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L'utilizzo degli alimenti speciali (AAN Hawaii 2011)

Use of special food for dietary therapy of Parkinson's disease

Objectives
to diagnose and treat dysphagia and constipation, to avoid malnutrition and improve levodopa absorption in Parkinson’s disease (PD)

Background
A complete nutritional status assessment is recommended as part of the multidisciplinary approach to PD.  Validated diagnostic scales for the early diagnosis and monitoring of dysphagia and constipation are available.

Methods
We assessed the nutritional status of 210 consecutive PD patients admitted to our  Institute from January to June 2010 (anthropometrics, structured nutritional history designed to detect postprandial OFF periods, biochemical markers and Malnutrition Universal Screening Tool – MUST) and screened them for dysphagia (SDQ scale)  and constipation (RomeIII criteria).  Patients underwent also a complete neurological work-up to assess PD status.  They were prescribed tailored dietary treatment: low-protein lunch, low-protein dietary regimen based on low-protein food and/or use of thickeners for fluid food and/or oral high-calorie, low-protein supplements (2Kcal/ml).

Results
Mean body mass index was 26.7±4.23kg/m2. 75% were taking levodopa (509.2± 221.5 mg) and were prescribed a low-protein lunch; 32% had postprandial motor blocks and were prescribed low-protein food.  MUST indicated moderate to severe malnutrition in 9.6% and  3.8% reported weight loss >10% in last six months; they were given high-calorie, low-protein supplements. 59% had constipation and were prescribed soluble fiber supplements.  Dysphagia was ruled out only in 42%; 28% had dysphagia for fluids and were prescribed thickeners; 11% had general dysphagia and was given a semi-solid dietary regimen.

Comments
Dietary treatment is required in many PD patients.  Protein redistribution and low-protein food promote levodopa absorption, ameliorating postprandial motor blocks.  Nutritional status assessment based on MUST and anthropometric measurements enables the correct use of oral supplements.  Dysphagia for solids and liquids is a common, dangerous and often undetected condition that can be managed by dietary measures.  

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