{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:58:01Z","timestamp":1786121881326,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Multiple system atrophy (MSA) leads to progressive weight loss and nutritional decline, yet the prognostic significance of specific nutritional factors remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n This study aimed to examine the prognostic value of nutritional parameters, including prognostic nutritional index (PNI), and the annual rate of body mass index (BMI) decline (\u2206BMI), in patients with MSA.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively analyzed 215 patients with MSA diagnosed according to the 2022 Movement Disorder Society Criteria. Baseline clinical and nutritional parameters included onset age, motor subtype, orthostatic hypotension (OH), Unified MSA Rating Scale (UMSARS) Part I\u2010item 2 and Part IV scores, PNI, and BMI. \u2206BMI was calculated post\u2010diagnosis. Survival length was defined as the time from diagnosis to death or tracheostomy. Factors associated with survival were assessed using log\u2010rank and Cox proportional hazards analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The mean survival after diagnosis was 3.3 (SD 2.0) years. Log\u2010rank tests showed significant associations of the MSA\u2010P subtype, lower PNI, greater \u2206BMI, higher UMSARS Part I\u2010item 2 and Part IV scores, and OH with shorter survival. In multivariate Cox models, lower PNI (HR 2.12; 95% CI 1.14\u20133.94;\n p<\/jats:italic>\n \u2009=\u20090.018), greater \u2206BMI (HR 2.90; 95% CI 1.58\u20135.31;\n p<\/jats:italic>\n \u2009<\u20090.001), and higher UMSARS Part I\u2010item 2 scores (HR 1.59; 95% CI 1.10\u20132.30;\n p<\/jats:italic>\n \u2009=\u20090.014) independently predicted shorter survival.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Nutritional decline, as assessed by PNI and \u2206BMI, predicts shorter survival in MSA independently of the severity of dysphagia. These findings emphasize the importance of monitoring nutritional status alongside swallowing function to improve clinical outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/mdc3.70767","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T07:12:23Z","timestamp":1786086743000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutritional Factors and Weight Loss Predict Tracheostomy\u2010Free Survival in Multiple System Atrophy"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0560-2524","authenticated-orcid":false,"given":"Yuri","family":"Asano","sequence":"first","affiliation":[{"name":"Department of Neurology Tokyo Metropolitan Neurological Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kota","family":"Bokuda","sequence":"additional","affiliation":[{"name":"Department of Neurology Tokyo Metropolitan Neurological Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Neurology Tokyo Metropolitan Matsuzawa Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsuke","family":"Tobisawa","sequence":"additional","affiliation":[{"name":"Department of Neurology Tokyo Metropolitan Neurological Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utako","family":"Nagaoka","sequence":"additional","affiliation":[{"name":"Department of Neurology Tokyo Metropolitan Neurological Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazushi","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Neurology Tokyo Metropolitan Neurological Hospital Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3828-9669","authenticated-orcid":false,"given":"Toshio","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Neurology Tokyo Metropolitan Neurological Hospital Tokyo Japan"},{"name":"Department of Neurology Tokyo Metropolitan Fuchu Medical Center for the Disabled Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"issue":"6","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1002\/mds.29005","article-title":"The Movement Disorder Society criteria for the diagnosis of multiple system atrophy","volume":"37","author":"Wenning GK","year":"2022","journal-title":"Mov Disord"},{"issue":"3","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/S1474-4422(12)70327-7","article-title":"The natural history of multiple 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are elevated in serum of patients with multiple system atrophy","volume":"8","author":"Kaufman E","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12974-017-0863-0","article-title":"Early strong intrathecal inflammation in cerebellar type multiple system atrophy by cerebrospinal fluid cytokine\/chemokine profiles: a case control study","volume":"14","author":"Yamasaki R","year":"2017","journal-title":"J Neuroinflammation"},{"issue":"3","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/bpa.12678","article-title":"Oligodendroglial alpha\u2010synucleinopathy\u2010driven neuroinflammation in multiple system atrophy","volume":"29","author":"Hoffmann A","year":"2019","journal-title":"Brain Pathol"},{"issue":"7","key":"e_1_2_10_22_1","first-page":"e815","article-title":"Serum albumin and beta\u2010amyloid deposition in the human brain","volume":"95","author":"Kim 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