Diet Quality, Physical Activity Tied to Mortality Risk in Parkinson Disease

A healthier diet and an active lifestyle, before and after PD diagnosis, has a protective effect against mortality.

A healthy diet and active lifestyle are associated with a reduced rate of all-cause mortality among adults with Parkinson disease (PD), according to study findings published in JAMA Network Open.

Previous studies have shown that better diet quality and increased physical activity are linked with a lower risk for incident PD. Yet, there is limited research on the long-term impact of these factors’ on all-cause mortality from PD. Currently, PD treatments show little evidence of slowing progressive neuron loss, and there is no consensus on complementary, disease-modifying lifestyle behaviors, according to researchers of current study.

This is the first prospective study to focus on PD patients and analyzing the combination of diet and exercise.

For this study, the researchers analyzed data of 599 women (median age at diagnosis, 71.9 years) who participated in the Nurses’ Health Study (NHS) from 1984 to 2012 and 652 men (median age at diagnosis, 73.4 years) who took part in the Health Professionals Follow-Up Study (HPFS) from 1986 to 2012. These participants developed PD during the studies.

The researchers used the Alternative Healthy Eating Index (AHEI) to assess overall diet quality prediagnosis. Physical activity was measured by data from questionnaires administered every 2 to 4 years and metabolic equivalent task (MET) hours per week.

Consuming a high diet quality and engaging in physical activity or exercise could be targets for improved PD outcome.

Mortality through 2018, the primary outcome of the study, was assessed using the National Death Index. The researchers found that during 32 to 34 years of follow-up, 942 participants (529 men) died.

Before diagnosis, participants in the highest quartile for cumulative mean AHEI scores had a 0.69 adjusted hazard ratio [aHR] (95% CI, 0.56-0.85; P =.002) compared with participants with the lowest quartile of scores. After diagnosis, it was 0.57 (95% CI, 0.42-0.78; P <.001).

Before and after diagnosis, the HR for cumulative mean MET hours per week was 0.71 (95% CI, 0.57-0.87; P =.004) and 0.47 (95% CI, 0.35-0.63; P <.001), respectively.

There was also an inverse association for PD-specific mortality (postdiagnosis AHEI: HR, 0.52 [95% CI, 0.33-0.80]; postdiagnosis MET: HR, 0.37 [95% CI, 0.25-0.55]).

Individuals who scored high for healthy diet and physical activity had the lowest mortality risk before PD diagnosis (HR, 0.51; 95% CI, 0.36-0.73; P =.19) and after diagnosis (HR, 0.35; 95% CI, 0.23-0.52; P =.64).

“Consuming a high diet quality and engaging in physical activity or exercise could be targets for improved PD outcome,” the researchers said.

Limitations of the study include possible reverse causation, lack of neurologists’ confirming PD diagnosis, and generalization to populations that are not largely White and of higher socioeconomic status.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Zhang X, Molsberry SA, Schwarzschild MA, et al. Association of diet and physical activity with all-cause mortality among adults with Parkinson disease. JAMA Network Open. Published online August 19, 2022. doi: 10.1001/jamanetworkopen.2022.27738