Weight control and physical exercise in people with multiple sclerosis: Current knowledge and future perspectives

Mokhtarzade, Motahare; Alinejad, Hamid Agha; Motl, Robert W.; Negaresh, Raoof; Baker, Julien S.; Zimmer, Philipp

doi:10.1016/j.ctim.2019.02.006

Cited by 18 publications

(24 citation statements)

References 71 publications

(90 reference statements)

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“…We observed comparable time-courses of EAE in terms of neurological signs and body weight. Others also observed a notable weight loss of fat and muscle mass in EAE mice (Bernardes et al, 2016), while both cachexia (Kamalian et al, 1975;Van Waesberghe et al, 1999) and weight gain (Mokhtarzade et al, 2019) were reported in MS. More recent studies also indicate that hypothalamic inflammation precedes both involuntary weight loss and obesity [ (Clarke, 2010) and references within]. Our experiments also indicate that the phase in loss of body weight coincides with hypothalamic inflammation.…”

Section: Discussionmentioning

confidence: 90%

The sex-specific patterns of changes in hypothalamic-pituitary-gonadal axis during experimental autoimmune encephalomyelitis

Milosevic

Janjic

Lavrnja

et al. 2020

Brain, Behavior, and Immunity

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Multiple sclerosis develops during reproductive years in a sex-specific manner. Various neuroendocrine changes have been described in this inflammatory, demyelinating, and debilitating disease. We here aimed to determine the extent and sex specificity of alterations in the hypothalamic-pituitary-gonadal axis in the rat model of multiple sclerosis named experimental autoimmune encephalomyelitis (EAE). During the EAE course, the hypothalamic tissue showed transient upregulation of inflammatory marker genes Gfap, Cd68, Ccl2, and Il1b in both sexes, but accompanied by sex-specific downregulation of Kiss1 (in females only) and Gnrh1 (in males only) expression. In females, the expression of gonadotrope-specific genes Lhb, Cga, and Gnrhr was also inhibited, accompanied by decreased basal but not stimulated serum luteinizing hormone (LH) levels and a transient arrest of the estrous cycle. In contrast, Fshb expression and serum progesterone levels were transiently elevated, findings consistent with the maintenance of the corpora lutea, and elevated immunohistochemical labeling of ovarian StAR, a rate limiting protein in steroidogenic pathway. In males, downregulation of Gnrhr expression and basal and stimulated serum LH and testosterone levels were accompanied by inhibited testicular StAR protein expression. We propose that inflammation of hypothalamic tissue downregulates Kiss1 and Gnrh1 expression in females and males, respectively, leading to sexspecific changes downstream the axis.

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Section: Discussionmentioning

confidence: 90%

The sex-specific patterns of changes in hypothalamic-pituitary-gonadal axis during experimental autoimmune encephalomyelitis

Milosevic

Janjic

Lavrnja

et al. 2020

Brain, Behavior, and Immunity

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“…Nonetheless, there is evidence suggesting that PwMS who perform more PA have a lower BMI and are less likely to be obese [18,19]. This discrepancy may be explained by the parameters used to assess obesity.…”

Section: Discussionmentioning

confidence: 99%

The Association between Body Mass Index and Leisure-Time Physical Activity in Adults with Multiple Sclerosis

Kalron

2020

IJERPH

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(1) Purpose: Conflicting information exists regarding the relationship between obesity, leisure-time physical activity (PA), and disability in people with multiple sclerosis (PwMS). We aimed to investigate the association between leisure-time PA and weight status in a relatively large cohort of PwMS. Furthermore, we examined this relationship according to the level of neurological disability. (2) Methods: The study included 238 PwMS (138 women) with a mean Expanded Disability Status Scale (EDSS) score of 2.5 (standard deviation [SD] = 1.7), mean disease duration of 6.4 (SD = 8.2) years, and mean age of 40.5 (SD = 12.9) years. Obesity was defined using two different metrics, each based on body mass index (BMI). Leisure-time PA was determined by the Godin–Shephard leisure-time PA questionnaire. Statistical analyses included multivariate logistic regression, the chi-square test, and Pearson coefficient correlations. (3) Results: The unadjusted odds ratio (OR) between leisure-time PA and BMI based on the World Health Organization’s (WHO) definition was 1.070 (p = 0.844) for overweight and 1.648 (p = 0.254) for obesity. The adjusted OR was 1.126 (p = 0.763) for overweight and 1.093 (p = 0.847) for obesity after adjustment for age, gender, and disability status. Chi-square analysis revealed no significant correlation between leisure-time PA and obesity (p = 0.564) according to the BMI threshold for PwMS. The unadjusted OR (95% confidence interval [CI]) between disability level and BMI based on the WHO definition was 1.674 (p = 0.220) for overweight and 0.618 (p = 0.460) for obesity. The adjusted OR was 1.130 (p = 0.787) for overweight and 0.447 (p = 0.234) for obesity after adjustment for age, gender, and leisure-time PA. Similarly, chi-square analysis revealed no significant correlation between disability level and obesity (p = 0.701) per the BMI threshold for PwMS. (4) Conclusions: No association was found between leisure-time PA and BMI in PwMS. An additional finding was the absence of any association between obesity and neurological disability level in the multiple sclerosis cohort.

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“…Weight loss may be associated with a more favorable progression of disease for patients with obesity and MS. Although nonoperative weight loss regimens may be beneficial, the chance of reaching long-term significant weight loss appears to be small [28]. In the present study, metabolic surgery (with gastric bypass or sleeve gastrectomy) showed weight loss in line with patients without MS and also showed significant improvements in both obesity-specific and generic HRQoL.…”

Section: Discussionmentioning

confidence: 47%

Bariatric and metabolic surgery in patients with morbid obesity and multiple sclerosis - a nationwide, matched cohort study

Stenberg

Forsberg

Hedström

et al. 2021

Surgery for Obesity and Related Diseases

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Background: Despite an association between obesity and multiple sclerosis (MS), very little is known regarding the safety and efficacy outcomes for patients with MS and severe obesity undergoing metabolic surgery. Objectives: The aim of the present study was to evaluate early complications and efficacy outcomes of metabolic surgery in patients with severe obesity and MS. Setting: Nationwide, Sweden. Methods: In this, matched cohort study, 196 patients with an MS diagnosis in the Swedish MS register who were undergoing metabolic surgery (gastric bypass or sleeve gastrectomy) with a registration in the Scandinavian Obesity Surgery Registry (SOReg) were matched 1:10 with a control group without MS diagnosis from the SOReg. A 2-stage matching procedure was used (exact match by surgical method, followed by propensity Score matching, including age, sex, preoperative BMI, surgical center, surgical access, year of surgery, hypertension, diabetes, sleep apnea, and dyslipidemia). Results: Weight loss at 2 years after surgery was similar for patients with MS and controls (total weight loss 31.6 6 9.1 versus 31.8 6 9.2, P 5 .735). No significant differences were seen in either the overall postoperative complication rate (7.9% versus 7.2%, P 5 .778), or serious postoperative complications (3.7% versus 2.8%, P 5 .430). All aspects of health-related quality of life (HRQoL) improved in both groups but less so for the physical aspects of HRQoL in patients with MS. Conclusion: Metabolic surgery is a safe and efficient treatment for severe obesity in patients with MS, and it leads to subsequent improvements in HRQoL. Further studies addressing the effects of metabolic surgery on MS-related symptoms are needed.

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Weight control and physical exercise in people with multiple sclerosis: Current knowledge and future perspectives

Cited by 18 publications

References 71 publications

The sex-specific patterns of changes in hypothalamic-pituitary-gonadal axis during experimental autoimmune encephalomyelitis

The sex-specific patterns of changes in hypothalamic-pituitary-gonadal axis during experimental autoimmune encephalomyelitis

The Association between Body Mass Index and Leisure-Time Physical Activity in Adults with Multiple Sclerosis

Bariatric and metabolic surgery in patients with morbid obesity and multiple sclerosis - a nationwide, matched cohort study

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