title: Covariation between plasma phosphate and daytime cortisol in early Parkinson's disease.
abstract: Disturbed phosphate homeostasis in early Parkinson's disease (PD) may originate from a stress-related condition and nutritional status among other risk factors, age, and gender.
  
  
  
  Risk of malnutrition using Mini-nutritional assessment (MNA score) and plasma levels of protein markers and daytime cortisol at the time of diagnosis in PD (n= 75) were compared with a control group (n= 24). Cognition was assessed using the Mini-Mental State Examination (MMSE score) and motor function using Unified Parkinson's Disease Rating Scale (UPDRS-part III scale).
  
  
  
  The patients with PD had significantly lower MNA score than controls which correlated with plasma phosphate levels. The logistic regression revealed that increasing MNA protected from low plasma phosphate, final score (OR = 0.399; 95% CI = 0.196-0.816;p= .012) and total score (OR = 0.656; 95% CI = 0.422-1.018;p= .060). Phosphate correlated with albumin (r= .315;p< .006), transferrin (r= .331;p< .004) and cortisol (r=-0.355;p< .002) confirmed by logistic regressions. Increasing albumin protects from low phosphate after adjusting in logistic regression (OR = 0.806; 95% CI = 0.682-0.952;p= .011) and after including variables from Table 1 in backwards elimination, final step (OR = 0.800; 95% CI = 0.660-0.969;p= .022). MNA total score and cortisol correlated inversely, confirmed in logistic regression for MNA total score (OR = 0.786; 95% CI = 0.627-0.985;p= .037) and for MNA initial score (OR = 0.650; 95% CI = 0.453-0.930;p= .020).
  
  
  
  This study highlights the importance of phosphate for optimal nutritional status by association with MNA score and albumin in plasma. An inverse relationship between phosphate and cortisol indicate, in addition, that low phosphate levels may affect cognition and motor function in PD.
authors.affiliation: Department of Public Health and Clinical Medicine, Family Medicine Umeå University Umeå Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Håglin
authors.affiliation: Department of Public Health and Clinical Medicine, Family Medicine Umeå University Umeå Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Bäckman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002940:Circadian Rhythm; D003071:Cognition / Q000502:physiology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007980:Levodopa / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000097:blood; D008875:Middle Aged; D015596:Nutrition Assessment; D010300:Parkinson Disease / Q000097:blood* / Q000188:drug therapy / Q000523:psychology; D010710:Phosphates / Q000097:blood*; D012709:Serum Albumin / Q000378:metabolism; D014168:Transferrin / Q000378:metabolism
chemical_list: D000978:Antiparkinson Agents; D010710:Phosphates; D012709:Serum Albumin; D014168:Transferrin; D007980:Levodopa; D006854:Hydrocortisone
keywords: Mini‐Nutritional Assessment; Parkinson's disease; albumin; cognition; cortisol; phosphate; stress; transferrin