Health behaviors of people with multiple sclerosis and its associations with MS related outcomes: a German clinical cohort

Abstract

BackgroundHealth behaviors in persons with multiple sclerosis (pwMS) have been associated with MS-related disease outcomes.ObjectiveThe aim of the study was to gain knowledge about current patient health behaviors in a convenience sample representative for pwMS presenting to a large university-based outpatient clinic and to investigate associations between modifiable risk factors with physical impairment, quality of life (QoL) and cardiovascular comorbidities.MethodsA questionnaire was administered at the MS Outpatient Clinic of the University Medical Center Hamburg Eppendorf asking for health behaviors regarding dietary habits assessed with the German adaptation of the validated Spanish short Diet Quality Screener (sDQS), level of physical activity assessed with the Godin Leisure Time Questionnaire (GLTEQ) and tobacco smoking. Participants were asked to report cardiovascular comorbidities using items from the Self-Report Comorbidity Questionnaire for Multiple Sclerosis. Additionally, cardiovascular risk factors like blood pressure, height and weight (to calculate BMI) and waist circumference were measured. MS specific clinical data, e.g., disease course, duration, disability and MS-specific QoL were collected from the clinical database. Descriptive analyses were performed and multivariate regression analyses for complete cases were carried out for each of the three outcome variables including all mentioned modifiable risk factors (dietary behavior, smoking, physical activity and BMI) as independent variables.ResultsIn this sample of 399 pwMS the mean age was 42 years (SD 12.8) with a mean disease duration since diagnosis of 7.4 years (SD 8.4) and a mean EDSS of 2.8 (SD 1.9). 24% were current smokers, 44% were insufficiently physically active and 54% did not follow a healthy dietary pattern. 49% of this relatively young clinical population was overweight and 27% reported one or more cardiovascular comorbidities. Most modifiable risk factors showed no convincing associations with MS-related disease outcomes in the multiple regression analyses.ConclusionThis clinical cohort of pwMS shows a high prevalence of critical health behaviors and comorbidities and emphasizes the need for monitoring, education and assistance for behavior change in this population.

Waist Circumference and Body Mass Index as Predictors of Disability Progression in Multiple Sclerosis: A Systematic Review and Meta-Analysis

“…A total of 16 [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] studies comprising a total of 7962 PwMS with a mean age of 42.1 years were included in the meta-analysis. Primary and secondary outcomes are summarized in Table 1 .…”

“…Ten studies [ 23 , 26 , 27 , 29 , 30 , 34 , 35 , 36 , 37 , 38 ] reported the mean WC in the male and female population. The pooled mean WC in the male subgroup was 94.67 cm (95% CI [92.56, 96.78], I 2 = 88%, p q = < 0.01) ( Figure 4 ), and the pooled mean WC in the female subgroup was 87.83 cm (95% CI [83.93, 91.73], (I 2 = 98%, p q < 0.01) ( Figure 5 ).…”

“…Given the increased risk of cardiovascular comorbidities in PwMS and their detrimental impact on the overall disease severity and disability progression, WC and BMI in the upper normal ranges can still have a negative effect on disease progression and the overall quality of life of PwMS and are correlated with the patient’s disability levels [ 27 , 28 , 32 , 36 ]. Concerning the potential underlying pathophysiological mechanisms, several pathways appear to be linking obesity and neuroinflammation.…”

“… Forest plot: pooled mean BMI values [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. …”

“… Forest plot: pooled mean WC values in the female subset [ 23 , 26 , 27 , 29 , 30 , 34 , 35 , 36 , 37 , 38 ]. …”