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Dietary and lifestyle variables in relation to incidence of Parkinson’s disease in Greece

  • NEURO-EPIDEMIOLOGY
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Abstract

Identification of dietary and lifestyle variables associated with the development of Parkinson’s disease (PD) may offer pathogenetic clues and prevention opportunities. In a population-based prospective cohort study, 26,173 participants in the EPIC–Greece cohort had sociodemographic, anthropometric, medical, dietary and lifestyle variables ascertained at enrolment and periodically reassessed with follow-up contacts. Based on these data, subjects were screened as possible PD cases if they (1) reported either a medical diagnosis of PD or use of anti-PD drugs and (2) did not report preceding causes of secondary parkinsonism. For diagnostic validation, possible incident PD cases were assessed by a focused 3-item telephone questionnaire. Cox proportional hazards regression was used to evaluate associations between potential predictors and incident PD. The main multivariate model included gender, age, marital status, schooling years, farming occupation, smoking status, caffeinated coffee, body mass index, physical activity and energy intake. Additional models included all above variables plus one dietary item at a time. Incidence rate adjusted to the European population was 16.9 per 100,000 person-years. In multivariate models, incident PD exhibited strong positive association with consumption of milk, but not cheese or yoghurt. This finding may help narrow down the search for potential dairy product components with a facilitatory role in PD. Concerning other dietary components, inverse association was found between polyunsaturated fat intake and incident PD. Also, inverse association was found with tobacco smoking, in line with previous studies, but not with caffeine.

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References

  1. Chen H, Zhang SM, Hernan MA, Willett WC, Ascherio A. Diet and Parkinson’s disease: a potential role of dairy products in men. Ann Neurol. 2002;52:793–801.

    Article  PubMed  Google Scholar 

  2. Hernan MA, Takkouche B, Caamano-Isorna F, Gestal-Otero JJ. A meta-analysis of coffee drinking, cigarette smoking, and the risk of Parkinson’s disease. Ann Neurol. 2002;52:276–84.

    Article  PubMed  Google Scholar 

  3. Alves G, Forsaa EB, Pedersen KF, Dreetz Gjerstad M, Larsen JP. Epidemiology of Parkinson’s disease. J Neurol. 2008;255(Suppl 5):18–32.

    Article  PubMed  Google Scholar 

  4. Elbaz A, Moisan F. Update in the epidemiology of Parkinson’s disease. Curr Opin Neurol. 2008;21:454–60.

    Article  PubMed  Google Scholar 

  5. Tanner CM. Advances in environmental epidemiology. Mov Disord. 2010;25(Suppl 1):S58–62.

    Article  PubMed  Google Scholar 

  6. Wirdefeldt K, Adami HO, Cole P, Trichopoulos D, Mandel J. Epidemiology and etiology of Parkinson’s disease: a review of the evidence. Eur J Epidemiol. 2011;26(Suppl 1):S1–58.

    Article  PubMed  Google Scholar 

  7. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599–608.

    Article  PubMed  Google Scholar 

  8. Bingham S, Riboli E. Diet and cancer–the European prospective investigation into cancer and nutrition. Nat Rev Cancer. 2004;4:206–15.

    Article  PubMed  CAS  Google Scholar 

  9. Riboli E, Hunt KJ, Slimani N, et al. European prospective investigation into cancer and nutrition (epic): study populations and data collection. Public Health Nutr. 2002;5:1113–24.

    Article  PubMed  CAS  Google Scholar 

  10. Gallo V, Bueno-De-Mesquita HB, Vermeulen R, et al. Smoking and risk for amyotrophic lateral sclerosis: analysis of the EPIC cohort. Ann Neurol. 2009;65:378–85.

    Article  PubMed  Google Scholar 

  11. Michaud DS, Gallo V, Schlehofer B, et al. Coffee and tea intake and risk of brain tumors in the European prospective investigation into cancer and nutrition (EPIC) cohort study. Am J Clin Nutr. 2010;92:1145–50.

    Article  PubMed  CAS  Google Scholar 

  12. Psaltopoulou T, Kyrozis A, Stathopoulos P, Trichopoulos D, Vassilopoulos D, Trichopoulou A. Diet, physical activity and cognitive impairment among elders: the EPIC-Greece cohort (European prospective investigation into cancer and nutrition). Public Health Nutr. 2008;11:1054–62.

    Article  PubMed  CAS  Google Scholar 

  13. Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc. 1993;25:71–80.

    Article  PubMed  CAS  Google Scholar 

  14. Trichopoulou A, Gnardellis C, Lagiou A, Benetou V, Trichopoulos D. Body mass index in relation to energy intake and expenditure among adults in Greece. Epidemiology. 2000;11:333–6.

    Article  PubMed  CAS  Google Scholar 

  15. Gnardellis C, Trichopoulou A, Katsouyanni K, Polychronopoulos E, Rimm EB, Trichopoulos D. Reproducibility and validity of an extensive semiquantitative food frequency questionnaire among Greek school teachers. Epidemiology. 1995;6:74–7.

    Article  PubMed  CAS  Google Scholar 

  16. Katsouyanni K, Rimm EB, Gnardellis C, Trichopoulos D, Polychronopoulos E, Trichopoulou A. Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers. Int J Epidemiol. 1997;26(Suppl 1):S118–27.

    Article  PubMed  Google Scholar 

  17. Goldbohm RA, van ‘t Veer P, van den Brandt PA, et al. Reproducibility of a food frequency questionnaire and stability of dietary habits determined from five annually repeated measurements. Eur J Clin Nutr. 1995;49:420–9.

    PubMed  CAS  Google Scholar 

  18. Willett WC, Sampson L, Browne ML, et al. The use of a self-administered questionnaire to assess diet 4 years in the past. Am J Epidemiol. 1988;127:188–99.

    PubMed  CAS  Google Scholar 

  19. Trichopoulou A, Georga K, editors. Composition tables of simple and composite foods. Parisianos: Athens, Greece; 2004.

    Google Scholar 

  20. Gibb WR, Lees AJ. A comparison of clinical and pathological features of young- and old-onset Parkinson’s disease. Neurology. 1988;38:1402–6.

    Article  PubMed  CAS  Google Scholar 

  21. Van Den Eeden SK, Tanner CM, Bernstein AL, et al. Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity. Am J Epidemiol. 2003;157:1015–22.

    Article  Google Scholar 

  22. de Lau LM, Bornebroek M, Witteman JC, Hofman A, Koudstaal PJ, Breteler MM. Dietary fatty acids and the risk of Parkinson disease: the Rotterdam study. Neurology. 2005;64:2040–5.

    Article  PubMed  Google Scholar 

  23. de Lau LM, Breteler MM. Epidemiology of Parkinson’s disease. Lancet Neurol. 2006;5:525–35.

    Article  PubMed  Google Scholar 

  24. Elbaz A, Tranchant C. Epidemiologic studies of environmental exposures in Parkinson’s disease. J Neurol Sci. 2007;262:37–44.

    Article  PubMed  Google Scholar 

  25. Shulman LM. Gender differences in Parkinson’s disease. Gend Med. 2007;4:8–18.

    Article  PubMed  Google Scholar 

  26. Taylor KS, Cook JA, Counsell CE. Heterogeneity in male to female risk for Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2007;78:905–6.

    Article  PubMed  CAS  Google Scholar 

  27. Semchuk KM, Love EJ, Lee RG. Parkinson’s disease and exposure to agricultural work and pesticide chemicals. Neurology. 1992;42:1328–35.

    Article  PubMed  CAS  Google Scholar 

  28. Gorell JM, Johnson CC, Rybicki BA, Peterson EL, Richardson RJ. The risk of Parkinson’s disease with exposure to pesticides, farming, well water, and rural living. Neurology. 1998;50:1346–50.

    Article  PubMed  CAS  Google Scholar 

  29. Ascherio A, Chen H, Weisskopf MG, et al. Pesticide exposure and risk for Parkinson’s disease. Ann Neurol. 2006;60:197–203.

    Article  PubMed  CAS  Google Scholar 

  30. Rocca WA, Anderson DW, Meneghini F, et al. Occupation, education, and Parkinson’s disease: a case-control study in an Italian population. Mov Disord. 1996;11:201–6.

    Article  PubMed  CAS  Google Scholar 

  31. Seidler A, Hellenbrand W, Robra BP, et al. Possible environmental, occupational, and other etiologic factors for Parkinson’s disease: a case-control study in Germany. Neurology. 1996;46:1275–84.

    Article  PubMed  CAS  Google Scholar 

  32. Kuopio AM, Marttila RJ, Helenius H, Rinne UK. Environmental risk factors in Parkinson’s disease. Mov Disord. 1999;14:928–39.

    Article  PubMed  CAS  Google Scholar 

  33. Hellenbrand W, Seidler A, Robra BP, et al. Smoking and Parkinson’s disease: a case-control study in Germany. Int J Epidemiol. 1997;26:328–39.

    Article  PubMed  CAS  Google Scholar 

  34. Louis ED, Luchsinger JA, Tang MX, Mayeux R. Parkinsonian signs in older people: prevalence and associations with smoking and coffee. Neurology. 2003;61:24–8.

    Article  PubMed  Google Scholar 

  35. Allam MF, Campbell MJ, Hofman A, Del Castillo AS, Fernandez-Crehuet Navajas R. Smoking and Parkinson’s disease: systematic review of prospective studies. Mov Disord. 2004;19:614–21.

    Article  PubMed  Google Scholar 

  36. Morens DM, Grandinetti A, Reed D, White LR, Ross GW. Cigarette smoking and protection from Parkinson’s disease: false association or etiologic clue? Neurology. 1995;45:1041–51.

    Article  PubMed  CAS  Google Scholar 

  37. Gorell JM, Rybicki BA, Johnson CC, Peterson EL. Smoking and Parkinson’s disease: a dose-response relationship. Neurology. 1999;52:115–9.

    Article  PubMed  CAS  Google Scholar 

  38. Tanner CM, Goldman SM, Aston DA, et al. Smoking and Parkinson’s disease in twins. Neurology. 2002;58:581–8.

    Article  PubMed  CAS  Google Scholar 

  39. Thacker EL, O’Reilly EJ, Weisskopf MG, et al. Temporal relationship between cigarette smoking and risk of Parkinson disease. Neurology. 2007;68:764–8.

    Article  PubMed  CAS  Google Scholar 

  40. O’Reilly EJ, Chen H, Gardener H, Gao X, Schwarzschild MA, Ascherio A. Smoking and Parkinson’s disease: using Parental smoking as a proxy to explore causality. Am J Epidemiol. 2009;169:678–82.

    Article  PubMed  Google Scholar 

  41. Allam MF, Campbell MJ, Del Castillo AS, Fernandez-Crehuet Navajas R. Parkinson’s disease protects against smoking? Behav Neurol. 2004;15:65–71.

    PubMed  Google Scholar 

  42. Evans AH, Lawrence AD, Potts J, et al. Relationship between impulsive sensation seeking traits, smoking, alcohol and caffeine intake, and Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2006;77:317–21.

    Article  PubMed  CAS  Google Scholar 

  43. Benedetti MD, Bower JH, Maraganore DM, et al. Smoking, alcohol, and coffee consumption preceding Parkinson’s disease: a case-control study. Neurology. 2000;55:1350–8.

    Article  PubMed  CAS  Google Scholar 

  44. Hu G, Bidel S, Jousilahti P, Antikainen R, Tuomilehto J. Coffee and tea consumption and the risk of Parkinson’s disease. Mov Disord. 2007;22:2242–8.

    Article  PubMed  Google Scholar 

  45. Ascherio A, Zhang SM, Hernan MA, et al. Prospective study of caffeine consumption and risk of Parkinson’s disease in men and women. Ann Neurol. 2001;50:56–63.

    Article  PubMed  CAS  Google Scholar 

  46. Saaksjarvi K, Knekt P, Rissanen H, Laaksonen MA, Reunanen A, Mannisto S. Prospective study of coffee consumption and risk of Parkinson’s disease. Eur J Clin Nutr. 2008;62:908–15.

    Article  PubMed  CAS  Google Scholar 

  47. Sasco AJ, Paffenbarger RSJ, Gendre I, Wing AL. The role of physical exercise in the occurrence of Parkinson’s disease. Arch Neurol. 1992;49:360–5.

    Article  PubMed  CAS  Google Scholar 

  48. Chen H, Zhang SM, Schwarzschild MA, Hernan MA, Ascherio A. Physical activity and the risk of Parkinson disease. Neurology. 2005;64:664–9.

    Article  PubMed  CAS  Google Scholar 

  49. Thacker EL, Chen H, Patel AV, et al. Recreational physical activity and risk of Parkinson’s disease. Mov Disord. 2008;23:69–74.

    Article  PubMed  Google Scholar 

  50. Logroscino G, Sesso HD, Paffenbarger RSJ, Lee IM. Physical activity and risk of Parkinson’s disease: a prospective cohort study. J Neurol Neurosurg Psychiatry. 2006;77:1318–22.

    Article  PubMed  CAS  Google Scholar 

  51. Hamer M, Chida Y. Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence. Psychol Med. 2009;39:3–11.

    Article  PubMed  CAS  Google Scholar 

  52. Park M, Ross GW, Petrovitch H, et al. Consumption of milk and calcium in midlife and the future risk of Parkinson disease. Neurology. 2005;64:1047–51.

    Article  PubMed  CAS  Google Scholar 

  53. Chen H, O’reilly E, McCullough ML, et al. Consumption of dairy products and risk of Parkinson’s disease. Am J Epidemiol. 2007;165:998–1006.

    Article  PubMed  Google Scholar 

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Acknowledgments

The work was support by the Hellenic Health Foundation, the Stavros Niarchos Foundation and the Hellenic Ministry of Health and Social Solidarity. We thank Chrysa Bikou and Theodora Psaltopoulou for their help.

Dr. Dimitris Vassilopoulos is deceased. He was Professor & Chairman of the 1st Department of Neurology, University of Athens Medical School.

Conflict of interest

Authors have no financial disclosures.

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Authors and Affiliations

  1. 1st Department of Neurology, Eginition Hospital, University of Athens Medical School, 74 Vas. Sofias Avenue, 11528, Athens, Greece

    Andreas Kyrozis, Apostolia Ghika & Dimitris Vassilopoulos

  2. Hellenic Health Foundation, 10-12 Tetrapoleos, 11527, Athens, Greece

    Panayiotis Stathopoulos & Antonia Trichopoulou

  3. Department of Hygiene and Epidemiology, University of Athens Medical School, 75 Mikras Asias street, 11527, Athens, Greece

    Panayiotis Stathopoulos & Antonia Trichopoulou

  4. Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Dimitrios Trichopoulos

Authors
  1. Andreas Kyrozis
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  2. Apostolia Ghika
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  3. Panayiotis Stathopoulos
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  4. Dimitris Vassilopoulos
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  5. Dimitrios Trichopoulos
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  6. Antonia Trichopoulou
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Corresponding author

Correspondence to Andreas Kyrozis.

Additional information

Dimitris Vassilopoulos: Deceased.

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Kyrozis, A., Ghika, A., Stathopoulos, P. et al. Dietary and lifestyle variables in relation to incidence of Parkinson’s disease in Greece. Eur J Epidemiol 28, 67–77 (2013). https://doi.org/10.1007/s10654-012-9760-0

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  • DOI: https://doi.org/10.1007/s10654-012-9760-0

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