Association analysis of the nutritional status and related factors in patients with Parkinson's disease

Abstract

Objective To investigate the association between the nutritional status and related factors in patients with Parkinson's disease (PD). Methods Seventy-two patients with PD (PD group) and 71 age-and sex-matched healthy controls (control group) were enrolled in this study from September 2014 to November 2017 at the First Affiliated Hospital of Sun Yat-sen University. Their serum nutritional indices, including serum albumin, prealbumin, transferrin, free fatty acid and retinol conjugated protein, were collected. The PD participants were interviewed and assessed using motor and non-motor scales, including Hoehn and Yahr stage, Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Questionnaire for Parkinson's Disease (NMSS), Mini-Mental State Examination (MMSE), Unified Dyskinesia Rating Scale (UDysRS) and 39-item Parkinson's Disease Questionnaire (PDQ-39). Their medication dosage was indicated by daily levodopa equivalent doses (LEDD). Body mass index (BMI) was used to determine their nutritional status, with abnormal nutritional status defined as BMI lower than 20 kg/m2. Results Levels of serum albumin (41.60 (40.28,43.98) g/L vs 44.00 (42.30, 46.20) g/L, Z=4.500, P<0.01), transferrin ((2.32±0.34) g/L vs (2.51±0.34) g/L, t=-3.305, P=0.001), and free fatty acid (418.00 (289.75, 637.25) μmol/L vs 547.00 (386.00, 699.00) μmol/L, Z=2.079, P=0.038) of the PD group were significantly lower than those of the control group. There was a significant negative correlation between serum albumin and MDS-UPDRS-Ⅱscore (r=-0.254, P=0.031), MDS-UPDRS-Ⅳ score (r=-0.256, P=0.030), years of dyskinesia (r=-0.240, P=0.043), years of motor fluctuation (r=-0.304, P=0.009) and LEDDs (r=-0.321, P=0.006). Disease duration was negatively correlated with serum albumin (r=-0.285, P=0.015) and transferrin (r=-0.275, P=0.019), and age (r=-0.252, P=0.032) was negatively correlated with prealbumin. The forward binary Logistic regression model indicated that abnormal nutritional status was closely associated with rigidity (OR=1.171, 95%CI 1.013-1.354, P=0.032), akinesia (OR=1.070, 95%CI 1.000-1.144, P=0.048), UDysRS score (OR=1.051, 95%CI 1.004-1.099, P=0.032), MDS-UPDRS-Ⅳ score (OR=1.177, 95%CI 1.018-1.360, P=0.027) and MMSE score (OR=0.821, 95%CI 0.678-0.994, P=0.043), but not correlated with tremor and axial symptoms. Compared with PD patients with abnormal nutritional status, PD patients with normal nutritional status had higher MMSE scores (28.00 (27.00, 29.00) vs 28.00 (25.00, 28.00), Z=-2.060, P=0.039), lower rigidity (9.60±3.83 vs 12.00±4.29, t=-2.264, P=0.027), akinesia (19.98±8.00 vs 24.42±8.06, t=-2.071, P=0.042) and MDS-UPDRS-Ⅳ scores (8.00 (5.00, 11.00) vs 10.00 (9.00, 13.00), Z=2.642, P=0.008). Conclusions PD patients tend to have a lower serum nutritional indices. PD patients with lower levels of serum nutritional indices are characterized by more severe motor complication, longer disease duration, older age and higher LEDD. PD patients with abnormal nutritional status have worse cognition and more severe motor symptoms (rigidity, akinesia and motor complication). Key words: Parkinson disease; Nutritional status; Factor analysis, statistical