A case-control study of dietary salt intake in pediatric-onset multiple sclerosis

McDonald, Jamie; Graves, Jennifer; Waldman, Amy; Lotze, Timothy; Schreiner, Teri; Belman, Anita; Greenberg, Benjamin; Weinstock‐Guttman, Bianca; Aaen, Gregory; Tillema, Jan Mendelt; Hart, Janace; Lulu, Sabeen; Ness, Jayne; Harris, Yolanda; Rubin, Jennifer; Candee, Meghan; Krupp, Lauren; Gorman, Mark; Benson, Lina; Rodriguez, Moses; Chitnis, Tanuja; Mar, Soe; Barcellos, Lisa F.; Laraia, Barbara A.; Rose, John; Roalstad, Shelly; Simmons, Timothy; Casper, T. Charles; Waubant, Emmanuelle

doi:10.1016/j.msard.2016.02.011

Cited by 69 publications

(58 citation statements)

References 23 publications

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“…The findings of Nourbakhsh et al are in the same direction with a previous report from the same group showing a lack of association between sodium intake and the risk of developing MS,9 but they contrast with the immunological findings and what we found in a Hispanic cohort of adult MS 8. Several factors could have accounted for divergent findings.…”

supporting

confidence: 79%

Salt intake in multiple sclerosis: friend or foe?

Farez

2016

J Neurol Neurosurg Psychiatry

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supporting

confidence: 79%

Salt intake in multiple sclerosis: friend or foe?

Farez

2016

J Neurol Neurosurg Psychiatry

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“…Spot urine testing is affordable and practical although its use for estimating sodium intake has remained controversial. 13 Using the same cohort of patients and appropriate controls, we did not find any association of sodium intake and risk of developing paediatric MS. 14 Our study had 80% power to detect a modest increase of 60% in the hazard of relapse in patients with excessive sodium intake (HR of 1.6). Farez et al 7 reported incidence rate ratios of more than 2.5 and 3.3 for patients with medium and high sodium intake compared to those with low sodium intake, respectively.…”

Section: Discussionmentioning

confidence: 82%

Dietary salt intake and time to relapse in paediatric multiple sclerosis

Nourbakhsh

Graves²,

Casper

et al. 2016

J Neurol Neurosurg Psychiatry

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Background Salt intake was reported to be associated with increased clinical and MRI activity in adult patients with relapsing-remitting multiple sclerosis (MS). Objective To determine if salt intake is associated with time to relapse in patients with paediatric-onset MS. Methods Paediatric-onset MS and patients with clinically isolated syndrome (CIS) within 4 years of disease onset were recruited from 15 paediatric MS centres in the USA as part of a case–control study. Patients with available prospective relapse data subsequent to enrolment were included in this project. Dietary sodium intake was assessed by self-report questionnaire using the validated Block Kids Food Screener. Cox proportional-hazards regression models were employed to determine the association of sodium density, excess sodium intake and sodium density tertiles with time to relapse following study enrolment, adjusting for several confounders. Results 174 relapsing-remitting MS/CIS patients were included in this analysis (mean age of 15.0 years, and 64.9% females). Median duration of follow-up was 1.8 years. In an unadjusted analysis, density of daily sodium intake was not associated with time to relapse, and patients with excess sodium intake had no decrease in time to relapse as compared with patients with non-excess sodium intake. The multivariable analysis demonstrated that patients in the medium and high tertile of sodium density had a HR of 0.69 (95% CI 0.37 to 1.30, p=0.25) and 1.37 (95% CI 0.74 to 2.51, p=0.32) compared with patients in the lowest tertile, respectively. Conclusions Higher salt intake was not associated with decreased time to relapse in patients with paediatric-onset MS.

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“…Obesity in childhood or at 20 years of age has been confirmed as a risk factor in a cohort of 1235 adult MS patients [109], and further increases the risk in patients with previous EBV infection [110] and carrying the HLA-DRB1*15 allele [111]. Diet has been investigated as a possible risk factor: in this context the role of salt-intake has been investigated in a recent publication, but no correlation was found [112].…”

Section: Mri: a True Distinctive Pattern In Ped-ms?mentioning

confidence: 99%

Pediatric versus adult MS: similar or different?

Ghezzi

Baroncini

Zaffaroni

et al. 2017

Mult Scler Demyelinating Disord

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In this review the most important aspects of pediatric multiple sclerosis are presented and compared with the adult form. Some findings appear peculiar of pediatric MS: a. Clinical manifestations are similar in adolescents and adults with MS, however in very young subjects MS frequency at onset is similar in males and females, with a higher frequency of brainstem/cerebellar involvement and acute polysymptomatic/ADEM like onset; b. The course is relapsing-remitting in the large majority of patients, with a high relapse rate; c. Mild or severe disability is reached after a longer interval, but at a lower age compared to adult MS; d. The frequency of cognitive dysfunction is relatively high, with a quick deterioration but also the capability to partially recover with time; e. MRI is fundamental for diagnosis and prognosis: the pattern of MRI has some peculiar aspects in pediatric MS patients: i) the classic diagnostic criteria cannot be fulfilled, ii) lesion load is more relevant, iii) lesions are less destructive, have a more pronounced inflammatory pattern and have enhanced capability to recover with time; f. Diagnostic criteria of adults can be applied to patients with less than 18 years, but with limitations for subjects with less than 12 years and ADEM-like onset; g. The approach in differential diagnosis is particular complex and many disorders with clinical manifestations in the pediatric age must be considered: in this context it is important to pay attention to clinical, MRI and CSF red flags. Anti-MOG abs syndrome has been recently identified and should be carefully considered in patients with Acquired Demyelinating Syndrome; h. CSF oligoclonal bands are less frequent in pediatric MS patients, their presence in patients with Acquired Demyelinating Syndrome is strongly correlated to the risk of MS; i. The interplay between genetic and environmental factors determine the risk of developing MS; j. MS has a more pronounced inflammatory pattern (as suggested by the high relapse rate and the most relevant inflammatory pattern at brain MRI); k. The treatment is based on the approach used for adults: as MS has a strong impact on patients and their family the model of care should involve a team with specialized neurologists, pediatricians and neuro-pediatricians, nurses, psychologists, social workers and specialists of rehabilitative medicine.

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A case-control study of dietary salt intake in pediatric-onset multiple sclerosis

Cited by 69 publications

References 23 publications

Salt intake in multiple sclerosis: friend or foe?

Salt intake in multiple sclerosis: friend or foe?

Dietary salt intake and time to relapse in paediatric multiple sclerosis

Pediatric versus adult MS: similar or different?

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