Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE, der DGN und der DGG

 

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Zusammenfassung

Fragestellung: Neurologische Erkrankungen können zu Schluckstörungen mit konsekutiver Aspiration führen und gehen mit einem erhöhten Risiko für Mangelernährung einher. Die vorliegende Leitlinie soll evidenzbasierte Empfehlungen zur klinischen Ernährung in der Neurologie geben. Der akute Schlaganfall, der Morbus Parkinson, die Chorea Huntington und die Multiple Sklerose wurden als neurologische Erkrankungen ausgewählt, da hier die Ernährung eine besondere Rolle spielt.

Methodik: Es wurde eine systematische Literaturrecherche zur Ernährung bei den genannten Krankheitsbildern durchgeführt. Die Ergebnisse wurden in einer interdisziplinären Arbeitsgruppe aus Neurologen und Ernährungsmedizinern diskutiert. Auf dieser Basis wurden von der Arbeitsgruppe Empfehlungen erarbeitet, die auf der Konsensuskonferenz am 14. September 2011 vorgestellt, diskutiert und z. T. modifiziert wurden. Die modifizierten Empfehlungen wurden am 16. Juni 2012 auf einer 2. Konsensuskonferenz verabschiedet.

Ergebnisse: Die Leitlinie enthält 75 Empfehlungen zur Ernährung von Patienten mit neurologischen Erkrankungen. Bei Erkrankungen, die zu einer Dysphagie führen, sollten zeitnah ein Screening und ein Assessment auf Dysphagie erfolgen. Ausgehend von den erhobenen Befunden ist die Ernährung entsprechend zu modifizieren. Dies reicht von Texturmodifikationen über Sondenernährung bis zur Notwendigkeit einer parenteralen Ernährung. Patienten mit Morbus Parkinson und Chorea Huntington haben bereits in frühen Krankheitsstadien ein erhöhtes Risiko für Mangelernährung. Um diese zu vermeiden, werden auch hier ein regelmäßiges Screening, Assessment und bei Bedarf entsprechende ernährungsmedizinische Interventionen empfohlen. Bei der Einnahme von L-Dopa-haltigen Medikamenten ist auf die Interaktion mit eiweißhaltiger Nahrung zu achten. Bei Multipler Sklerose liegt für den Einsatz von „Spezialdiäten“ oder Nahrungssupplementen keine ausreichende wissenschaftliche Evidenz vor, sie werden deshalb generell nicht empfohlen.

Schlussfolgerung: Durch ein frühzeitiges Screening und Assessment auf Dysphagie und auf Mangelernährung kann die Ernährung von Patienten mit neurologischen Erkrankungen optimiert werden. Die Texturmodifikation von Speisen und Getränken, Trinknahrung, Ernährung über nasogastrale Sonden, über PEG-Sonden, PEJ-Sonden und parenterale Ernährung stellen mögliche ernährungsmedizinische Interventionen dar. Sämtliche Interventionen sollten bei entsprechender Indikation frühzeitig eingeleitet werden.

Abstract

Purpose: Neurologic diseases can lead to swallowing disorders. This may cause aspiration during oral intake of food and fluid and involves a higher risk for malnutrition. The present guideline is supposed to give evidence-based recommendations for clinical nutrition in neurology. Acute stroke, Parkinsonʼs disease, Chorea Huntington and Multiple Sclerosis were chosen because here nutrition can become an import issue.

Methods: A systematic literature search about nutrition and the mentioned disease patterns was conducted. The results were discussed in an interdisciplinary working group that consisted of neurologists and physicians with expertise for nutritional medicine. On this basis the working group developed recommendations, which were presented, discussed and partly modified at the consensus conference on September 14^th, 2011. The revised form of these recommendations was passed at a second consensus conference on June 16^th, 2012.

Results: The guideline includes 75 recommendations for patients with neurologic diseases. If the existing disease leads to dysphagia, screening and assessment of dysphagia should be performed early. Nutritional intervention has to be adapted according to medical findings. This ranges from texture modification and tube feeding to necessity for parenteral nutrition. Patients with Morbus Parkinson and Chorea Huntington have a higher risk for malnutrition already in early stages of disease. Regular screening, assessment and, if needed, nutritional interventions are recommended to avoid malnutrition. When using L-Dopa-containing medication the interactions with food proteins have to be taken into account. There is no adequate scientific evidence for the application of specific diets or nutritional supplements in Multiple Sclerosis, therefore such interventions cannot be recommended in general.

Conclusion: Nutrition for patients with neurologic diseases can be optimized by early screening and assessment of dysphagia and malnutrition. The texture modification of food and drinks, oral nutritional supplements, nutrition through a nasogastric tube, PEG tube, PEJ tube and parenteral nutrition are possible nutritional medical interventions. All indicated interventions shoud be introduced early.

^* DGEM Steering Committee: Bischoff SC, Lochs H, Weimann A, Adolph M, Ockenga J, Sieber C.

• Literatur

• 1 Leischker A, Wirth R, Busch E et al. Leitlinie „Enterale Ernährung bei Patienten mit Schlaganfall“. Aktuel Ernahrungsmed 2007; 32: 332-348
  PubMedGoogle Scholar
• 2 Stingel K, Schütz T, Koller M et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) – Methodik zum Leitlinien-Update Klinische Ernährung. Aktuel Ernahrungsmed 2013; 38: 90-96
  Google Scholar
• 3 Koller M, Schutz T, Valentini L et al. Outcome models in clinical studies: Implications for designing and evaluating trials in clinical nutrition. Clin Nutr 2013; 32: 650-657
  CrossrefPubMedGoogle Scholar
• 4 Daniels SK, Brailey K, Foundas AL. Lingual discoordination and dysphagia following acute stroke: analyses of lesion localization. Dysphagia 1999; 14: 85-92
  CrossrefPubMedGoogle Scholar
• 5 Veis SL, Logemann JA. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil 1985; 66: 372-375
  PubMedGoogle Scholar
• 6 Ertekin C, Aydogdu I, Tarlaci S et al. Mechanisms of dysphagia in suprabulbar palsy with lacunar infarct. Stroke 2000; 31: 1370-1376
  CrossrefPubMedGoogle Scholar
• 7 Martino R, Terrault N, Ezerzer F et al. Dysphagia in a patient with lateral medullary syndrome: insight into the central control of swallowing. Gastroenterology 2001; 121: 420-426
  CrossrefPubMedGoogle Scholar
• 8 Holas MA, DePippo KL, Reding MJ. Aspiration and relative risk of medical complications following stroke. Arch Neurol 1994; 51: 1051-1053
  CrossrefPubMedGoogle Scholar
• 9 Kidd D, Lawson J, Nesbitt R et al. The natural history and clinical consequences of aspiration in acute stroke. QJM 1995; 88: 409-413
  PubMedGoogle Scholar
• 10 Smithard DG, O’Neill PA, Parks C et al. Complications and outcome after acute stroke. Does dysphagia matter?. Stroke 1996; 27: 1200-1204
  CrossrefPubMedGoogle Scholar
• 11 Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999; 30: 744-748
  CrossrefPubMedGoogle Scholar
• 12 Hilker R, Poetter C, Findeisen N et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke 2003; 34: 975-981
  CrossrefPubMedGoogle Scholar
• 13 Wang Y, Lim LL, Heller RF et al. A prediction model of 1-year mortality for acute ischemic stroke patients. Arch Phys Med Rehabil 2003; 84: 1006-1011
  CrossrefPubMedGoogle Scholar
• 14 Martino R, Foley N, Bhogal S et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005; 36: 2756-2763
  CrossrefPubMedGoogle Scholar
• 15 Gordon C, Hewer RL, Wade DT. Dysphagia in acute stroke. Br Med J (Clin Res Ed) 1987; 295: 411-414
  CrossrefPubMedGoogle Scholar
• 16 Wade DT, Hewer RL. Motor loss and swallowing difficulty after stroke: frequency, recovery, and prognosis. Acta Neurol Scand 1987; 76: 50-54
  CrossrefPubMedGoogle Scholar
• 17 Barer DH. The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry 1989; 52: 236-241
  CrossrefPubMedGoogle Scholar
• 18 DePippo KL, Holas MA, Reding MJ. Validation of the 3-oz water swallow test for aspiration following stroke. Arch Neurol 1992; 49: 1259-1261
  Google Scholar
• 19 Kidd D, Lawson J, Nesbitt R et al. Aspiration in acute stroke: a clinical study with videofluoroscopy. Q J Med 1993; 86: 825-829
  Google Scholar
• 20 Odderson IR, Keaton JC, McKenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil 1995; 76: 1130-1133
  CrossrefPubMedGoogle Scholar
• 21 Hinds NP, Wiles CM. Assessment of swallowing and referral to speech and language therapists in acute stroke. QJM 1998; 91: 829-835
  CrossrefPubMedGoogle Scholar
• 22 Scottish Intercollegiate Guidelines Network. Management of patients with stroke: identification and management of dysphagia, a national clinical guideline. 2010
  Google Scholar
• 23 Trapl M, Enderle P, Nowotny M et al. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke 2007; 38: 2948-2952
  Google Scholar
• 24 Sellars C, Bowie L, Bagg J et al. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke 2007; 38: 2284-2291
  CrossrefPubMedGoogle Scholar
• 25 Lakshminarayan K, Tsai AW, Tong X et al. Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke 2010; 41: 2849-2854
  CrossrefPubMedGoogle Scholar
• 26 Evans A, Perez I, Harraf F et al. Can differences in management processes explain different outcomes between stroke unit and stroke-team care?. Lancet 2001; 358: 1586-1592
  CrossrefPubMedGoogle Scholar
• 27 Hinchey JA, Shephard T, Furie K et al. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005; 36: 1972-1976
  CrossrefPubMedGoogle Scholar
• 28 Ramsey DJ, Smithard DG, Kalra L. Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke 2003; 34: 1252-1257
  CrossrefPubMedGoogle Scholar
• 29 Bours GJ, Speyer R, Lemmens J et al. Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review. J Adv Nurs 2009; 65: 477-493
  CrossrefPubMedGoogle Scholar
• 30 Ramsey DJ, Smithard DG, Kalra L. Can pulse oximetry or a bedside swallowing assessment be used to detect aspiration after stroke?. Stroke 2006; 37: 2984-2988
  CrossrefPubMedGoogle Scholar
• 31 Teramoto S, Matsuse T, Fukuchi Y et al. Simple two-step swallowing provocation test for elderly patients with aspiration pneumonia. Lancet 1999; 353: 1243
  PubMedGoogle Scholar
• 32 Teramoto S, Fukuchi Y. Detection of aspiration and swallowing disorder in older stroke patients: simple swallowing provocation test versus water swallowing test. Arch Phys Med Rehabil 2000; 81: 1517-1519
  CrossrefPubMedGoogle Scholar
• 33 Warnecke T, Teismann I, Meimann W et al. Assessment of aspiration risk in acute ischaemic stroke – evaluation of the simple swallowing provocation test. J Neurol Neurosurg Psychiatry 2008; 79: 312-314
  CrossrefPubMedGoogle Scholar
• 34 Zaidi NH, Smith HA, King SC et al. Oxygen desaturation on swallowing as a potential marker of aspiration in acute stroke. Age Ageing 1995; 24: 267-270
  CrossrefPubMedGoogle Scholar
• 35 Collins MJ, Bakheit AM. Does pulse oximetry reliably detect aspiration in dysphagic stroke patients?. Stroke 1997; 28: 1773-1775
  CrossrefPubMedGoogle Scholar
• 36 Sellars C, Dunnet C, Carter R. A preliminary comparison of videofluoroscopy of swallow and pulse oximetry in the identification of aspiration in dysphagic patients. Dysphagia 1998; 13: 82-86
  CrossrefPubMedGoogle Scholar
• 37 Smith HA, Lee SH, O’Neill PA et al. The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool. Age Ageing 2000; 29: 495-499
  CrossrefPubMedGoogle Scholar
• 38 Lim SH, Lieu PK, Phua SY et al. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia 2001; 16: 1-6
  CrossrefPubMedGoogle Scholar
• 39 Colodny N. Comparison of dysphagics and nondysphagics on pulse oximetry during oral feeding. Dysphagia 2000; 15: 68-73
  PubMedGoogle Scholar
• 40 Leder SB. Use of arterial oxygen saturation, heart rate, and blood pressure as indirect objective physiologic markers to predict aspiration. Dysphagia 2000; 15: 201-205
  CrossrefPubMedGoogle Scholar
• 41 Wang TG, Chang YC, Chen SY et al. Pulse oximetry does not reliably detect aspiration on videofluoroscopic swallowing study. Arch Phys Med Rehabil 2005; 86: 730-734
  CrossrefPubMedGoogle Scholar
• 42 Martino R, Pron G, Diamant N. Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidelines. Dysphagia 2000; 15: 19-30
  CrossrefPubMedGoogle Scholar
• 43 Dziewas R, Ritter M, Schilling M et al. Pneumonia in acute stroke patients fed by nasogastric tube. J Neurol Neurosurg Psychiatry 2004; 75: 852-856
  CrossrefPubMedGoogle Scholar
• 44 Falsetti P, Acciai C, Palilla R et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis 2009; 18: 329-335
  CrossrefPubMedGoogle Scholar
• 45 Logemann JA, Veis S, Colangelo L. A screening procedure for oropharyngeal dysphagia. Dysphagia 1999; 14: 44-51
  CrossrefPubMedGoogle Scholar
• 46 Bartolome G, Buchholz DW, Feussneret H. Schluckstörungen: Diagnostik und Rehabilitation. In: Bartolome G, ed. Klinische Eingangsuntersuchung bei Schluckstörungen. Schluckstörungen: Diagnostik und Rehabilitation. München, Jena: Urban & Fischer; 2006
  Google Scholar
• 47 Gmeinwieser J, Golder W, Lehner K et al. X-ray diagnosis of the upper gastrointestinal tract at risk for aspiration using a nonionic iso-osmolar contrast medium. Rontgenpraxis 1988; 41: 361-366
  PubMedGoogle Scholar
• 48 Ekberg O, Olsson R. Dynamic radiology of swallowing disorders. Endoscopy 1997; 29: 439-446
  Article in Thieme ConnectPubMedGoogle Scholar
• 49 Rosenbek JC, Robbins JA, Roecker EB et al. A penetration-aspiration scale. Dysphagia 1996; 11: 93-98
  Google Scholar
• 50 Warnecke T, Ritter MA, Kroger B et al. Fiberoptic endoscopic Dysphagia severity scale predicts outcome after acute stroke. Cerebrovasc Dis 2009; 28: 283-289
  CrossrefPubMedGoogle Scholar
• 51 Warnecke T, Teismann I, Oelenberg S et al. The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients. Stroke 2009; 40: 482-486
  CrossrefPubMedGoogle Scholar
• 52 Dziewas R, Warnecke T, Hamacher C et al. Do nasogastric tubes worsen dysphagia in patients with acute stroke?. BMC Neurol 2008; 8: 28-2377-8-28
  CrossrefPubMedGoogle Scholar
• 53 Leder SB, Sasaki CT, Burrell MI. Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia 1998; 13: 19-21
  Google Scholar
• 54 Langmore SE. Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?. Curr Opin Otolaryngol Head Neck Surg 2003; 11: 485-489
  Google Scholar
• 55 Prosiegel M, Diener HC, Putzki N. Neurogene Dysphagie. Leitlinien für die Diagnostik und Therapie in der Neurologie. Stuttgart: Georg Thieme Verlag; 2008
  Google Scholar
• 56 Kelly AM, Leslie P, Beale T et al. Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity?. Clin Otolaryngol 2006; 31: 425-432
  Google Scholar
• 57 Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare?. Laryngoscope 2007; 117: 1723-1727
  CrossrefPubMedGoogle Scholar
• 58 Smithard DG, O’Neill PA, England RE et al. The natural history of dysphagia following a stroke. Dysphagia 1997; 12: 188-193
  CrossrefPubMedGoogle Scholar
• 59 Kleindorfer D, Panagos P, Pancioli A et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke 2005; 36: 720-723
  CrossrefPubMedGoogle Scholar
• 60 Carnaby G, Hankey GJ, Pizzi J. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurol 2006; 5: 31-37
  Google Scholar
• 61 Ickenstein GW, Hofmayer A, Lindner-Pfleghar B et al. Standardisation of diagnostic and therapeutic procedures for neurogenic oropharyngeal dysphagia (NOD). Neurol Rehabil 2009; 15: 290-300
  PubMedGoogle Scholar
• 62 Dziewas R, Warnecke T, Olenberg S et al. Towards a basic endoscopic assessment of swallowing in acute stroke – development and evaluation of a simple dysphagia score. Cerebrovasc Dis 2008; 26: 41-47
  Google Scholar
• 63 Ickenstein GW, Riecker A, Hohlig C et al. Pneumonia and in-hospital mortality in the context of neurogenic oropharyngeal dysphagia (NOD) in stroke and a new NOD step-wise concept. J Neurol 2010; 257: 1492-1499
  CrossrefPubMedGoogle Scholar
• 64 Blackmer J. Tube feeding in stroke patients: a medical and ethical perspective. Can J Neurol Sci 2001; 28: 101-106
  PubMedGoogle Scholar
• 65 Dennis MS, Lewis SC, Warlow C et al. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet 2005; 365: 764-772
  CrossrefPubMedGoogle Scholar
• 66 Dennis M, Lewis S, Cranswick G et al. FOOD Trial Collaboration. FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technol Assess 2006; 10: iii-iv, ix – x, 1 – 120
  PubMedGoogle Scholar
• 67 Kreymann KG, Berger MM, Deutz NE et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr 2006; 25: 210-223
  CrossrefPubMedGoogle Scholar
• 68 Volkert D, Berner YN, Berry E et al. ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr 2006; 25: 330-360
  CrossrefPubMedGoogle Scholar
• 69 Braunschweig CL, Levy P, Sheean PM et al. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr 2001; 74: 534-542
  CrossrefPubMedGoogle Scholar
• 70 Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J 2006; 82: 383-391
  CrossrefPubMedGoogle Scholar
• 71 Daniels SK, Brailey K, Priestly DH et al. Aspiration in patients with acute stroke. Arch Phys Med Rehabil 1998; 79: 14-19
  CrossrefPubMedGoogle Scholar
• 72 Broadley S, Croser D, Cottrell J et al. Predictors of prolonged dysphagia following acute stroke. J Clin Neurosci 2003; 10: 300-305
  CrossrefPubMedGoogle Scholar
• 73 Finucane TE, Bynum JP. Use of tube feeding to prevent aspiration pneumonia. Lancet 1996; 348: 1421-1424
  CrossrefPubMedGoogle Scholar
• 74 Mamun K, Lim J. Role of nasogastric tube in preventing aspiration pneumonia in patients with dysphagia. Singapore Med J 2005; 46: 627-631
  PubMedGoogle Scholar
• 75 Nakajoh K, Nakagawa T, Sekizawa K et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med 2000; 247: 39-42
  CrossrefPubMedGoogle Scholar
• 76 Finestone HM, Greene-Finestone LS, Wilson ES et al. Prolonged length of stay and reduced functional improvement rate in malnourished stroke rehabilitation patients. Arch Phys Med Rehabil 1996; 77: 340-345
  CrossrefPubMedGoogle Scholar
• 77 Gariballa SE, Parker SG, Taub N et al. Influence of nutritional status on clinical outcome after acute stroke. Am J Clin Nutr 1998; 68: 275-281
  CrossrefPubMedGoogle Scholar
• 78 Kudsk KA, Croce MA, Fabian TC et al. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 1992; 215: 503-511; discussion 511-513
  CrossrefPubMedGoogle Scholar
• 79 Moore FA, Feliciano DV, Andrassy RJ et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992; 216: 172-183
  CrossrefPubMedGoogle Scholar
• 80 Gramlich L, Kichian K, Pinilla J et al. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 2004; 20: 843-848
  CrossrefPubMedGoogle Scholar
• 81 Montecalvo MA, Steger KA, Farber HW et al. Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal tube feedings. The Critical Care Research Team. Crit Care Med 1992; 20: 1377-1387
  CrossrefPubMedGoogle Scholar
• 82 Taylor S. Audit of nasogastric feeding practice at two acute hospitals: is early enteral feeding associated with reduced mortality and hospital stay?. Journal of Human Nutrition and Dietetics 1993; 477-489
  PubMedGoogle Scholar
• 83 Nyswonger GD, Helmchen RH. Early enteral nutrition and length of stay in stroke patients. J Neurosci Nurs 1992; 24: 220-223
  CrossrefPubMedGoogle Scholar
• 84 Davalos A, Ricart W, Gonzalez-Huix F et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke 1996; 27: 1028-1032
  CrossrefPubMedGoogle Scholar
• 85 Bath PM, Bath FJ, Smithard DG. Interventions for dysphagia in acute stroke. Cochrane Database Syst Rev 2000; (02) CD000323
  PubMedGoogle Scholar
• 86 Peschl L, Zeilinger M, Munda W et al. Percutaneous endoscopic gastrostomy – a possibility for enteral feeding of patients with severe cerebral dysfunctions. Wien Klin Wochenschr 1988; 100: 314-318
  PubMedGoogle Scholar
• 87 Norton B, Homer-Ward M, Donnelly MT et al. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ 1996; 312: 13-16
  CrossrefPubMedGoogle Scholar
• 88 Park RH, Allison MC, Lang J et al. Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. BMJ 1992; 304: 1406-1409
  CrossrefPubMedGoogle Scholar
• 89 Anderson MR, O’Connor M, Mayer P et al. The nasal loop provides an alternative to percutaneous endoscopic gastrostomy in high-risk dysphagic stroke patients. Clin Nutr 2004; 23: 501-506
  CrossrefPubMedGoogle Scholar
• 90 Beavan J, Conroy SP, Harwood R et al. Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial. Age Ageing 2010; 39: 624-630
  CrossrefPubMedGoogle Scholar
• 91 Kostadima E, Kaditis AG, Alexopoulos EI et al. Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients. Eur Respir J 2005; 26: 106-111
  CrossrefPubMedGoogle Scholar
• 92 Oehmichen F, Ballmer PE, Druml C et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) – Ethische und rechtliche Gesichtspunkte der Künstlichen Ernährung. Aktuel Ernahrungsmed 2013; 38: 112-117
  Article in Thieme ConnectPubMedGoogle Scholar
• 93 National Institute for Health and Clinical Excellence. Nutrition support in adults. Clinical guideline 32, 2006
  PubMedGoogle Scholar
• 94 Strong RM, Condon SC, Solinger MR et al. Equal aspiration rates from postpylorus and intragastric-placed small-bore nasoenteric feeding tubes: a randomized, prospective study. JPEN J Parenter Enteral Nutr 1992; 16: 59-63
  CrossrefPubMedGoogle Scholar
• 95 Spain DA, DeWeese RC, Reynolds MA et al. Transpyloric passage of feeding tubes in patients with head injuries does not decrease complications. J Trauma 1995; 39: 1100-1102
  CrossrefPubMedGoogle Scholar
• 96 Lien HC, Chang CS, Chen GH. Can percutaneous endoscopic jejunostomy prevent gastroesophageal reflux in patients with preexisting esophagitis?. Am J Gastroenterol 2000; 95: 3439-3443
  CrossrefPubMedGoogle Scholar
• 97 Jabbar A, McClave SA. Pre-pyloric versus post-pyloric feeding. Clin Nutr 2005; 24: 719-726
  CrossrefPubMedGoogle Scholar
• 98 Rhoney DH, Parker Jr D, Formea CM et al. Tolerability of bolus versus continuous gastric feeding in brain-injured patients. Neurol Res 2002; 24: 613-620
  CrossrefPubMedGoogle Scholar
• 99 Serpa LF, Kimura M, Faintuch J et al. Effects of continuous versus bolus infusion of enteral nutrition in critical patients. Rev Hosp Clin Fac Med Sao Paulo 2003; 58: 9-14
  CrossrefPubMedGoogle Scholar
• 100 Lee JS, Auyeung TW. A comparison of two feeding methods in the alleviation of diarrhoea in older tube-fed patients: a randomised controlled trial. Age Ageing 2003; 32: 388-393
  CrossrefPubMedGoogle Scholar
• 101 Coben RM, Weintraub A, DiMarino Jr AJ et al. Gastroesophageal reflux during gastrostomy feeding. Gastroenterology 1994; 106: 13-18
  PubMedGoogle Scholar
• 102 Baeten C, Hoefnagels J. Feeding via nasogastric tube or percutaneous endoscopic gastrostomy. A comparison. Scand J Gastroenterol Suppl 1992; 194: 95-98
  PubMedGoogle Scholar
• 103 Huggins PS, Tuomi SK, Young C. Effects of nasogastric tubes on the young, normal swallowing mechanism. Dysphagia 1999; 14: 157-161
  CrossrefPubMedGoogle Scholar
• 104 Wang TG, Wu MC, Chang YC et al. The effect of nasogastric tubes on swallowing function in persons with dysphagia following stroke. Arch Phys Med Rehabil 2006; 87: 1270-1273
  CrossrefPubMedGoogle Scholar
• 105 Leder SB, Suiter DM. Effect of nasogastric tubes on incidence of aspiration. Arch Phys Med Rehabil 2008; 89: 648-651
  CrossrefPubMedGoogle Scholar
• 106 Langdon PC, Lee AH, Binns CW. High incidence of respiratory infections in ‘nil by mouth’ tube-fed acute ischemic stroke patients. Neuroepidemiology 2009; 32: 107-113
  CrossrefPubMedGoogle Scholar
• 107 Abe S, Ishihara K, Adachi M et al. Oral hygiene evaluation for effective oral care in preventing pneumonia in dentate elderly. Arch Gerontol Geriatr 2006; 43: 53-64
  CrossrefPubMedGoogle Scholar
• 108 Bagyi K, Haczku A, Marton I et al. Role of pathogenic oral flora in postoperative pneumonia following brain surgery. BMC Infect Dis 2009; 9: 104
  CrossrefPubMedGoogle Scholar
• 109 Langmore SE, Terpenning MS, Schork A et al. Predictors of aspiration pneumonia: how important is dysphagia?. Dysphagia 1998; 13: 69-81
  CrossrefPubMedGoogle Scholar
• 110 Bassim CW, Gibson G, Ward T et al. Modification of the risk of mortality from pneumonia with oral hygiene care. J Am Geriatr Soc 2008; 56: 1601-1607
  CrossrefPubMedGoogle Scholar
• 111 Gosney M, Martin MV, Wright AE. The role of selective decontamination of the digestive tract in acute stroke. Age Ageing 2006; 35: 42-47
  CrossrefPubMedGoogle Scholar
• 112 Chan EY, Ruest A, Meade MO et al. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 2007; 334: 889
  CrossrefPubMedGoogle Scholar
• 113 Whelan K. Inadequate fluid intakes in dysphagic acute stroke. Clin Nutr 2001; 20: 423-428
  CrossrefPubMedGoogle Scholar
• 114 Vivanti AP, Campbell KL, Suter MS et al. Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia. J Hum Nutr Diet 2009; 22: 148-155
  CrossrefPubMedGoogle Scholar
• 115 Challiner YC, Jarrett D, Hayward MJ et al. A comparison of intravenous and subcutaneous hydration in elderly acute stroke patients. Postgrad Med J 1994; 70: 195-197
  CrossrefPubMedGoogle Scholar
• 116 Gariballa SE, Parker SG, Taub N et al. A randomized, controlled, a single-blind trial of nutritional supplementation after acute stroke. JPEN J Parenter Enteral Nutr 1998; 22: 315-319
  CrossrefPubMedGoogle Scholar
• 117 Dennis MS, Lewis SC, Warlow C et al. Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial. Lancet 2005; 365: 755-763
  CrossrefPubMedGoogle Scholar
• 118 Milne AC, Potter J, Vivanti A et al. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2009; (02) CD003288. doi: DOI: CD003288.
  PubMedGoogle Scholar
• 119 Ha L, Hauge T, Spenning AB et al. Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial. Clin Nutr 2010; 29: 567-573
  CrossrefPubMedGoogle Scholar
• 120 Rabadi MH, Coar PL, Lukin M et al. Intensive nutritional supplements can improve outcomes in stroke rehabilitation. Neurology 2008; 71: 1856-1861
  CrossrefPubMedGoogle Scholar
• 121 Stratton RJ, Ek AC, Engfer M et al. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev 2005; 4: 422-450
  CrossrefPubMedGoogle Scholar
• 122 Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: An evidence-based approach to treatment. CABI Publishing; 2003
  Google Scholar
• 123 Williams LS, Rotich J, Qi R et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology 2002; 59: 67-71
  CrossrefPubMedGoogle Scholar
• 124 Leder SB, Suiter DM, Warner HL. Answering orientation questions and following single-step verbal commands: effect on aspiration status. Dysphagia 2009; 24: 290-295
  CrossrefPubMedGoogle Scholar
• 125 Diniz PB, Vanin G, Xavier R et al. Reduced incidence of aspiration with spoon-thick consistency in stroke patients. Nutr Clin Pract 2009; 24: 414-418
  CrossrefPubMedGoogle Scholar
• 126 Bhattacharyya N, Kotz T, Shapiro J. The effect of bolus consistency on dysphagia in unilateral vocal cord paralysis. Otolaryngol Head Neck Surg 2003; 129: 632-636
  CrossrefPubMedGoogle Scholar
• 127 Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia 2001; 16: 119-122
  CrossrefPubMedGoogle Scholar
• 128 Clave P, de Kraa M, Arreola V et al. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther 2006; 24: 1385-1394
  CrossrefPubMedGoogle Scholar
• 129 Logemann JA, Gensler G, Robbins J et al. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. J Speech Lang Hear Res 2008; 51: 173-183
  CrossrefPubMedGoogle Scholar
• 130 Ozaki K, Kagaya H, Yokoyama M et al. The risk of penetration or aspiration during videofluoroscopic examination of swallowing varies depending on food types. Tohoku J Exp Med 2010; 220: 41-46
  CrossrefPubMedGoogle Scholar
• 131 National Collaborating Centre for Chronic Conditions. Stroke – Diagnosis and initial management of stroke and transient ischaemic attack. July 2008
  Google Scholar
• 132 National Stroke Foundation. Clinical Guidelines for Stroke Management. 2010
  Google Scholar
• 133 Foley NC, Martin RE, Salter KL et al. A review of the relationship between dysphagia and malnutrition following stroke. J Rehabil Med 2009; 41: 707-713
  CrossrefPubMedGoogle Scholar
• 134 Wright L, Cotter D, Hickson M et al. Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet. J Hum Nutr Diet 2005; 18: 213-219
  CrossrefPubMedGoogle Scholar
• 135 Markus HS, Tomkins AM, Stern GM. Increased prevalence of undernutrition in Parkinson’s disease and its relationship to clinical disease parameters. J Neural Transm Park Dis Dement Sect 1993; 5: 117-125
  PubMedGoogle Scholar
• 136 Wang G, Wan Y, Cheng Q et al. Malnutrition and associated factors in Chinese patients with Parkinson’s disease: Results from a pilot investigation. Parkinsonism Relat Disord 2010; 16: 119-123
  CrossrefPubMedGoogle Scholar
• 137 Durrieu G, LLau ME, Rascol O et al. Parkinson’s disease and weight loss: a study with anthropometric and nutritional assessment. Clin Auton Res 1992; 2: 153-157
  CrossrefPubMedGoogle Scholar
• 138 Barichella M, Villa MC, Massarotto A et al. Mini Nutritional Assessment in patients with Parkinson’s disease: correlation between worsening of the malnutrition and increasing number of disease-years. Nutr Neurosci 2008; 11: 128-134
  CrossrefPubMedGoogle Scholar
• 139 Lorefat B, Ganowiak W, Wissing U et al. Food habits and intake of nutrients in elderly patients with Parkinson’s disease. Gerontology 2006; 52: 160-168
  CrossrefPubMedGoogle Scholar
• 140 Chen H, Zhang SM, Hernan MA et al. Weight loss in Parkinson’s disease. Ann Neurol 2003; 53: 676-679
  CrossrefPubMedGoogle Scholar
• 141 Lorefalt B, Granerus AK, Unosson M. Avoidance of solid food in weight losing older patients with Parkinson’s disease. J Clin Nurs 2006; 15: 1404-1412
  CrossrefPubMedGoogle Scholar
• 142 Davies KN, King D, Davies H. A study of the nutritional status of elderly patients with Parkinson’s disease. Age Ageing 1994; 23: 142-145
  CrossrefPubMedGoogle Scholar
• 143 Barichella M, Cereda E, Pezzoli G. Major nutritional issues in the management of Parkinson’s disease. Mov Disord 2009; 24: 1881-1892
  CrossrefPubMedGoogle Scholar
• 144 Bachmann CG, Trenkwalder C. Body weight in patients with Parkinson’s disease. Mov Disord 2006; 21: 1824-1830
  CrossrefPubMedGoogle Scholar
• 145 Miller N, Noble E, Jones D et al. Hard to swallow: dysphagia in Parkinson’s disease. Age Ageing 2006; 35: 614-618
  CrossrefPubMedGoogle Scholar
• 146 Jost WH. Gastrointestinal dysfunction in Parkinson’s Disease. J Neurol Sci 2010; 289: 69-73
  CrossrefPubMedGoogle Scholar
• 147 Hayes MW, Fung VS, Kimber TE et al. Current concepts in the management of Parkinson disease. Med J Aust 2010; 192: 144-149
  PubMedGoogle Scholar
• 148 Wood LD, Neumiller JJ, Setter SM et al. Clinical review of treatment options for select nonmotor symptoms of Parkinson’s disease. Am J Geriatr Pharmacother 2010; 8: 294-315
  CrossrefPubMedGoogle Scholar
• 149 Coates C, Bakheit AM. Dysphagia in Parkinson’s disease. Eur Neurol 1997; 38: 49-52
  CrossrefPubMedGoogle Scholar
• 150 Johnston BT, Li Q, Castell JA et al. Swallowing and esophageal function in Parkinson’s disease. Am J Gastroenterol 1995; 90: 1741-1746
  PubMedGoogle Scholar
• 151 Leopold NA, Kagel MC. Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia 1997; 12: 11-18; discussion 19-20
  CrossrefPubMedGoogle Scholar
• 152 Monte FS, da Silva-Junior FP, Braga-Neto P et al. Swallowing abnormalities and dyskinesia in Parkinson’s disease. Mov Disord 2005; 20: 457-462
  CrossrefPubMedGoogle Scholar
• 153 Nagaya M, Kachi T, Yamada T et al. Videofluorographic study of swallowing in Parkinson’s disease. Dysphagia 1998; 13: 95-100
  CrossrefPubMedGoogle Scholar
• 154 Michou E, Hamdy S. Dysphagia in Parkinson’s disease: a therapeutic challenge?. Expert Rev Neurother 2010; 10: 875-878
  CrossrefPubMedGoogle Scholar
• 155 Troche MS, Okun MS, Rosenbek JC et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology 2010; 75: 1912-1919
  CrossrefPubMedGoogle Scholar
• 156 Invernizzi M, Carda S, Viscontini GS et al. Osteoporosis in Parkinson’s disease. Parkinsonism Relat Disord 2009; 15: 339-346
  CrossrefPubMedGoogle Scholar
• 157 Sato Y, Manabe S, Kuno H et al. Amelioration of osteopenia and hypovitaminosis D by 1alpha-hydroxyvitamin D3 in elderly patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1999; 66: 64-68
  CrossrefPubMedGoogle Scholar
• 158 Dachverband Osteologie e. V.. DVO-Leitlinie 2009 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei Erwachsenen. Osteologie 2009; 18: 304-328
  PubMedGoogle Scholar
• 159 Astarloa R, Mena MA, Sanchez V et al. Clinical and pharmacokinetic effects of a diet rich in insoluble fiber on Parkinson disease. Clin Neuropharmacol 1992; 15: 375-380
  CrossrefPubMedGoogle Scholar
• 160 Cereda E, Barichella M, Pezzoli G. Controlled-protein dietary regimens for Parkinson’s disease. Nutr Neurosci 2010; 13: 29-32
  CrossrefPubMedGoogle Scholar
• 161 Diener H, Weimar C. Leitlinien für Diagnostik und Therapie in der Neurologie. 5.. überarbeitete Auflage ed. Stuttgart: Georg Thieme Verlag; 2012
  Article in Thieme ConnectGoogle Scholar
• 162 Carter JH, Nutt JG, Woodward WR et al. Amount and distribution of dietary protein affects clinical response to levodopa in Parkinson’s disease. Neurology 1989; 39: 552-556
  CrossrefPubMedGoogle Scholar
• 163 Cereda E, Barichella M, Pedrolli C et al. Low-protein and protein-redistribution diets for Parkinson’s disease patients with motor fluctuations: a systematic review. Mov Disord 2010; 25: 2021-2034
  CrossrefPubMedGoogle Scholar
• 164 Cereda E, Gini A, Pedrolli C et al. Disease-specific, versus standard, nutritional support for the treatment of pressure ulcers in institutionalized older adults: a randomized controlled trial. J Am Geriatr Soc 2009; 57: 1395-1402
  CrossrefPubMedGoogle Scholar
• 165 Moore O, Kreitler S, Ehrenfeld M et al. Quality of life and gender identity in Parkinson’s disease. J Neural Transm 2005; 112: 1511-1522
  CrossrefPubMedGoogle Scholar
• 166 Stewart KC, Fernandez HH, Okun MS et al. Distribution of motor impairment influences quality of life in Parkinson’s disease. Mov Disord 2008; 23: 1466-1468
  CrossrefPubMedGoogle Scholar
• 167 Li H, Zhang M, Chen L et al. Nonmotor symptoms are independently associated with impaired health-related quality of life in Chinese patients with Parkinson’s disease. Mov Disord 2010; 25: 2740-2746
  CrossrefPubMedGoogle Scholar
• 168 Klepac N, Trkulja V, Relja M et al. Is quality of life in non-demented Parkinson’s disease patients related to cognitive performance? A clinic-based cross-sectional study. Eur J Neurol 2008; 15: 128-133
  CrossrefPubMedGoogle Scholar
• 169 Zangaglia R, Martignoni E, Glorioso M et al. Macrogol for the treatment of constipation in Parkinson’s disease. A randomized placebo-controlled study. Mov Disord 2007; 22: 1239-1244
  CrossrefPubMedGoogle Scholar
• 170 Leow LP, Huckabee ML, Anderson T et al. The impact of dysphagia on quality of life in ageing and Parkinson’s disease as measured by the swallowing quality of life (SWAL-QOL) questionnaire. Dysphagia 2010; 25: 216-220
  CrossrefPubMedGoogle Scholar
• 171 Plowman-Prine EK, Sapienza CM, Okun MS et al. The relationship between quality of life and swallowing in Parkinson’s disease. Mov Disord 2009; 24: 1352-1358
  CrossrefPubMedGoogle Scholar
• 172 A’Campo LE, Wekking EM, Spliethoff-Kamminga NG et al. The benefits of a standardized patient education program for patients with Parkinson’s disease and their caregivers. Parkinsonism Relat Disord 2010; 16: 89-95
  CrossrefPubMedGoogle Scholar
• 173 Rao AK. Enabling functional independence in Parkinson’s disease: update on occupational therapy intervention. Mov Disord 2010; 25 (Suppl. 01) S146-151
  CrossrefPubMedGoogle Scholar
• 174 Bucks RS, Cruise KE, Skinner TC et al. Coping processes and health-related quality of life in Parkinson’s disease. Int J Geriatr Psychiatry 2011; 26: 247-255
  CrossrefPubMedGoogle Scholar
• 175 Korner U, Bondolfi A, Buhler E et al. Ethical and legal aspects of enteral nutrition. Clin Nutr 2006; 25: 196-202
  CrossrefPubMedGoogle Scholar
• 176 Krogh K, Christensen P. Neurogenic colorectal and pelvic floor dysfunction. Best Pract Res Clin Gastroenterol 2009; 23: 531-543
  CrossrefPubMedGoogle Scholar
• 177 Ueki A, Otsuka M. Life style risks of Parkinson’s disease: association between decreased water intake and constipation. J Neurol 2004; 251 (Suppl. 07) vII18-23
  CrossrefPubMedGoogle Scholar
• 178 Volkert D, Bauer J, Frühwald T et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE und der DGG: Klinische Ernährung in der Geriatrie – Teil des laufenden S3-Leitlinienprojekts Klinische Ernährung. Aktuel Ernahrungsmed 2013; 38: e1-e48
  Article in Thieme ConnectPubMedGoogle Scholar
• 179 Loser C, Wolters S, Folsch UR. Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients: a four-year prospective study. Dig Dis Sci 1998; 43: 2549-2557
  CrossrefPubMedGoogle Scholar
• 180 Bannerman E, Pendlebury J, Phillips F et al. A cross-sectional and longitudinal study of health-related quality of life after percutaneous gastrostomy. Eur J Gastroenterol Hepatol 2000; 12: 1101-1109
  CrossrefPubMedGoogle Scholar
• 181 Loeser C, von Herz U, Kuchler T et al. Quality of life and nutritional state in patients on home enteral tube feeding. Nutrition 2003; 19: 605-611
  CrossrefPubMedGoogle Scholar
• 182 Loser C, Aschl G, Hebuterne X et al. ESPEN guidelines on artificial enteral nutrition – percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005; 24: 848-861
  CrossrefPubMedGoogle Scholar
• 183 Phillips W, Shannon KM, Barker RA. The current clinical management of Huntington’s disease. Mov Disord 2008; 23: 1491-1504
  CrossrefPubMedGoogle Scholar
• 184 Aziz NA, van der Marck MA, Pijl H et al. Weight loss in neurodegenerative disorders. J Neurol 2008; 255: 1872-1880
  CrossrefPubMedGoogle Scholar
• 185 Djousse L, Knowlton B, Cupples LA et al. Weight loss in early stage of Huntington’s disease. Neurology 2002; 59: 1325-1330
  CrossrefPubMedGoogle Scholar
• 186 Aziz NA, van der Burg JM, Landwehrmeyer GB et al. Weight loss in Huntington disease increases with higher CAG repeat number. Neurology 2008; 71: 1506-1513
  CrossrefPubMedGoogle Scholar
• 187 Farrer LA, Yu PL. Anthropometric discrimination among affected, at-risk, and not-at-risk individuals in families with Huntington disease. Am J Med Genet 1985; 21: 307-316
  CrossrefPubMedGoogle Scholar
• 188 Marder K, Zhao H, Eberly S et al. Dietary intake in adults at risk for Huntington disease: analysis of PHAROS research participants. Neurology 2009; 73: 385-392
  CrossrefPubMedGoogle Scholar
• 189 Robbins AO, Ho AK, Barker RA. Weight changes in Huntington’s disease. Eur J Neurol 2006; 13: e7
  PubMedGoogle Scholar
• 190 Morales LM, Estevez J, Suarez H et al. Nutritional evaluation of Huntington disease patients. Am J Clin Nutr 1989; 50: 145-150
  PubMedGoogle Scholar
• 191 Lanska DJ, Lanska MJ, Lavine L et al. Conditions associated with Huntington’s disease at death. A case-control study. Arch Neurol 1988; 45: 878-880
  CrossrefPubMedGoogle Scholar
• 192 Lanska DJ, Lavine L, Lanska MJ et al. Huntington’s disease mortality in the United States. Neurology 1988; 38: 769-772
  CrossrefPubMedGoogle Scholar
• 193 Aziz NA, Swaab DF, Pijl H et al. Hypothalamic dysfunction and neuroendocrine and metabolic alterations in Huntington’s disease: clinical consequences and therapeutic implications. Rev Neurosci 2007; 18: 223-251
  PubMedGoogle Scholar
• 194 Hamilton JM, Wolfson T, Peavy GM et al. Rate and correlates of weight change in Huntington’s disease. J Neurol Neurosurg Psychiatry 2004; 75: 209-212
  CrossrefPubMedGoogle Scholar
• 195 Sanberg PR, Fibiger HC, Mark RF. Body weight and dietary factors in Huntington’s disease patients compared with matched controls. Med J Aust 1981; 1: 407-409
  PubMedGoogle Scholar
• 196 Pratley RE, Salbe AD, Ravussin E et al. Higher sedentary energy expenditure in patients with Huntington’s disease. Ann Neurol 2000; 47: 64-70
  CrossrefPubMedGoogle Scholar
• 197 Gaba AM, Zhang K, Marder K et al. Energy balance in early-stage Huntington disease. Am J Clin Nutr 2005; 81: 1335-1341
  PubMedGoogle Scholar
• 198 Gu M, Gash MT, Mann VM et al. Mitochondrial defect in Huntington’s disease caudate nucleus. Ann Neurol 1996; 39: 385-389
  CrossrefPubMedGoogle Scholar
• 199 Underwood BR, Broadhurst D, Dunn WB et al. Huntington disease patients and transgenic mice have similar pro-catabolic serum metabolite profiles. Brain 2006; 129: 877-886
  CrossrefPubMedGoogle Scholar
• 200 Mochel F, Charles P, Seguin F et al. Early energy deficit in Huntington disease: identification of a plasma biomarker traceable during disease progression. PLoS One 2007; 2: e647
  CrossrefPubMedGoogle Scholar
• 201 Petersen A, Bjorkqvist M. Hypothalamic-endocrine aspects in Huntington’s disease. Eur J Neurosci 2006; 24: 961-967
  CrossrefPubMedGoogle Scholar
• 202 Petersen A, Gil J, Maat-Schieman ML et al. Orexin loss in Huntington’s disease. Hum Mol Genet 2005; 14: 39-47
  PubMedGoogle Scholar
• 203 Kremer HP, Roos RA, Dingjan G et al. Atrophy of the hypothalamic lateral tuberal nucleus in Huntington’s disease. J Neuropathol Exp Neurol 1990; 49: 371-382
  CrossrefPubMedGoogle Scholar
• 204 Popovic V, Svetel M, Djurovic M et al. Circulating and cerebrospinal fluid ghrelin and leptin: potential role in altered body weight in Huntington’s disease. Eur J Endocrinol 2004; 151: 451-455
  CrossrefPubMedGoogle Scholar
• 205 Trejo A, Tarrats RM, Alonso ME et al. Assessment of the nutrition status of patients with Huntington’s disease. Nutrition 2004; 20: 192-196
  CrossrefPubMedGoogle Scholar
• 206 Nance MA, Sanders G. Characteristics of individuals with Huntington disease in long-term care. Mov Disord 1996; 11: 542-548
  CrossrefPubMedGoogle Scholar
• 207 Edmonds C. Huntington’s chorea, dysphagia and death. Med J Aust 1966; 2: 273-274
  PubMedGoogle Scholar
• 208 Heemskerk AW, Roos RA. Dysphagia in Huntington’s disease: a review. Dysphagia 2011; 26: 62-66
  CrossrefPubMedGoogle Scholar
• 209 Leopold NA, Kagel MC. Dysphagia in Huntington’s disease. Arch Neurol 1985; 42: 57-60
  CrossrefPubMedGoogle Scholar
• 210 Hunt VP, Walker FO. Dysphagia in Huntington’s disease. J Neurosci Nurs 1989; 21: 92-95
  CrossrefPubMedGoogle Scholar
• 211 Kagel MC, Leopold NA. Dysphagia in Huntington’s disease: a 16-year retrospective. Dysphagia 1992; 7: 106-114
  CrossrefPubMedGoogle Scholar
• 212 Mochizuki H, Kamakura K, Kumada M et al. A patient with Huntington’s disease presenting with laryngeal chorea. Eur Neurol 1999; 41: 119-120
  CrossrefPubMedGoogle Scholar
• 213 Hamakawa S, Koda C, Umeno H et al. Oropharyngeal dysphagia in a case of Huntington’s disease. Auris Nasus Larynx 2004; 31: 171-176
  CrossrefPubMedGoogle Scholar
• 214 Myers RH, Sax DS, Koroshetz WJ et al. Factors associated with slow progression in Huntington’s disease. Arch Neurol 1991; 48: 800-804
  CrossrefPubMedGoogle Scholar
• 215 Trejo A, Boll MC, Alonso ME et al. Use of oral nutritional supplements in patients with Huntington’s disease. Nutrition 2005; 21: 889-894
  CrossrefPubMedGoogle Scholar
• 216 Gaba A, Zhang K, Moskowitz CB et al. Harris-Benedict equation estimations of energy needs as compared to measured 24-h energy expenditure by indirect calorimetry in people with early to mid-stage Huntington’s disease. Nutr Neurosci 2008; 11: 213-218
  CrossrefPubMedGoogle Scholar
• 217 Sobotka L, Schneider SM, Berner YN et al. ESPEN Guidelines on Parenteral Nutrition: geriatrics. Clin Nutr 2009; 28: 461-466
  CrossrefPubMedGoogle Scholar
• 218 Pennington CR. Disease and malnutrition in British hospitals. Proc Nutr Soc 1997; 56: 393-407
  CrossrefPubMedGoogle Scholar
• 219 Payne A. Nutrition and diet in the clinical management of multiple sclerosis. J Hum Nutr Diet 2001; 14: 349-357
  CrossrefPubMedGoogle Scholar
• 220 Thomas FJ, Wiles CM. Dysphagia and nutritional status in multiple sclerosis. J Neurol 1999; 246: 677-682
  CrossrefPubMedGoogle Scholar
• 221 Slawta JN, Wilcox AR, McCubbin JA et al. Health behaviors, body composition, and coronary heart disease risk in women with multiple sclerosis. Arch Phys Med Rehabil 2003; 84: 1823-1830
  CrossrefPubMedGoogle Scholar
• 222 Hewson DC, Phillips MA, Simpson KE et al. Food intake in multiple sclerosis. Hum Nutr Appl Nutr 1984; 38: 355-367
  PubMedGoogle Scholar
• 223 Khurana SR, Bamer AM, Turner AP et al. The prevalence of overweight and obesity in veterans with multiple sclerosis. Am J Phys Med Rehabil 2009; 88: 83-91
  CrossrefPubMedGoogle Scholar
• 224 Schwarz S, Leweling H. Multiple sclerosis and nutrition. Mult Scler 2005; 11: 24-32
  CrossrefPubMedGoogle Scholar
• 225 Fawcett J, Sidney JS, Hanson MJ et al. Use of alternative health therapies by people with multiple sclerosis: an exploratory study. Holist Nurs Pract 1994; 8: 36-42
  PubMedGoogle Scholar
• 226 Schwartz CE, Laitin E, Brotman S et al. Utilization of unconventional treatments by persons with MS: is it alternative or complementary?. Neurology 1999; 52: 626-629
  CrossrefPubMedGoogle Scholar
• 227 Winterholler M, Erbguth F, Neundorfer B. The use of alternative medicine by multiple sclerosis patients – patient characteristics and patterns of use. Fortschr Neurol Psychiatr 1997; 65: 555-561
  Article in Thieme ConnectPubMedGoogle Scholar
• 228 Bowling AC, Stewart TM. Current Complementary and Alternative Therapies for Multiple Sclerosis. Curr Treat Options Neurol 2003; 5: 55-68
  CrossrefPubMedGoogle Scholar
• 229 Farinotti M, Simi S, Di Pietrantonj C et al. Dietary interventions for multiple sclerosis. Cochrane Database Syst Rev 2007; (01) CD004192
  PubMedGoogle Scholar
• 230 Weinstock-Guttman B, Baier M, Park Y et al. Low fat dietary intervention with omega-3 fatty acid supplementation in multiple sclerosis patients. Prostaglandins Leukot Essent Fatty Acids 2005; 73: 397-404
  CrossrefPubMedGoogle Scholar
• 231 Bates D, Cartlidge NE, French JM et al. A double-blind controlled trial of long chain n-3 polyunsaturated fatty acids in the treatment of multiple sclerosis. J Neurol Neurosurg Psychiatry 1989; 52: 18-22
  PubMedGoogle Scholar
• 232 Millar JH, Zilkha KJ, Langman MJ et al. Double-blind trial of linoleate supplementation of the diet in multiple sclerosis. Br Med J 1973; 1: 765-768
  CrossrefPubMedGoogle Scholar
• 233 Paty DW, Cousin HK, Read S et al. Linoleic acid in multiple sclerosis: failure to show any therapeutic benefit. Acta Neurol Scand 1978; 58: 53-58
  PubMedGoogle Scholar
• 234 Swank RL, Dugan BB. Effect of low saturated fat diet in early and late cases of multiple sclerosis. Lancet 1990; 336: 37-39
  CrossrefPubMedGoogle Scholar
• 235 Eyles D, Almeras L, Benech P et al. Developmental vitamin D deficiency alters the expression of genes encoding mitochondrial, cytoskeletal and synaptic proteins in the adult rat brain. J Steroid Biochem Mol Biol 2007; 103: 538-545
  CrossrefPubMedGoogle Scholar
• 236 Brown SJ. The role of vitamin D in multiple sclerosis. Ann Pharmacother 2006; 40: 1158-1161
  CrossrefPubMedGoogle Scholar
• 237 Hayes CE. Vitamin D: a natural inhibitor of multiple sclerosis. Proc Nutr Soc 2000; 59: 531-535
  CrossrefPubMedGoogle Scholar
• 238 Auer DP, Schumann EM, Kumpfel T et al. Seasonal fluctuations of gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis. Ann Neurol 2000; 47: 276-277
  CrossrefPubMedGoogle Scholar
• 239 Mahon BD, Gordon SA, Cruz J et al. Cytokine profile in patients with multiple sclerosis following vitamin D supplementation. J Neuroimmunol 2003; 134: 128-132
  CrossrefPubMedGoogle Scholar
• 240 Lakatos P, Nagy Z, Kiss L et al. Prevention of corticosteroid-induced osteoporosis by alfacalcidol. Z Rheumatol 2000; 59 (Suppl. 01) 48-52
  CrossrefPubMedGoogle Scholar
• 241 Ferretti G, Bacchetti T, Principi F et al. Increased levels of lipid hydroperoxides in plasma of patients with multiple sclerosis: a relationship with paraoxonase activity. Mult Scler 2005; 11: 677-682
  CrossrefPubMedGoogle Scholar
• 242 Jensen GE, Clausen J. Glutathione peroxidase activity, associated enzymes and substrates in blood cells from patients with multiple sclerosis – effects of antioxidant supplementation. Acta Pharmacol Toxicol (Copenh) 1986; 59 (Suppl. 07) 450-453
  PubMedGoogle Scholar
• 243 Mai J, Sorensen PS, Hansen JC. High dose antioxidant supplementation to MS patients. Effects on glutathione peroxidase, clinical safety, and absorption of selenium. Biol Trace Elem Res 1990; 24: 109-117
  CrossrefPubMedGoogle Scholar
• 244 Wade DT, Young CA, Chaudhuri KR et al. A randomised placebo controlled exploratory study of vitamin B-12, lofepramine, and L-phenylalanine (the „Cari Loder regime“) in the treatment of multiple sclerosis. J Neurol Neurosurg Psychiatry 2002; 73: 246-249
  CrossrefPubMedGoogle Scholar
• 245 Shatin R. Multiple Sclerosis and Geography. New Interpretation of Epidemiological Observations. Neurology 1964; 14: 338-344
  CrossrefPubMedGoogle Scholar
• 246 Butcher J. The distribution of multiple sclerosis in relation to the dairy industry and milk consumption. N Z Med J 1976; 83: 427-430
  PubMedGoogle Scholar
• 247 Ghezzi A, Zaffaroni M. Neurological manifestations of gastrointestinal disorders, with particular reference to the differential diagnosis of multiple sclerosis. Neurol Sci 2001; 22 (Suppl. 02) 117-122
  CrossrefPubMedGoogle Scholar
• 248 Hewson DC. Is there a role for gluten-free diets in multiple sclerosis?. Hum Nutr Appl Nutr 1984; 38: 417-420
  PubMedGoogle Scholar
• 249 Ehrentheil OF, Schulman MH, Alexander L. Role of food allergy in multiple sclerosis. Neurology 1952; 2: 412-426
  CrossrefPubMedGoogle Scholar
• 250 Ramagopalan SV, Dyment DA, Guimond C et al. Childhood cow’s milk allergy and the risk of multiple sclerosis: a population based study. J Neurol Sci 2010; 291: 86-88
  CrossrefPubMedGoogle Scholar
• 251 Vickrey BG, Hays RD, Harooni R et al. A health-related quality of life measure for multiple sclerosis. Qual Life Res 1995; 4: 187-206
  CrossrefPubMedGoogle Scholar
• 252 Fischer JS, LaRocca NG, Miller DM et al. Recent developments in the assessment of quality of life in multiple sclerosis (MS). Mult Scler 1999; 5: 251-259
  PubMedGoogle Scholar