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1.
Nutr Neurosci ; 25(2): 246-255, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32264793

RESUMO

Background: Weight homeostasis is complex in Parkinson's disease (PD) and body weight changes substantially throughout the course of the disease. We designed a case-control study to (i) investigate whether PD is associated with changes in resting energy expenditure (REE), (ii) to assess how accurately REE could be predicted for individuals with PD utilizing the equations constructed for healthy individuals, and (iii) to eventually construct a new equation.Materials & Methods: Measured REE (mREE) was compared between 122 PD patients and 122 gender and body mass index (BMI)-matched controls. The accuracy of estimated REE by 5 common equations (Harris/Benedict-1919, Roza/Shizgal-1984, Mifflin St. Jeor, WHO/FAO and aggregate formula) was investigated in PD using Bland-Altman analysis and reported as the frequency of accurate predictions (±10%). Concordance correlation coefficients (CCC) were also calculated. Then, we regressed a new REE equation - using gender, age, weight, height and Hoehn-Yahr stage - and validated it in an independent sample (N = 100).Results: No significant difference in mREE was recorded between the whole PD sample and healthy controls. However, mREE was increased in patients with BMI ≥ 30 kg/m2 and Hoehn-Yahr stage ≥ 3. Limited accuracy was present in the available REE equations (accurate prediction [±10%] frequency, <60% for all). For the new equation, the proportion of accurate prediction was 67.0% (overestimation, 24.0%) and CCC was 0.77.Conclusion: PD patients are not commonly characterized by an increase in REE. This is limited to patients suffering from obesity and more severe disease. Common REE equations appear to be inaccurate. The new predictive equation proposed in this study provided better REE estimates.


Assuntos
Doença de Parkinson , Metabolismo Basal , Índice de Massa Corporal , Calorimetria Indireta , Estudos de Casos e Controles , Metabolismo Energético , Humanos , Doença de Parkinson/tratamento farmacológico , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
2.
Nutr Neurosci ; 25(6): 1128-1136, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33151126

RESUMO

BACKGROUND: Parkinson's disease (PD) patients have lower levels of serum 25-hydroxyvitamin D (25(OH)D) than the general population. Previous studies have suggested a negative association between 25(OH)D and clinical features of PD, but the data are inconsistent. MATERIALS AND METHODS: We conducted a cross-sectional, observational study. Serum 25(OH)D, disease (Hoehn-Yahr stage [HY]) and clinical symptom (Unified Parkinson Disease Rating Scale [UPDRS]) severity and global cognitive functions (Mini-Mental State Examination [MMSE]) were studied in 500 consecutive PD patients not using vitamin D supplements. Information on sunlight exposure and dietary intakes (using a 66-item food frequency questionnaire) were also collected. A convenient sample of age and sex-matched community healthy controls (N = 100) was included as a control group. RESULTS: PD patients had lower 25(OH)D serum levels than controls. Deficiency status (<20 ng/mL) was found in 65.6% of patients. 25(OH)D levels were independently correlated to sunlight exposure (P = .002) and vitamin D intake (P = .009). In multivariate models, using a Mendelian randomization approach, lower serum 25(OH)D was associated with more severe disease (HY, P = .035), worse clinical symptoms (UPDRS Part-III total score [P = .006] and dopaminergic [P = .033] and non-dopaminergic subscores [P = .001]) and greater global cognitive function impairment (P = .041). Neither cognitive functions nor clinical features were associated with reduced intake of vitamin D and sunlight exposure. CONCLUSION: : Serum 25(OH)D was negatively correlated with disease and symptoms severity, as well as with global cognitive functions. Our study adds to the evidence that low 25(OH)D may affect the progression of PD negatively. Intervention studies in this area are required.


Assuntos
Doença de Parkinson , Calcifediol , Estudos Transversais , Humanos , Vitamina D/análogos & derivados
3.
Int J Food Sci Nutr ; 70(1): 107-115, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29792366

RESUMO

In Zambia, chronic malnutrition still is one of the most common problem among children. To fight against malnutrition, the easiest short-term solution could be to combine specific types of food with affordable local plants. A large variety of natural food resources grow in Zambia, such as Moringa oleifera (MO), whose leaves are known for their health benefits, but are not consumed much by local populations. We analysed Zambian MO powder obtained from dried leaves and found that it contains large amounts of protein, minerals and vitamins, such as iron, calcium and carotenoids. These characteristics make MO a good and sustainable complementary solution to malnutrition. We also evaluated the acceptability and the safety of dietary supplementation with MO powder in malnourished children for 30 days. A daily dose of 14 g daily was safe and well accepted. Its regular use in the menu of local populations may be viable proposition.


Assuntos
Suplementos Nutricionais , Desnutrição/dietoterapia , Moringa oleifera/química , Valor Nutritivo , Adolescente , Antropometria , Composição Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Dieta , Feminino , Humanos , Desnutrição/etiologia , Desnutrição/prevenção & controle , Minerais/análise , Folhas de Planta/química , Pós , Segurança , Vitaminas/análise , Zâmbia
4.
Br J Nutr ; 110(2): 347-53, 2013 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-23228187

RESUMO

Dysautonomia symptoms of nutritional interest may often occur in Parkinson's disease (PD), but the role played in affecting the risk of malnutrition still needs to be clarified. A total of 208 consecutive PD outpatients hospitalised on a scheduled basis were assessed for nutritional risk by the Malnutrition Universal Screening Tool. Presence of dysautonomia symptoms (dysphagia, sialorrhoea and constipation) was investigated using clinical rating scales. In our population, prevalence of nutritional risk was 17·2 (95 % CI 12·1, 24·0) % and relied mainly on unintentional weight loss. Sialorrhoea, dysphagia, dysphagia to liquids and constipation were observed in 10·6, 11·0, 14·4 and 59·6 % of the patients, respectively. Nutritional risk was independently associated with the number of dysautonomia symptoms (OR 1·39 (95 % CI 1·00, 1·96); P= 0·048) but not with single symptoms. An independent association was also found with the severity of motor symptoms (Hoehn-Yahr stage, OR 1·48 (95 % CI 1·00, 2·55); P= 0·049) and levodopa dose (OR 1·16 (95 % CI 1·04, 1·31) mg/kg per d; P= 0·009). Nutritional risk in PD outpatients appears to depend mainly on dysautonomic syndrome, disease severity and levodopa dosage. Implications for outcome deserve further investigation. The assessment of nutritional status and of gastrointestinal dysautonomia symptoms should be part of the routine work-up of a PD patient.


Assuntos
Gastroenteropatias/etiologia , Levodopa/efeitos adversos , Desnutrição , Doença de Parkinson/complicações , Disautonomias Primárias , Índice de Gravidade de Doença , Sialorreia , Idoso , Intervalos de Confiança , Constipação Intestinal/epidemiologia , Constipação Intestinal/etiologia , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Feminino , Gastroenteropatias/epidemiologia , Hospitalização , Humanos , Levodopa/administração & dosagem , Levodopa/uso terapêutico , Masculino , Desnutrição/epidemiologia , Desnutrição/etiologia , Pessoa de Meia-Idade , Estado Nutricional , Razão de Chances , Pacientes Ambulatoriais , Prevalência , Disautonomias Primárias/epidemiologia , Disautonomias Primárias/etiologia , Fatores de Risco , Sialorreia/epidemiologia , Sialorreia/etiologia , Redução de Peso
6.
Br J Nutr ; 102(4): 563-70, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19203422

RESUMO

The Mini Nutritional Assessment (MNA) is recommended for grading nutritional status in the elderly. A new index for predicting the risk of nutrition-related complications, the Geriatric Nutritional Risk Index (GNRI), was recently proposed but little is known about its possible use in the assessment of nutritional status. Thus, we aimed to investigate its ability to assess the nutritional status and predict the outcome when compared with the MNA. Anthropometry and biochemical parameters were determined in 241 institutionalised elderly (ninety-four males and 147 females; aged 80.1 (SD 8.3) years). Nutritional risk and nutritional state were graded by the GNRI and MNA, respectively. At 6 months outcomes were: death; infections; bedsores. According to the GNRI and MNA, the prevalence of high risk (GNRI < 92)/malnutrition (MNA < 17), moderate risk (GNRI 92-98)/malnutrition at-risk (MNA 17-23.5) and no risk (GNRI > 98)/good status (MNA > 24) were 20.7/12.8%, 36.1/39% and 43.2/48.2%, respectively, with poor agreement in scoring the patient (Cohen's kappa test: kappa = 0.29; 95% CI 0.19, 0.39). GNRI categories showed a stronger association (OR) with overall outcomes than MNA classes, although no difference (P>0.05) was found between malnutrition (v. 'good status', OR 6.4; 95% CI 2.1, 71.9) and high nutritional risk (v. 'no risk', OR 9.7; 95% CI 3.0, 130). Multivariate logistic regression revealed the GNRI as an independent predictor of complications. In overall-outcome prediction, a good sensitivity was found only for GNRI < 98 (0.86 (95% CI 0.67, 0.96)). The combination of a GNRI > 98 with an MNA > 24 seemed to exclude adverse outcomes. The GNRI showed poor agreement with the MNA in nutritional assessment, but appeared to better predict outcome. In home-care resident elderly, outcome prediction should be performed by combining the suggestions from both these tools.


Assuntos
Avaliação Geriátrica , Avaliação Nutricional , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Instituição de Longa Permanência para Idosos , Humanos , Institucionalização , Masculino , Estado Nutricional , Risco , Sensibilidade e Especificidade
7.
J Am Coll Nutr ; 27(3): 406-13, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18838529

RESUMO

OBJECTIVE: To investigate how total lymphocyte count (TLC) and the Geriatric Nutritional Risk Index (GNRI) are associated with short-term nutritional-related complications (death, infections, bedsores) in institutionalised elderly. METHODS: 220 home-care resident elderly (age +/- SD; 80.7 +/- 7.9, range: 67-98 years) were studied (anthropometry, biochemistry, food intake) and prospectively followed over a period of 3 months for the occurrence of health complications. Nutritional risk was assessed by GNRI. Patients were categorized according to GNRI (<92, 92-98, >98) and TLC (<900, 900-1499, >or=1500/mm3). RESULTS: GNRI was significantly associated with TLC according to both simple and adjusted correlation models (p < 0.001) and to multiple stepwise regression analysis (p < 0.005). TLC < 900 revealed a higher specificity (87.8%) than sensitivity (30.6%) in identifying "at-risk" patients (GNRI < 92). Adjusted multiple logistic regression revealed a significant association between overall 3-month health outcomes and both TLC and food intake. TLC was the only significant predictor for infections, while death was independently associated with GNRI and food intake. When a GNRI < 92 and a TLC < 900 were considered together, the sensitivity was 0.83 (95% confidence interval, C.I.95%: 0.66-1.0) and 0.89 (C.I.95%: 0.68-1.00) for overall complications (Odds ratio: 22.1; C.I.95%: 5.1-96.1) and infections (Odds ratio: 20.8; C.I.95%: 2.6-168.8), respectively. The association of a GNRI > 98 with a TLC >or= 1500 was able to exclude health complications. CONCLUSIONS: In the institutionalised elderly patients, GNRI confirmed its predictive value even for short-term health complications, particularly when death was considered. However, the use of TLC might improve the evaluation of nutritional risk and the identification of patients at risk of infections. Nutrition study should be considered to confirm possible risk reduction.


Assuntos
Doenças do Sistema Imunitário/complicações , Contagem de Linfócitos , Desnutrição/complicações , Avaliação Nutricional , Medição de Risco , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Feminino , Indicadores Básicos de Saúde , Instituição de Longa Permanência para Idosos , Humanos , Doenças do Sistema Imunitário/imunologia , Institucionalização , Contagem de Linfócitos/métodos , Masculino , Análise de Regressão , Fatores de Risco , Estatística como Assunto
8.
Gerontology ; 53(4): 184-6, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17290145

RESUMO

BACKGROUND: The Geriatric Nutritional Risk Index (GNRI) is a new index recently introduced for predicting risk of nutritional-related complications in elderly patients. It combines albumin with information about body weight: GNRI = (1.489 x albumin, g/l) + (41.7 x present/ideal body weight), with ideal weight calculated according to the Lorentz formula. Because standing height (SH) is frequently difficult to obtain in older people, in Lorentz equations this parameter has been replaced by estimated height (EH) from knee height. Though, if EH is well accepted as a valid surrogate for SH, the same might not be expected for its use in ideal body weight calculation, with possible consequences in grading nutritional risk correctly. OBJECTIVE: The aim of this study was to investigate whether the use of SH rather than EH for the calculation of ideal body weight predicts similar outcomes by GNRI. METHODS: Body weight, SH and EH were obtained in 231 long-term care resident elderly (88 males and 143 females, mean age +/- SD 80.0 +/- 8.4, range 65-97 years). Blood samples were assessed for albumin concentration. Ideal body weight was derived from the Lorentz formula using both SH and EH. According to both ideal weight estimates, nutritional risk was defined by the GNRI score. RESULTS: The Pearson correlation coefficients were high for both EH (with SH; r = 0.90) and estimates of ideal body weight (r = 0.90) and all were highly significant (p < 0.0001). A statistically significant difference was found between SH and EH (p = 0.0265). Similar and expectable differences in significance have also been observed between ideal body weights (p = 0.0271). However, an accordance of 95.2% has been detected (Kendall's tau test: tau = 0.85, p < 0.0001) in grading nutritional risk by GNRI. CONCLUSION: The use of EH for ideal body weight calculation and nutritional risk assessment by GNRI is feasible. Thus, GNRI seems to have been designed in the best way and its use is really attractive, particularly when considering the low-grade participation demanded of the patient in the assessment. This simple and valid assessment tool should be taken into greater consideration.


Assuntos
Antropometria/métodos , Estatura , Avaliação Geriátrica , Joelho , Avaliação Nutricional , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Peso Corporal , Estudos de Viabilidade , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Padrões de Referência , Medição de Risco
9.
Parkinsonism Relat Disord ; 42: 40-46, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28647435

RESUMO

INTRODUCTION: Our objective is to describe the dietary habits, food preferences and adherence to Mediterranean diet (MeDi) of a large sample of Italian Parkinson's Disease (PD) patients compared to a group of controls. METHODS: Dietary habits of 600 PD patients from throughout Italy and 600 controls matched by gender, age, education, physical activity level and geographical residence, were collected using the ON-GP Food Frequency Questionnaire. Then, we compared patients by disease duration and the presence of swallowing disturbances. RESULTS: Overall, adherence of PD patients (males, 53.8%; mean disease duration, 9.2 ± 7.0 years) to MeDi was similar to controls (score, 4.8 ± 1.7 vs. 4.9 ± 1.6; P = 0.294). Patients consumed less alcohol and fish and drank significantly less water, coffee, and milk which resulted also in lower total fluids intake. On the contrary, they ate more fruit, cooked vegetables, cereals and baked items, more dressings and more sweets in general. Disease duration was associated with increased intake of several food groups but it was not associated with changes in MeDi score (P = 0.721). Patients with swallowing disturbances (n = 72) preferred softer and more viscous food but preferences did not result in differences in dietary pattern. However, patients with dysphagia drank less fluids (P = 0.043). DISCUSSION: PD patients presented different dietary habits and food preferences compared to the general population and adherence to MeDi was not associated with disease duration. Self-reported dysphagia was associated with reduced intake of fluids. These aspects may be amenable to change in order to improve the management of nutritional issues in this patient population.


Assuntos
Dieta Mediterrânea , Comportamento Alimentar , Conhecimentos, Atitudes e Prática em Saúde , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Idoso , Análise de Variância , Estudos de Casos e Controles , Transtornos de Deglutição/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
10.
Clin Nutr ; 36(4): 1054-1061, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-27406858

RESUMO

BACKGROUND & AIMS: Parkinson's disease (PD) patients can benefit considerably from appropriate nutritional care, particularly from diet. However, there is limited evidence on the eating habits of PD patients and their relationship with the features of the disease. METHODS: We conducted a large case-control study. Consecutive PD patients (N = 600) receiving systematic nutritional care and healthy controls (N = 600) matched (1:1) for age, gender, education, physical activity level and residence were studied using a 66-item food frequency questionnaire. The relationship between dietary habits and the following features of PD were investigated in patients: body weight, energy balance, constipation, and levodopa therapy (dose) and its related motor complications. RESULTS: PD patients had lower BMI and reported higher food intake than controls. BMI was found to be inversely associated with disease duration and severity, and levodopa-related motor complications, whereas energy intake was positively associated with these variables. An increase in protein intake by 10 g over physiological requirements (0.8 g/kg/day) corresponded to a mean increase in levodopa dose of 0.7 mg/kg/day. Constipation was also associated with higher levodopa requirements. Finally, protein intake and its distribution throughout the day influenced levodopa-related motor complications. CONCLUSION: The management of protein intake and the treatment of constipation should be considered to be an integral part of the care of PD patients. Attention should always be focused on energy intake also. This would result in the maintenance of nutritional status, the optimization of levodopa-therapy and the minimization of its related motor complications.


Assuntos
Constipação Intestinal/etiologia , Dieta Saudável , Ingestão de Energia , Comportamento Alimentar , Desnutrição/etiologia , Doença de Parkinson/fisiopatologia , Cooperação do Paciente , Idoso , Antiparkinsonianos/administração & dosagem , Antiparkinsonianos/efeitos adversos , Antiparkinsonianos/uso terapêutico , Estudos de Casos e Controles , Constipação Intestinal/epidemiologia , Estudos Transversais , Feminino , Interações Alimento-Droga , Hospitais Especializados , Humanos , Itália/epidemiologia , Levodopa/administração & dosagem , Levodopa/efeitos adversos , Levodopa/uso terapêutico , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Ambulatório Hospitalar , Doença de Parkinson/tratamento farmacológico , Prevalência , Risco , Índice de Gravidade de Doença
11.
Neurology ; 87(12): 1274-80, 2016 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-27543643

RESUMO

OBJECTIVES: Our objective was to evaluate the efficacy of probiotics and prebiotics in patients with Parkinson disease (PD) and constipation. METHODS: We conducted a tertiary setting, randomized, double-blind, placebo-controlled trial in patients with PD with Rome III-confirmed constipation based on 2-week stool diary data at baseline. Patients (n = 120) were randomly assigned (2:1) to either a fermented milk, containing multiple probiotic strains and prebiotic fiber, or placebo, once daily for 4 weeks. The primary efficacy endpoint was the increase in the number of complete bowel movements (CBMs) per week. The key secondary endpoints were 3 or more CBMs and an increase by one or more CBMs per week during weeks 3 and 4. RESULTS: For the primary endpoint, the consumption of a fermented milk containing probiotics and prebiotics resulted in a higher increase in the number of CBMs (mean 1.2, 95% confidence interval [CI] 0.8-1.6) than placebo (0.1, 95% CI -0.4% to 0.6%) (mean difference 1.1, 95% CI 0.4-1.8; p = 0.002). For the key secondary endpoints, a higher number of patients in the probiotics-prebiotics group vs the placebo group reported 3 or more CBMs (p = 0.030; 58.8% vs 37.5%; odds ratio = 2.4, 95% CI 1.1-5.2) and an increase by one or more CBMs (p = 0.004; 53.8% vs 25.0%; odds ratio = 3.5, 95% CI 1.8-8.1) during weeks 3 and 4. CONCLUSIONS: The consumption of a fermented milk containing multiple probiotic strains and prebiotic fiber was superior to placebo in improving constipation in patients with PD. CLINICALTRIALSGOV IDENTIFIER: NCT02459717. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with PD who have constipation, fermented milk containing probiotics and prebiotics increases the frequency of CBMs.


Assuntos
Constipação Intestinal/dietoterapia , Leite , Doença de Parkinson/complicações , Doença de Parkinson/dietoterapia , Prebióticos/administração & dosagem , Probióticos/administração & dosagem , Idoso , Animais , Constipação Intestinal/etiologia , Defecação , Método Duplo-Cego , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Satisfação do Paciente , Prebióticos/efeitos adversos , Probióticos/efeitos adversos , Índice de Gravidade de Doença , Centros de Atenção Terciária , Resultado do Tratamento
12.
J Am Med Dir Assoc ; 17(7): 640-6, 2016 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-27143236

RESUMO

OBJECTIVES: To estimate prevalence of sarcopenia and dynapenia in outpatients with Parkinson disease (PD) and to investigate their association with the features of the disease. DESIGN: Cross-sectional study. SETTING: A specialized tertiary care center. PARTICIPANTS: Consecutive patients (n = 364) aged 65 years or older, affected by parkinsonian syndromes. MEASUREMENTS: Skeletal muscle mass (SMM), as well as strength and gait speed (GS) were assessed by bioimpedence analysis, handgrip dynamometry, and the 4-meter walking test, respectively. Based on these assessments, sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People criteria. Dynapenia was defined as handgrip strength less than 30 kg in men and less than 20 kg in women. RESULTS: In total, 235 patients (64.6%) had a diagnosis of idiopathic PD. Low SMM index was recorded in 27 patients. Due to gait disturbances and postural instability, GS could not be measured in 98 patients and was found to be reduced in 61.3% of those assessed. Prevalence of sarcopenia and dynapenia was 6.6% (95% confidence interval [CI] 4.3-9.7) and 75.5% (95% CI 70.8-79.9), respectively. Sarcopenia tended to be higher in patients unable to perform GS assessment and was unrelated to the type of parkinsonian syndrome. It was associated with older age, longer disease duration, more severe disease, and higher disability in activities of daily living, as assessed by disease-specific clinical rating scale. Dynapenia was directly associated with parkinsonism other than PD, older age, and disability, whereas regular physical therapy appeared to be a preventive factor. However, it was unrelated to disease duration and severity. Finally, the disability score of activities of daily living was inversely correlated with handgrip strength and GS, whereas no association was found with SMM index. CONCLUSION: Being primarily motor disorders, parkinsonian syndromes are characterized by progressive disability in performing activities of daily living. Impaired functional status is a prominent feature of this patient population, independently of disease duration and severity. Sarcopenia is mainly related to advancing disease and, due to a significant sparing of SMM, is an infrequent condition, likely to play a minor role in disability. Several factors could be responsible for this favorable body composition (eg, motor symptoms, levodopa therapy) and deserve further investigation. The prognostic impact of sarcopenia also needs to be addressed.


Assuntos
Transtornos Parkinsonianos , Sarcopenia , Comorbidade , Estudos Transversais , Bases de Dados Factuais , Humanos , Países Baixos , Casas de Saúde , Transtornos Parkinsonianos/fisiopatologia , Sarcopenia/fisiopatologia , Inquéritos e Questionários
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