Association of Diet and Physical Activity With All-Cause Mortality Among Adults With Parkinson Disease

Abstract

IMPORTANCEGreater diet quality and physical activity level are associated with a lower risk of developing Parkinson disease (PD). However, information regarding the association between lifestyle behaviors and survival after PD diagnosis remains limited. OBJECTIVE To examine the association of prediagnosis and postdiagnosis overall diet quality and physical activity with all-cause mortality among individuals with PD. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study analyzed male participants in the Health Professionals Follow-up Study from 1986 to 2012 and female participants in the Nurses' Health Study from 1984 to 2012. Participants who were diagnosed with PD and had complete baseline dietary assessment data were included. Data were analyzed from January 2021 to February 2022.EXPOSURES Prediagnosis diet quality, assessed by the Alternative Healthy Eating Index (AHEI), and physical activity, assessed by metabolic equivalent task (MET) hours per week reported on questionnaires, were the primary exposures of interest to minimize reverse causation.MAIN OUTCOMES AND MEASURES Mortality, which was followed up until 2018, was the primary outcome. Cox proportional hazards regression models were used to estimate the association of diet and physical activity with mortality individually and jointly, and the models were adjusted for age, total energy intake, caffeine intake, and other lifestyle risk factors. RESULTSThe sample comprised 1251 individuals with PD, which included 652 men (52.1%) with a median (IQR) age at diagnosis of 73.4 (67.5-78.7) years. During the 32 to 34 years of follow-up, 942 participants died. The adjusted hazard ratio (HR) comparing the highest vs the lowest AHEI quartile was 0.69 (95% CI, 0.56-0.85) for prediagnosis analyses and 0.57 (95% CI, 0.42-0.78) for postdiagnosis analyses. Similar results were obtained for cumulative mean MET hours per week in the prediagnosis analyses (HR, 0.71; 95% CI, 0.57-0.87) and postdiagnosis analyses (HR, 0.47; 95% CI, 0.35-0.63). The inverse association persisted for PD-specific mortality (postdiagnosis AHEI: HR, 0.52 [95% CI, 0.33-0.80]; postdiagnosis physical activity: HR, 0.37 [95% CI, 0.25-0.55]). In the joint analyses of diet quality and physical activity before the PD diagnosis, the adjusted HR was 0.51 (95% CI, 0.36-0.73) for individuals in the highest vs lowest tertiles for both variables. The HR for diet quality and physical activity after the diagnosis was 0.35 (95% CI, 0.23-0.52). CONCLUSIONS AND RELEVANCEResults of this study showed that a healthy dietary pattern and an active lifestyle were associated with a lower rate of all-cause mortality among individuals with PD.Consuming a healthy diet and engaging in physical activity or exercise could be targeted to improve PD outcomes.

Recommending Healthy Diet and Exercise to Patients With Parkinson Disease—No Reason to Hold Back

“…However, the current study also suggests that a healthy diet and higher levels of recreational physical activity may accomplish what medical intervention thus far has not been able to do: slow the pace of progression; that is, if the factors associated with PD susceptibility and mortality were the same factors associated with disease severity over time. To this end, other studies have shown healthy food and/or physical activity to be inversely associated with, and thus possibly lead to, improved nonmotor features of PD, such as constipation, excessive daytime sleepiness, and depression, that greatly affect patients’ health-related quality of life .…”

“…Because PD has a long prodromal period, it is of utmost importance to find factors that may change the pathological cascade of events even before PD diagnosis and help slow neurodegenerative progression. The results of the cohort study by Zhang et al are promising and suggest that maintaining a healthy diet and higher levels of recreational physical activity is associated with improved patient outcome by preventing earlier mortality. These results not only reinforce the public health recommendations to engage in these behaviors for staying healthy in general but also add to a growing body of evidence of such behaviors providing protection against PD-related neurodegeneration specifically .…”

“…It has been shown that certain nutritional components, including protein redistribution diets, fiber, vitamin C, and caffeine, improve levodopa absorption and reduce PD motor fluctuation, whereas supplementation with vitamin B 12 , vitamin B 6 , and folic acid is gaining traction for attenuating hyperhomocysteinemia after levodopa initiation with its potential negative metabolic consequences. 6 Answering these questions and understanding the mechanisms behind the observed protective properties of diet and physical activity require large and well-conducted studies that will document and trace PD progression profiles in addition to prospective studies of mortality, such as the one by Zhang et al 1 The Nurses' Health Study and Health Professionals Follow-up Study are powerful in that they were designed as prospective cohorts with repeated collection of diet and physical activity data as well as other potential risk factors over an extended follow-up period. These studies also have an impressively complete follow-up record, given that health professionals are likely to understand the importance of and adhere to the demands of decades-long research.…”

“…Although Zhang et al point to the importance of a healthy lifestyle approach in PD care, they do not address whether such prohealth behaviors are beneficial in reducing PD-specific progression to disability and mortality or simply act as a better control for common comorbidities, such as hypertension, diabetes, and hypercholesterolemia, in older adults in general. That is, are the decreased mortality and other health benefits among patients with PD greater than those seen among age-matched individuals without PD?…”

“…It has been shown that certain nutritional components, including protein redistribution diets, fiber, vitamin C, and caffeine, improve levodopa absorption and reduce PD motor fluctuation, whereas supplementation with vitamin B 12 , vitamin B 6 , and folic acid is gaining traction for attenuating hyperhomocysteinemia after levodopa initiation with its potential negative metabolic consequences . Answering these questions and understanding the mechanisms behind the observed protective properties of diet and physical activity require large and well-conducted studies that will document and trace PD progression profiles in addition to prospective studies of mortality, such as the one by Zhang et al…”