Anxiety symptoms and nutritional status in Parkinson's disease

Anxiety symptoms and nutritional status in Parkinson's disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anxiety symptoms and nutritional status in Parkinson's disease Raissa Dias Fernandez, Lane Viana Krejcová, Daniela Lopes Gomes This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7811138/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Parkinson's disease (PD) presents motor and non-motor symptoms, which include nutritional problems and anxiety. The objective was evaluate the anxiety and nutritional status of people with PD. Methods : This is a cross-sectional, descriptive, and analytical study. Results: 91 participants: age arround 63 years, majority men, married, retired. Dividing the group between adults and elderly (>60 years of age), the majority of adults had a normal nutritional status or were overweight, and elderly people were overweight. The anxiety score was higher in female participants (p=0.005), without a partner (p=0.0034); negative correlation between age and the anxiety score (r=0.180; p=0.044); positive correlation between the triceps skinfold and anxiety (r=0.183; p=0.041); the correlation between sex and anxiety level remained independent of marital status and age. Conclusion: The early detection of nutritional disorders and anxiety levels in people with PD, especially in women, is of great importance as it can affect their clinical outcomes. Anxiety Female Nutritional status Parkinson's disease Neurodegenerative Disorder Introduction Parkinson's Disease (PD) was first described as "Shaking Paralysis" [ 1 ]. It is a progressive degenerative neurological disorder of the central nervous system that mainly affects the motor system, leading to the death of neurons present in the substantia nigra, located in the midbrain [ 2 ], the substantia nigra neurons are mainly dopaminergic [ 3 ]. PD motor symptoms are usually observed are: resting tremor, muscle rigidity, bradykinesia and postural/gait impairment. Among the non-motor symptoms of the disease are observed: constipation, anosmia, anxiety, depression, and sleep disorders [ 4 ]. Physical and emotional stress associated with the behavioral disturbances commonly observed in people with PD can lead to impaired nutritional status [ 5 ]. However, recent findings suggest that the nutritional profile of individuals with PD may be more heterogeneous than previously assumed. Some studies have identified subgroups of patients with PD presenting with overweight or obesity, particularly in early or stable stages of the disease [ 6 , 7 ]. Moreover, the relationship between excessive weight and psychological conditions, such as anxiety, has been increasingly investigated [ 8 ]. Although several factors related to the association between obesity and anxiety have been previously described, the mechanisms and pathways underlying these connections remain unclear [ 9 ]. Possible links include psychosocial factors; individuals living with obesity often experience social stigma, which may exacerbate psychological distress and contribute to a negative feedback loop [ 10 , 11 ]. The symptomatic progression of PD exerts a negative impact on mood, and anxiety symptoms are frequently observed in the patients [ 12 , 13 ]. Anxiety is known to be present in neurological disorders and seems to be associated with imbalances in neurotransmitter systems such as serotoninergic and noradrenergic, that affect the functions of the limbic system [ 14 , 15 ]. Previous studies have shown that anxiety has a prevalence of 31% in patients with PD [ 16 ]. Anxiety disorders, such as generalized anxiety, agoraphobia, panic, and social phobia are present in 20% to 40% of PD patients [ 17 ]. The use of screening tools to detect anxiety is the first important step in recognizing the presentation of these symptoms, so a full psychiatric evaluation may be recommended [ 18 ]. In the present study, we investigated the presentation of subtypes of anxiety using the Parkinson Anxiety Scale (PAS), a validated instrument developed specifically for patients with PD that includes three subscales assessing persistent anxiety, episodic anxiety, and avoidance behavior [ 18 ]. Although relatively recent, PAS has shown good reliability and is increasingly used in international research. The Portuguese version validated for use in Brazil was applied in the current study to ensure cultural and linguistic adequacy. The hypothesis of our research is that anxiety symptoms negatively affect the nutritional status of patients with Parkinson’s disease. The main objective of the present study was to evaluate whether anxiety symptoms affect nutritional status in PD. Methods A cross-sectional, descriptive, and analytical study was carried out in two different public services. The first collection site was at the neurology outpatient clinic of Hospital Ophir Loyola (Belém-PA, Brazil), which has around 40 patients in its registry, of which 33 were evaluated. The second collection site was at the Institute of Health Sciences (ICS), in the LAERF laboratory (Laboratory of Studies in Functional Rehabilitation), in the “Baila Parkinson” extension project, developed in Universidade Federal do Pará (UFPA). Therefore, the total number of participants from both groups in this study was ninety-one. No formal power analysis was conducted prior to data collection. The sample was defined by convenience, according to the flow of eligible patients attending the outpatient clinic and the availability of participants enrolled in the was program during the data collection period. Ethics The research protocol was reviewed and approved by the Research Ethics Committee of the Núcleo de Medicina Tropical of the Federal University of Pará (CEP/NMT-UFPA; Opinion No. 4.937.107) and by the Research Ethics Committee of Hospital Ophir Loyola (CEP/HOL; Opinion No. 5.081.449). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki, Resolution No. 466/12 of the Brazilian National Health Council, and other relevant institutional and national regulations. All participants were fully informed about the objectives and procedures of the study and provided written informed consent prior to participation. Participant confidentiality and anonymity were maintained throughout the research process. Consent for Publication Not applicable. Participants Ninety-one individuals diagnosed with Parkinson's Disease participated in this research. They were diagnosed with Parkinson's Disease according to the criteria of the Brain Bank of London (UK Parkinson's Disease Society Brain Bank), included both genders, and were accepted at any stage of the disease. Given the known differences in body composition and nutritional status standards between adults and elderly individuals, particularly regarding BMI classification, participants were classified into two age groups: adults (under 60 years old) and elderly (60 years and above). This classification aimed to account for potential age-related variations in nutritional status and anxiety symptoms. All participants signed an Informed Consent Form to join the study. Patients with indications of cognitive risk, with psychiatric illnesses, with less than a year since diagnosis, and participants who didn’t want to participate in the research or sign the Informed Consent Form were excluded from the sample. Instruments and Procedures for data collection Data collection was carried out using three instruments: a socioeconomic and clinical data questionnaire, an anthropometric data form, and the Parkinson’s Disease Anxiety Scale (PAS). The PAS is a validated and specific tool for assessing anxiety symptoms in individuals with Parkinson’s disease. The other two instruments were developed by the researcher and included both closed and open-ended questions. Participants were first interviewed to obtain socioeconomic and demographic information, including personal identification (initials only), age, contact number (if agreed), gender, current medications, marital status, education, and income. Next, anthropometric measurements were taken, followed by completion of the PAS. All instruments were administered in person by the main researcher, a health professional and principal investigator of the study. Data were collected directly from participants, without the use of electronic medical records or clinical charts. The data collection took place between March and May 2022. Anthropometric data form To assess the nutritional status, weight, and height were measured with an Omron digital scale, which supported up to 180kg, and with a portable stadiometer with an exact height of 200cm and, a precision of 1cm. When participants were unable to stand on the scale or remain upright for height measurement due to mobility limitations (such as those using wheelchairs or who had significant difficulty walking) these data were estimated using the method described by Chumlea [19], which calculates height and weight based on two measurements: arm circumference and knee height [20,21]. After data collection, patients’ Body Mass Index (BMI) was calculated (BMI = weight/height²) to classify their nutritional status according to the WHO classification [22]. Another anthropometric measurement obtained was the tricipital skinfold thickness (TS), measured with a Lange caliper on the posterior aspect of the non-dominant arm. TS is widely used as an indicator of subcutaneous fat, which represents a significant portion of total body fat. Higher TS values indicate greater subcutaneous fat accumulation and are directly associated with obesity and excess body fat. Conversely, lower TS values may suggest undernutrition or reduced fat reserves. Thus, TS correlates strongly with nutritional status, providing valuable information about fat stores and helping to identify individuals at risk of malnutrition or obesity [23,24]. Nutritional Status Classification Nutritional status was classified using two indicators: Body Mass Index (BMI) and tricipital skinfold (TS) thickness. For BMI, participants were categorized as underweight, eutrophic, overweight, or obese based on WHO guidelines [22]. For adults (<60 years), BMI was classified as: underweight (<18.5), eutrophic (18.5–24.9), overweight (25–29.9), and obese (≥30 kg/m²) [22]. For elderly participants (≥60 years), BMI cutoffs followed the Lipschitz [25] classification: underweight (27). BMI classification was applied only to elderly participants (≥60 years), since different cutoff points are used for adults and older adults. In contrast, TS classification is based on percentiles adjusted for age and sex, allowing its application to the entire sample. TS was classified using percentiles for age and sex as per Frisancho [26]: Severe malnutrition: 85th percentile, Parkinson’s Disease Anxiety Scale The participants' anxiety symptoms were assessed using the PAS, a questionnaire developed by Leentjens [18]to specifically assess the severity of anxiety symptoms in patients with PD. It is a valid and reliable tool for measuring anxiety in patients with PD, and its original version shows good sensitivity and specificity. The PAS consists of 12 questions, divided into three subscales (persistent anxiety, episodic anxiety, and avoidance behavior). The first subscale contains five questions and assesses Persistent Anxiety (Subscale A), with five answer options distributed on a Likert scale: (not at all or never; very little or rarely; little or sometimes; moderately or often and very or practically always), the scores on each item range from 0 (not at all or never) to 4 (very much or practically always), and the total value of this subscale is 20 points [18]. The second subscale assesses Episodic Anxiety (Subscale B) and contains four questions, with five answer options (never; rarely; sometimes; frequent; and always) also on a Likert scale from 0 (never) to 4 (always), the total value of this subscale is 16 points. The third and final part assesses Avoidance Behavior (Subscale C) and contains three questions and five answer options (never; rarely; sometimes; frequent; and always), scoring from 0 (never) to 4 (always) and a maximum score of 12 points. The total sum of the ∑SCORE subscales (A+B+C) totals 48 points, which is the maximum [18]. In the original validation, cut-off values were used as the average for each subscale, for the total score (cut-off = 14), for the persistent anxiety subscale (cut-off = 10), for the episodic anxiety subscale (cut-off = 5), and for the avoidance behavior subscale (cut-off = off = 4) [18]. Statistical Analysis Statistical analyses were performed using SPSS software, version 24.0. In the descriptive stage, measures of central tendency and dispersion (mean and standard deviation) were calculated for continuous variables, and frequencies and proportions for categorical variables. In the analytical stage, independent samples t-tests were used to compare total PAS anxiety scores between sociodemographic groups (e.g., sex, marital status, education level, and income) to explore potential associations with anxiety symptoms. Pearson correlation was applied to assess the linear relationship between total anxiety scores and continuous nutritional variables (e.g., age, BMI, and tricipital skinfold). Variables that showed statistically significant associations (p < 0.05) in the bivariate analyses were included in a multiple linear regression model, with the total PAS anxiety score as the dependent variable. The model included sex, marital status, and age as covariates to adjust for potential confounding effects. A statistical significance level of 95% (p < 0.05) was adopted for all analyses. There were no missing data in the final dataset. Results Of the 91 participants evaluated, the majority were male (68%), married (54.9%), with an age of 63.4 ± 10.4 years, and 64.8% were elderly (over 60 years of age). Almost 22% had completed high school, 73% were retired and 46% had a monthly income of up to 3 minimum wages. Regarding the anxiety scale, 60% showed symptoms of anxiety. The cut-off criteria observed in the original validation were considered; the total PAS score had a mean of 18.5±11, indicating the presence of anxiety in the sample; in the PAS-C subscale the mean was 4.38±3.7 (Table 1). Tables Table 1 - Sociodemographic and socioeconomic profile and anxiety symptoms in people with Parkinson's disease treated in public services in Belém – PA, 2022 Sociodemographic and Socioeconomic Profile N=91 % Sex Male 62 68.13 Female 29 31.86 Marital Status Married 50 54.94 Single 16 17.58 Stable union 9 9.89 Divorced Widowed 8 8 8.79 8.79 Age Range Under 60 years old Over 60 years old 32 59 35.16 64.83 Education Illiterate 5 5.49 Incomplete Elementary Education 7 7.69 Complete Primary education 9 9.89 Incomplete high school 19 20.87 Complete high school 20 21.97 Technical education 1 1.09 Incomplete higher education 9 9.89 Complete Higher Education 13 14.28 Postgraduate 8 8.79 Occupation Retired 67 7.62 Working 8 8.79 Receiving govt aid 16 17.58 Income Up to 1 minimum wage 34 37.36 >1 to 3 minimum wages 42 46.15 >3 to 6 minimum wages 15 16.48 PAS Anxiety detected No Anxiety 55 36 60.4 36.6 Total score -PAS (Subescalas A+B+C) Subscale-A (Persistent Anxiety) Subscale-B (Episodic Anxiety) Subscale-C (Avoidance Behavior) AVG -STD 18.5±11.4 9.39±6.0 4.28±3.9 4.38 ±3.7 Cut off 14 10 5 4 About nutritional profile, tricipital skinfold thickness (TS), 40.6% were eutrophic and 40.6% were overweight. Among the elderly, 42.1% were overweight. According to the TS measurements, 48.3% were obese (Table 2). Table 2 - Nutritional Profile in people with Parkinson's Disease treated in Public Services in Belém – PA, 2022 Nutritional Profile AVG ± STD Interval BMI 25.8 ± 3.7 16.4 – 33.2 TS 19.4 ± 7.7 5.0 – 35.5 TS % 139 ±114.9 39.0-111.6 Nutritional Profile / G ender AVG Interval BMI Women BMI Men TS Women TS Men 26.03 25.7 24.1 17.3 19.1- 33.1 18.9 – 32.4 14.0- 35.5 5.0 -30.0 Malnutrition 1 3.12 Eutrophy 13 40.6 Overweight 13 40.6 Obesity 5 15.6 BMI Classification of Elderly People n=59 % Low weight 9 15.2 Deficit risk 11 18.6 Eutrophy 14 23.7 Overweight 25 42.3 TS Classification n=91 % Severe malnutrition 9 9.8 Moderate malnutrition 7 7.6 Mild malnutrition 8 8.7 Eutrophy 13 14.2 Overweight 10 10.9 Obesity 44 48.3 BMI= Body Mass Index; TS= Triceps skinfold T-test for independent samples Higher anxiety scores were observed in female participants (p=0.005), those without a partner (p=0.034) (Table 3). Table 3 - Total Anxiety score according to the socioeconomic and sociodemographic profile of people with Parkinson's Disease treated in Public Services in Belém – PA, 2022 Socioeconomic profile Total Anxiety Score AVG ± STD p-value* Sex Male (n=62) 16.3 ± 10.7 0.005 Female (n=29) 23.3 ± 11.5 Marital status With partner (n=59) 16.7 ± 11.5 0.034 No partner (n=32) 21.9 ± 10.5 Education No higher education (n=61) 19.5 ± 11.4 0.230 With higher education (n=30) 16.5 ± 11.2 Income ≤ 3 minimum wages (n=77) 18.9 ± 11.4 0.429 Over 3 minimum wages (n=14) 16.3 ± 11.3 T-test for independent samples A negative correlation was observed between age and the total anxiety score (r=0.180; p= 0.044) and a positive correlation between TS and the anxiety score (r= 0.183; p= 0.041) (Table 4). Table 4- Factors correlated to the total anxiety score of people with Parkinson's Disease treated in Public Services in Belém – PA, 2022 PAS total score Age (years) BMI (kg/m 2 ) TS (mm) r p-value r p-value R p-value -0.180 0.044 * 0.007 0.472 0.183 0.041* * Pearson correlation test; BMI= Body Mass Index; TS= Triceps skinfold. According to the multiple linear regression model: In model 1, the correlation between anxiety score and the female sex was maintained (B= 0.290; 95% CI, 2.137; 11.935; p<0.005); In model 2, it was observed that the correlation between anxiety and female sex remained independent of the marital situation (B=0.239; CI=0.518 – 11.114; p=0.032) and in model 3, the correlation between anxiety and female sex remained, regardless of marital status and age (B=0.230; CI=0.302 - 10.856; p=0.039) (Table 5). Sociodemographic variables associated with anxiety (as shown in Table 3) and their independent predictive value (Table 5) help identify risk profiles that may impact nutritional outcomes. These findings support the central objective of the study, which was to assess whether anxiety symptoms affect nutritional status in PD. Table 5 - Multiple linear regression between the total Anxiety Scale score in people with Parkinson's Disease treated in Public Services in Belém – PA, 2022. Total anxiety score B IC 95% (minimum; maximum) p-value Model 1 Sex 0.290 2.137; 11.935 0.005 Model 2 Sex 0.239 0.518;11.114 0.032 Marital Status 0.130 -2.081; 8.259 0.238 Modelo 3 Sex 0.230 0.302; 10.856 0.039 Marital Status 0.119 -2.324; 7.981 0.278 Age -0.146 -378; 0.61 0.154 Multiple linear regression; Dependent variable: PAS total score co-variable: Sex, marital status, age (years). B = Regression coefficient. Discussion The present study aimed to evaluate whether anxiety symptoms affect the nutritional status of individuals with Parkinson’s disease (PD). A high prevalence of anxiety symptoms was found (approximately 60%), along with a significant association between anxiety scores and tricipital skinfold thickness (TS), reflecting increased adiposity. Although PD is traditionally linked to weight loss and malnutrition [5,27], nearly 90% of our sample was classified as overweight or obese based on TS measurements. This contradicts earlier assumptions and supports recent evidence suggesting a more heterogeneous nutritional profile in PD [7,28]. The high proportion of excess weight in our sample may be influenced by reduced physical activity due to motor symptoms, side effects of medications, and psychosocial stressors. Anxiety, in particular, may contribute through mechanisms such as emotional eating, hormonal imbalances, and lifestyle changes [9,11]. The positive correlation between TS and anxiety supports the hypothesis that anxiety plays a role in increased adiposity. Women and participants without a partner had higher anxiety scores. Female sex is a known risk factor for mood disorders in PD, with symptoms like fatigue, sadness, and pain being more commonly reported [29]. Most women in our sample were postmenopausal, which may contribute to vulnerability to emotional disorders [30]. The absence of a partner may also lead to social isolation, a factor associated with anxiety in PD [31,32]. Additionally, most participants reported low income (1–3 minimum wages), reflecting economic vulnerability that can worsen anxiety symptoms, particularly among people with chronic conditions like PD [33,34]. Social and financial stress may further reduce access to healthy food and emotional support, negatively affecting both nutritional and mental health. A negative correlation was observed between age and anxiety, with younger participants showing higher anxiety levels. This finding aligns with previous studies that associate early-onset PD with greater emotional burden and increased anxiety [34,36]. This study has limitations, including the sample size, which was dependent on the flow of participants in the Baila Parkinson project, and potential recall bias due to the nature of the PAS scale. Although the regression model adjusted for sex, age, and marital status, other potential confounding variables such as disease duration, medication use, and functional status were not included. This omission should be considered a limitation, as these factors may influence both anxiety symptoms and nutritional status in individuals with Parkinson’s disease. Still, our findings contribute to a better understanding of how anxiety relates to nutritional status in PD and highlight the need for integrated care that addresses both emotional and nutritional aspects. Conclusion Anxiety is a complex symptom with multifactorial causes and significant effects on individuals with Parkinson’s disease (PD). Our findings highlight the importance of early screening for anxiety, especially among women and those with social vulnerabilities, to guide timely and effective treatment strategies. Furthermore, the demonstrated association between anxiety levels and nutritional status underscores the need for continuous and integrated monitoring of both mental health and nutritional parameters in this population. Therefore, multidisciplinary care that addresses non-motor symptom including emotional and nutritional aspects is essential to minimize potential risks and improve overall quality of life in people living with PD. Declarations Data Availability Statement :The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Funding Declaration : Not applicable Registration Number : Not applicable Ethics Approval : The research protocol was reviewed and approved by the Research Ethics Committee of the Núcleo de Medicina Tropical of the Federal University of Pará (CEP/NMT‑UFPA) under Opinion number 4.937.107, and by the Research Ethics Committee of Hospital Ophir Loyola (CEP/HOL) under Opinion number 5.081.449. Consent to Participate : All participants were informed about the objectives and procedures of the study and provided written informed consent prior to participation. Consent for Publication : All authors have read and approved the final version of the manuscript and consent to its publication. Conflicts of interest : The authors report no conflicts of interest. References Hayes, M. T. Parkinson’s Disease and Parkinsonism. 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Fernandez","email":"data:image/png;base64,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","orcid":"","institution":"Universidade Federal do Pará","correspondingAuthor":true,"prefix":"","firstName":"Raissa","middleName":"Dias","lastName":"Fernandez","suffix":""},{"id":544734062,"identity":"0b88326f-cad5-4245-a428-a33e17f4fe52","order_by":1,"name":"Lane Viana Krejcová","email":"","orcid":"","institution":"Universidade Federal do 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07:54:04","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":112476,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7811138/v1/ce1241846aa36115a150a8b3.html"},{"id":105566548,"identity":"5795adeb-38e1-464c-980e-3c32f8ce1b02","added_by":"auto","created_at":"2026-03-27 12:56:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1907130,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7811138/v1/6ec71555-2a6e-4d68-8465-b2b0ff6d7a46.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anxiety symptoms and nutritional status in Parkinson's disease","fulltext":[{"header":"Introduction","content":"\u003cp\u003eParkinson's Disease (PD) was first described as \"Shaking Paralysis\" [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is a progressive degenerative neurological disorder of the central nervous system that mainly affects the motor system, leading to the death of neurons present in the substantia nigra, located in the midbrain [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], the substantia nigra neurons are mainly dopaminergic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePD motor symptoms are usually observed are: resting tremor, muscle rigidity, bradykinesia and postural/gait impairment. Among the non-motor symptoms of the disease are observed: constipation, anosmia, anxiety, depression, and sleep disorders [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePhysical and emotional stress associated with the behavioral disturbances commonly observed in people with PD can lead to impaired nutritional status [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, recent findings suggest that the nutritional profile of individuals with PD may be more heterogeneous than previously assumed. Some studies have identified subgroups of patients with PD presenting with overweight or obesity, particularly in early or stable stages of the disease [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMoreover, the relationship between excessive weight and psychological conditions, such as anxiety, has been increasingly investigated [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Although several factors related to the association between obesity and anxiety have been previously described, the mechanisms and pathways underlying these connections remain unclear [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Possible links include psychosocial factors; individuals living with obesity often experience social stigma, which may exacerbate psychological distress and contribute to a negative feedback loop [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe symptomatic progression of PD exerts a negative impact on mood, and anxiety symptoms are frequently observed in the patients [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Anxiety is known to be present in neurological disorders and seems to be associated with imbalances in neurotransmitter systems such as serotoninergic and noradrenergic, that affect the functions of the limbic system [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Previous studies have shown that anxiety has a prevalence of 31% in patients with PD [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Anxiety disorders, such as generalized anxiety, agoraphobia, panic, and social phobia are present in 20% to 40% of PD patients [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe use of screening tools to detect anxiety is the first important step in recognizing the presentation of these symptoms, so a full psychiatric evaluation may be recommended [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In the present study, we investigated the presentation of subtypes of anxiety using the Parkinson Anxiety Scale (PAS), a validated instrument developed specifically for patients with PD that includes three subscales assessing persistent anxiety, episodic anxiety, and avoidance behavior [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Although relatively recent, PAS has shown good reliability and is increasingly used in international research. The Portuguese version validated for use in Brazil was applied in the current study to ensure cultural and linguistic adequacy.\u003c/p\u003e\u003cp\u003eThe hypothesis of our research is that anxiety symptoms negatively affect the nutritional status of patients with Parkinson\u0026rsquo;s disease. The main objective of the present study was to evaluate whether anxiety symptoms affect nutritional status in PD.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA cross-sectional, descriptive, and analytical study was carried out in two different public services. The first collection site was at the neurology outpatient clinic of Hospital Ophir Loyola (Bel\u0026eacute;m-PA, Brazil), which has around 40 patients in its registry, of which 33 were evaluated. The second collection site was at the Institute of Health Sciences (ICS), in the LAERF laboratory (Laboratory of Studies in Functional Rehabilitation), in the \u003cem\u003e\u0026ldquo;Baila Parkinson\u0026rdquo;\u003c/em\u003e extension project, developed in Universidade Federal do Par\u0026aacute; (UFPA). Therefore, the total number of participants from both groups in this study was ninety-one. No formal power analysis was conducted prior to data collection. The sample was defined by convenience, according to the flow of eligible patients attending the outpatient clinic and the availability of participants enrolled in the was \u0026nbsp;program during the data collection period.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eEthics\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe research protocol was reviewed and approved by the Research Ethics Committee of the N\u0026uacute;cleo de Medicina Tropical of the Federal University of Par\u0026aacute; (CEP/NMT-UFPA; Opinion No. 4.937.107) and by the Research Ethics Committee of Hospital Ophir Loyola (CEP/HOL; Opinion No. 5.081.449). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki, Resolution No. 466/12 of the Brazilian National Health Council, and other relevant institutional and national regulations. All participants were fully informed about the objectives and procedures of the study and provided written informed consent prior to participation. Participant confidentiality and anonymity were maintained throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for Publication\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eParticipants\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNinety-one individuals diagnosed with Parkinson\u0026apos;s Disease participated in this research. They were diagnosed with Parkinson\u0026apos;s Disease according to the criteria of the Brain Bank of London (UK Parkinson\u0026apos;s Disease Society Brain Bank), included both genders, and were accepted at any stage of the disease. Given the known differences in body composition and nutritional status standards between adults and elderly individuals, particularly regarding BMI classification, participants were classified into two age groups: adults (under 60 years old) and elderly (60 years and above). This classification aimed to account for potential age-related variations in nutritional status and anxiety symptoms. All participants signed an Informed Consent Form to join the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients with indications of cognitive risk, with psychiatric illnesses, with less than a year since diagnosis, and participants who didn\u0026rsquo;t want to participate in the research or sign the Informed Consent Form were excluded from the sample.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eInstruments and Procedures for data collection\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eData collection was carried out using three instruments: a socioeconomic and clinical data questionnaire, an anthropometric data form, and the Parkinson\u0026rsquo;s Disease Anxiety Scale (PAS). The PAS is a validated and specific tool for assessing anxiety symptoms in individuals with Parkinson\u0026rsquo;s disease. The other two instruments were developed by the researcher and included both closed and open-ended questions.\u003c/p\u003e\n\u003cp\u003eParticipants were first interviewed to obtain socioeconomic and demographic information, including personal identification (initials only), age, contact number (if agreed), gender, current medications, marital status, education, and income. Next, anthropometric measurements were taken, followed by completion of the PAS.\u003c/p\u003e\n\u003cp\u003eAll instruments were administered in person by the main researcher, a health professional and principal investigator of the study. Data were collected directly from participants, without the use of electronic medical records or clinical charts. The data collection took place between March and May 2022.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAnthropometric data form\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the nutritional status, weight, and height were measured with an Omron digital scale, which supported up to 180kg, and with a portable stadiometer with an exact height of 200cm and, a precision of 1cm. When participants were unable to stand on the scale or remain upright for height measurement due to mobility limitations (such as those using wheelchairs or who had significant difficulty walking) these data were estimated using the method described by Chumlea [19], which calculates height and weight based on two measurements: arm circumference and knee height [20,21].\u003c/p\u003e\n\u003cp\u003eAfter data collection, patients\u0026rsquo; Body Mass Index (BMI) was calculated (BMI = weight/height\u0026sup2;) to classify their nutritional status according to the WHO classification [22]. Another anthropometric measurement obtained was the tricipital skinfold thickness (TS), measured with a Lange caliper on the posterior aspect of the non-dominant arm. TS is widely used as an indicator of subcutaneous fat, which represents a significant portion of total body fat. Higher TS values indicate greater subcutaneous fat accumulation and are directly associated with obesity and excess body fat. Conversely, lower TS values may suggest undernutrition or reduced fat reserves. Thus, TS correlates strongly with nutritional status, providing valuable information about fat stores and helping to identify individuals at risk of malnutrition or obesity [23,24].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eNutritional Status Classification\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNutritional status was classified using two indicators: Body Mass Index (BMI) and tricipital skinfold (TS) thickness. For BMI, participants were categorized as underweight, eutrophic, overweight, or obese based on WHO guidelines [22]. For adults (\u0026lt;60 years), BMI was classified as: underweight (\u0026lt;18.5), eutrophic (18.5\u0026ndash;24.9), overweight (25\u0026ndash;29.9), and obese (\u0026ge;30 kg/m\u0026sup2;) [22]. For elderly participants (\u0026ge;60 years), BMI cutoffs followed the Lipschitz [25] classification: underweight (\u0026lt;22), eutrophic (22\u0026ndash;27), and overweight/obese (\u0026gt;27).\u003c/p\u003e\n\u003cp\u003eBMI classification was applied only to elderly participants (\u0026ge;60 years), since different cutoff points are used for adults and older adults. In contrast, TS classification is based on percentiles adjusted for age and sex, allowing its application to the entire sample.\u003c/p\u003e\n\u003cp\u003eTS was classified using percentiles for age and sex as per Frisancho [26]: Severe malnutrition: \u0026lt;5th percentile; Moderate malnutrition: 5th\u0026ndash;15th percentile; Mild malnutrition: 15th\u0026ndash;25th percentile; Eutrophic: 25th\u0026ndash;75th percentile; Overweight: 75th\u0026ndash;85th percentile and Obese: \u0026gt;85th percentile,\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eParkinson\u0026rsquo;s Disease Anxiety Scale\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The participants\u0026apos; anxiety symptoms were assessed using the PAS, a questionnaire developed by Leentjens [18]to specifically assess the severity of anxiety symptoms in patients with PD. It is a valid and reliable tool for measuring anxiety in patients with PD, and its original version shows good sensitivity and specificity.\u003c/p\u003e\n\u003cp\u003eThe PAS consists of 12 questions, divided into three subscales (persistent anxiety, episodic anxiety, and avoidance behavior). The first subscale contains five questions and assesses Persistent Anxiety (Subscale A), with five answer options distributed on a Likert scale: (not at all or never; very little or rarely; little or sometimes; moderately or often and very or practically always), the scores on each item range from 0 (not at all or never) to 4 (very much or practically always), and the total value of this subscale is 20 points\u0026nbsp;[18].\u003c/p\u003e\n\u003cp\u003eThe second subscale assesses Episodic Anxiety (Subscale B) and contains four questions, with five answer options (never; rarely; sometimes; frequent; and always) also on a Likert scale from 0 (never) to 4 (always), the total value of this subscale is 16 points. The third and final part assesses Avoidance Behavior (Subscale C) and contains three questions and five answer options (never; rarely; sometimes; frequent; and always), scoring from 0 (never) to 4 (always) and a maximum score of 12 points. The total sum of the \u0026sum;SCORE subscales (A+B+C) totals 48 points, which is the maximum [18].\u003c/p\u003e\n\u003cp\u003eIn the original validation, cut-off values were used as the average for each subscale, for the total score (cut-off = 14), for the persistent anxiety subscale (cut-off = 10), for the episodic anxiety subscale (cut-off = 5), and for the avoidance behavior subscale (cut-off = off = 4) [18].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStatistical Analysis\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using SPSS software, version 24.0. In the descriptive stage, measures of central tendency and dispersion (mean and standard deviation) were calculated for continuous variables, and frequencies and proportions for categorical variables.\u003c/p\u003e\n\u003cp\u003eIn the analytical stage, independent samples t-tests were used to compare total PAS anxiety scores between sociodemographic groups (e.g., sex, marital status, education level, and income) to explore potential associations with anxiety symptoms. Pearson correlation was applied to assess the linear relationship between total anxiety scores and continuous nutritional variables (e.g., age, BMI, and tricipital skinfold).\u003c/p\u003e\n\u003cp\u003eVariables that showed statistically significant associations (p \u0026lt; 0.05) in the bivariate analyses were included in a multiple linear regression model, with the total PAS anxiety score as the dependent variable. The model included sex, marital status, and age as covariates to adjust for potential confounding effects.\u003c/p\u003e\n\u003cp\u003eA statistical significance level of 95% (p \u0026lt; 0.05) was adopted for all analyses. There were no missing data in the final dataset.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 91 participants evaluated, the majority were male (68%), married (54.9%), with an age of 63.4 \u0026plusmn; 10.4 years, and 64.8% were elderly (over 60 years of age). Almost 22% had completed high school, 73% were retired and 46% had a monthly income of up to 3 minimum wages. Regarding the anxiety scale, 60% showed symptoms of anxiety. The cut-off criteria observed in the original validation were considered; the total PAS score had a mean of 18.5\u0026plusmn;11, indicating the presence of anxiety in the sample; in the PAS-C subscale the mean was 4.38\u0026plusmn;3.7 (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 - Sociodemographic and socioeconomic profile and anxiety symptoms in people with Parkinson\u0026apos;s disease treated in public services in Bel\u0026eacute;m \u0026ndash; PA, 2022\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic and Socioeconomic Profile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=91\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e68.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e31.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e54.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e17.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eStable union\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e9.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8.79\u003c/p\u003e\n \u003cp\u003e8.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Range\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUnder 60 years old\u003c/p\u003e\n \u003cp\u003eOver 60 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e35.16\u003c/p\u003e\n \u003cp\u003e64.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e5.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eIncomplete Elementary Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e7.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eComplete Primary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e9.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eIncomplete high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e20.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eComplete high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e21.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eTechnical education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eIncomplete higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e9.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eComplete Higher Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e14.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e7.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eWorking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eReceiving govt aid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e17.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eUp to 1 minimum wage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e37.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026gt;1 to 3 minimum wages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e46.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026gt;3 to 6 minimum wages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e16.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAS\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAnxiety detected\u003c/p\u003e\n \u003cp\u003eNo Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e60.4\u003c/p\u003e\n \u003cp\u003e36.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTotal score -PAS (Subescalas A+B+C)\u003c/p\u003e\n \u003cp\u003eSubscale-A (Persistent Anxiety)\u003c/p\u003e\n \u003cp\u003eSubscale-B (Episodic Anxiety)\u003c/p\u003e\n \u003cp\u003eSubscale-C (Avoidance Behavior)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAVG -STD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e18.5\u0026plusmn;11.4\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e9.39\u0026plusmn;6.0\u003c/p\u003e\n \u003cp\u003e4.28\u0026plusmn;3.9\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4.38\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;3.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCut off\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbout nutritional profile, tricipital skinfold thickness (TS), \u0026nbsp;40.6% were eutrophic and 40.6% were overweight. Among the elderly, 42.1% were overweight. According to the TS measurements, 48.3% were obese (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2 - Nutritional Profile in people with Parkinson\u0026apos;s Disease treated in Public Services in Bel\u0026eacute;m \u0026ndash; PA, 2022\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNutritional Profile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAVG \u0026plusmn; STD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e25.8 \u0026plusmn; 3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e16.4 \u0026ndash; 33.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eTS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e19.4 \u0026plusmn; 7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e5.0 \u0026ndash; 35.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eTS %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e139 \u0026plusmn;114.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e39.0-111.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNutritional Profile /\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eG\u003c/strong\u003e\u003cstrong\u003eender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAVG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eBMI Women\u003c/p\u003e\n \u003cp\u003eBMI Men\u003c/p\u003e\n \u003cp\u003eTS Women\u003c/p\u003e\n \u003cp\u003eTS Men\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e26.03\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e19.1- 33.1\u003c/p\u003e\n \u003cp\u003e18.9 \u0026ndash; 32.4\u003c/p\u003e\n \u003cp\u003e14.0- 35.5\u003c/p\u003e\n \u003cp\u003e5.0 -30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eMalnutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026nbsp;Eutrophy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e40.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e40.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI Classification of Elderly People\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en=59\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Low weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eDeficit risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eEutrophy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTS Classification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en=91\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eSevere malnutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eModerate malnutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eMild malnutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eEutrophy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI= Body Mass Index; TS= Triceps skinfold\u003c/p\u003e\n\u003cp\u003eT-test for independent samples\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHigher anxiety scores were observed in female participants (p=0.005), those \u0026nbsp;without a partner (p=0.034) (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3 - Total Anxiety score according to the socioeconomic and sociodemographic profile of people with Parkinson\u0026apos;s Disease treated in Public Services in Bel\u0026eacute;m \u0026ndash; PA, 2022\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"547\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocioeconomic profile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Anxiety Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003eAVG \u0026plusmn; STD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003ep-value*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003eMale (n=62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e16.3 \u0026plusmn; 10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003eFemale (n=29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e23.3 \u0026plusmn; 11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003eWith partner (n=59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e16.7 \u0026plusmn; 11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003eNo partner (n=32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e21.9 \u0026plusmn; 10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003eNo higher education (n=61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e19.5 \u0026plusmn; 11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003eWith higher education (n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e16.5 \u0026plusmn; 11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cu\u003e\u0026le;\u0026nbsp;\u003c/u\u003e3 minimum wages\u003cu\u003e\u0026nbsp;\u003c/u\u003e(n=77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e18.9 \u0026plusmn; 11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 350px;\"\u003e\n \u003cp\u003eOver 3 minimum wages (n=14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e16.3 \u0026plusmn; 11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eT-test for independent samples\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA negative correlation was observed between age and the total anxiety score (r=0.180; p= 0.044) and a positive correlation between TS and the anxiety score (r= 0.183; p= 0.041) (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4-\u003c/strong\u003e Factors correlated to the total anxiety score of people with Parkinson\u0026apos;s Disease treated in Public Services in Bel\u0026eacute;m \u0026ndash; PA, 2022\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"554\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePAS total score\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 194px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003eTS (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.044\u003c/strong\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*\u0026nbsp;Pearson correlation test; BMI= Body Mass Index; TS= Triceps skinfold.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the multiple linear regression model: In model 1, the correlation between anxiety score and the female sex was maintained (B= 0.290; 95% CI, 2.137; 11.935; p\u0026lt;0.005); In model 2, it was observed that the correlation between anxiety and female sex remained independent of the marital situation (B=0.239; CI=0.518 \u0026ndash; 11.114; p=0.032) and in model 3, the correlation between anxiety and female sex remained, regardless of marital status and age (B=0.230; CI=0.302 - 10.856; p=0.039) (Table 5).\u003c/p\u003e\n\u003cp\u003eSociodemographic variables associated with anxiety (as shown in Table 3) and their independent predictive value (Table 5) help identify risk profiles that may impact nutritional outcomes. These findings support the central objective of the study, which was to assess whether anxiety symptoms affect nutritional status in PD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e - Multiple linear regression between the total Anxiety Scale score in people with Parkinson\u0026apos;s Disease treated in Public Services in Bel\u0026eacute;m \u0026ndash; PA, 2022.\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"597\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eTotal anxiety score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eIC 95%\u003c/p\u003e\n \u003cp\u003e(minimum; maximum)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e2.137; 11.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.518;11.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e-2.081; 8.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModelo 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.302; 10.856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.039\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e-2.324; 7.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 260px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e-0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e-378; 0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 597px;\"\u003e\n \u003cp\u003eMultiple linear regression; Dependent variable: PAS total score co-variable: Sex, marital status, age (years). \u003cem\u003eB\u003c/em\u003e = Regression coefficient.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion ","content":"\u003cp\u003eThe present study aimed to evaluate whether anxiety symptoms affect the nutritional status of individuals with Parkinson’s disease (PD). A high prevalence of anxiety symptoms was found (approximately 60%), along with a significant association between anxiety scores and tricipital skinfold thickness (TS), reflecting increased adiposity. Although PD is traditionally linked to weight loss and malnutrition [5,27], nearly 90% of our sample was classified as overweight or obese based on TS measurements. This contradicts earlier assumptions and supports recent evidence suggesting a more heterogeneous nutritional profile in PD [7,28].\u003c/p\u003e\n\u003cp\u003eThe high proportion of excess weight in our sample may be influenced by reduced physical activity due to motor symptoms, side effects of medications, and psychosocial stressors. Anxiety, in particular, may contribute through mechanisms such as emotional eating, hormonal imbalances, and lifestyle changes [9,11]. The positive correlation between TS and anxiety supports the hypothesis that anxiety plays a role in increased adiposity.\u003c/p\u003e\n\u003cp\u003eWomen and participants without a partner had higher anxiety scores. Female sex is a known risk factor for mood disorders in PD, with symptoms like fatigue, sadness, and pain being more commonly reported [29]. Most women in our sample were postmenopausal, which may contribute to vulnerability to emotional disorders [30]. The absence of a partner may also lead to social isolation, a factor associated with anxiety in PD [31,32].\u003c/p\u003e\n\u003cp\u003eAdditionally, most participants reported low income (1–3 minimum wages), reflecting economic vulnerability that can worsen anxiety symptoms, particularly among people with chronic conditions like PD [33,34]. Social and financial stress may further reduce access to healthy food and emotional support, negatively affecting both nutritional and mental health.\u003c/p\u003e\n\u003cp\u003eA negative correlation was observed between age and anxiety, with younger participants showing higher anxiety levels. This finding aligns with previous studies that associate early-onset PD with greater emotional burden and increased anxiety [34,36].\u003c/p\u003e\n\u003cp\u003eThis study has limitations, including the sample size, which was dependent on the flow of participants in the Baila Parkinson project, and potential recall bias due to the nature of the PAS scale. Although the regression model adjusted for sex, age, and marital status, other potential confounding variables such as disease duration, medication use, and functional status were not included. This omission should be considered a limitation, as these factors may influence both anxiety symptoms and nutritional status in individuals with Parkinson’s disease. Still, our findings contribute to a better understanding of how anxiety relates to nutritional status in PD and highlight the need for integrated care that addresses both emotional and nutritional aspects.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAnxiety is a complex symptom with multifactorial causes and significant effects on individuals with Parkinson’s disease (PD). Our findings highlight the importance of early screening for anxiety, especially among women and those with social vulnerabilities, to guide timely and effective treatment strategies. Furthermore, the demonstrated association between anxiety levels and nutritional status underscores the need for continuous and integrated monitoring of both mental health and nutritional parameters in this population. Therefore, multidisciplinary care that addresses non-motor symptom including emotional and nutritional aspects is essential to minimize potential risks and improve overall quality of life in people living with PD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e:The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistration Number\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e: The research protocol was reviewed and approved by the Research Ethics Committee of the Núcleo de Medicina Tropical of the Federal University of Pará (CEP/NMT‑UFPA) under Opinion number 4.937.107, and by the Research Ethics Committee of Hospital Ophir Loyola (CEP/HOL) under Opinion number 5.081.449.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e: All participants were informed about the objectives and procedures of the study and provided written informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e: All authors have read and approved the final version of the manuscript and consent to its publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e: The authors report no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHayes, M. 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CEFAC.;23(2):e11220.\u003c/li\u003e\n\u003cli\u003eFreshtehnejad SM, Hadizadeh H, Farhadi F, Shahidi GA, Delbari A, L\u0026ouml;kk J. \u003cstrong\u003eComparison of the psychological symptoms and disease-specific quality of life between early-and typical-onset Parkinson\u0026apos;s disease patients\u003c/strong\u003e. Rev. Parkinson\u0026apos;s Dis. (2014). V:819260.\u003c/li\u003e\n\u003cli\u003eMoriyama TS, Chagas MHN, Silveira-Moriyama L, Tumas,V, Lees AJ, Crippa JA, et al. \u003cstrong\u003eDiagnosing social anxiety in Parkinson\u0026apos;s disease: characteristics and frequencies according to two diagnostic criteria\u003c/strong\u003e. Rev. Arch Clin Psychiatry (S\u0026atilde;o Paulo-2016). v;43(6):139-142.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anxiety, Female, Nutritional status, Parkinson's disease, Neurodegenerative Disorder","lastPublishedDoi":"10.21203/rs.3.rs-7811138/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7811138/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Parkinson's disease (PD) presents motor and non-motor symptoms, which include nutritional problems and anxiety. The objective was evaluate the anxiety and nutritional status of people with PD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This is a cross-sectional, descriptive, and analytical study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003e91 participants: age arround 63 years, majority men, married, retired. Dividing the group between adults and elderly (\u0026gt;60 years of age), the majority of adults had a normal nutritional status or were overweight, and elderly people were overweight. The anxiety score was higher in female participants (p=0.005), without a partner (p=0.0034); negative correlation between age and the anxiety score (r=0.180; p=0.044); positive correlation between the triceps skinfold and anxiety (r=0.183; p=0.041); the correlation between sex and anxiety level remained independent of marital status and age. \u003cstrong\u003eConclusion: \u003c/strong\u003eThe early detection of nutritional disorders and anxiety levels in people with PD, especially in women, is of great importance as it can affect their clinical outcomes.\u003c/p\u003e","manuscriptTitle":"Anxiety symptoms and nutritional status in Parkinson's disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 07:53:54","doi":"10.21203/rs.3.rs-7811138/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33a3e55b-d1d5-4b75-9a18-4c075b5675c4","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-27T10:12:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-14 07:53:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7811138","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7811138","identity":"rs-7811138","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}