficulties with swallowing, chewing, and maintaining a balanced diet. These challenges can arise due to muscle weakness, impaired respiratory function, and limited mobility.

Consequently, patients may be at risk of malnutrition, which can exacerbate the progression of the disease and impact overall health and quality of life.

Importance of Nutrition in DMD Management

Nutrition plays a crucial role in managing DMD by supporting muscle function, promoting optimal growth and development, and preserving overall health. Adequate intake of essential nutrients, including protein, vitamins, and minerals, is vital for muscle repair and regeneration, energy production, and immune function.

Moreover, maintaining a healthy body weight can help alleviate some of the physical burden associated with DMD and improve mobility and independence.

Optimizing Nutritional Support

As physicians, there are several strategies we can employ to optimize nutritional support for patients with DMD:

• Multidisciplinary Approach: Collaborate with a multidisciplinary team, including dietitians, speech therapists, and occupational therapists, to assess and address the unique nutritional needs of each patient comprehensively.
• Individualized Dietary Plans: Tailor dietary plans to accommodate the specific challenges and preferences of each patient, considering factors such as chewing and swallowing difficulties, food allergies or intolerances, and energy requirements.
• Nutrient-Dense Foods: Encourage the consumption of nutrient-dense foods rich in protein, calcium, vitamin D, and antioxidants to support muscle health, bone strength, and immune function. Incorporate a variety of food sources to ensure adequate nutrient intake.
• Texture Modifications: Patients can modify the texture of foods as needed to facilitate easier chewing and swallowing. This may involve pureeing, chopping, or thickening foods to minimize the risk of choking and aspiration.
• Supplementation: Consider the use of nutritional supplements, such as protein powders, vitamin D, calcium, and omega-3 fatty acids, to bridge nutrient gaps and support overall nutritional status. Consult with a dietitian or nutritionist to determine appropriate supplement dosages and formulations.
• Hydration: Ensure adequate hydration by encouraging regular fluid intake, especially in patients with reduced mobility or those taking medications that may increase the risk of dehydration. Monitor fluid balance closely, particularly during periods of illness or hot weather.
• Monitoring and Adjustment: Regularly monitor nutritional status through assessments of growth, weight, body composition, and biochemical markers. Adjust dietary interventions as needed based on individual responses and changing needs over time.

And here are some daily nutrition goals to share with DMD patients:

• Breakfast food should be rich in protein and lower in sugar.
• Increase water intake to at least half of a patient’s body weight in ounces (e.g., at least 30 oz for someone weighing 60 lbs).
• Steer clear of high-sodium foods and avoid extra salt.
• When preparing proteins, grilling, baking, or broiling is preferred. Lean fish and poultry are suggested choices.
• Include a salad in both lunch and dinner meals.
• Avoid starchy foods and replace them with vegetables lower in starch content.
• Adequate water intake and increased fiber can help prevent constipation.
• Daily caloric consumption should typically be around 80 percent of what individuals without DMD consume, and it’s also advised to avoid excessive calories and salt (limited to no more than 1500 mg daily) while ensuring adequate calcium intake.

It’s also important to be mindful of both overnutrition and undernutrition risks in DMD patients. Manage overnutrition by following a low glycemic index diet, limiting caloric intake, and increasing fruit and vegetable consumption.

Watch for signs of undernutrition, such as decreased muscle strength and gastrointestinal issues, and adjust dietary strategies accordingly.

Optimizing nutritional support is an integral aspect of managing DMD, and by taking a proactive and individualized approach to nutrition, we can enhance the quality of life and outcomes for patients living with DMD.

Reference:

“Proper Nutrition for People with Duchenne Muscular Dystrophy.” CureDuchenne, 14 July 2023, cureduchenne.org/care/nutrition-duchenne/.