Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis

Azary, Saeedeh; Schreiner, Teri; Graves, Jennifer; Waldman, Amy; Belman, Anita; Guttman, Bianca Weinstock; Aaen, Gregory; Tillema, Jan Mendelt; Mar, Soe; Hart, Janace; Ness, Jayne; Harris, Yolanda; Krupp, Lauren; Gorman, Mark; Benson, Leslie; Rodriguez, Moses; Chitnis, Tanuja; Rose, John; Barcellos, Lisa F.; Lotze, Tim; Carmichael, Suzan L.; Roalstad, Shelly; Casper, Charlie; Waubant, Emmanuelle

doi:10.1136/jnnp-2017-315936

Cited by 77 publications

(70 citation statements)

References 39 publications

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“…Higher sodium levels in random urine samples were associated with higher rate of new MRI lesions and relapses, yet 24‐hour urine sodium levels, and salt intake from food frequency questionnaires showed no association . In pediatric MS, a higher saturated fat intake and lower vegetable intake were independently associated with higher relapse risk …”

Section: Cause Versus Course – Are the Risk Factors Different?mentioning

confidence: 99%

Environmental and genetic risk factors for MS: an integrated review

Waubant

Lucas

Mowry

et al. 2019

Ann Clin Transl Neurol

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221

184

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Recent findings have provided a molecular basis for the combined contributions of multifaceted risk factors for the onset of multiple sclerosis (MS). MS appears to start as a chronic dysregulation of immune homeostasis resulting from complex interactions between genetic predispositions, infectious exposures, and factors that lead to pro‐inflammatory states, including smoking, obesity, and low sun exposure. This is supported by the discovery of gene–environment (GxE) interactions and epigenetic alterations triggered by environmental exposures in individuals with particular genetic make‐ups. It is notable that several of these pro‐inflammatory factors have not emerged as strong prognostic indicators. Biological processes at play during the relapsing phase of the disease may result from initial inflammatory‐mediated injury, while risk factors for the later phase of MS, which is weighted toward neurodegeneration, are not yet well defined. This integrated review of current evidence guides recommendations for clinical practice and highlights research gaps.

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Section: Cause Versus Course – Are the Risk Factors Different?mentioning

confidence: 99%

Environmental and genetic risk factors for MS: an integrated review

Waubant

Lucas

Mowry

et al. 2019

Ann Clin Transl Neurol

Self Cite

221

184

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“…For example, dietary salt intake has been studied as a possible contributing factor to disease onset and subsequent disease activity with conflicting results 7, 8, 9, 10. In addition, lower iron intake (but not other dietary factors) were associated with increased risk of pediatric MS, while higher saturated fat and vegetable intake were associated with increased and decreased relapse risk, respectively 11, 12. Although prevention of relapses is an important treatment outcome, preservation of cognitive and physical functioning in patients with MS are also important goals.…”

Section: Introductionmentioning

confidence: 99%

Altered tryptophan metabolism is associated with pediatric multiple sclerosis risk and course

Nourbakhsh

Bhargava

Tremlett

et al. 2018

Ann Clin Transl Neurol

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ObjectiveTo determine if altered tryptophan (Trp) metabolism is associated with MS risk or disease severity in children.MethodsParticipants with pediatric‐onset MS and clinically isolated syndrome (CIS) within 4 years of disease onset and healthy controls underwent collection of serum. Longitudinal disability and processing speed measures and relapse data were collected in cases. Global metabolomics were conducted in 69/67 cases/controls. Targeted Trp measurement was performed in a discovery group (82 cases, 50 controls) and a validation group (92 cases, 50 controls), while functional gut microbiome analysis was done in 17 cases. Adjusted logistic, linear and negative binomial regression and Cox‐proportional hazard models were used.ResultsUsing global metabolomics data, higher relative abundances of Trp and indole lactate, a known gut microbiota‐derived Trp metabolite, were associated with lower risk of MS. In cases, higher relative abundances of gut microbiota‐derived Trp metabolites were associated with lower disability and higher processing speed scores and higher relative abundance of kynurenine was associated with higher relapse rate. Using targeted tryptophan measures, in the discovery and validation groups, each 1 mcg/mL increase in serum Trp level was associated with 20% (95% CI: 4–34%) and 32% (95% CI: 16–44%) decrease in adjusted odds of having MS, respectively. A lower relative abundance of gut microbial genes involved in Trp catabolism was associated with higher relapse risk.InterpretationTrp metabolism by the gut microbiota and the kynurenine pathway may be relevant to the risk of MS in children as well as MS activity and severity.

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“…In the JNNP paper ‘The contribution of dietary intake to relapse rate in early pediatric multiple sclerosis’ by Azary et al , the role of diet assessed via questionnaire in influencing relapse risk in a cohort of paediatric patients with MS is investigated 1. The study includes 219 children with relapsing-remitting MS or clinically isolated syndrome, of whom 93 experienced a relapse event over the course of approximately 2 years.…”

Section: A Discussion Of the Role Of Diet In Disease Course In Pediatmentioning

confidence: 99%

Diet and disease modification in multiple sclerosis: a nutritional epidemiology perspective

Fitzgerald¹

2017

J Neurol Neurosurg Psychiatry

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Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis

Abstract: This study suggests that in children with MS, high energy intake from fat, especially saturated fat, may increase the hazard to relapse, while vegetable intake may be independently protective.

Cited by 77 publications

References 39 publications

Environmental and genetic risk factors for MS: an integrated review

Environmental and genetic risk factors for MS: an integrated review

Altered tryptophan metabolism is associated with pediatric multiple sclerosis risk and course

Diet and disease modification in multiple sclerosis: a nutritional epidemiology perspective

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