Increased energy expenditure in Parkinson's disease.

Levi, Sonia; M, Cox; Lugon, Myriam; HODKINSON, MALCOLM; Tomkins, Andrew

doi:10.1136/bmj.301.6763.1256

Cited by 99 publications

(87 citation statements)

References 4 publications

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“…There are several reports of increased energy expenditure being the cause of weight loss [3,13,14]. Using the indirect calorimetric method, Broussolle et al [3] determined energy expenditure in 18 patients with PD, 6 healthy volunteers, and 6 patients with essential tremor.…”

Section: ■ Increased Energy Expenditurementioning

confidence: 99%

Weight loss in Parkinson’s disease

Kashihara

2006

J Neurol

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Weight loss is frequent in patients with Parkinson's disease (PD). Reduced energy intake and/or increased energy expenditure have been postulated as the cause. Dysphagia, anorexia, and gastrointestinal dysfunction may be possible causes of reduced energy intake; whereas, rigidity, tremor, and levodopa-induced dyskinesia may increase energy expenditure. Levodopa may enhance glucose metabolism resulting in enhanced energy expenditure. Depression, anti-parkinsonian drugs, and medical complications such as pneumonia and malignancies also may facilitate weight loss in PD. Combinations of various degrees of these factors, especially in advanced PD, may produce weight loss. Such weight loss is associated with malnutrition which may precipitate infection and decubitis; accelerate motor, behavioral, and autonomic impairment; consequently spoiling one's quality of life. Attention must be paid as well to motor symptoms to prevent or reverse weight loss in PD patients.

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Section: ■ Increased Energy Expenditurementioning

confidence: 99%

Weight loss in Parkinson’s disease

Kashihara

2006

J Neurol

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“…Weight loss may result from reduced energy intake or increased energy expenditure. Two recent studies have demonstrated that energy expenditure is markedly increased in some patients with Parkinson's disease (Levi et al, 1990;Brouselle et al, 1991) and it has been suggested that a raised metabolic rate is a feature of the disease, even in it's early stages, and that this might result in weight loss (Brouselle et al, 1991). Significantly increased energy expenditure might also result from sustained involuntary movements, both tremors and dyskinesias.…”

Section: Introductionmentioning

confidence: 96%

Increased prevalence of undernutrition in Parkinson's disease and its relationship to clinical disease parameters

Markus

Tomkins

Stern

1993

J Neural Transm Gen Sect

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An anthropometric study was performed in 95 subjects (53 male, 42 female) with Parkinson's disease. Weight, height, triceps and biceps skin-fold thicknesses, and mid-arm circumference were recorded. A high incidence of undernutrition was found (23.6% of males and 22.5% of females, as defined by recent British guidelines). A subgroup of severely disabled patients with Parkinson's disease had a significantly lower mean body mass index than a similarly disabled control group with chronic pyramidal upper motor neuron lesions (males 20.6 v 23.2 kg/m2 p < 0.05; females 20.6 v 26.6 kg/m2 p < 0.01), suggesting that the undernutrition is not due to chronic illness or immobility alone. Correlation between anthropometric indices and clinical features of disease demonstrated that the presence of moderate or severe dyskinetic movements was the clinical parameter most strongly related to undernutrition. The reduction in anthropometric indices was most marked for skin fold thickness (related to percentage body fat) and least for arm muscle circumference (related to lean body mass); therefore the weight loss seen in Parkinson's disease is primarily due to fat loss rather than muscle loss.

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“…Depression, which develops either as a reaction to the diagnosis of a chronic and progressive disease, or as a result of neurotransmitter deficiency in 25 -30% of patients (Richard et al, 1997), is often associated with reduced food intake. Furthermore, it has been suggested that the disease promotes underweightness by increasing basal metabolism, but the results of metabolic studies have not been univocal: basal metabolism measured by indirect calorimetry was increased in three studies (Levi et al, 1990;Broussolle et al, 1991;Markus et al, 1992), but not in a fourth (Toth et al, 1997), which actually found a reduction in daily energy consumption in PD patients as compared to healthy controls using the technique based on double labeled water ( 2 H 2 , 18 O). What is more, the majority of PD patients are elderly and physiological aging is associated with functional losses that promote undernutrition, such as the reduction in digestive secretions, in intestinal absorption and in protein synthesis and with other factors that reduce dietary intake, such as impairment of the senses of smell and taste, and of mastication due to loss of teeth and poorly functioning dental prostheses (Jensen et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Is underweightness still a major problem in Parkinson's disease patients?

et al. 2003

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Objective: To evaluate the current rate of underweightness amongst Parkinson's disease (PD) patients at an Italian referral centre. Design: Epidemiological study on consecutive patients presenting for the first time in a 16-month period. Setting: Nutritional service of PD referral centre in Milan, Italy. Subjects: Three-hundred and sixty-four PD patients diagnosed according to CAPIT criteria. Methods: Anthropometric assessments: BMI and waist-to-hip ratio; evaluation of therapeutic physical activity (h=week). Results: Three-hundred and sixty-four patients were included (180 female, 184 male), mean (s.d.) age 65.9 (8.9) y, mean (s.d.) duration of PD 10.6 (5.3) y; 134 patients (37%) were overweight and 92 (25%) were obese; 11 (3%) were underweight; 127 (35%) had normal BMI. No important differences in BMI according to sex and smoking status were observed. There was highly significant inverse correlation between duration of disease and BMI (P < 0.001): mean (s.d.) duration of disease was 9.7 (4.7) y in overweight þ obese patients, 11.1 (5.5) y in patients with normal BMI and 14.1 (7.2) y in underweight patients (P ¼ 0.0059). The waist-to-hip ratio was a cardiovascular risk factor in 47.7% of men and 73.8% of women. Mean (s.d.) therapeutic physical activity was 1.07 (1.59) h=week in overweight and obese patients vs 1.61 (2.04) h=week in patients with normal BMI (50.5% increase; P ¼ 0.03). Conclusions: At present underweightness is uncommon in PD patients in Italy; this may be due to the increase in the prevalence of overweightness in the Italian population and to modern antiparkinsonian therapy. Sponsorship: Fondazione Grigioni per il Morbo di Parkinson.

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Increased energy expenditure in Parkinson's disease.

Cited by 99 publications

References 4 publications

Weight loss in Parkinson’s disease

Weight loss in Parkinson’s disease

Increased prevalence of undernutrition in Parkinson's disease and its relationship to clinical disease parameters

Is underweightness still a major problem in Parkinson's disease patients?

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