Mischley Laurie K, Murawska Magdalena
Bastyr University Research Institute, Bastyr University, Kenmore, WA 98028, USA.
Department of Radiology, School of Medicine, University of Washington, Seattle, WA 98109-8057, USA.
Nutrients. 2025 Jul 16;17(14):2330. doi: 10.3390/nu17142330.
: A growing body of evidence suggests that diet can modify Parkinson's disease (PD) outcomes, although there is disagreement about what should be included and excluded in such a diet. Existing evidence suggests that adherence to the MIND and Mediterranean (MEDI) diets are associated with reduced PD symptoms, but only a few variables from the adherence scales are responsible for the statistically observed improvement. : The goal was to use patient-reported outcomes in a large cohort to identify the foods and dietary patterns (PRO diet) most strongly associated with the fewest PD symptoms over time, and to develop a composite adherence scale to enable comparisons between MEDI, MIND, and PRO. : Data were obtained from the prospective longitudinal natural history study and from Modifiable Variables in Parkinsonism (MVP)-a study designed to identify behaviors associated with patient-reported outcomes (PRO-PD). Upon the completion of the binary and food frequency data collection, using various predictive models and considering congruence with historical data, the PRO diet was created via an iterative process. Our goal was to create a new scale and compare its performance to the existing MIND and MEDI scores. The comparison was made at baseline, using the regression models for PRO-PD and the different scales as the predictors. The models were compared via the Akaike Information Criterion (AIC). To examine whether baseline adherence levels predicted subsequent symptom trajectories, the baseline PRO diet adherence and subsequent slope of progression were evaluated. : Data from 2290 individuals with PD were available for this analysis. The Mediterranean and MIND diets showed almost identical effects. For both the diets, the effect they had on non-motor symptoms was about twice the effect on motor symptoms. The slopes for the total PRO-PD for MEDI, MIND, and PRO-21 were -64.20467, -64.04220, and -28.61995, respectively. The AIC value differences were substantial (>2), indicating meaningful improvements in the model fit for total PRO-PD, as follows: MEDI: 28,897.24, MIND: 28,793.08, and PRO-21: 27,500.71. The subset of individuals who were most adherent to the PRO-21 diet at baseline had the slowest subsequent progression, as measured by a 43% reduced PRO-PD slope, compared to the less adherent groups. : The PRO-21 outperformed the MIND and MEDI diets in the model fit, overcoming the ceiling effects and showing orders of magnitude and superior explanatory power for variance in PD outcomes, despite the smaller per-unit effect sizes. However, its rigorous demands may introduce barriers related to cost, feasibility, and sustainability, underscoring the need for future intervention trials to assess real-world feasibility, adherence, side effects, and clinical impact.
越来越多的证据表明，饮食可以改变帕金森病（PD）的病情发展，尽管对于这种饮食中应包含和排除哪些内容存在分歧。现有证据表明，坚持MIND饮食和地中海（MEDI）饮食与PD症状减轻有关，但依从性量表中只有少数变量对统计学上观察到的改善有作用。
目标是在一个大型队列中使用患者报告的结果来确定与随时间出现最少PD症状最密切相关的食物和饮食模式（PRO饮食），并制定一个综合依从性量表，以便能够比较MEDI、MIND和PRO。
数据来自前瞻性纵向自然史研究以及帕金森病可改变变量（MVP）研究——一项旨在确定与患者报告结果（PRO-PD）相关行为的研究。在完成二元和食物频率数据收集后，使用各种预测模型并考虑与历史数据的一致性，通过迭代过程创建了PRO饮食。我们的目标是创建一个新的量表，并将其性能与现有的MIND和MEDI分数进行比较。在基线时进行比较，使用PRO-PD的回归模型以及不同量表作为预测因子。通过赤池信息准则（AIC）对模型进行比较。为了检查基线依从水平是否能预测随后的症状轨迹，评估了基线PRO饮食依从性和随后的进展斜率。
本分析可获得来自2290名PD患者的数据。地中海饮食和MIND饮食显示出几乎相同的效果。对于这两种饮食，它们对非运动症状的影响大约是对运动症状影响的两倍。MEDI、MIND和PRO-21的总PRO-PD斜率分别为-64.20467、-64.04220和-28.61995。AIC值差异很大（>2），表明总PRO-PD模型拟合有显著改善，如下：MEDI：28,897.24，MIND：28,793.08，PRO-21：27,500.⑦1。与依从性较低的组相比，基线时最坚持PRO-21饮食的个体子集随后的进展最慢，以PRO-PD斜率降低43%衡量。
在模型拟合方面，PRO-21优于MIND和MEDI饮食，克服了天花板效应，并且尽管单位效应量较小，但对PD结果的方差显示出数量级和更高的解释力。然而，其严格的要求可能会带来与成本、可行性和可持续性相关的障碍，这突出表明未来需要进行干预试验，以评估实际可行性、依从性、副作用和临床影响。
