Brief Report
Impact of Overweight and Obesity on Functional and Clinical Outcomes of Early Parkinson's Disease

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Abstract

Objective

To determine whether being overweight or obese contributes to disease progression and functional status in Parkinson's disease (PD).

Design

Cohort study using data from the Parkinson Progression Markers Initiative (PPMI).

Setting and Participants

A total of 399 drug-naive patients with early PD were classified into normal weight (body mass index of 18.5–24.9, n = 139), overweight (25.0–29.9, n = 167), and obese (30.0 or more, n = 93) groups.

Methods

The primary outcome was the development of functional dependency. Functional dependency was defined as a Schwab and England score of less than 80% at any time point that remained throughout follow-up. The secondary outcomes were the changes in the Movement Disorders Society Unified Parkinson Disease Rating Scale motor score measured in the off-medication state and the Montreal Cognitive Assessment score across visits.

Results

Over a 5-year follow-up period, the incidence of functional dependency was higher in the obese group than in the normal weight group (P = .001). No difference was observed between the overweight and normal weight groups (P = .429). The multivariable Cox model confirmed that obesity, but not overweight, increased the risk of dependency (hazard ratio 2.63, 95% confidence interval 1.32–5.23, P = .006). The increase in the Movement Disorders Society Unified Parkinson Disease Rating Scale motor score was greater in the obesity (P < .001) and overweight (P = .004) groups than in the normal weight group. Changes in the Montreal Cognitive Assessment score did not differ among the groups (P = .978).

Conclusions and Implications

We found that obesity is related to an increased risk of functional dependency and rapid motor progression in patients with early PD. Although being overweight did not increase the risk of dependency, this condition was associated with rapid motor progression.

Section snippets

Patients

The PPMI study is an international, multicenter, cohort study that aimed to identify biomarkers of PD progression.9 In total, 423 drug-naïve participants with early PD were recruited from 33 sites in the United States, Europe, Australia, and Israel between 2010 and 2013. The methodology and details of the study assessments are available on the PPMI website (ppmi-info.org/). At enrollment, patients with PD were required to be 30 years or older at diagnosis; have 2 symptoms among bradykinesia,

Results

The baseline characteristics of each group are summarized in Table 1. A total of 307 patients completed 5 years of study follow-up (normal weight group, n = 109; overweight group, n = 136; and obese group, n = 62). The BMI of the normal, overweight, and obese groups at the 5-year follow-up was 23.0 ± 2.4, 26.9 ± 2.7, and 32.6 ± 4.0 kg/m2, respectively. Fourteen patients (10%) in the normal weight group, 22 (13%) in the overweight group, and 24 (26%) in the obese group developed functional

Discussion

We found that obesity is related to an increased risk of functional dependency and rapid motor progression in patients with early PD. Although being overweight did not increase the risk of dependency, this condition was associated with rapid motor progression. These conflicting results on functioning suggest that the progression of motor symptoms combined with increasing age makes obese patients with PD more vulnerable to functional decline. On the other hand, neither obesity nor overweight was

Conclusions and Implications

Our findings may highlight the importance of weight management in overweight and obese patients with early PD. Further studies are required to validate the negative impact of excess body weight on functional and clinical outcomes in the early stages of PD.

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    Parkinson's Progression Markers Initiative (PPMI), a public private partnership, is funded by the Michael J. Fox Foundation for Parkinson's Research and funding partners, including AbbVie, Avid, Biogen, Bristol-Myers Squibb, Covance, GE Healthcare, Genentech, GlaxoSmithKline, Lundbeck, Eli Lilly, Merck, Meso Scale Discovery, Pfizer, Piramal, Roche, Sanofi Genzyme, Servier, TEVA, and UCB.

    This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

    The authors declare no conflicts of interest.

    Author Contributions: Dr. R Kim designed the research, acquired and analyzed the data and drafted the manuscript. Dr. JS Jun designed the research, analyzed the data, and made critical revisions to the manuscript.

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