Large observational study of 2,116 Italian PD patients found overall BMI similar to the general population but with sex-specific differences: women had lower BMI, received higher levodopa dosage per kg, and exhibited more dyskinesia, and BMI correlated with levodopa dose and complications.

Although not mechanistic, these clinically relevant findings support personalized levodopa dosing and integrated nutritional management to mitigate motor complications and inform clinical trial stratification and therapeutic optimization.

OBJECTIVES: Body weight management and nutritional care may have important implications for Parkinson's disease (PD) management, particularly levodopa therapy and related complications. Previous studies have shown differences from the general population and provided discordant findings reasonably related to limitations in the design. We provided an updated picture of body mass index (BMI) status in Italian patients with PD and investigated the potential relationship with and implications for the management of levodopa therapy and related complications. METHODS: A large observational study in consecutive patients with idiopathic PD (N = 2116; men, 57.6%). BMI status and clinical data were collected. Standardized prevalence of BMI categories was calculated and compared to the Italian population. Associations with levodopa therapy and related complications were investigated. RESULTS: At the population level, the standardized prevalence of BMI categories was similar to the general population. However, women presented lower and higher rates of overweight (21.5% Vs. 27.6%) and normal-weight (60.9% Vs. 56.0%), respectively, while men presented an opposite picture (overweight, 46.5% Vs. 42.0%; normal-weight, 41.1% Vs. 43.9%). Women were characterized by higher dyskinesia and lower OFF periods according to UPDRS-part IV subscores, and they were receiving higher levodopa dosages (mg/kg) independently of BMI status, but BMI status was also associated with levodopa dose and complications. CONCLUSIONS: BMI status in Italian patients with PD was similar to the general population, but presented sex differences. Women had lower BMI than men. This appeared to be related to higher levodopa dosage and related complications, which highlights the importance of a multidisciplinary approach for the optimization of pharmacological treatment.