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In the article, “Muscle-target nutritional support for rehabilitation in patients with parkinsonian syndrome,” Drs. Barichella et al. examined the efficacy of nutritional support with a whey protein-based formula enriched with leucine and vitamin D on the functional outcomes of multidisciplinary intensive rehabilitation treatment in 150 patients with Parkinson Disease (PD) or parkinsonism, via a pragmatic, bicentric, assessor-blind randomized controlled trial. They found that nutritional support resulted in better lower extremity function and preserved muscle mass in patients with parkinsonism. In response, Drs. Botello et al. cite previous literature linking loss of muscle mass with disease progression in these patients. Although commending the inclusion of patients with atypical parkinsonism in the trial, they inquire whether there were differences between PD and non-PD parkinsonism. Responding to these comments, the authors note that all patients at their institute undergo a brain MRI and are not recruited into trials before two-year follow-up to improve diagnostic accuracy. Highlighting the limitation of any comparison between patients with PD and non-PD parkinsonism in their study because of the small number of the latter, they note that there was no interaction between treatment and diagnosis but that additional study is needed to definitively answer this question. This exchange highlights the importance of nutritional supplementation to improve lower extremity functioning in patients with parkinsonism, but the study also highlights the need for caution with subanalysis particularly when numbers are small.
In the article, “Muscle-target nutritional support for rehabilitation in patients with parkinsonian syndrome,” Drs. Barichella et al. examined the efficacy of nutritional support with a whey protein-based formula enriched with leucine and vitamin D on the functional outcomes of multidisciplinary intensive rehabilitation treatment in 150 patients with Parkinson Disease (PD) or parkinsonism, via a pragmatic, bicentric, assessor-blind randomized controlled trial. They found that nutritional support resulted in better lower extremity function and preserved muscle mass in patients with parkinsonism. In response, Drs. Botello et al. cite previous literature linking loss of muscle mass with disease progression in these patients. Although commending the inclusion of patients with atypical parkinsonism in the trial, they inquire whether there were differences between PD and non-PD parkinsonism. Responding to these comments, the authors note that all patients at their institute undergo a brain MRI and are not recruited into trials before two-year follow-up to improve diagnostic accuracy. Highlighting the limitation of any comparison between patients with PD and non-PD parkinsonism in their study because of the small number of the latter, they note that there was no interaction between treatment and diagnosis but that additional study is needed to definitively answer this question. This exchange highlights the importance of nutritional supplementation to improve lower extremity functioning in patients with parkinsonism, but the study also highlights the need for caution with subanalysis particularly when numbers are small.
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Author disclosures are available upon request (journal{at}neurology.org).
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