Nutritional status of old people with Parkinson’s disease and its associated factors: an integrative review

Arruda, Nívola Beatriz Mendonça de; Silva, Suelane Renata de Andrade; Asano, Nadja Maria Jorge; Coriolano, Maria das Graças Wanderley de Sales

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Revista Brasileira de Geriatria e Gerontologia

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Brasil

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Review Articles • Rev. bras. geriatr. gerontol. 23 (5) • 2020 • https://doi.org/10.1590/1981-22562020023.200254 copy

Nutritional status of old people with Parkinson’s disease and its associated factors: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Identify the factors associated with the Nutritional Status of old people with Parkinson’s disease (PD) through an integrative literature review.

Method

The databases LILACS, MEDLINE, BDENF, Scielo and Pubmed were used with no filters for year of publication nor study design. We included the studies with old population (age ≥60 years) in Portuguese, English or Spanish. Studies not addressing the subject, publications not available in full, and those that did not answer the guiding question were excluded. In addition to the associated factors, information regarding the objectives, study design, investigated sample, instruments for nutritional assessment, and main results were extracted. The methodological quality of the studies was assessed by the instruments Critical Appraisal Skill Program and Agency for Health care and Research and Quality. To summarize the associated factors, the percentage of studies whose intergroup analysis, association or correlation was significant for the expected outcome was considered.

Results

The final analysis resulted in 8 papers. The factors associated with the Nutritional Status among the PD-related clinical variables were duration and severity of the disease, motor symptoms, and cognitive function. Regarding the clinical-nutritional variables, they were associated with body fat, biochemical parameters, physical, domestic and mobility activities, energy intake, and eating habits.

Conclusion

Weight loss in PD is a complex and multifactorial consequence, and the early diagnose of nutritional changes in these patients is essential. Further studies in this population are necessary in order to better understand this process of weight loss in old patients with PD.

Keywords
Health of the Elderly; Nutritional Status; Nutritional Assessment; Parkinson’s Disease

Database	Combination of keywords	Papers found	Papers meeting the inclusion criteria	Papers meeting the exclusion criteria	Sample
LILACS	(“diet” or “diet regime”) and (“nutritional status” or “nutrition status”) and (“nutritional assessment”) and (“Parkinson's disease”)	0	0	0	0
MEDLINE		8	0	8	0
BDENF		0	0	0	0
SCIELO		0	0	0	0
PUBMED	("factors") AND (“nutrition assessment” or "nutritional status" or “nutritional” or “diet” or “Food Regime”) AND ("parkinson" OR "parkinson disease" OR "parkinsonism")	312	4	308	4
TOTAL	-	320	4	316	4

Author, place and year	Study design, objective, and instruments used to determine the Nutritional Status	Sample	Main results related to the Nutritional Status of old people with PD
Lorefält et al.²²22 Lorefält B, Ganowiak W, Palhagen S, Toss G, Unosson M, Granerus AK. Factors of importance for weight loss in elderly patients with Parkinson’s disease. Acta Neurol Scand. 2004;110:180-7. Disponível em: https://doi.org/10.1111/j.1600-0404.2004.00307.x, Sweden, 2004	Case-control study. Objective: to find the factors underlying weight loss in patients with PD using the following instruments: DXA, indirect calorimetry, and respiratory quotient.	n = 28 patients with PD (18 women / 10 men) 28 healthy controls matched by gender and age (± 5 years) n = 26 PD patients treated with l-dopa for a minimum of 2 years. Evaluated twice / one year interval.	During the 1-year interval, there was a reduction in both body weight (from 0.5-8.0 kg/year), and in BMI 24.2 ± 2.8 to 23.2 ± 3.5, and in fat mass. But 10% of patients who lost weight had a BMI <22kg/m².
Lorefält et al.²³23 Lorefält B, Ganowiak W, Wissing U, Granérus AK, Unosson M. Food habits and intake of nutrients in elderly patients with Parkinson’s Disease. Gerontology. 2006;52:160-8. Disponível em: https://doi.org/10.1159/000091825, Sweden, 2005	Case-control study. Objective: to investigate eating habits and nutrient intake in old patients with or without PD, in addition to checking if there was weight loss, using the following instruments: Food Record for three consecutive days and Calculation of energy and nutrient intake.	n = 26 patients with PD (17 women / 9 men) 26 healthy controls matched by gender and age (± 5 years) Evaluated twice / one year interval.	There was no significant difference between the number of food events per day by the groups in relation to weight loss In the 1-year interval, the number of complete meals prepared decreased to all patients, as well as the activities of daily living in need of help with food Regarding energy requirement in the group with weight loss which had increased needs, the consumption of calories was insufficient. But in the group without weight loss, the caloric requirement reduced The weight loss group had a higher consumption of fat and protein.
Lorefält et al.²⁴24 Lorefalt B, Toss G, Granerus AK. Weight loss, body fat mass, and leptina in Parkinson’s disease. Mov Disord. 2009;24:885-90. Disponível em: https://doi.org/10.1002/mds.22466, Sweden, 2009	Case-control study. Objective: to evaluate leptin levels in PD patients and its possible role in weight loss using the following instruments: DXA and Assessment of body fat mass.	n = 26 patients with PD (17 women / 9 men) 26 healthy controls matched by gender and age (± 5 years)	Serum leptin correlated with body weight, both in the first year and in the second year in all female PD patients; however, it did not occur in male patients. In women with PD with and without weight loss, serum leptin levels decreased significantly between one and two years. Serum leptin levels were correlated with body mass in all female and male participants. The body fat mass in PD patients decreased by 1.4 kg between the 1st and 2nd years. Both in the 1st year and in the 2nd year, body fat mass was lower in patients with weight loss Leptin levels were low in both PD patients and controls.
Cheshire and Wszolek²⁵25 Cheshire WPJ, Wszolek ZK. Body mass index is reduced early in Parkinson’s disease, Parkinsonism. Relat Disord. 2005;11:35-8. Disponível em: https://doi.org/10.1016/j.parkreldis.2004.07.001, USA, 2005	Case-control Study. Objective: to compare the weight loss of PD patients with controls and patients with ET or without neurological disease, and observe whether this difference preceded the symptomatic onset of PD using BMI.	n = 100 patients with PD; n = 24 patients o f a subgroup of PD with pre-morbid data (pre-PD); n = 50 patients with ET; n = 50 cases of CS.	BMI was on average 9% lower in PD than in the comparison groups with ET or control with CS. A similar reduction in BMI occurred prior to diagnosis in 24 cases of PD.
Barichella et al.²⁶26 Barichella M, Villa MC, Massarotto A, Cordara SE, Marczewska A, Vairo A, et al. Mini nutritional assessment in patients with Parkinson’s disease: correlation between worsening of the malnutrition and increasing number of disease-years. Nutr Neurosci. 2008;11:128-34. Disponível em: https://doi.org/10.1179/147683008X301441, Italia, 2008	3-year cohort study. Objective: to monitor the Nutritional Status of PD patients using MNA.	n = 61 patients with PD (37 men / 24 women) There were 2 losses after 3 years	Body weight and BMI decreased significantly between 2004 and 2007. There was an increase from 22.9% (8 patients) in 2004 to 34.3% (12 patients) in 2007 with Nutritional Risk (score ≤23), according to MNA.
Jaafar et al.²⁷27 Jaafar AF, Gray WK, Porter B, Turnbull EJ, Walker RW. A cross-sectional study of the nutritional status of community-dwelling people with idiopathic Parkinson’s disease. BMC Neurol. 2010;10:1-9. Disponível em: https://doi.org/10.1186/1471-2377-10-124, England, 2010	Cross-sectional study. Objective: to evaluate the prevalence of malnutrition in people in the community with PD and the associated factors using the following instruments: BMI, MUST, MUAC, TSF and HGS.	N = 161, n = 123 patients with PD, 82 with nutritional data collected (34 men / 48 women).	15% of patients had malnutrition (BMI <20 Kg/m²) 23.5% of patients had a medium or high risk of malnutrition, according to MUST. In women, low weight (BMI <20 kg/m²) was associated with greater unintentional weight loss, lower values of MUAC, TSF and HGS. Said associations were not found in men.
Van Steijn et al.²⁸28 van Steijn J, van Harten B, Flapper E, Droogsma E, van Walderveen P, Blaauw M, et al. The nutritional status of dutch elderly patients with Parkinson’s disease. J Nutr Health Aging. 2014;18(6):601-7. Disponível em: https://doi.org/10.1007/s12603-014-0444-1, Netherlands, 2013	Cross-sectional study. Objective: to assess the prevalence of (risk of) malnutrition in Dutch PD patients, as well as their risk factors using the following instruments: MNA, BMI, CNAQ and Oral Nutritional Supplement.	N = 140 patients with PD, n = 102 (54 men / 49 women) Divided into 2 groups: Normal (79) and at risk of malnutrition (23).	MNA 2% of patients had malnutrition (score <17); 20.5% of patients had risk of malnutrition ( 17 ≤ score ≤23.5). BMI 2% of the patients had malnutrition (BMI <20 kg/m²). The risk group had less appetite (CNAQ), used more oral nutritional supplements, and was more dependent on care compared to the normal group (KATZ).
Tomic et al.²⁹29 Tomic S, Pekic V, Popijac Z, Pucic T, Petek M, Kuric TG, et al. What increases the risk of malnutrition in Parkinson’s disease?. J Neurologic Sci. 2017;375:235-8. Disponível em: https://doi.org/10.1016/j.jns.2017.01.070, Croatia, 2017	Cross-sectional study. Objective: to determine the prevalence of malnutrition and factors influencing patients with PD using MNA.	n = 107 patients with PD; n = 96 patients with PD (57 men / 39 women) Age in three groups (40-60 years, 60-80 years, and >80 years); n = 74 (60 - 80 years); n = 10 (>80 years).	MNA 60 - 80 years old: 83.3% with Risk of Malnutrition; 75% with Malnutrition >80 years old: 3.7% with Risk of Malnutrition; 0 Malnutrition.

Category	Associated factors	Papers related to the associated factors	% of studies reporting it factor association	Codes
Personal variables	Age	25, 26, 27 p<0.01, 29 p= 0.041	2/4 (50%)	?
Personal variables	Gender	22 p<0.0001, 24 p<0.05, 26, 27	2/4 (50%)	?
PD-related clinical variables	Disease stage	27, 28, 29 *p= 0.017	1/3 (33,33%)	-
	Medication	22p<0.01, 24p=0.05, 28,29	2/4 (50%)	?
	Disease duration and severity	24p<0,001, 25, 26 p=0,0096, 27p=0,006, 28, 29 p=0,017	4/6 (66,66%)	+
	Motor symptoms	22p<0.01, 23p<0.01, 25, 27, 29 *p<0,001	3/5 (60%)	+
	Non-motor symptoms	23*p<0,01, 25, 27,29	1/4 (25%)	-
	Cognitive function	22p<0.01, 23p<0,05, 27, 29 *p=0,004	3/4 (75%)	+
Clinical-nutritional variables	Body fat	22p<0,01, 23p<0,01, 27*p<0,05	3/3 (100%)	+
	Biochemical parameters	24p<0.001, 29p= 0.018	2/2 (100%)	+
	Physical, domestic and mobility activities	22p<0.01, 23p<0,05, 28*p<0.001	3/3 (100%)	+
	Energy Intake	22p<0,05, 23p<0,05	2/2 (100%)	+
	Resting energy expenditure (REE)	22 *p<0.01	1/1 (100%)	?
	Respiratory quotient	22 *p<0.01	1/1 (100%)	?
	Eating Habits	23p<0,05, 25, 26 p=0.0009, 28*p=0.008, 29	3/5 (60%)	+
	Use of alcohol and tobacco	27	0/1 (0%)	-
	Gastrointestinal symptoms	25, 28	0/2 (0%)	-

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[1] Correspondence Nívola Beatriz Mendonça de Arruda nivolabeatriz@hotmail.com