Nutrition Guidelines for Duchenne Muscular Dystrophy (DMD)

Overview

Duchenne Muscular Dystrophy is a progressive neuromuscular disorder that affects muscle strength and function. Nutrition does not cure DMD, but a wellplanned diet can help maintain optimal body composition, support respiratory and cardiac health, and improve quality of life.

Energy Needs

Energy requirements change as the disease progresses:

• Early ambulatory stage: Children are often more active; caloric intake should match or slightly exceed estimated needs (3040kcal/kg/day).
• Late ambulatory to nonambulatory stage: Mobility declines, leading to reduced energy expenditure. Caloric intake should be adjusted to 2530kcal/kg/day to avoid excess weight gain.

Why it matters: Both undernutrition and obesity can worsen respiratory function and increase the risk of cardiovascular complications.

Protein

Protein supports muscle repair, immune function, and wound healing. Recommendations:

• Provide 1.21.5g/kg body weight per day of highquality protein.
• Include a variety of sources: lean meats, fish, dairy, eggs, legumes, and soy products.
• Distribute protein evenly across meals (e.g., 2030g per meal) to maximize muscle protein synthesis.

Fat

Fat is a dense source of calories and essential fatty acids:

• Target 3035% of total calories from fat.
• Prefer unsaturated fats: olive oil, avocado, nuts, and fatty fish (rich in EPA/DHA).
• Limit saturated fats (<10% of calories) and avoid transfatty acids.

Micronutrients of Special Interest

Calcium & Vitamin D

Bone health is critical because corticosteroid therapy increases fracture risk.

• Calcium: 1,300mg/day for children 918y; 1,000mg/day for adults.
• Vitamin D: 6001,000IU/day; higher doses may be required to maintain serum 25OHD30ng/mL.

Iron

Prevent anemia, which can exacerbate fatigue.

• Girls 913y: 8mg/day; boys 913y: 11mg/day; adults: 8mg/day.
• Include ironrich foods (red meat, fortified cereals) and pair with vitaminC for better absorption.

Antioxidants (VitaminsC &E, Selenium)

Oxidative stress contributes to muscle degeneration.

• Fruits, vegetables, nuts, and seeds provide natural antioxidants.
• Supplementation only under professional supervision.

Hydration

Adequate fluid intake supports cardiac function, aids digestion, and reduces the risk of constipation.

• General guideline: 1.52L/day, adjusted for activity, fever, or medications.
• Encourage water, herbal teas, and lowsugar juices.
• Avoid excessive sugary drinks that add empty calories.

Practical Tips for Families & Caregivers

• Meal planning: Use a weekly menu that balances protein, carbs, and healthy fats.
• Portion control: Use measuring cups or a kitchen scale to avoid inadvertent overeating.
• Texture modification: As swallowing difficulties develop, incorporate pureed foods or thickened liquids.
• Supplements: Only add vitamin D, calcium, or multivitamins after checking blood levels.
• Regular monitoring: Track weight, height, BMI, and body composition every 36months.
• Consult a dietitian: A professional familiar with DMD can personalize recommendations.

If your child uses a feeding tube, collaborate with a speechlanguage pathologist and dietitian to set appropriate formula rates and ensure nutrient adequacy.

Key TakeHome Messages

1. Adjust calories as mobility changes to prevent both undernutrition and obesity.
2. Provide 1.21.5g/kg of highquality protein daily.
3. Include healthy fats and limit saturated and trans fats.
4. Prioritize calcium, vitaminD, iron, and antioxidantrich foods.
5. Maintain consistent hydration.
6. Work with a multidisciplinary team for individualized care.