Duchenne muscular dystrophy (DMD) is a disorder that causes progressive muscle weakness and a loss of function. The symptoms appear early in life, and most affected individuals require the use of a wheelchair by the age of 12.

Muscular dystrophy, loss of mobility, and complications from treatment can affect many other aspects of a person’s health, including their nutritional status.

According to a 2024 study, among 93 boys with DMD between the ages of 6 and 12, nearly 42% were underweight, overweight, or had obesity.

Dietary health and weight management are important in people with DMD, given the effects the disease has on the muscles and bones, which can be worsened by the person not getting adequate nutrition.

Read on to learn more about the ways in which DMD can affect nutritional health and steps that can be taken to support better nutrition with this disease.

People with DMD face a number of challenges to their nutritional health, including both over- and undernutrition.

Decreased muscle strength can make it difficult to complete a variety of bodily functions, including digestion. As neck muscles become weaker, swallowing can become difficult. This is known as dysphagia, and it can make it harder to eat and may limit the nutrients a person consumes.

Weakened muscles in the digestive tract can also affect how food moves through the gut. This can impact nutrient absorption and lead to other complications like constipation and reflux.

Together, this can make it hard for a person to get all the nutrients they need and may lead to undernutrition.

On the other hand, loss of muscle strength and mobility can lead to reduced physical activity. This can decrease the number of calories needed to maintain a healthy weight. Combined with the effects of some medications that can increase appetite, this may lead to overnutrition and associated complications.

Improper nutrition and weight management can be especially problematic for people with DMD due to the effects the condition and its treatment can have on muscles and bones.

Bone fractures, pain, and bone loss are all common among people with neuromuscular disorders like DMD, and not getting enough nutrition may worsen these problems.

Because mobility and muscle health are impacted by DMD, the nutritional needs of people with this condition are also affected.

Calorie needs may be higher or lower based on how much physical activity a person is able to do and how much energy their body needs to carry out regular functions like breathing and digestion.

A registered dietitian, in partnership with a physical therapist and the rest of the person’s DMD care team, can help determine nutritional needs based on that individual’s current health status.

Some general recommendations provided by experts with DMD advocacy groups are outlined below.

Hydration is crucial with DMD and can prevent many complications like constipation and kidney problems.

Fluid needs vary based on various factors, including age and weight. A general rule for achieving adequate daily hydration is to drink an 8-oz glass of water for every 20 lbs a person weighs. (For example, a person weighing 200 lbs should drink 10 glasses of water per day.)

Age-based recommendations are more general and suggest:

• 4 glasses per day for kids 4 to 8 years of age
• 6 glasses per day for kids 9 to 13 years of age
• 8 to 9 glasses per day for kids 14 to 18 years of age
• 10 glasses per day for adults 19 years or older

Recommendations on macronutrients — protein, fats, and carbohydrates — also vary based on age and weight.

For a person with DMD, it is recommended that each of these accounts for the following portion of daily calories:

• Protein: 10% to 35%
• Fats: 30% to 40%
• Carbohydrates: 45% to 65%

For people with DMD, diets higher in unsaturated fats than saturated fats are recommended. Olive, sunflower, and fish oils are all good sources of monounsaturated fats.

Animal products and highly processed foods often contain high levels of saturated fats and should be limited.

Many foods are good sources of carbohydrates, but those with a low glycemic index, which means they are broken down more slowly, may help maintain more consistent energy levels throughout the day.

Examples of low glycemic foods include:

• vegetables, like peppers, broccoli, tomatoes, leafy greens, and eggplant
• fruits such as strawberries, apples, lemons, limes, and pears
• chickpeas and beans
• whole or full fat milk
• plain yogurt
• dark chocolate
• cashews and peanuts

Many of these foods are also good sources of fiber, which can help support digestive health. It is recommended that men under the age of 50 eat 31 to 34 grams of fiber per day and women under 50 eat 25 to 28 grams of fiber per day.

Calcium and vitamin D are important for people with DMD due to the condition’s effect on bone health.

Calcium regulation has been found to be disrupted in people with DMD, and corticosteroids used in DMD management can lead to bone loss. This can lead to an increased risk for bone complications like osteoporosis, bone pain, and fractures.

For this reason, people with DMD who are taking corticosteroids have higher calcium requirements than others. Calcium requirements for people with DMD receiving steroids are:

• Ages 1 to 3: 750 mg/day
• Ages 4 to 8: 1200 mg/day
• Ages 9+: 1500 mg/day

The daily recommended dose of vitamin D is 600 IU per day, regardless of age (except in infants).

Dairy products, along with calcium-fortified juices, bread, and cereals, are good sources of both calcium and vitamin D. Other dietary sources include:

• tofu
• salmon and sardines
• corn tortillas
• cooked soybeans and boiled white beans
• almonds
• broccoli

Supplements can also be used to reach the daily recommended levels of calcium and vitamin D if dietary sources are not enough. However, too much of either can have negative health effects.

A registered dietitian can help ensure a person is receiving the correct amounts of vitamins and minerals based on their individual needs.

Swallowing difficulties are common with many types of neural and muscular disorders. Dysphagia with DMD is managed differently than other types of dysphagia, though.

While most people with dysphagia need their food thickened to help with swallowing, people with DMD may actually benefit from thinning the consistency of their food.

A speech-language pathologist who has experience with DMD can help provide specific recommendations for managing dysphagia with this condition.

In addition to thinning food, they may recommend reducing the amount of solid food eaten. Other tips include “rinsing” by following up each bite with a couple of swallows of water.

If dysphagia worsens to the point where eating is no longer safe or possible, a feeding tube may be recommended. This can help maintain nutritional health while avoiding some of the complications of dysphagia, such as aspiration, which can be serious or life threatening.

People with DMD face a variety of nutritional challenges that can lead to not getting enough nutrition.

Both undernutrition and overnutrition are common, which can lead to additional complications that affect bone, metabolic, and heart health.

A registered dietitian is an important part of the DMD care team to ensure proper nutrition, even before issues arise. These professionals can provide specific dietary recommendations for a person based on their individual needs, including activity levels, age, weight, and treatment history.