Association of blood lipids with onset and prognosis of amyotrophic lateral sclerosis: results from the ALS Swabia registry
Open accessAbstract
Background: To date, the role of blood lipid levels and their association with the onset and prognosis of ALS is controversial. We explored these associations in a large, population-based case–control study. Methods: Between October 2010 and June 2014, 336 ALS patients (mean age 65.7 ± 10.7; 57.7% male) and 487 sex- and age-matched controls from the same geographic region were recruited within the ALS registry in Southwest Germany. Triglycerides and cholesterol (high-density lipoprotein (HDL), low-density lipoprotein (LDL), total) were measured. The ALS cohort was followed up for vital status. Conditional logistic regression models were applied to calculate odds ratio (OR) for risk of ALS associated with serum lipid concentrations. In ALS patients only, survival models were used to appraise the prognostic value. Results: High concentration of total cholesterol (OR 1.60, 95% confidence interval (CI) 1.03–2.49, top vs. bottom quartile), but not HDL, LDL, LDL–HDL ratio, or triglycerides, was positively associated with the risk of ALS. During the median follow-up time of 88.9 months, 291 deaths occurred among 336 ALS patients. In the adjusted survival analysis, higher HDL (HR 1.72, 95% CI 1.19–2.50) and LDL cholesterol levels (HR 1.58, 95% CI 1.11–2.26) were associated with higher mortality in ALS patients. In contrast, higher triglyceride levels were associated with lower mortality (HR 0.68, 95% CI 0.48–0.96). Conclusion: The results highlight the importance to distinguish cholesterol from triglycerides when considering the prognostic role of lipid metabolism in ALS. It further strengthens the rationale for a triglyceride-rich diet, while the negative impact of cholesterol must be further explored.
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Observational studies indicate a higher level of total cholesterol among ALS cases than controls.
“The association observed for a history of hypercholesterolemia and a higher risk of ALS in this study is consistent with Mendelian randomization studies suggesting a causal positive association between total cholesterol and low-density lipoprotein (LDL) and ALS risk [30, 31] as well as with observational studies indicating a higher level of total cholesterol among ALS cases than controls [32].”
From Lifestyle and medical conditions in relation to ALS risk and progression—an introduction to the Swedish ALSrisc Study (2024) · cites this paper as [32]
The Results section says total cholesterol concentrations were similarly distributed among ALS cases and controls, contrary to the claimed overall difference. The Case–control study subsection does find higher ALS odds in the top cholesterol quartile, but that does not establish higher cholesterol levels among cases overall. No page numbers are available in our copy. (LLM, conf=0.83)
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A novel evaluation of potential risk and prognostic factors for amyotrophic lateral sclerosis
Chourpiliadis, C. P. (2026) · doi:10.69622/30703637
Kochen, N. N., Zafari, S., Renaud, A., Schneider, N., Vunnam, N., Liao, E. E., Dutton, J. R., Braun, A. R., & Sachs, J. N. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.06.01.728552
Zhang, H., Li, C., Yu, J., Liang, Y., Wu, Y., & Cao, F. (2026) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-026-04503-2
Zhang, X., Zhang, L., Chen, L., Yu, W., Zhao, Y., 黄银辉, & Xu, Z. (2026) · Molecular Neurobiology · doi:10.1007/s12035-026-06106-1
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Serum Biomarkers for Nutritional Monitoring in Motor Neuron Disease: A Longitudinal Cohort Study
Roscoe, S., Allen, S. P., McDermott, C. J., & Stavroulakis, T. (2026) · Nutrients · doi:10.3390/nu18172913
Knezović, A., Krsnik, A., Homolak, J., Perhoč, A. B., Deškin, A., Virag, D., Šalković‐Petrišić, M., & Barilar, J. O. (2026) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2026.106982
Benito-Casado, C., Ferrer-Donato, Á., Barroso-García, G., Domínguez-Vías, G., Domínguez-Rubio, R., Povedano, M., & Fernández-Martos, C. M. (2026) · Research Square · doi:10.21203/rs.3.rs-11467142/v1
- Authors
- Michels, S., Kurz, D., Rosenbohm, A., Peter, R. S., Just, S., Bäzner, H., Börtlein, A., Dettmers, C., Gold, H.-J., Kohler, A., Naumann, M., Ratzka, P., Ludolph, A. C., Rothenbacher, D., Nagel, G., Dorst, J., & the ALS Registry Swabia Study Group
- Affiliations
- Universität Ulm (DE)
- Katharinenhospital (DE)
- Kliniken Schmieder (DE)
- SLK-Kliniken Heilbronn (DE)
- University Hospital Augsburg (DE)
- Corresponding author
- Dorst, Johannes
- ORCID
- Venue
- Journal of Neurology
- Published
- 2023-02-28
- Volume
- 270
- Issue
- 6
- Pages
- 3082-3090
- ISSN
- 0012-1037 (ISSN-L)
- 0340-5354
- 1432-1459
- PMC
- PMC10193299
- OpenAlex
- W4322617130
- Cited by
- 35
- References
- 55
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 9 · 2023: 4
- FWCI
- 5.95
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Neurology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DZNE Pub (submittedVersion, cc-by)
- OPUS (Augsburg University) (submittedVersion, cc-by)
- Funders
- German Research Council (577 631)
- Universität Ulm
- Topics
- Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Keywords
- amyotrophic lateral sclerosis, serum lipids, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, ALS risk, ALS mortality, prognosis, lipid metabolism
- MeSH terms
- Aged, Amyotrophic Lateral Sclerosis, Cholesterol, Female, Humans, Lipids, Lipoproteins, HDL, Cholesterol, HDL, Male, Middle Aged, Prognosis, Registries, Triglycerides, Case-Control Studies
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