British Journal of Nutrition

Full Papers

Dietary Surveys and Nutritional Epidemiology

Nutritional risk and gastrointestinal dysautonomia symptoms in Parkinson's disease outpatients hospitalised on a scheduled basis

Michela Barichellaa1, Emanuele Ceredaa2 c1, Carmen Madioa1, Laura Iorioa1, Chiara Pusania1, Raffaella Cancelloa1, Riccardo Caccialanzaa2, Gianni Pezzolia1 and Erica Cassania1

a1 Parkinson Institute, Istituti Clinici di Perfezionamento (ICP), via Bignami 1, 20126 Milan, Italy

a2 Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy


Dysautonomia symptoms of nutritional interest may often occur in Parkinson's disease (PD), but the role played in affecting the risk of malnutrition still needs to be clarified. A total of 208 consecutive PD outpatients hospitalised on a scheduled basis were assessed for nutritional risk by the Malnutrition Universal Screening Tool. Presence of dysautonomia symptoms (dysphagia, sialorrhoea and constipation) was investigated using clinical rating scales. In our population, prevalence of nutritional risk was 17·2 (95 % CI 12·1, 24·0) % and relied mainly on unintentional weight loss. Sialorrhoea, dysphagia, dysphagia to liquids and constipation were observed in 10·6, 11·0, 14·4 and 59·6 % of the patients, respectively. Nutritional risk was independently associated with the number of dysautonomia symptoms (OR 1·39 (95 % CI 1·00, 1·96); P= 0·048) but not with single symptoms. An independent association was also found with the severity of motor symptoms (Hoehn–Yahr stage, OR 1·48 (95 % CI 1·00, 2·55); P= 0·049) and levodopa dose (OR 1·16 (95 % CI 1·04, 1·31) mg/kg per d; P= 0·009). Nutritional risk in PD outpatients appears to depend mainly on dysautonomic syndrome, disease severity and levodopa dosage. Implications for outcome deserve further investigation. The assessment of nutritional status and of gastrointestinal dysautonomia symptoms should be part of the routine work-up of a PD patient.

(Received May 18 2012)

(Revised September 20 2012)

(Accepted September 20 2012)

(Online publication December 11 2012)

Key Words:

  • Parkinson's disease;
  • Nutritional risk;
  • Outpatients;
  • Dysphagia;
  • Sialorrhoea;
  • Constipation


c1 Corresponding author: E. Cereda, fax +39 382 502801, email


  Abbreviations: MUST, Malnutrition Universal Screening Tool; PD, Parkinson's disease; WL, weight loss