Few Mild-to-Moderate PD Patients Suffer from Malnutrition, Yet Almost One Third Are at Risk

11 September 2014

Results from One of the First Controlled Studies Counters Common Belief, According to New Article in the Journal of Parkinson's Disease

Patients with Parkinson’s disease (PD) can experience difficulties with food preparation and ingestion, which could contribute to poor nutrition and place them at risk for malnourishment. Published studies have also suggested that PD is associated with low weight, however, few studies included control groups. A report published in the Journal of Parkinson’s Disease counters this conclusion in patients with mild-to-moderate PD, finding that the incidence or risk of malnutrition is no different for patients with mild-to-moderate PD compared to healthy controls.

“To our knowledge, this is one of the few studies worldwide that includes matched controls,” says lead author Seyed-Mohammad Fereshtehnejad, MD, MPH, of the Division of Clinical Geriatrics of the Department of Neurobiology, Care Sciences, and Society of the Karolinska Institute, Stockholm, Sweden, and the Firoozgar Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran. “The results of this study indicate the same nutritional status among mild-to-moderate PD patients compared with healthy controls.”

Many factors could lead to poor nutrition in PD patients, including motor difficulties with swallowing and chewing (dysphagia), cutting, and bringing food to the mouth. PD-related constipation and depression can also dampen a patient’s appetite and change dietary habits. Consequences of malnutrition include higher medical costs, lower quality of life, and increased risk of morbidity and mortality.

To determine if PD patients are malnourished, 143 Iranian mild-to-moderate PD patients and 145 age- and sex-matched healthy controls were enrolled in this study. Any PD patients suffering from other chronic conditions influencing nutritional state, such as hypertension or diabetes, were following special diets, or exhibiting cognitive impairment were excluded.

Nutritional status was evaluated using the Persian version of the Mini Nutritional Assessment (MNA) questionnaire. In 10-15 minute interviews, patients answered 18 questions about appetite, dietary matters, feeding, self-perception of health, nutrition and malnutrition and were assessed for body mass index (BMI), weight loss, and arm and calf circumference. The maximum score on the MNA is 30; scores of 24-30 signify healthy nutrition, 17-23.5 indicate risk for malnutrition, and

The results indicated that there was no significant difference in mean MNA score between the two groups (25.14 for PD patients vs. 24.43 for controls). Three (2.1%) PD patients were malnourished and 37 (25.9%) were at risk for malnutrition. Similar findings were found in the control group: 3 (2.0%) were malnourished and 51 (35.2%) were at risk of malnutrition. In fact, mild-to-moderate PD patients did better than controls on some measures, including weight loss, psychological stress, protein intake, and consumption of fruits and vegetables. Mean calf circumference was significantly lower in the PD patients.

Nevertheless, the authors emphasize that the findings may be limited to patients with mild-to-moderate PD and caution that close to 30% of this patient population is at risk for malnutrition. “The low rate of severe malnutrition in our population may be attributed to the source of patient selection,” says lead investigator John Lökk, MD, PhD, of the Department of Geriatric Medicine of Karolinska University Hospital, Stockholm, Sweden. “They were all recruited from an outpatient clinic and thus the more disabled in-hospitalized cases were not included, those which are probably at a higher risk for developing malnutrition.” Dr. Lökk also suggests that the patients studied normally lived with their families, thus the patients might have benefited from the special care provided by their family members.

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Prevalence of Malnutrition in Patients with Parkinson’s Disease: A Comparative Study with Healthy Controls using Mini Nutritional Assessment (MNA) Questionnaire,” by Seyed-Mohammad Fereshtehnejad, Ladan Ghazi, Motahhareh Sadeghi, Dena Khaefpanah, Gholam Ali Shahidi, Ahmad Delbari, and Johan Lökk (DOI: 10.3233/JPD-130323). Volume 4, Issue 3 (September 2014).

Full text of the article is available to credentialed journalists upon request. Contact Astrid Engelen, IOS Press, at +31 20 688 3355, a.engelen@iospress.nl to obtain a copy or additional information. Journalists wishing to interview the authors should contact Seyed-Mohammad Fereshtehnejad, MD, MPH, at +46 8-585 854 72, +46 73-930 26 27 (mobile) or sm.fereshtehnejad@ki.se.


Launched in June 2011 the Journal of Parkinson’s Disease is dedicated to providing an open forum for original research in basic science, translational research and clinical medicine that will expedite our fundamental understanding and improve treatment of Parkinson’s disease. The journal is international and multidisciplinary and aims to promote progress in the epidemiology, etiology, genetics, molecular correlates, pathogenesis, pharmacology, psychology, diagnosis and treatment of Parkinson’s disease. It publishes research reports, reviews, short communications, and letters-to-the- editor and offers very rapid publication and an affordable open access option.


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