Levodopa dose linked to malnutrition risk in Parkinson’s disease

By Eleanor McDermid, Senior medwireNews Reporter

The malnutrition often seen in patients with Parkinson’s disease (PD) could be partly an effect of levodopa medication, research suggests.

Alice Laudisio (Campus Bio-Medico University, Rome, Italy) and colleagues found that the presence of malnutrition risk in patients with PD, based on a Mini Nutritional Assessment (MNA) score of 23.5 or lower, was significantly associated with the levodopa equivalent daily dose (LEDD).

However, it was not related to dose of dopamine agonists, they report in Movement Disorders.

Of the 75 patients in the study, 35% were at risk of malnutrition. These patients were taking an average LEDD of 11.3 mg/kg, compared with 8.4 mg/kg among those not at risk. They also had lower levels of total serum proteins and higher Unified Parkinson's Disease Rating Scale scores (UPDRS; 57 vs 43).

The researchers suggest that the association between malnutrition and the LEDD might be an effect of dyskinesia caused by levodopa medication, or the need to take the drug several times daily in fasting conditions. Or malnutrition could result from a direct effect of levodopa on fat metabolism, skeletal muscle glucose uptake or eating behaviour, they speculate.

“Alternatively, patients taking higher [levodopa] dosages may have more advanced disease, possibly because of longer survival, thus having poorer nutritional status”, they say, although they note that the association remained significant after accounting for comorbidities.

A higher LEDD remained significantly associated with malnutrition risk after accounting for variables including age, gender and diagnosis of chronic pulmonary disease, as did a higher UPDRS score.

Conversely, malnutrition was not associated with dose of dopamine agonists, which have in fact been linked to weight gain and even compulsive eating.

“Further dedicated studies should assess whether use of dopamine agonists might prevent malnutrition, or at least improve nutritional status, in patients with Parkinson's disease”, conclude the researchers.

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