Diet pattern and prodromal features of Parkinson disease

Abstract

Objective: To assess the relationship between diet pattern and prodromal Parkinson disease (PD) features.

Methods: These analyses include 47,679 participants from the Nurses' Health Study and the Health Professionals Follow-up Study. Since 1986, both cohorts have collected dietary information every 4 years and calculated scores for adherence to different diet patterns, including the alternate Mediterranean diet (aMED) and the Alternative Healthy Eating Index (AHEI). In 2012, participants responded to questions regarding constipation and probable REM sleep behavior disorder. For a subset of 17,400 respondents to the 2012 questionnaire, 5 additional prodromal features of PD were assessed in 2014 to 2015. We used multinomial logistic regression to estimate the association between baseline (1986) diet pattern score quintiles and number of prodromal features (0, 1, 2, or ≥3) in 2012 to 2015. Additional analyses investigated the association between long-term adherence to these dietary patterns over 20 years and prodromal features suggestive of PD.

Results: In a comparison of extreme aMED diet quintiles, the odds ratio for ≥3 vs 0 features was 0.82 (95% confidence interval [CI] 0.68-1.00, false discovery rate [FDR]-adjusted p trend = 0.03) at baseline and 0.67 (95% CI 0.54-0.83, FDR-p trend < 0.001) for long-term diet; results were equally strong for the association with AHEI scores. Higher adherence to these diets was inversely associated with individual features, including constipation, excessive daytime sleepiness, and depression.

Conclusions: The inverse association between these diet patterns and prodromal PD features is consistent with previous findings and suggests that adherence to a healthy diet may reduce the occurrence of nonmotor symptoms that often precede PD diagnosis.

© 2020 American Academy of Neurology.

Figures

Figure 1. Diet pattern association with ≥3 vs 0 prodromal features at each diet assessment between 1986 and 2006

Multivariable-adjusted pooled odds ratios for ≥3 vs 0 prodromal features comparing extreme quintiles of diet score at each time of diet assessment between 1986 and 2006 and the mean diet score for first 2 assessments (1986, 1990) and last 2 assessments (2002, 2006) for both alternate Mediterranean diet (aMED) and Alternative Healthy Eating Index (AHEI) dietary patterns. Models are adjusted for age (years) and cohort- and questionnaire cycle–specific quintiles of caffeine intake, energy intake, and physical activity, as well as smoking pack-year and body mass index categories.

Figure 2. Association with each prodromal feature comparing extreme quintiles of adherence to aMED diet pattern

Cohort-specific and pooled multivariable-adjusted odds ratios for each of the 7 prodromal features comparing each the extreme quintiles of alternate Mediterranean diet (aMED) adherence at baseline and for cumulative average diet between 1986 and 2006. Models are adjusted for age in years at baseline and cohort-specific quintiles of caffeine intake, caloric intake, and physical activity, as well as smoking pack-year categories and body mass index categories. (A) Health Professionals Follow-up Study (HPFS), (B) Nurses' Health Study (NHS), and (C) pooled cohort. pRBD= probable REM sleep behavior disorder. aStatistically significant heterogeneity across cohorts. bMarginally statistically significant heterogeneity across cohort.

Figure 3. Association with each prodromal feature comparing extreme quintiles of adherence to the AHEI diet pattern

Cohort-specific and pooled multivariable-adjusted ORs for each of the 7 prodromal features comparing the extreme quintiles of Alternative Healthy Eating Index (AHEI) adherence at baseline and for cumulative average diet between 1986 and 2006. Models are adjusted for age in years at baseline, cohort-specific quintile of caffeine intake, caloric intake, and physical activity, as well as smoking pack-year categories and body mass index categories. (A) Health Professionals Follow-up Study (HPFS), (B) Nurses' Health Study (NHS), and (C) pooled cohort. pRBD= probable REM sleep behavior disorder. bMarginally statistically significant heterogeneity across cohort.