Low-Protein and Protein-Redistribution Diets for Parkinson's Disease Patients with Motor Fluctuations: A Systematic Review
Identifieur interne : 000976 ( PascalFrancis/Checkpoint ); précédent : 000975; suivant : 000977Low-Protein and Protein-Redistribution Diets for Parkinson's Disease Patients with Motor Fluctuations: A Systematic Review
Auteurs : Emanuele Cereda [Italie] ; Michela Barichella [Italie] ; Carlo Pedrolli [Italie] ; Gianni Pezzoli [Italie]Source :
- Movement disorders [ 0885-3185 ] ; 2010.
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Abstract
The American Academy of Neurology suggests advising the redistribution of daily protein meal content to every Parkinson's disease (PD) patient with motor fluctuations during levodopa treatment. However, no comprehensive evaluation of this complementary therapy has been performed. A systematic review of intervention studies investigating the neurologic outcome of low-protein (<0.8 g/kg of ideal weight/day) and protein-redistribution diets in patients with PD experiencing motor fluctuations during levodopa treatment. All studies (uncontrolled or randomized) investigating a low-protein and/or a protein-redistribution diet (LPD and PRD) and involving patients with PD with motor fluctuations were included, provided that sufficient information on dietary protein content and neurologic outcome measures was available. We identified 16 eligible studies, but they were markedly heterogeneous. There was not enough evidence to support the use of LPD. Response to PRD seemed very good. Acceptability appeared high upon introduction, but it seemed to progressively decrease over time. On average, PRD resulted in improved motor function, but also complications occurred. At the beginning, drop-outs were due to levodopa side effects rather than unsatisfactory benefits. Long-term adherence was more affected by changes in dietary habits than by diet-related side effects. Efficacy and benefits appeared to be higher when the intervention was proposed to subjects in the early stages of PD. PRD can be safely advised to fluctuating patients with PD, but those in whom benefits override the possible inconveniences still need to be identified. The long-term effects of PRD on nutritional status should be evaluated and true effectiveness in clinical practice should be reassessed, given the changes in levodopa formulations and the introduction of several adjuvants (levodopa degradation inhibitors and/or dopamine agonists).
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aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Milano</wicri:noRegion></affiliation></author><author><name sortKey="Pedrolli, Carlo" sort="Pedrolli, Carlo" uniqKey="Pedrolli C" first="Carlo" last="Pedrolli">Carlo Pedrolli</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Dietetic and Clinical Nutrition Unit, Trento Hospital</s1><s2>Trento</s2><s3>ITA</s3><sZ>3 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Trento</wicri:noRegion></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>Department of Neuroscience, Parkinson Institute, Istituti Clinici di Perfezionamento</s1><s2>Milano</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Milano</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno 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aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Milano</wicri:noRegion></affiliation></author><author><name sortKey="Barichella, Michela" sort="Barichella, Michela" uniqKey="Barichella M" first="Michela" last="Barichella">Michela Barichella</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neuroscience, Parkinson Institute, Istituti Clinici di Perfezionamento</s1><s2>Milano</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Milano</wicri:noRegion></affiliation></author><author><name sortKey="Pedrolli, Carlo" sort="Pedrolli, Carlo" uniqKey="Pedrolli C" first="Carlo" last="Pedrolli">Carlo Pedrolli</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Dietetic and Clinical Nutrition Unit, Trento Hospital</s1><s2>Trento</s2><s3>ITA</s3><sZ>3 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Trento</wicri:noRegion></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>Department of Neuroscience, Parkinson Institute, Istituti Clinici di Perfezionamento</s1><s2>Milano</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 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="2010">2010</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>Fluctuations</term><term>Human</term><term>Levodopa</term><term>Nervous system diseases</term><term>Parkinson disease</term><term>Protein S</term><term>Vitronectin</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Protéine S</term><term>Vitronectine</term><term>Homme</term><term>Fluctuation</term><term>Lévodopa</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The American Academy of Neurology suggests advising the redistribution of daily protein meal content to every Parkinson's disease (PD) patient with motor fluctuations during levodopa treatment. However, no comprehensive evaluation of this complementary therapy has been performed. A systematic review of intervention studies investigating the neurologic outcome of low-protein (<0.8 g/kg of ideal weight/day) and protein-redistribution diets in patients with PD experiencing motor fluctuations during levodopa treatment. All studies (uncontrolled or randomized) investigating a low-protein and/or a protein-redistribution diet (LPD and PRD) and involving patients with PD with motor fluctuations were included, provided that sufficient information on dietary protein content and neurologic outcome measures was available. We identified 16 eligible studies, but they were markedly heterogeneous. There was not enough evidence to support the use of LPD. Response to PRD seemed very good. Acceptability appeared high upon introduction, but it seemed to progressively decrease over time. On average, PRD resulted in improved motor function, but also complications occurred. At the beginning, drop-outs were due to levodopa side effects rather than unsatisfactory benefits. Long-term adherence was more affected by changes in dietary habits than by diet-related side effects. Efficacy and benefits appeared to be higher when the intervention was proposed to subjects in the early stages of PD. PRD can be safely advised to fluctuating patients with PD, but those in whom benefits override the possible inconveniences still need to be identified. The long-term effects of PRD on nutritional status should be evaluated and true effectiveness in clinical practice should be reassessed, given the changes in levodopa formulations and the introduction of several adjuvants (levodopa degradation inhibitors and/or dopamine agonists).</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0885-3185</s0></fA01><fA03 i2="1"><s0>Mov. disord.</s0></fA03><fA05><s2>25</s2></fA05><fA06><s2>13</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Low-Protein and Protein-Redistribution Diets for Parkinson's Disease Patients with Motor Fluctuations: A Systematic Review</s1></fA08><fA11 i1="01" i2="1"><s1>CEREDA (Emanuele)</s1></fA11><fA11 i1="02" i2="1"><s1>BARICHELLA (Michela)</s1></fA11><fA11 i1="03" i2="1"><s1>PEDROLLI (Carlo)</s1></fA11><fA11 i1="04" i2="1"><s1>PEZZOLI (Gianni)</s1></fA11><fA14 i1="01"><s1>Department of Neuroscience, Parkinson Institute, Istituti Clinici di Perfezionamento</s1><s2>Milano</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ></fA14><fA14 i1="02"><s1>Dietetic and Clinical Nutrition Unit, Trento Hospital</s1><s2>Trento</s2><s3>ITA</s3><sZ>3 aut.</sZ></fA14><fA20><s1>2021-2034</s1></fA20><fA21><s1>2010</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>20953</s2><s5>354000193258110040</s5></fA43><fA44><s0>0000</s0><s1>© 2010 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>43 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>10-0474322</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Movement disorders</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>The American Academy of Neurology suggests advising the redistribution of daily protein meal content to every Parkinson's disease (PD) patient with motor fluctuations during levodopa treatment. However, no comprehensive evaluation of this complementary therapy has been performed. A systematic review of intervention studies investigating the neurologic outcome of low-protein (<0.8 g/kg of ideal weight/day) and protein-redistribution diets in patients with PD experiencing motor fluctuations during levodopa treatment. All studies (uncontrolled or randomized) investigating a low-protein and/or a protein-redistribution diet (LPD and PRD) and involving patients with PD with motor fluctuations were included, provided that sufficient information on dietary protein content and neurologic outcome measures was available. We identified 16 eligible studies, but they were markedly heterogeneous. There was not enough evidence to support the use of LPD. Response to PRD seemed very good. Acceptability appeared high upon introduction, but it seemed to progressively decrease over time. On average, PRD resulted in improved motor function, but also complications occurred. At the beginning, drop-outs were due to levodopa side effects rather than unsatisfactory benefits. Long-term adherence was more affected by changes in dietary habits than by diet-related side effects. Efficacy and benefits appeared to be higher when the intervention was proposed to subjects in the early stages of PD. PRD can be safely advised to fluctuating patients with PD, but those in whom benefits override the possible inconveniences still need to be identified. 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