Determinants of Low Body Mass Index in Patients with Parkinson’s Disease: A Multicenter Case-Control Study

Article type: Research Article

Authors: Suzuki, Keisuke^{a; *} | Okuma, Yasuyuki^b | Uchiyama, Tomoyuki^c | Miyamoto, Masayuki^d | Haruyama, Yasuo^e | Kobashi, Gen^e | Sakakibara, Ryuji^f | Shimo, Yasushi^g | Hatano, Taku^g | Hattori, Nobutaka^h | Yamamoto, Toshimasa^h | Hirano, Shigekiⁱ | Yamamoto, Tatsuyaⁱ | Kuwabara, Satoshiⁱ | Kaji, Yoshiaki^a | Fujita, Hiroaki^a | Kadowaki, Taro^a | Hirata, Koichi^a

Affiliations: [a] Department of Neurology, Dokkyo Medical University, Tochigi, Japan | [b] Department of Neurology, Juntendo University Shizuoka Hospital, Shizuoka, Japan | [c] Department of Neurology, International University of Health and Welfare, Narita, Japan | [d] Department of Clinical Medicine for Nursing, Dokkyo Medical University School of Nursing, Tochigi, Japan | [e] Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan | [f] Department of Internal Medicine, Neurology Division, Sakura Medical Center, Toho University, Tokyo, Japan | [g] Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan | [h] Department of Neurology, Saitama Medical University, Saitama, Japan | [i] Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan

Correspondence: [*] Correspondence to: Keisuke Suzuki, MD, PhD, Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan. Tel.: +81 282 86 1111; Fax: +81 282 86 5884; E-mail: keisuke@dokkyomed.ac.jp.

Abstract: Background:In Parkinson’s disease (PD) patients, the factors related to weight loss remain unclear. Objective:To investigate determinants of low body mass index (BMI) in PD patients. Methods:We identified factors associated with low BMI in PD patients in a multicenter case-control study. A total of 435 PD patients and 401 controls were included. Results:The mean BMI was significantly lower in PD patients than in controls (22.0±3.4 kg/m2 vs. 25.4±4.3 kg/m2), with an adjusted odds ratio (AOR) of 3.072 (95% CI, 2.103–4.488; p < 0.001) for low BMI (<22 kg/m2) in PD. Compared to the high-BMI PD group (>22 kg/m2), the low-BMI PD group (<22 kg/m2) had more women; a longer disease duration; higher revised Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) II and IV scores; an increased levodopa equivalent dose (LED); and increased constipation, visual hallucination, dysphagia, dyskinesia and wearing off rates. There were no between-group differences in depression, anhedonia, apathy, sleep problems and daytime sleepiness. Multivariable analysis showed that visual hallucination (AOR, 2.408; 95% CI, 1.074–5.399; p = 0.033) and the MDS-UPDRS IV (AOR, 1.155; 95% CI, 1.058–1.260; p = 0.001) contributed to low BMI after controlling for clinical factors. In a second model, visual hallucination (AOR, 2.481; 95% CI, 1.104–5.576; p = 0.028) and dyskinesia (sum of the MDS-UPDRS 4.3–4.6) (AOR, 1.319; 95% CI, 1.043–1.668; p = 0.021) significantly contributed to low BMI. Conclusion:PD patients were 3 times more likely than healthy controls to have a low BMI. Motor complications, particularly dyskinesia, and visual hallucination were significantly associated with low BMI in PD patients.

Keywords: Parkinson’s disease, body mass index, visual hallucination, dyskinesia, motor complication

DOI: 10.3233/JPD-191741

Journal: Journal of Parkinson's Disease, vol. 10, no. 1, pp. 213-221, 2020