Higher‐quality diet and non‐consumption of meat are associated with less self‐determined disability progression in people with multiple sclerosis: A longitudinal cohort study

Abstract

Background and purpose: Modifiable lifestyle factors, including diet, may affect clinical outcomes in multiple sclerosis (MS). This study assessed the relationships between diet, and disability, fatigue, and depression risk in people with MS.Methods: Participants from the Health Outcomes and Lifestyle In a Sample of people with Multiple sclerosis (HOLISM) international cohort were assessed over 2.5 years.Dietary data were obtained using a modified Diet Habits Questionnaire (DHQ), disability using the calculated Patient-determined MS Severity Score (P-MSSS), fatigue using the Fatigue Severity Scale, and depression risk using the Patient Health Questionnaire-2.Participants reported whether they were experiencing symptoms due to a recent relapse. Cross-sectional and prospective relationships of diet and disease outcomes were explored, adjusted for relevant confounders.Results: Among 1,346 participants, higher DHQ scores showed significant dosedependent associations with lower frequencies of severe disability, fatigue, and depression risk, cross-sectionally. Prospectively, higher baseline DHQ scores were associated with a lower risk of increasing disability, those above the median having 41% and 36% lower risk of increasing disability, and 0.30 P-MSSS points less disability progression, but were not associated with fatigue or depression risk. Meat consumption was associated with 0.22 P-MSSS points higher disability cross-sectionally, while prospectively, baseline meat consumption was associated with 76% higher risk of increasing disability and 0.18 P-MSSS points higher disability progression. Dairy consumption showed mixed associations cross-sectionally and prospectively.Conclusions: These results show that better quality of diet, as well as not consuming meat, were associated with reduced disability progression in people with MS. Substantiation of these findings in other settings may inform opportunities to manage disability progression in people with MS using dietary modifications.

Efficacy of Diet on Fatigue and Quality of Life in Multiple Sclerosis

“…24 A second recent meta-analysis of randomized, controlled trials found that probiotic supplementation improved mental health among people with MS. 25 Furthermore, omega-3 fatty acid supplementation was found to have no effect on disability status but did significantly reduce serum tumor necrosis factor-α, a marker of inflammation. 26 In addition, several observational studies have shown that higher diet quality is associated with reduced risk of MS [27][28][29] and reduced relapse rate, disability status, brain volume loss, fatigue, cognitive impairment, depression, and increased physical and mental QoL among people with MS. [30][31][32][33][34][35] Based on the associations of weight with comorbidity burden, weight loss with reduced MS disability, and the microbiome and metabolites with the immune system, the National MS Society recommends "general healthy" diet changes. 36 The current state of evidence as of 2019 did not support recommendations for any specific dietary approach, 8 thus necessitating the Nation MS Society's recommendation for a general healthy diet.…”

Using Online 24-h Dietary Methodology to Validate the Psychometric Properties of a Dietary Scoring Tool with an International Sample of Adults Living with Multiple Sclerosis

“…Our internal consistency results demonstrated a weak effect of the sub-scores and our findings also show that the DHQ sub-scores are targeted in assessing the overall diet quality for people with RRMS. While studies have used the total DHQ data as indicative of higher versus lower quality of intake, generally [ 32 ], they are unable to differentiate between the complex interrelationships that patterns of eating reflect. Despite this, a recent analysis did find an influence of meat intake as was also found in our analysis [ 32 ].…”

“…While studies have used the total DHQ data as indicative of higher versus lower quality of intake, generally [ 32 ], they are unable to differentiate between the complex interrelationships that patterns of eating reflect. Despite this, a recent analysis did find an influence of meat intake as was also found in our analysis [ 32 ]. The study also used the HOLISM data providing support for the findings from our smaller sample.…”

“…The DHQ is the primary tool used to capture dietary data for two large national MS cohorts [ 7 , 32 ]. Diet was queried using a modified version of the DHQ dietary screening tool, omitting questions regarding sodium intake and alcohol, as described previously [ 13 ].…”

Social determinants of health in multiple sclerosis

“…However, the effect of dietary interventions on MS outcomes has been studied, with the overwhelming majority of studies examining food supplements rather than overall diet quality. An observational study identified an association between a healthier diet and higher mental and physical health quality of life scores; a dose-response relationship was observed between diet habits questionnaire score and quality of life score 74 . In a second study, healthier dietary intake on subscales for fibre, fruit and vegetables, and fat was associated with better quality of life scores 75 .…”