Eating disorders (EDs) in patients with Parkinson’s disease (PD) are mainly described through impulse control disorders but represent one end of the spectrum of food addiction (FA). Although not formally recognized by DSM-5, FA is well described in the literature on animal models and humans, but data on prevalence and risk factors compared with healthy controls (HCs) are lacking. We conducted a cross-sectional study including 200 patients with PD and 200 age- and gender-matched HCs. Characteristics including clinical data (features of PD/current medication) were collected. FA was rated using DSM-5 criteria and the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Patients with PD had more EDs compared to HCs (27.0% vs. 13.0%, respectively, p < 0.001). They mainly had FA (24.5% vs. 12.0%, p = 0.001) and night eating syndrome (7.0% vs. 2.5% p = 0.03). In PD patients, FA was associated with female gender (p = 0.04) and impulsivity (higher attentional non-planning factor) but not with the dose or class of dopaminergic therapy. Vigilance is necessary, especially for PD women and in patients with specific impulsive personality traits. Counterintuitively, agonist dopaminergic treatment should not be used as an indication for screening FA in patients with PD.
Introduction
In Parkinson’s disease (PD), compulsive eating is part of the spectrum of impulse control disorders (ICDs) that also include pathologic gambling, compulsive buying and hypersexuality1. Eating disorders (EDs) are abnormal eating habits that negatively affect a person's physical and/or mental health 2. The psychiatric community categorizes these disorders as separate entities with a distinct set of symptoms [i.e. binge eating disorder (BED)] but the general term may also include food addiction (FA). The concept of FA, a highly controversial subject, refers to people who exhibit substance dependence symptoms in relation to certain high-fat and high-sugar foods3.
Abstract
Summary
investigated EDs in patients with PD compared to a matching general population. Our main findings were: (1) patients with PD had more EDs than the general population; (2) patients with PD had FA and NES, with marginal BED or bulimia; and (3) FA were related to gender and an impulsivity-specific dimension but not to treatment.
Our study is the first to show that FA is very common in patients with PD (24.5%), far exceeding the rate of the general population (9%)34. However, other alterations of eating behavior in the population with PD have been already described as “insatiable craving” “with uncontrollable traits” but they have not yet been estimated
A case–control study investigating food addiction in Parkinson patients.
de Chazeron, I., Durif, F., Lambert, C., Chereau-Boudet, I., Fantini, M.L., Marques, A., Derost, P., Debilly, B., Brousse, G., Boirie, Y. and Llorca, P.M.
Patients with PD (based on the UK Brain Bank criteria) were screened during regularly scheduled follow-up visits at the Movement Disorders Unit of Clermont-Ferrand Hospital, France, over a 12-month period. HCs were recruited at health check centers in the same region over a 24-month period.
multifactorial analyses were used, patients observed underwent deep brain stimulation and therefore were at a more advanced stage of disease compared to our disease cohort, which corresponded to a symptomatic population with PD that had not reached an advanced stage. NES and sleep-related eating disorders have been frequently reported in patients with idiopathic restless legs syndrome (RLS).
Methodology
Sample Size
200 subjects with PD and 200 HCs. The distribution by age and gender was similar between groups due to the matched design. There were 60% men (n = 120) and the mean age was 67.5 years old (SD 9.9). Significantly more patients with PD with an underweight BMI class compared to HCs and significantly more HCs in in the obesity BMI class than PD subjects. The mean age at onset of PD was 60.2 years (SD 10.0), and the median disease duration was 5.8 years (IQR: 3.0; 10.7). The mean MDS-UPDRS for the medication score for parts I (non-motor experiences of daily living) and III (motor examination) were 1.7 (SD 1.8) and 16.7 (SD 9.8), respectively.
Conclusion
FA and NES in PD subjects
Our study is the first to show that FA is very common in patients with PD (24.5%), far exceeding the rate of the general population (9%)34. However, other alterations of eating behavior in the population with PD have been already described as “insatiable craving” “with uncontrollable traits” but they have not yet been estimated35,36,37,38. Based on recent systematic reviews by Pursey et al.15 and Burrows et al.39 it is estimated that FA affects approximately 20% of the population (range 5.4–56.8%) but the great majority of studies have been performed outside Europe and concern specific populations such as patients attending bariatric surgery or obese subjects.
FA in the elderly and women
Few studies have focused on FA in the general population, especially in the elderly. One study42 focused exclusively on 342 women over the age of 65 and, according to the DSM-5 criteria, observed a prevalence of all EDs at 3.25%, with 1.68% being BED. Binge eating episodes were reported by 5.6% of women and picking/nibbling by 18.9% of women. These figures are close to ours, although our population was mixed in terms of gender and our FA criteria were absent from their study. Around 1.5% of individuals in the general population can present NES43. This syndrome has been more specifically observed in women, and 9.1% of them aged ≥ 55 years old reported getting up during the night to eat in the study by Andersen44. Food cravings are extremely common, particularly among women45, which seems to be confirmed by our study when looking at the multivariate analysis results for FA for the whole population.
Cravings for specific types of foods, such as sweet or high-fat foods, has been described for women with BED46, but we did not observe this in the FA analyses, except for chocolate. Patients with PD also reported frequent cravings not only for chocolate but also for sugar-rich foods.
URL
Key Words
De Chazeron, Ingrid, et al. “A Case–Control Study Investigating Food Addiction in Parkinson Patients.” Scientific Reports, vol. 11, no. 1, May 2021, p. 10934. DOI.org (Crossref), https://doi.org/10.1038/s41598-021-90266-8.