Eating Hubs in Multiple Sclerosis: Exploring the Relationship Between Mediterranean Diet and Disability Status in Italy

Abstract

BackgroundMultiple Sclerosis (MS) is a complex disease in which multiple factors contribute to disability accrual. Mediterranean Diet (MeDi) has shown beneficial effects across neurodegenerative diseases. We hypothesize that specific food habits, rather than global adherence to MeDi, might impact on MS. We aimed to (i) evaluate differences in adherence to MeDi between people living with MS (PwMS) and healthy controls (HC); (ii) characterize eating patterns in PwMS and HC, identifying the most influential MeDi items for each group by the use of network analysis; (iii) explore the relationship between patients' eating habits and disability.Materials and MethodsIn this cross-sectional study, we consecutively recruited 424 PwMS and 165 matched HC. Data were obtained through the administration of self-reported questionnaires. Expanded Disability Status Scale (EDSS) and Fatigue Severity Scale (FSS) were evaluated in the MS population. We performed between-groups comparisons via unpaired two-sample t-test and X2 test as appropriate. We calculated food networks in both MS cases and HC using and tested the association between hub nodes and disability. Finally, we conducted a post-hoc analysis, investigating the relationship between food items, lifestyle factors (smoking, exercise) and clinical outcomes.ResultsMost participants adhered sufficiently to MeDi. Exploring each group separately, fruit, vegetables, cereal, and fish were identified as hubs in PwMS, while meat and alcohol were identified as hubs in HC. Hubs were all inter-correlated, indicating that eating habits of PwMS include a large intake of all the foods identified as hubs. EDSS was predicted by the intake of vegetables (beta = −0.36, p < 0.03) and fish (beta = −0.34, p < 0.02). The model including smoking pack/year, International Physical Activity Questionnaire (IPAQ) score and intake of “negative foods” predicted 6% of the variance in EDSS (p < 0.001), while the model including smoking pack/year and IPAQ score predicted 4% of the variance in FSS (p < 0.001).ConclusionsWe identified a sufficient adherence to MeDi in our population. PwMS showed overall a healthier dietary pattern than HC. Vegetables and fish intake were associated with disability outcomes. Future longitudinal studies applying integrated approaches are needed to understand lifestyle added value to the use of standard pharmacological therapies.

Lower Multiple Sclerosis Severity Score Is Associated with Higher Adherence to Mediterranean Diet in Subjects with Multiple Sclerosis from Northwestern Italy

“…Overall, the dietary patterns of our cohort were similar to the average per capita supply of the Italian population and to the amounts of food group available for consumption corrected for waste in Italy [ 25 ]. This data was confirmed in a previous investigation of dietary intake between PwMS and health control [ 26 , 27 , 28 ]. Regarding MD adherence, PwMS from the Northwest of Italy showed low intakes of some healthy Mediterranean foods such as vegetables, fruits, legumes, nuts, and fish and a moderate consumption of wine.…”

Association between Expanded Disability Status Scale score and dietary antioxidant capacity in patients with multiple sclerosis

“…Felicetti et al ( 20 ) also conducted a study to investigate the association between a Mediterranean diet, which has a beneficial effect in neurodegenerative diseases, and EDSS in MS patients. In a cross-sectional study by Coe et al ( 21 ) and another study by Di Majo et al ( 22 ), positive health outcomes were found with higher consumption of carotene, magnesium, fatty fish, fruits and vegetables, and sodium and worse outcomes with consumption of fiber, red meat, and saturated fat (women only).…”

Associations between Mediterranean Diet Adherence, Quality of Life, and Mental Health in Patients with Multiple Sclerosis: A Cross-Sectional Study

“…Moreover, a multi-center, cross-sectional study performed on 478 patients presenting clinically definite MS demonstrated that a low adherence to the MD was higher in overweight patients compared to obese patients, even if MD adherence had no significant relationship with the levels of patients' disability [44]. Another cross-sectional study conducted on 424 MS patients and 165 matched healthy individuals showed that MS patients exhibited a healthier dietary pattern overall compared to healthy individuals and that vegetables and seafood consumption were related with improved disability outcomes [45].…”

“…In a case-control study, a fish/seafood intake one time per week or one time per month with consistent fish oil treatment was related with a 44% lower disease risk or clinically isolated syndrome (CIS) compared to an intake of fish/seafood lower than one time per month and no fish oil supplement use [44]. Currently, only a few studies have evaluated the possible beneficial effect of healthy dietary patterns such as the Mediterranean diet (MD) on the disease disability and symptom severity of individuals with MS-studies which have suffered from several controversial and inconclusive results [45][46][47][48][49][50][51].…”