Major Nutritional Issues in the Management of Parkinson's Disease
Identifieur interne : 002F12 ( Main/Merge ); précédent : 002F11; suivant : 002F13Major Nutritional Issues in the Management of Parkinson's Disease
Auteurs : Michela Barichella [Italie] ; Emanuele Cereda [Italie] ; Gianni Pezzoli [Italie]Source :
- Movement disorders [ 0885-3185 ] ; 2009.
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- Pascal (Inist)
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Abstract
As with other neurodegenerative diseases, neurologic and nutritional elements may interact affecting each other in Parkinson's disease (PD). However, the long-term effects of such interactions on prognosis and outcome have not been given much attention and are poorly addressed by current research. Factors contributing to the clinical conditions of patients with PD are not only the basic features of PD, progression of disease, and the therapeutic approach but also fiber and nutrient intakes (in terms of both energy and protein content), fluid and micronutrient balance, and pharmaconutrient interactions (protein and levodopa). During the course of PD nutritional requirements frequently change. Accordingly, both body weight gain and loss may occur and, despite controversy, it seems that both changes in energy expenditure and food intake contribute. Nonmotor symptoms play a significant role and dysphagia may be responsible for the impairment of nutritional status and fluid balance. Constipation, gastroparesis, and gastro-oesophageal reflux significantly affect quality of life. Finally, any micronutrient deficiencies should be taken into account. Nutritional assessments should be performed routinely. Optimization of pharmacologic treatment for both motor and nonmotor symptoms is essential, but nutritional interventions and counseling could and should also be planned with regard to nutritional balance designed to prevent weight loss or gain; optimization of levodopa pharmacokinetics and avoidance of interaction with proteins; improvement in gastrointestinal dysfunction (e.g., dysphagia and constipation); prevention and treatment of nutritional deficiencies (micro-nutrients or vitamins). A balanced Mediterranean-like dietary regimen should be recommended before the introduction of levodopa; afterward, patients with advanced disease may benefit considerably from protein redistribution and low-protein regimens.
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aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Milano</wicri:noRegion></affiliation></author><author><name sortKey="Cereda, Emanuele" sort="Cereda, Emanuele" uniqKey="Cereda E" first="Emanuele" last="Cereda">Emanuele Cereda</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Parkinson Institute, Instituti Clinici di Perfezionamento</s1><s2>Milano</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Milano</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>International Center for the Assessment of Nutritional Status (ICANS), University of Milan</s1><s2>Milan</s2><s3>ITA</s3><sZ>2 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Pezzoli, Gianni" sort="Pezzoli, Gianni" uniqKey="Pezzoli G" first="Gianni" last="Pezzoli">Gianni Pezzoli</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Parkinson Institute, Instituti Clinici di Perfezionamento</s1><s2>Milano</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Milano</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Body weight</term><term>Clinical management</term><term>Dysfunction</term><term>Gastrointestinal</term><term>Levodopa</term><term>Nervous system diseases</term><term>Parkinson disease</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Conduite à tenir</term><term>Gastrointestinal</term><term>Trouble fonctionnel</term><term>Poids corporel</term><term>Lévodopa</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">As with other neurodegenerative diseases, neurologic and nutritional elements may interact affecting each other in Parkinson's disease (PD). However, the long-term effects of such interactions on prognosis and outcome have not been given much attention and are poorly addressed by current research. Factors contributing to the clinical conditions of patients with PD are not only the basic features of PD, progression of disease, and the therapeutic approach but also fiber and nutrient intakes (in terms of both energy and protein content), fluid and micronutrient balance, and pharmaconutrient interactions (protein and levodopa). During the course of PD nutritional requirements frequently change. Accordingly, both body weight gain and loss may occur and, despite controversy, it seems that both changes in energy expenditure and food intake contribute. Nonmotor symptoms play a significant role and dysphagia may be responsible for the impairment of nutritional status and fluid balance. Constipation, gastroparesis, and gastro-oesophageal reflux significantly affect quality of life. Finally, any micronutrient deficiencies should be taken into account. Nutritional assessments should be performed routinely. Optimization of pharmacologic treatment for both motor and nonmotor symptoms is essential, but nutritional interventions and counseling could and should also be planned with regard to nutritional balance designed to prevent weight loss or gain; optimization of levodopa pharmacokinetics and avoidance of interaction with proteins; improvement in gastrointestinal dysfunction (e.g., dysphagia and constipation); prevention and treatment of nutritional deficiencies (micro-nutrients or vitamins). A balanced Mediterranean-like dietary regimen should be recommended before the introduction of levodopa; afterward, patients with advanced disease may benefit considerably from protein redistribution and low-protein regimens.</div></front></TEI><affiliations><list><country><li>Italie</li></country><region><li>Lombardie</li></region><settlement><li>Milan</li></settlement></list><tree><country name="Italie"><noRegion><name sortKey="Barichella, Michela" sort="Barichella, Michela" uniqKey="Barichella M" first="Michela" last="Barichella">Michela Barichella</name></noRegion><name sortKey="Cereda, Emanuele" sort="Cereda, Emanuele" uniqKey="Cereda E" first="Emanuele" last="Cereda">Emanuele Cereda</name><name sortKey="Cereda, Emanuele" sort="Cereda, Emanuele" uniqKey="Cereda E" first="Emanuele" last="Cereda">Emanuele Cereda</name><name sortKey="Pezzoli, Gianni" sort="Pezzoli, Gianni" uniqKey="Pezzoli G" first="Gianni" last="Pezzoli">Gianni Pezzoli</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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