Objective: We endeavor to draw attention to what appears to be a gap in the management of ALS patients and the potential uncertainty of clinical drug trial research results in the absence of a structured approach to ensure nutritional adequacy.Methods: A selective literature review was curated to focus on the barriers to measure the adequacy of daily nutritional intake in the context of physical challenges and functional impairments facing ALS patients. The consequences of a negative energy (calorie) balance are highlighted and discussed from the perspective of clinical drug trials and daily ALS care.Conclusion: We propose that by redirecting the emphasis away from the exclusive focus on symptoms to the fundamental principles of maintaining adequate nutritional intake, we will mitigate the consequences of nutrition as an uncontrolled variable to improve global efforts in battling ALS.
Keywords: Nutrition; body composition; clinical trials; gastrostomy tube.