ESPEN Congress Leipzig Prognostic impact of body composition

Transcription

1 ESPEN Congress Leipzig 2013 Prognostic impact of body composition Malnutrition and body composition changes in neurodegenerative diseases: as bad as in chronic diseases? E. Cereda (IT)

2 Malnutrition and body composition changes in neurodegenerative diseases: as bad as in chronic diseases? Emanuele Cereda MD, PhD NUTRIT NUTRITION & DIETETICS SERVICE ION & DIETETICS SERVICE FONDAZIONE I.R.C.C.S. POLICLINICO SAN MATTEO

3 START Prognostic impact of malnutrition and body composition

4 75%

5 EPIDEMIOLOGY * OF NEURODEGENERATIVE DISEASES Disease Patients (N) Alzheimer s disease Parkinson s disease Fronto-temporal dementia Huntington s disease Amyotrophic lateral sclerosis Progressive supranuclear palsy Spinocerebellar ataxias Prion disease * USA population (approximately 275 millions) Prevalence ( / inhabitants)

6 SHARED COMMON FEATURES Advanced age Nutritional deterioration Weight loss (also as prodromal) Disease duration Disease severity Disability and dysphagia Neuro-inflammation but no systemic stress response

7 DEMENTIA (& ALZHEIMER S DISEASE)

8 HYPOTHESIZED FACTORS Predementia apathy Loss of initiative Reduced olfactory function

9 53 studies ( N= elderly ) 4.2% (range 0 26%) 45 studies ( N= elderly) 7.7% (range 0 38%) 73 studies ( N= elderly ) 27.2% (range 0 61%) CAREGIVING

10 SYSTEMATIC REVIEW AND META-ANALYSIS DEMENTIA PREVALENCE OF MALNUTRITION WITHIN A SPECIFIC HEALTH CARE SETTING AND ACCROSS DIFFERENT SETTINGS

11 COMMUNITY-DWELLING / OUPATIENTS MNA 24 = 79.3% MNA<17 = 2.9% MNA = 17.8% (N=561)

12 COMMUNITY-DWELLING / OUPATIENTS MNA 24 = 51.2% MNA<17 = 5.2% MNA = 42.6% (N=940)

13 MNA<17 = 14.2% MNA 24 = 59.6% MNA = 26.2% BMI < 21 kg/m 2 = 17.5%

14 DETERMINANTS OF MALNUTRITION Cross-sectional data More advanced age Worse cognitive profile Worse functional profile Worse behavioural profile Increased burden for caregivers

15 MALNUTRITION & COGNITIVE DECLINE Prospective data

16 MALNUTRITION & COGNITIVE DECLINE Prospective data Soto et al. J Alzheimers Dis 2012;28: Rapid cognitive decline (3 points of MMSE in 6 months) by weight loss (4% in 1 year of follow-up) Adjusted HR = 1.50 ( )

17 Progressive loss (4% in 1 year) A severe loss (5 kg in 6 months) 33.4% 10.2% Hospitalization, acute disease, institutionalization, and change of living arrangements

18 MALNUTRITION & OUTCOME LIMITED EVIDENCE In institutions, after adjusting for main admission diagnosis, malnutrition is independently associated with outcome (mortality). However, Magaziner et al. J Am Geriatr Soc 2005;53: Cereda et al. Arch Gerontol Geriatr 2013;56:

19 BODY COMPOSITION Apparently conflicting data AD CNT BMI FFM(%) J Am Dietet Assoc 1996;96: J Nutr Health Aging 2010;14:823-7

20 BODY COMPOSITION & OUTCOME Volpato et al. J Am Geriatr Soc 2004;523:886-91

21 PARKINSON S DISEASE

22 KEY ISSUES Mov Disord 2009;24: Body weight Gastrointestinal dysfunction Protein intake

23 2011

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25 Eur J Clin Nutr 2003; 57:543-7 %

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27 Difference in BMI between patients with Parkinson s disease and healthy controls DISEASE SEVERITY

28 Case-control study (80 PD vs. 80 controls) Matched for sex, age and nutritional status

29 POTENTIAL MECHANISMS Levodopa therapy Dyskinesias/rigidity (physical activity?) Adipose tissue lipolysis energy expenditure Reduced insulin secretion GH IGF-1 axis

30 Mov Disord 2010;13: ,4-Dihydroxy-L-phenylalanin (Levodopa) Daily protein intake = 1.0 g/kg/day

31 8 Weeks (2 Mths) 8 Weeks (2 Mths) NO EFFECT ON BODY COMPOSITION

32 Higher whole-body protein turnover

33 Eur J Clin Nutr 2003; 57:543-7 %

34 Case-control study (80 PD vs. 80 controls) Matched for sex, age and nutritional status

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37 PROGNOSTIC IMPACT For both malnutrition and body composition is still to be defined...

38 CONCLUSION More research is needed to clarify the prognostic impact of body composition in neurodegenerative diseases

39 ACKNOWLEDGMENTS