Improved Patient-Reported Outcomes Shown With Mediterranean Diet in Parkinson Disease

The Mediterranean (MEDI) and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets were associated with fewer patient-reported symptoms of Parkinson disease (PD) over time, according to study findings published in Nutrients.

MEDI and MIND are 2 popular diets in neurology due to their historical use in the treatment of Alzheimer disease and established rating scales. These diets have additionally been associated with a reduced risk of PD diagnosis. However, researchers said that studies evaluating their impact on disease progression in patients already diagnosed with PD are lacking.

There are differences between the 2 diets, they note, in which the MIND diet rewards higher intake of green leafy vegetables, berries, and beans only, while penalizing higher intake of cheese, butter, and margarine. Conversely, the MEDI diet rewards higher consumption of all vegetables, fruit, and legumes without specification for green leafy vegetables, berries, or beans, and minimizes most dairy while allowing cheese.

“There are enough differences between these diets that, prior to disease onset, there is a need for modification studies to confirm prospectively if adherence to the MEDI and MIND diets correlates with better patient-reported outcomes (PROs) over time in population-based studies,” said the study authors.

A cross-sectional analysis of participants enrolled in the ongoing Modifiable Variables in Parkinsonism (MVP) Study (NCT02194816) was conducted to investigate whether MIND and MEDI scores were associated with improved PROs in patients with PD, as well as to determine which questions on the MEDI and MIND scales were more strongly correlated with PD symptom severity.

The PROs in Parkinson’s Disease (PRO-PD), a subjective scale of 33 commmon PD symptoms, was utilized for the primary outcome measure of PD severity in the MVP study. The 15-question MIND and validated 14-question MEDI diet questions were inserted into the diet portion of the larger MVP Study. Surveys reported between the dates of January 1, 2020 and July 1, 2022 were included for analysis.

“Individual items of each diet were assessed for association with PRO-PD score, and significant associations were used in a restricted analysis for association with PRO-PD score.”

A total of 1205 participants were included in the analysis, with ages ranging from 36 to 90 with an average age of 66.4 years. The cohort was primarily female, Caucasian, had an annual income greater than $60,000, and a higher education degree.

The average Hoehn and Yahr (H&Y) scale score was 1.9, time elapsed since PD diagnosis was 7.2 years, and the PRO-PD score was 844, with a nonmotor PRO-PD score of 422 and a motor PRO-PD score of 301. The average MEDI score was 7.8 and the MIND diet was 9.8.

After adjusting for age, gender, income, and years since diagnosis, for each 1-point increase in the MIND and MEDI scores, total PRO-PD scores were 52.9 points lower (95% CI, −66.4 to −39.4; P < .001) and 25.6 points lower (95% CI, −37.2 to −14.0; P < .001), respectively.

Nonmotor PRO-PD subscore showed a decrease of 13.0 (95% CI, −19.1 to −6.94; P < .001) per point increase in MEDI score and a decrease of 27.3 (95% CI, −34.4 to −20.2; P < .001) points per point increase in MIND score. Motor PRO-PD sub-score had a decrease of 9.78 (95% CI, −14.3 to −5.23; P < .001) points per point increase in MEDI score and a decrease of 19.8 (95% CI, −25.1 to −14.5; P < .001) points per point increase in MIND score.

When regression coefficients were compared, they showed that MIND had a significantly reduced slope compared with MEDI for total PRO-PD (P < .001), nonmotor PRO-PD (P < .001), and motor (P = .007) scores.

“This study suggests MIND and MEDI scores are associated with fewer patient-reported symptoms over time, with each MIND point being twice as strong as a MEDI point in reducing symptom severity,” concluded the study authors.

“Future dietary intervention trials should consider the MIND diet as a therapeutic strategy for improving long-term PD outcomes.”

Reference

Fox DJ, Park SJ, Mischley LK. Comparison of associations between MIND and Mediterranean diet scores with patient-reported outcomes in Parkinson’s disease. Nutrients. 2022 Dec 6;14(23):5185. doi:10.3390/nu14235185