JAMA Netw Open: Healthy eating and participating in physical activity or exercise can be used to improve PD outcomes

Lifestyle behaviors, including diet and physical activity, are associated with the risk of developing Parkinson's disease (PD), the second most common neurodegenerative disease, for example, better dietary quality and higher levels of physical activity are associated
with a lower risk of developing PD and prodromal symptoms, as assessed by the Alternative Healthy Eating Index (AHEI) and Alternative Mediterranean Diet (aMED) scores.
However, little is known about their long-term role in PD survival
.
Few prospective studies evaluated the combined outcomes of diet and physical activity associated with all-cause mortality, and none focused specifically on people with
PD.
Despite improvements in the clinical management of PD motor symptoms, there is little evidence that current treatments slow progressive neuronal loss
.
The lack of consensus guidelines on complementary, disease-modifying lifestyle behaviours may be due in part to insufficient
evidence from prospective studies and randomised clinical trials.

Gao Xiang's team at the School of Public Health of Fudan University published an important research result
in the journal JAMA Network Open.
To examine the relationship
between overall diet quality and physical activity before and after diagnosis and all-cause mortality in patients with PD from the two cohorts of the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS) in the United States.

This population-based cohort study analyzed male participants in the 1986-2012 Health Professionals Follow-up study and female participants
in the 1984-2012 Nurses' Health study.
Participants
with confirmed PD and complete baseline dietary assessment data were included.
The data analysis period is from January 2021 to February 2022
.
Pre-diagnostic diet quality assessed by the Alternative Healthy Eating Index (AHEI) and physical activity assessed by weekly metabolic equivalent task (MET) hours reported by questionnaires are the main concerns of reducing inverse causality exposure
.
The primary outcome was mortality
at follow-up to 2018.
The Cox proportional hazards regression model was used to estimate the association between diet and physical activity and mortality, respectively and in combination, and adjusted for
age, total energy intake, caffeine intake, and other lifestyle risk factors.

Among the 1251 PD patients, 652 (52.
1%) were male, and the median age was 73.
4 (67.
5 ~ 78.
7) years
.
During the 32~34 year follow-up period, 942 participants died
.

1.
In pre-diagnostic analysis and post-diagnosis analysis, the adjusted risk ratios (HR) comparing the highest and lowest AHEI quartiles were 0.
69 (95% CI, 0.
56 ~ 0.
85) and 0.
57 (95% CI, 0.
42 ~ 0.
78),
respectively.

Table 2.
According to AHEI, the association between diet quality and mortality risk in patients with Parkinson's disease

2.
Similar results were obtained in the pre-diagnostic analysis, the weekly cumulative average MET hours (hazard ratio, 0.
71; 95% CI, 0.
57 ~ 0.
87) and post-diagnostic analysis (risk ratio, 0.
47; 95% confidence interval, 0.
35 to -0.
63).

Negatively associated with PD-specific mortality (AHEI: hazard ratio after diagnosis, 0.
52 [95% CI, 0.
33 ~ 0.
80]; Post-diagnostic physical activity: hazard ratio, 0.
37 [95% CI, 0.
25 ~ 0.
55]).

Table 3.
Association between physical activity and mortality risk in Parkinson's disease patients calculated based on MET hours per week

3.
In a combined analysis of diet quality and physical activity prior to PD diagnosis, individuals with both variables in the highest third compared to those in the lowest third had an adjusted HR of 0.
51 (95% CI, 0.
36-0.
73).

The HR for dietary quality and physical activity after diagnosis was 0.
35 (95% CI, 0.
23 ~ 0.
52).

Table 4.
A combined analysis of diet quality and physical activity on the risk of death in patients with Parkinson's disease

This cohort study showed that better diet quality and higher levels of physical activity were inversely associated
with a risk of death in both men and women with PD.
A high-quality diet and participation in physical activity or exercise may be the goals of
improving PD outcomes.
Reverse causality cannot be completely ruled out, and the results
need to be interpreted with caution.

Original source

Zhang X, Molsberry SA, Schwarzschild MA, Ascherio A, Gao X.
Association of Diet and Physical Activity With All-Cause Mortality Among Adults With Parkinson Disease.
JAMA Netw Open.
2022; 5(8):e2227738.
doi:10.
1001/jamanetworkopen.
2022.
27738