{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:05:04Z","timestamp":1788185104711,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Lactate is increasingly recognized as an energy substrate, but its relevance to amyotrophic lateral sclerosis (ALS) remains unclear. We examined whether blood lactate is associated with survival and weight loss in ALS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included an Australian exploratory cohort and a Japanese validation cohort with clinical data matched to measures of blood lactate. The primary outcome was survival from onset to death or tracheostomy. In the exploratory cohort, survival was analyzed using Kaplan\u2013Meier curves stratified by the first quartile (Q1) of lactate and multivariable Cox regression. This cutoff was applied for log\u2010rank analysis in the validation cohort. The secondary outcome was 3\u2010month body mass index (BMI) change (\u0394BMI). Associations between baseline lactate and \u0394BMI were assessed using multivariable regression in the exploratory cohort, whereas Q1\u2010based stratification was used in the validation cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The exploratory cohort included 110 patients with ALS (57 with \u0394BMI data) and 86 healthy controls; the validation cohort included 36 patients (17 with \u0394BMI data). In the exploratory cohort, lower lactate levels (below Q1; 1.05\u2009mmol\/L) were associated with shorter survival (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031) and remained independently predictive of higher risk for mortality (adjusted hazard ratio [HR] per 1 SD\u2009=\u20090.57, 95% confidence interval [CI]\u2009=\u20090.35\u20130.91). This association was confirmed in the validation cohort (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). Lactate was independently associated with \u0394BMI (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.53,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032), and patients with lower lactate had a greater BMI decline (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Lower blood lactate is associated with increased risk for earlier death and greater weight loss in ALS, suggesting that lactate is a prognostic biomarker of nutritional status. ANN NEUROL 2026;99:1526\u20131535<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.78184","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T08:18:44Z","timestamp":1772957924000},"page":"1526-1535","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Blood Lactate as a Prognostic Biomarker for Survival and Weight Loss in Amyotrophic Lateral Sclerosis: An Exploratory\u2013Validation Study"],"prefix":"10.1002","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6384-4427","authenticated-orcid":false,"given":"Ryutaro","family":"Nakamura","sequence":"first","affiliation":[{"name":"Department of Neurology Shiga University of Medical Science  Otsu Shiga Japan"},{"name":"Australian Institute for Bioengineering and Nanotechnology The University of Queensland  Brisbane Queensland Australia"},{"name":"University of Queensland Centre for Motor Neuron Disease Research 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