Dietary and Lifestyle Management Strategies
While dietary changes are not enough to directly impact muscle degeneration, proper nutrition is essential because many patients with muscular dystrophy have limited mobility or are inactive due to muscle weakness. These limitations predispose them to obesity, dehydration, and constipation (NINDS 2011).
Nutritional requirements in patients with DMD have received relatively little attention, as revealed by a survey of 1491 articles conducted in 2009. This survey found only 6 articles that directly investigated nutritional requirements in boys with DMD, and only 3 of them were focused on younger children (Davidson 2009; Davoodi 2012). Nevertheless, this is an important aspect of management because steroid use, which is often started in early childhood, can exacerbate weight gain in many patients. Weight gain and obesity (attributed to mobility limitations) are more frequent in the early stages of muscular dystrophy, while malnutrition and weight loss are more common in later stages of the disease when patients have difficulty swallowing, breathing, or walking independently (Davidson 2009; NINDS 2011). In addition, obesity can further worsen the neuromuscular problems, as well as cardiovascular and respiratory function (Guglieri 2011; Morrison 2011).
A high-fiber, high-protein, low-calorie diet with proper fluid intake has been recommended for most patients with muscular dystrophy (NINDS 2011). For patients with OPMD, a high-protein diet is especially recommended, but can sometimes be challenging as swallowing difficulties become more accentuated, particularly for hard-to-chew foods, such as meat (Brais 2011).