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. 2021;10(4):485-492.
doi: 10.3233/JHD-210488.

Quantifying the Onset of Unintended Weight Loss in Huntington's Disease: A Retrospective Analysis of Enroll-HD

Amy C Ogilvie  1   2 , Peg C Nopoulos  1   3   4 , Jordan L Schultz  1   3   5
Affiliations

Quantifying the Onset of Unintended Weight Loss in Huntington's Disease: A Retrospective Analysis of Enroll-HD

Amy C Ogilvie et al. J Huntingtons Dis. 2021.

Abstract

Background: Unintended weight loss and decreased body mass indexes (BMIs) are common symptoms of individuals with manifest HD. It is unknown at what point during disease progression weight loss starts to accelerate relative to a healthy individual's weight and when recommended interventions should be initiated to have the strongest impact on patient care.

Objective: The objective of this study was to identify a point in time relative to age at motor onset when the decline in weight in HD starts to accelerate relative to a non-HD population. The relationship between initiation of weight loss interventions and changes in weight loss was also explored.

Methods: Participants from the fifth version of the Enroll-HD study were identified for this research. Linear mixed-effects piecewise regression models were used to estimate the point in time relative to the reported age of motor onset in which BMI started to decline in participants with HD compared to healthy non-HD controls. A post-hoc descriptive analysis was performed to look at when nutritional supplements and swallow therapy were initiated in participants with HD relative to motor onset.

Results: BMI decline in the HD group began to accelerate compared to controls approximately 5.7 years after the reported age of motor onset (95% CI: 4.7-6.9). The average initiation times of swallow therapy and nutritional supplements were 7.7 years (SD = 5.5 years) and 6.7 years (SD = 6.5 years) after motor onset, respectively.

Conclusion: Our findings suggest a potential point for intervention of nutrition programs or therapies used to prevent future weight loss.

Keywords: Huntington’s disease; body-weight trajectory; disease progression; weight loss.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors have no conflict of interest to report.

Figures

Figure 1:
Figure 1:. Participant Inclusion Flow Chart
Figure 1 presents the implementation of inclusion and exclusion criteria for all participants in this study.
Figure 2:
Figure 2:. Identification of Optimal Change Point Using Log Likelihood
Figure 2 displays a graph of the log likelihood value for each potential change point in years relative to motor onset. The optimal change point is identified as the point with the greatest log likelihood value.
Figure 3:
Figure 3:. Trajectories of BMI Over Time using the Optimal Change Point Model
Figure 3 presents a graph of the optimal change point model for male participants with HD and non-HD controls. Male HD participants had an age at motor onset of 46 years. Raw data are also plotted in the background and the change point is indicated with a dashed black line. Abbreviations: BMI: Body Mass Index HD: Huntington’s disease
Figure 4:
Figure 4:. Trajectories of BMI Over Timing by CAG Length using the Optimal Change Point Model
Figure 4 presents a graph of the optimal change point model for male participants stratified by CAG groupings. Age at onset varied for each group based on the average age at onset for the group from the data. Raw data are also plotted in the background. The change points are indicated with a dashed line. Abbreviations: BMI: Body Mass Index CAG: Cytosine-Adenine-Guanine
See this image and copyright information in PMC

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