Modified Mediterranean diet v. traditional Iranian diet: efficacy of dietary interventions on dietary inflammatory index score, fatigue severity and disability in multiple sclerosis patients

Abstract

Background Current evidence suggests that adherence to the Mediterranean Diet (MeD) can reduce inflammation in chronic diseases; however, studies pertaining to Relapsing-Remitting Multiple Sclerosis (RRMS) are limited. Therefore, the aim of this study was to investigate the potential of the modified MeD (mMeD) in improving Dietary Inflammatory Index (DII) scores, disability, and fatigue severity, compared to Traditional Iranian Diet (TID), in RRMS patients. Methods After initial screening (n=261), 180 RRMS patients were randomized to receive mMeD or TID (as control) for six months. DII score, Expanded Disability Status Scale (EDSS) and 21-item Modified Fatigue Impact Scale (MFIS) were evaluated at baseline and trial cessation. Multivariate analysis of covariance was conducted and adjusted for age, gender, body weight, body mass index, education level, supplement use, family history and duration of MS. Results Of the 180 patients enrolled, 147 participants were included in the final analysis (n of mMeD=68; n of TID=79). Self-reported adherence was good (˜81%). Dietary intakes of 45 food parameters were assessed through the food frequency questionnaire. The mMeD significantly reduced DII scores after six months (2.38±0.21 to −1.87±0.86, P<0.001), but TID did not elicit any changes (2.21±0.44 to 2.14±1.01, P=0.771). Additionally, MFIS total score decreased significantly (72.4±17.2 to 63.9±14.2, P<0.001), whereas there was no considerable improvement for EDSS in the mMeD group. Conclusion Adherence to mMeD, for six months, improved dietary inflammatory status and fatigue severity in RRMS patients, however, the traditional Iranian diet did not positively impact dietary inflammation and MFIS score.

Is there any association between dietary inflammatory index and quality of life? A systematic review

“…Bohlouli et al showed that adherence to an anti-inflammatory diet such as the Mediterranean diet improved fatigue severity in relapsing-remitting MS ( 57 ). Cross-sectional studies showed that the body composition and anthropometric measurements were directly associated with DII scores ( 58 , 59 ).…”

The health benefits and practical considerations for the adoption of a Mediterranean-style dietary pattern

“…A study from Iran investigated the potential of a modified MDP to improve dietary inflammatory index scores, disability and fatigue severity, in relapsing-remitting multiple sclerosis compared with a traditional Iranian diet, in 180 patients. Adherence to a MDP for 6 months improved dietary inflammatory status and fatigue severity relative to the traditional Iranian diet (19) . As reviewed by Clark and colleagues, the protective effects of the MDP against inflammation may be in part mediated through favourable changes to the gut microbiota composition and activity (20) .…”

“…Emerging evidence is focussing on the relationship between consumption of a MDP and many other chronic diseases (21) , including non-alcoholic fatty liver disease (NAFLD) (22) , cancers and colorectal cancer (23) , multiple sclerosis (19) , as well as positive roles in athletic performance (24) and weight management in pregnancy (25) .…”

Glatiramer Acetate Immunomodulation: Evidence of Neuroprotection and Cognitive Preservation

“…The MSIS-29 examines the physical, cognitive, and psychological impacts of multiple sclerosis on participants' lives; Figure 1A displays the statistical analyses between three studies [62,70,71]. The results of cross-cohort comparisons between MFIS scores, a test for physical and cognitive fatigue, are displayed in Figure 1B [66,[72][73][74]. FIS scores, an older version of the MFIS, were compared from four studies and the results are displayed in Figure 1C [64,73,[75][76][77].…”