Resting energy expenditure in Parkinson’s disease patients under dopaminergic treatment

ABSTRACT

Background: Weight homeostasis is complex in Parkinson’s disease (PD) and body weight changes substantially throughout the course of the disease. We designed a case–control study to (i) investigate whether PD is associated with changes in resting energy expenditure (REE), (ii) to assess how accurately REE could be predicted for individuals with PD utilizing the equations constructed for healthy individuals, and (iii) to eventually construct a new equation.

Materials & Methods: Measured REE (mREE) was compared between 122 PD patients and 122 gender and body mass index (BMI)-matched controls. The accuracy of estimated REE by 5 common equations (Harris/Benedict-1919, Roza/Shizgal-1984, Mifflin St. Jeor, WHO/FAO and aggregate formula) was investigated in PD using Bland–Altman analysis and reported as the frequency of accurate predictions (±10%). Concordance correlation coefficients (CCC) were also calculated. Then, we regressed a new REE equation – using gender, age, weight, height and Hoehn-Yahr stage – and validated it in an independent sample (N = 100).

Results: No significant difference in mREE was recorded between the whole PD sample and healthy controls. However, mREE was increased in patients with BMI ≥ 30 kg/m² and Hoehn-Yahr stage ≥ 3. Limited accuracy was present in the available REE equations (accurate prediction [±10%] frequency, <60% for all). For the new equation, the proportion of accurate prediction was 67.0% (overestimation, 24.0%) and CCC was 0.77.

Conclusion: PD patients are not commonly characterized by an increase in REE. This is limited to patients suffering from obesity and more severe disease. Common REE equations appear to be inaccurate. The new predictive equation proposed in this study provided better REE estimates.

KEYWORDS:

• Parkinson’s disease
• resting energy expenditure
• basal metabolic rate
• predictive equation
• indirect calorimetry
• levodopa
• dopaminergic therapy
• body weight
• weight homeostasis

Acknowledgements

M. Barichella, E. Cereda, S.A. Faierman, G. Pezzoli equally contributed to the conception and design of the research; G. Piuri contributed to the design of the research; C. Bolliri, E. Cassani, S. Caronni, E. Cereda, O.V. Donnarumma, S.A. Faierman, V. Ferri, G. Pinelli, G. Piuri, C. Pusani, E. Vaccarella contributed to the acquisition and analysis of the data; M. Barichella, E. Cereda, G. Piuri, G. Pezzoli contributed to the interpretation of the data; E. Cereda drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript. The authors wish to thank Dr Jennifer S Hartwig for assistance in editing the manuscript.

Disclosure statements

Dr Cereda reports the following conflicts of interest (not for the present study):

• Consulting or Advisory Role: Nutricia, Akern S.r.l., Wunder Sa.Bi. s.r.l., Fondazione Grigioni per il Morbo di Parkinson.

• Research Funding: Fondazione Grigioni per il Morbo di Parkinson, ESPEN.

• Speaker’s Honoraria: Nutricia, Nestlè Health Science, Eli Lilly S.p.A.

All the other Authors state: None declared.

Data availability statement

Data described in the manuscript, code book, and analytic code will not be made available because a specific note was not included in the informed consent at the time of protocol approval and recruitment. Therefore, data sharing was not approved by the Ethics Committees.

Additional information

Funding

This work was supported by the ‘Fondazione Grigioni per il Morbo di Parkinson’ and ‘Brain and Malnutrition in Chronic Diseases Association-ONLUS ’.