A Scoping Review of Modifiable Risk Factors in Pediatric Onset Multiple Sclerosis: Building for the Future

Abstract

Knowledge of the effect of modifiable lifestyle factors in the pediatric multiple sclerosis (MS) population is limited. We therefore conducted a scoping review, following the framework provided by Arksey and O’Malley. Four databases were searched for pediatric MS and modifiable lifestyle factors using index terms and keywords, from inception to May 2018. All quantitative and qualitative primary articles were included and limited to English and full text. Of the 7202 articles identified and screened, 25 full-text articles were relevant to our objective and were included. These articles focused on diet obesity, physical activity, and sleep. In cross-sectional analyses, these lifestyle factors were associated with increased risk of pediatric onset MS (POMS), and increased disease activity. Diet, particularly vitamin D and vegetable intake, was associated with reduced relapse rate. Obesity was linked to increased risk of POMS, and physical activity was associated with reduced relapse rate and sleep/rest fatigue. Thus, available studies of lifestyle related outcomes in pediatric MS suggest specific lifestyle related factors, including obesity, higher vitamin D levels, and higher physical activity may associate with lower disease burden in POMS. Studies reviewed are limited by their observational designs. Future studies with longitudinal and experimental designs may further clarify the role of modifiable lifestyle factors in this population.

Multiple Sclerosis—Related Dietary and Nutritional Issues: An Updated Scoping Review with a Focus on Pediatrics

“…Intriguingly, children with POMS performed better than matched controls in managing sleep hygiene, and higher levels of physical activity were associated with fewer sleep/rest fatigue symptoms [ 195 ]. It is noteworthy that, quite similar conclusions were also reached by other independent authors [ 183 ].…”

“…Due to its effects on levels of disease activity, depression and fatigue, and lower moderate to vigorous physical activity, prevention and/or treatment of obesity/being overweight has been deemed a critical aspect of POMS as well [ 183 ]. A case-control study comparing the BMI data of 60 French youths with POMS showed that overweight and obesity are more frequently observed at diagnosis, particularly in boys with POMS compared with non-neurologic controls and healthy French children.…”

Needs and Experiences of Children and Adolescents with Pediatric Multiple Sclerosis and Their Caregivers: A Systematic Review

“…Moreover, to add towards the burden of MS, a lack of awareness among teachers was reported in some of the studies reviewed [18,29,33,39]. Here, one study reported that teachers commonly misinterpreted fatigue-related symptoms of children as "laziness" [18,59]. As a consequence, increased pressure of school-related work and poorer academic performance could predispose CAMS towards poorer mental health and possibly negatively influence employment-related outcomes later on [40].…”

Cognitive Functioning in Patients with Pediatric-Onset Multiple Sclerosis, an Updated Review and Future Focus

“…SES can impact health directly due to poor accessibility to health care, limited knowledge about and adherence to treatment, and variable nutrition. Genetic risk factors and interactions between several risk factors (second-hand smoke, genetic predisposition, physical functioning) were also evaluated [119,120,121]. A recent pilot study [26] searched for genetic signatures associated with cognitive impairment in patients with POMS.…”