Diet quality and Parkinson's disease: Potential strategies for non-motor symptom management

Abstract

Introduction: Parkinson's disease (PD) is now considered a systemic disease, and some phenotypes may be modifiable by diet. We will compare the diet quality and intake of specific nutrients and food groups of PD patients with household and community controls to examine how diet may influence PD clinical features.

Methods: We conducted a case-control study of 98 PD patients and 83 controls (household = 53; community = 30) in central California, assessing dietary habits over the past month and calculating the Healthy Eating Index (HEI)-2015. We employed multivariate logistic and linear regression analyses to assess associations between diet and PD status, PD symptom profiles, and medication, adjusting for relevant confounders.

Results: PD patients had a lower HEI score than controls, with an OR of 0.65 (95% CI: 0.45, 0.94) per 10-points increase in HEI. Lower-quality diet was characterized by higher intakes of carbohydrates, total and added sugars, and trans fats and lower intakes of fiber, folate, unsaturated fatty acids, protein, and fat. PD patients with chronic constipation had a 4.84 point lower HEI score than those without (β per 10-point in HEI: -0.48; 95% CI: -0.97, -0.00). Furthermore, patients on high dopamine agonist doses consumed more sugar than those on lower doses.

Conclusion: PD patients consume a lower-quality diet compared to household and community controls. Dietary modifications may alleviate non-motor symptoms like constipation, and promoting a healthy diet should become a part of routine care and disease management for PD patients, with special attention on agonist-treated and hyposmic patients.

Keywords: Constipation; Diet quality; Nutrients; Parkinson’s disease; Phenotype.

Fig. 1.

Diet and Parkinson’s disease. (A) Associations of dietary patterns and components with Parkinson’s disease status (N = 181). Coefficients are odds ratios estimated from logistic regressions. Adjusted for age, gender, smoking, BMI, and energy intake. (B) Associations of Parkinson’s disease medications (high vs. low dose) with dietary patterns and specific nutrients (n = 98). Coefficients are from linear regressions of medications on dietary patterns and specific nutrients. Adjusted for age and gender. LED dichotomized into high and low doses for dopamine agonists (high: ≥200 mg; low: <200), levodopa (high: ≥500 mg; low: <500), total (high: ≥600 mg; low: <600), and Levodopa:LED total (high: ≥0.8; low: <0.8). (C) Associations of Parkinson’s disease non-motor symptoms (present vs. absent) with dietary patterns and specific nutrients (n = 98). Coefficients are from linear regressions of non-motor symptoms on dietary patterns and specific nutrients. Adjusted for age and gender. Parkinson patients self-reported chronic constipation requiring laxative use. Other non-motor symptoms assessed using the Non-Motor Symptom Assessment Scale. Abbreviations: CI, confidence interval; AHEI, Alternate Healthy Eating Index; HEI, Healthy Eating Index; aMED, alternate Mediterranean Diet score; MUFA, monounsaturated fatty acids; PUFA, polyunsaturated fatty acids.