We evaluated body weight changes in patients with Parkinson's disease (PD) after electrode implantation for deep brain stimulation (DBS) in the subthalamic nucleus (STN) in relation to clinical improvement. Thirty PD patients who received STN DBS were included (22 men, 8 women; mean age, 60.0 +/- 7.1 years; mean PD duration, 13.5 +/- 3.7 years; mean body mass index [BMI], 21.6 +/- 3.0 kg/m2). Body weight, physical activity, and Unified Parkinson's Disease Rating Scale (UPDRS) scores were noted before and 3 and 12 months after the procedure. Significant weight gain occurred in 29 patients; the mean increase was 14.8 +/- 9.8% of initial body weight in 1 year. Of the patients, 46.5% reported weight gain in the first 3 months, 21.4% gradual weight gain in the first 6 months, and 32.1% a slow increase for 1 year. Mean BMI increased up to 24.7 +/- 3.7 kg/m2. After 1 year, mean UPDRS motor score improved significantly in off and in on; and therapy complications improved by 91.0 +/- 17.0%. BMI changes at 3 and 12 months were significantly correlated to dyskinesia score changes, and levodopa dosage was not. In PD, STN DBS produces not only symptom control, but also weight gain. DBS candidates should be given nutritional counseling before the intervention to prevent rapid and/or excessive weight gain.

The evaluation of nutritional status should be part of the routine work-up of a Parkinson's disease patient. Dietary education should be included amongst the therapeutic measures designed to improve the general conditions in Parkinson's disease.

Protein intake interferes with levodopa therapy. Patients with advanced Parkinson's disease (PD) should restrict daily protein intake and shift protein intake to the evening. For further reduction of protein intake in the first part of the day, special low-protein products (LPP) should be used instead of normal food products at breakfast and lunch. We studied the efficacy of LPP on postprandial off periods, in PD patients on levodopa therapy. The methods included a randomized, cross-over, single-blind, pilot clinical trial comparing a 2-month balanced diet with a 2-month LPP diet in 18 PD patients with motor fluctuations. The off phases were significantly shorter after LPP diet than after balanced diet (postprandial off, 49 +/- 73 min vs. 79 +/- 72 min and total off, 164 +/- 148 min vs. 271 +/- 174 min, both P < 0.0001). Moreover, a reduction in total off time during LPP diet (3.3 +/- 2.7 hr vs. 4.7 +/- 3.3 hr, P < 0.0001), occurred also in the 9 patients who did not experience subjective benefit. No significant changes in hematological and biochemical variables or body composition were recorded; a slight reduction in body weight (mean, -1.8%) was observed. Consumption of LPP in the first part of the day ameliorates off periods in PD patients, but additional studies including pharmacokinetics are needed.

Objective: To evaluate the current rate of underweightness amongst Parkinson's disease (PD) patients at an Italian referral centre. Design: Epidemiological study on consecutive patients presenting for the first time in a 16-month period. Setting: Nutritional service of PD referral centre in Milan, Italy. Subjects: Three-hundred and sixty-four PD patients diagnosed according to CAPIT criteria. Methods: Anthropometric assessments: BMI and waist-to-hip ratio; evaluation of therapeutic physical activity (h=week). Results: Three-hundred and sixty-four patients were included (180 female, 184 male), mean (s.d.) age 65.9 (8.9) y, mean (s.d.) duration of PD 10.6 (5.3) y; 134 patients (37%) were overweight and 92 (25%) were obese; 11 (3%) were underweight; 127 (35%) had normal BMI. No important differences in BMI according to sex and smoking status were observed. There was highly significant inverse correlation between duration of disease and BMI (P < 0.001): mean (s.d.) duration of disease was 9.7 (4.7) y in overweight þ obese patients, 11.1 (5.5) y in patients with normal BMI and 14.1 (7.2) y in underweight patients (P ¼ 0.0059). The waist-to-hip ratio was a cardiovascular risk factor in 47.7% of men and 73.8% of women. Mean (s.d.) therapeutic physical activity was 1.07 (1.59) h=week in overweight and obese patients vs 1.61 (2.04) h=week in patients with normal BMI (50.5% increase; P ¼ 0.03). Conclusions: At present underweightness is uncommon in PD patients in Italy; this may be due to the increase in the prevalence of overweightness in the Italian population and to modern antiparkinsonian therapy. Sponsorship: Fondazione Grigioni per il Morbo di Parkinson.

Objective:T oestablish whether adiet based on the usage of low-protein products for renal patients (LPP) is associated with higher energy expenditure (EE) than afree low-protein diet (NO-LPP) by calculating 24 hEEbyindirect calorimetryusing an electronic armband monitor.Design:R andomized, cross-over, single-blind, pilot clinical trial performed comparing two different low-proteind ietary regimens.Subjects:Forty-two days with LPP and 42 days with NO-LPP regimen in six patients with Parkinson'sdisease with levodopa. Methods:Monitoring patient response to twodifferent nutritional schemes through indirect calorimetry(armband), BMI, Patient Global Improvement Scale.Results:Mean total EE was 1731^265 kcal/daywith NO-LPP vs.1 903^265 kcal/day with LPP ( p ¼ 0.02).Conclusions:The usage of LPP increases EE and improves motor function in PD patients to agreater extent than NO-LPP dietaryregimen. Calorie intake should be increased to prevent malnutrition in the long-term.Sponsorship:F ondazione Grigioni per il Morbo di Parkinson.