Reader response: Muscle-targeted nutritional support for rehabilitation in patients with parkinsonian syndrome

With great interest, we read the article by Barichella et al.1 that presents evidence of a nutritional strategy—in addition to an intensive rehabilitation program—associated with better rehabilitation outcomes in patients with parkinsonism. Previous evidence in patients with Parkinson disease linking muscle mass loss to disease progression2 and worse scores across multiple disease-domains (motor, mood, and quality of life),3 emphasize the importance of nutritional strategies accompanying an exercise program.4 Furthermore, the inclusion of patients with atypical parkinsonism represents a major strength demonstrating that nutritional strategies are fundamental in the management of patients with parkinsonism whether typical, atypical, or atypically atypical.5 We wonder whether there were any differences between Parkinson disease (PD) and non-PD parkinsonisms—regardless of the small number of patients with the latter—given the scarcity of studies on the topic. This article represents evidence for the systematic inclusion of nutritional strategies as a standard of care in patients with parkinsonism and encourages research that will allow to improve current interventions while addressing risks of malnutrition, even in patients with advanced stages of the disease.