Malnutrition risk in Parkinson's disease

Background: Unintentional weight loss and undernutrition have been found common in  Parkinson’s disease but its relation to other disease aspects is unclear.

Objectives: To explore nutritional status in relation to disease duration in Parkinson’s disease, as well as associations between nutritional status and motor and autonomic features.

Design: Cross-sectional.

Setting: South-Swedish outpatient Parkinson-clinic.

Participants: Home-dwelling people with Parkinson’s disease (n=71), without significant cognitive impairment (mean age, 67.3 years; 56% men; mean disease duration, 6.3 years).

Measurements: Parkinsonian motor symptoms, mobility, activity level, disability, dyskinesias, dysautonomia, under- and malnutrition risk screening (using MEONF II and MUST for undernutrition and SCREEN II for malnutrition) and anthropometric measures (BMI, handgrip strength, triceps skin-fold, mid-arm circumference and mid-upper arm muscle circumference) were recorded. The sample was divided into those with longer (n=34) and shorter disease duration (n=37) according to the median (5 years).

Results: Longer disease duration was associated with more, disability, dyskinesias and dysautonomia than shorter duration (P ≤0.04). Mean (SD) body weight and BMI were 80.3 (16.3) kg and 28.1 (4.8) kg/m 2, respectively, and did not differ between duration groups (body weight, 80.9 vs. 79.6 kg; BMI, 28.0 vs. 28.3 kg/m 2; P≥0.738). There were no differences in other anthropometric measures between duration groups (P ≥0.300). BMI identified 4% and 62% as under- and overweight, respectively, and 4% exhibited  undernutrition risk, whereas 87% were at risk for malnutrition. Nutritional and motor/dysautonomic variables showed relatively weak correlations (r s, ≤ 0.33), but people with orthostatic hypotension had lower BMI (26.7 vs 29.2 kg/m 2; P=0.026) and lower handgrip strength (33.2 vs 41.6 kg; P=0.025) than those without orthostatic hypotension.

Conclusion: Motor and autonomic features showed expected relationships with disease duration. In contrast to these observations, and to most previous reports on nutrition in PD, frequencies of underweight and undernutrition were low. However, malnutrition risk was high, emphasizing the need for regular clinical monitoring of nutritional status. The reasons for the preserved nutritional status have to be explored prospectively.