Weight Change and Body Composition in Patients With Parkinson's Disease

doi:10.1016/S0002-8223(95)00269-3

Journal of the American Dietetic Association

Volume 95, Issue 9, September 1995, Pages 979-983

https://doi.org/10.1016/S0002-8223(95)00269-3 Get rights and content

Abstract

Objective To compare reports of weight loss and actual measures of body composition to predict nutritional risk in patients with Parkinson's disease and matched control subjects.

Design Patients and control subjects were asked to record prior changes in weight and activity. Body composition was then compared in both groups using percentage ideal body weight (IBW), body mass index (BMI), triceps skinfold (TSF) thickness, midarm muscle circumference, and percentage body fat (BF) as determined by bioelectrical impedance.

Subjects Fifty-one free-living patients with Parkinson's disease and 49 matched control subjects were recruited from the neurology clinic and the surrounding area.

Main outcome measures We anticipated that reported weight loss would be greater and actual measures of body composition would show greater nutritional risk in the patients with Parkinson's disease.

Statistical analyses performed χ² Analysis was used to determine differences in the ratio of patients and control subjects who lost weight. Paired t tests were used to compare amount of weight change and measures of body composition. Correlations were performed among measures of weight change, body composition, and associated disease factors.

Results Patients with Parkinson's disease were four times more likely to report weight loss greater than 10 lb than the matched control subjects (odds ratio>4.2). Patients reported a mean (±standard deviation) weight loss of 7.2±2.9 lb and control subjects reported a mean weight gain of 2.1±1.6 lb (P<.01). Percentage IBW (P<.02), BMI (P<.009), TSF thickness (P<.005), and percentage BF (P<.022) were lower in patients. Significant correlations (P<.01) were found between reported weight change and percentage IBW, BMI, TSF, percentage BF, and stage of the disease.

Conclusions/application Patients with Parkinson's disease appear to be at greater nutritional risk than a matched population. Simple screening and assessment tools can be used to detect nutritional risk. J Am Diet Assoc. 1995; 95:979-983.

Section snippets

Subjects and Methods

The study was approved by the University of Kansas Medical Center human subjects committee. The 51 patients studied were diagnosed and followed up in the Parkinson's disease clinic. Forty-nine control subjects matched for age, sex, and race formed the comparison group. Both patients and control subjects were free-living. Thirty-eight patients were in stage II, 12 were in stage III, and only 1 was in stage IV of the disease according to the scale of Hoehn and Yahr (9). Duration of the disease,

Weight Change

Significantly more patients reported weight loss than matched control subjects, and the mean amount weight loss reported was significantly greater for the patients (Table 1, Table 2). Some patients lost weight initially and gained the same or more weight later. Thirty-one patients (61%) reported at least a 5-lb weight loss sometime since the diagnosis of the disease. During the same period, eight control subjects (20%) lost at least 5 lb.

Anthropometric and Body Composition Measures

Patients weighed less than control subjects, but

Weight Change

Accuracy of self-reported weight and historical weight change is always suspect, but these measures may have more merit than commonly perceived. Stunkard and Albaum (15), for example, studied 550 men and women at seven geographic sites and found that people reported their body weights with surprising accuracy. The participants in our study appeared to be reasonably aware of their weight, especially if weight changed. The patients’ perceptions were supported by good correlations with objective

Applications

The patients with Parkinson's disease in this study represent an elderly population who, because of their age, would normally be considered at increased risk for malnutrition and other health problems. The addition of Parkinson's disease appears to substantially increase the risk. For our population, weight change, percentage IBW, and/or BMI were effective screening measures.

Weight loss might be prevented by routinely monitoring indicators of nutritional risk and providing appropriate

References (24)

C.W. Bishop et al.
Norms for nutritional assessment of American adults by upper arm anthropometry
Am J Clin Nutr.
(1981)
H.C. Lukaski et al.
Assessment of fat-free mass using bioelectrical impedance measurements of the human body
Am J Clin Nutr.
(1985)
A.J. Stunkard et al.
The accuracy of self-reported weights
Am J Clin Nutr.
(1981)
J.V. White et al.
Nutrition screening initiativedevelopment and implementation of the public awareness checklist and screening tools
J Am Diet Assoc.
(1992)
D. Cohen
Dementia, depression and nutritional status
Prim Care.
(1994)
W.C. Koller et al.
Classification of parkinsonism
S.J. Kish et al.
Uneven pattern of dopamine loss in the striatum of patients with idiopathic Parkinson's disease
N Engl J Med.
(1988)
R. Pahwa et al.
A rational polypharmacy approach to Parkinson's disease
Int Med.
(1994)
G.W. Paulson
The psychological aspects of parkinsonism
Ohio State Med J.
(1981)
G. Durrieu et al.
Parkinson's disease and weight lossa study with anthropometric and nutritional assessment
Clin Autonom Res.
(1992)

R.S. Senaraty-Yapa et al.

Anthropometric and nutritional assessment of elderly patients with Parkinson's disease

J Clin Exp Gerontol.

(1989)

S. Levi et al.

Increased energy expenditure in Parkinson's disease

BMJ.

(1990)

Cited by (161)

Weight and survival after deep brain stimulation for Parkinson's disease
2023, Parkinsonism and Related Disorders
Weight loss in Parkinson's disease (PD) is common and associated with increased mortality. The clinical significance of weight changes following deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is unclear.
To address (1) whether PD patients exhibit progressive weight loss, (2) whether staged DBS surgery is associated with weight changes, and (3) whether survival after DBS correlates with post-DBS weight.
This is a single-center, longitudinal, retrospective cohort study of 1625 PD patients. We examined trends in weight over time and the relationship between weight and years survival after DBS using regression and mixed model analyses.
There was a decline in body weight predating motor symptom onset (n = 756, 0.70 ± 0.03% decrease per year, p < 0.001). Weight decline accelerated in the decade preceding death (n = 456, 2.18 ± 0.31% decrease per year, p < 0.001). DBS patients showed a weight increase of 2.0 ± 0.33% at 1 year following the first DBS lead implant (n = 455) and 2.68 ± 1.1% at 3 years if a contralateral DBS lead was placed (n = 249). The bilateral STN DBS group gained the most weight after surgery during 6 years of follow up (vs bilateral GPi, 3.03 ± 0.45% vs 1.89 ± 0.31%, p < 0.01). An analysis of the DBS cohort with date of death available (n = 72) revealed that post-DBS weight (0–12 months after the first or 0–36 months after the second surgery) was positively associated with survival (R² = 0.14, p < 0.001).
Though PD is associated with significant weight loss, DBS patients gained weight following surgery. Higher post-operative weight was associated with increased survival. These results should be replicated in other cohorts.
Weight loss and weight gain in Parkinson disease
2021, Parkinsonism and Related Disorders
Parkinson disease (PD) has been associated with both weight loss and gain in different stages of the disease. Our study aimed to determine the prevalence and associations with weight change over two years based on 3% and 5% weight change.
In this longitudinal analysis, weight at baseline and follow-up was used to classify patients into groups of weight loss, stable, and weight gain. Differences between these groups at baseline and then with change over time were tested.
The sample was 668 patients with mean(SD) age 66.1(10) and disease duration 5.3(5.4) years. Using 3% weight change criteria: 32.6% lost, 23.1% gained, and 55.7% had stable weight. Using 5% criteria: 22.6% lost, 15.7% gained, and 61.7% had stable weight. Age was associated with both 3% and 5% change in weight. Other associations with 5% weight change were disease duration, Total and Motor Unified Parkinson's Disease Rating Scale, Older Americans Resource and Services disability, and Hoehn & Yahr staging. The effects of 3% weight loss on Motor UPDRS, IADLs, and depression, and the effects of 5% weight loss on IADLs remained statistically significant when controlling for baseline differences in age, levodopa use, and Total UPDRS.
PD patients are more likely to experience 3% than 5% weight change and this lower threshold of weight change was associated with greater disease severity and disability over time. Attention to more subtle weight change may help identify those at greater risk of disability.
Interlinking dementia in Parkinson’s disease: Nutritional correlates of body composition
2020, Genetics, Neurology, Behavior, and Diet in Parkinson’s Disease: The Neuroscience of Parkinson’s Disease, Volume 2
Little evidence showed that body composition has a primary role in the development of dementia in Parkinson's disease (PD). However, several studies indicated that metabolic and nutritional dysfunctions have a relevant influence on disease outcome. The confluence of several disturbances, including disruption in fat and glucose metabolism, with nutritional component abnormalities, could be a crucial event when associated with dopamine depletion in the striatum of patients with PD. It was discussed that there may be a relationship between decreased insulin resistance and cholesterol lower levels as a possible risk factor to dementia associated with PD (PDD). The possibility that nutritional habits, metabolic disturbances, and dopamine depletion in the striatum could have a synergic action on PDD is taken into consideration. Thus, future studies should establish dietary measures for elderly patients with PD, associated or not with dementia.
Does reduced mastication influence cognitive and systemic health during aging?
2018, Physiology and Behavior
There is a growing body of literature which suggests that oral health and mastication can influence cognitive and systemic health during aging. However, it is currently unclear whether oral health, masticatory efficiency, cognitive health and systemic health merely deteriorate independently with age, or whether mechanisms exist linking mastication to cognitive and systemic health directly. The aim of this paper is to review the extent to which reduced mastication influences cognitive and systemic health during aging because this knowledge may underpin future interventions that improve quality of life. Current evidence suggests that a deterioration in mastication and oral health during aging can have: 1) direct effects on systemic health through mechanisms such as the migration of the oral microbiota into the systemic environment, and 2) indirect effects on systemic health through changes nutrient intake. A loss of teeth and reduction in masticatory efficiency during aging can have: 1) direct effects on cognitive performance and potentially impact cognitive health through mechanisms such as enhanced adult hippocampal neurogenesis, and 2) indirect effects on cognitive health through changes in nutrient intake. It is concluded that oral health and masticatory efficiency are modifiable factors which influence the risk poor cognitive and systemic health during aging, although it is currently premature to propose chewing-based interventions to slow the rate of cognitive decline and improve cognitive health during aging. Future research should include large-scale longitudinal studies which control for the types of confounding factors which concurrently influence the association between mastication and cognitive and systemic health.
Characterization of oromotor and limb motor dysfunction in the DJ1 -/- model of Parkinson disease
2018, Behavioural Brain Research
Parkinson disease (PD) is devastating to sensorimotor function that includes cranial/oromotor and limb motor deficits. However, the onset, progression, and neural correlates of PD-related dysfunctions are poorly understood. To address this gap, we used a genetic rat model of PD, DJ1 -/-, and hypothesized that motor deficits would manifest early in the disease process, be progressive in nature, and be related to pathologies in brainstem structures associated with sensorimotor function. The present study compares homozygous DJ1 -/- male rats to age-matched wild type controls. Progressive cranial sensorimotor function (ultrasonic vocalizations and tongue motor performance) and limb motor function (tapered balance beam) was analyzed at 2, 4, 6, and 8 months of age. Additionally, tyrosine hydroxylase cell counts were performed in the locus coeruleus and correlated to behavioral measures. We found that compared to wild type controls, DJ1 -/- show deficits in ultrasonic vocalizations as well as oromotor (tongue) deficits that were progressive. Overtime, DJ1 -/- rats cross a tapered balance beam with significantly decreased speed of traversal. Additionally, in the DJ1 -/-, tyrosine hydroxylase positive cells in the locus coeruleus are significantly reduced and are negatively correlated to oromotor behaviors. Characterizing the DJ1 -/- model of PD provides important foundational work necessary to define behavioral and early-onset biomarkers that parallels early-stage PD pathology in humans.
ESPEN guideline clinical nutrition in neurology
2018, Clinical Nutrition
Neurological diseases are frequently associated with swallowing disorders and malnutrition. Moreover, patients with neurological diseases are at increased risk of micronutrient deficiency and dehydration. On the other hand, nutritional factors may be involved in the pathogenesis of neurological diseases.
Multiple causes for the development of malnutrition in patients with neurological diseases are known including oropharyngeal dysphagia, impaired consciousness, perception deficits, cognitive dysfunction, and increased needs.
The present evidence- and consensus-based guideline addresses clinical questions on best medical nutrition therapy in patients with neurological diseases. Among them, management of oropharyngeal dysphagia plays a pivotal role. The guideline has been written by a multidisciplinary team and offers 88 recommendations for use in clinical practice for amyotrophic lateral sclerosis, Parkinson's disease, stroke and multiple sclerosis.

View all citing articles on Scopus

View full text

Weight Change and Body Composition in Patients With Parkinson's Disease

Abstract

Section snippets

Subjects and Methods

Weight Change

Anthropometric and Body Composition Measures

Weight Change

Applications

Am J Clin Nutr.

Am J Clin Nutr.

Am J Clin Nutr.

J Am Diet Assoc.

Prim Care.

Classification of parkinsonism

Uneven pattern of dopamine loss in the striatum of patients with idiopathic Parkinson's disease

N Engl J Med.

A rational polypharmacy approach to Parkinson's disease

Int Med.

The psychological aspects of parkinsonism

Ohio State Med J.

Parkinson's disease and weight lossa study with anthropometric and nutritional assessment

Clin Autonom Res.

Anthropometric and nutritional assessment of elderly patients with Parkinson's disease

J Clin Exp Gerontol.

Increased energy expenditure in Parkinson's disease

BMJ.