Parkinson Disease
Conditions
Keywords
Mediterranean diet, Microbiome, Constipation, Inflammation
Brief summary
This is a 10-week randomized, controlled study to investigate the effect of a Mediterranean diet intervention on gastrointestinal function in Parkinson's disease. After a 2-week run-in period, participants will be instructed to receive standard of care for constipation or receive standard of care + follow a Mediterranean diet for 8 weeks and answer daily and weekly questionnaires. Nutritional and neurological evaluations and stool samples will be collected at 0, 4 and 8 weeks.
Interventions
OTHERStandard of care + Mediterranean diet (intervention)
Participants will receive a constipation management handout that is distributed regularly to patients who present with constipation symptoms at an outpatient neurology clinic. The handout recommends increasing fluids daily, as well as increasing physical activity and dietary fiber intake. Laxative medications and recommendations for usage are included. Participants will be instructed to include the following in their diet: a) abundant use of olive oil for cooking and dressing dishes; b) consume ≥2 daily servings of vegetables; c) ≥2-3 daily serving of fruits; d) ≥3 weekly servings of legumes; e) ≥3 weekly servings of fish/seafood; f) ≥3 weekly serving of nuts/seeds; g) select white instead of red or processed meats; h) cook at least twice a week with sofrito. Limit consumption of cream, butter, processed meat, sugared beverages, industrial bakery products and desserts, and French fries or chips. For usual drinkers, the main source of alcohol should be wine.
Participants will receive a constipation management handout that is distributed regularly to patients who present with constipation symptoms at an outpatient neurology clinic. The handout recommends increasing fluids daily, as well as increasing physical activity and dietary fiber intake. Laxative medications and recommendations for usage are included.
Sponsors
University of Florida
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Intervention model description
A randomized, double-blind, controlled parallel study in which participants either follow a Mediterranean diet or their habitual diet for an 8-week intervention.
Eligibility
Sex/Gender
ALL
Age
40 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Physician-diagnosed Parkinson's disease aged 40-85 years * Drug naïve or on stable dosage of Parkinson's medications with no plans to change for the duration of the study protocol * Hoehn & Yahr stage =\<2.5 in the clinical ON state * Constipation syndrome scores \>=2.0 based on the GSRS * Consume \<20 grams of fiber daily based on the Block Fruit/Vegetable/Fiber screener * Able to complete informed consent in English * Willing to maintain habitual diet through the pre-baseline period. * Willing to make dietary changes to follow a Mediterranean diet and/or receive standard of care for constipation during the intervention period. * Willing to complete daily and weekly questionnaires and 12 dietary recalls over approximately 10 weeks. * Able to provide stool samples during the study collection periods. * Willing to avoid strenuous exercise and alcohol such as beer, wine, and cocktails 24 hours prior to each of the 3 study visits. * Able to fast (no food or drink, except water, or decaf tea) at least 12 hours before each study visit * Willing to discontinue taking prebiotic, herbal, or high-dose vitamin or mineral supplements that may impact inflammation during the pre-baseline period and throughout the study protocol.
Exclusion criteria
* Atypical or secondary Parkinsonism * Underweight (BMI \<18.5) * History of deep brain stimulation (DBS) surgery * Regular use of enemas or suppositories to alleviate constipation (e.g., \>1 time per week) * Use of another investigational product within 3 months of the screening visit * Antibiotic or probiotic supplement use within 2 months from the day of stool collection * Currently being treated for a physician-diagnosed GI disease or condition other than constipation, irritable bowel disease, gastroparesis, reflux or diverticular disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| GSRS Constipation Syndrome Score | 10 weeks | The difference between mean change (final - baseline) in constipation syndrome scores for the Med diet versus control diet. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Stool Frequency | Each week up to 10 weeks | Compare the number of stools between the intervention and control groups |
| Stool Form | Each day up to 10 weeks | Compare stool form, as measured by the Bristol Stool Form Scale (BSFS), between the intervention and control groups. The BSFS is scored between 1 (hard stool) - 7 (liquid stool). |
| Laxative Usage | Each week up to 10 weeks | Compare number of days using laxative medications between the intervention and control groups. |
| Digestive Health | Every week up to 10 weeks | Weekly GI symptoms assessed using the Gastrointestinal Symptom Rating Scale (GSRS). The GSRS consists of 15 questions related to 5 syndromes, constipation, diarrhea, reflux, abdominal pain, and indigestion. Symptoms are scored 1=no discomfort to 7=very severe discomfort. Scores from each of the 15 questions are summed for the total GSRS score. |
| Quality of Life Related to Digestive Health | Every week up to 10 weeks | Weekly GI experiences assessed using an in-house Digestion-Associated Quality of Life questionnaire. |
| Fecal Microbial Diversity | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in fecal microbial composition and diversity (i.e. alpha and beta diversity) will be assessed. |
| Fecal Microbial Quantitative Polymerase Chain Reaction (qPCR) | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in fecal microbial composition to quantify bacterial species of interest (e.g., F. prausnitzii, Prevotella, Roseburia, Bilophila, Akkermansia, etc.) will be assessed. |
| Intestinal Inflammation and Permeability | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in fecal calprotectin and zonulin will be assessed using enzyme-linked immunosorbent assay |
Other
| Measure | Time frame | Description |
|---|---|---|
| Mediterranean diet adherence | Each week up to 10 weeks | Compare Mediterranean diet adherence scores using the 14-Item Mediterranean diet adherence screener (MEDAS) between groups |
| Dietary Fiber Intake | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in dietary fiber intake as measured by averaged 4-day dietary recalls using the Automated Self-Administered 24-hour dietary recall (ASA-24) between groups |
| Body weight | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in body weight between groups |
| Body Composition (Fat Free Mass) | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in fat free mass using bio-impedance spectroscopy (BIS) between groups |
| Handgrip strength | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in handgrip strength will be assessed using a hand dynamometer between groups |
| Quality of Life (QOL) | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in QOL will be assessed using the Parkinson's Disease Quality of life -39 (PDQ-39) |
| Anxiety | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in symptoms of anxiety will be assessed using the Hamilton Anxiety Rating Scale |
| Depression | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in symptoms of anxiety will be assessed using the Hamilton Depression Rating Scale |
| Physical Activity | Baseline (Week 0); Midpoint (Week 4); Final (Week 8) | Changes in MET minutes will be assessed using the International Physical Activity Questionnaire (IPAQ). |
Countries
United States
Outcome results
None listed