Healthy Diet, Exercise Linked With Reduced Mortality Risk in Parkinson Disease

Greater diet quality and physical activity levels were associated with reduced risk of all-cause mortality among patients with Parkinson disease (PD), according to study findings published recently in JAMA Network Open.

As the fastest growing neurological disorder worldwide in terms of prevalence, PD development has been previously linked with lifestyle behaviors such as diet and exercise. However, the impact of these factors on long-term disease survival has remained unknown.

“Despite improvements in the clinical management of the motor symptoms of PD, there is little evidence that current treatments slow the progressive neuronal loss. Consensus guidelines on complementary, disease-modifying lifestyle behaviors are lacking, which could partly be attributed to insufficient evidence from prospective studies and randomized clinical trials,” researchers noted.

They conducted a population-based cohort study to assess the association of prediagnosis and postdiagnosis overall diet quality, assessed by the Alternative Healthy Eating Index (AHEI), and physical activity, measured via metabolic equivalent task (MET) hours per week, with all-cause mortality among patients with PD.

Participant data was derived from 2 large US cohorts, in which male patients were from the Health Professionals Follow-up Study (1986 to 2012) and female participants from the Nurses’ Health Study (1984 to 2012). Patients who were diagnosed with PD and had complete baseline dietary assessment data were included in the analysis. Data were analyzed from January 2021 to February 2022.

“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,” explained the study authors.

A total of 1251 individuals with PD (median [IQR] age at diagnosis, 73.4 [67.5-78.7] years; 52.1% men) were included in the analysis, of which 942 participants died during the 32 to 34 years of follow-up.

Compared with patients of the lowest AHEI quartile, indicating poor diet quality, those of the highest AHEI quartile were associated with a 31% (adjusted HR [aHR], 0.69; 95% CI, 0.56- 0.85; P for trend = .002) and 43% reduced mortality risk (aHR, 0.57; 95% CI, 0.42- 0.78; P for trend < .001) for prediagnosis and postdiagnosis analyses, respectively.

Similar results were shown when comparing patients of the lowest quartile of cumulative mean MET hours per week vs the highest quartile, with those reporting greater physical activity levels exhibiting a 29% (aHR, 0.71; 95% CI, 0.57-0.87; P for trend = .004) and 53% reduced mortality risk (aHR, 0.47; 95% CI, 0.35-0.63; P for trend < .001) for prediagnosis and postdiagnosis analyses, respectively.

Moreover, 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). For the joint analyses of diet quality and physical activity before and after the PD diagnosis, the adjusted HRs were 0.51 (95% CI, 0.36-0.73) and 0.35 (95% CI, 0.23-0.52), respectively, for individuals in the highest vs lowest tertiles for both variables.

Researchers said that as PD-specific deaths were not confirmed by neurologists, results should be viewed with caution. Participants were also predominantly of White race and had relatively higher socioeconomic status, which may limit the generalizability of the results to other populations.

“Consuming a high diet quality and engaging in physical activity or exercise could be targets for improved PD outcome,” concluded researchers. “Reverse causation cannot be totally excluded, and the results need to be interpreted with caution.”

Reference

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