Personalized Nutritional Intervention to Improve Mediterranean Diet Adherence in Female Patients with Multiple Sclerosis: A Randomized Controlled Study

Abstract

Background: Multiple sclerosis (MS) is a chronic immune-mediated central nervous system disorder that affects females twice as often as males. MS patients show increased susceptibility to obesity and related cardiometabolic disorders, while diet may influence disease course. In the present randomized controlled study, we aimed to increase Mediterranean Diet (MedDiet) adherence in MS women and improve their nutritional status. Methods: Adult women with relapsing-remitting MS (n = 40) were randomly allocated to intervention (n = 20) or control group (n = 20). Individual dietary plans based on MedDiet together with nutritional consultation were provided to the intervention group. Controls received general lifestyle advice according to “National Dietary Guidelines”. Medical history, anthropometry, dietary records, and blood withdrawal were performed at baseline and at 3 months. Results: Compared to controls, the intervention group demonstrated greater MedDiet adherence (p < 0.001), which was negatively associated with cholesterol intake levels (p < 0.05). At 3 months, women following MedDiet had ameliorated body weight and body composition compared to baseline (p < 0.001). Serum 1,25(OH)2D was significantly higher in both study groups at 3 months (p < 0.001), but in the intervention group, the mean increment was twofold compared to controls (p < 0.001). Conclusion: Personalized nutritional intervention in MS patients may improve MedDiet adherence and nutritional status towards cardioprotective health outcomes.

Improving Adherence to the Mediterranean Diet in Early Pregnancy Using a Clinical Decision Support System; A Randomised Controlled Clinical Trial

“…Regarding our primary outcome, we succeeded in proving our hypothesis that the use of CDSS increases adherence to the MD, as pregnant women in the CDSS group experienced an increase in the MedDietScore at the first trimester of their pregnancy, while women in the control group who received general lifestyle guidelines did not. Similarly, the same effect of CDSS application on MD adherence was observed in other studies of our group, which included breast cancer and multiple sclerosis patients [ 25 , 27 ]. As mentioned previously, a significant increase in MD adherence during pregnancy has been associated with several beneficial outcomes for both the mother and the offspring.…”

“…The present CDSS was developed by our research team in 2016, and ever since, it has been applied in clinical practice to assist dieticians in the nutritional care process, such as nutritional screening and monitoring. The CDSS allows patients to visit their personal dietary regimen at any time and to record and monitor their own progress, e.g., goals of body weight, physical activity, and consumption of fruits, vegetables, and legumes, via a login password [ 25 , 26 , 27 , 28 ]. Records can automatically be made available to the attending health care professional (e.g., physician, dietician), who will in turn assess patient progress and nutritional status.…”

Mediterranean Diet and Physical Activity Nudges versus Usual Care in Women with Rheumatoid Arthritis: Results from the MADEIRA Randomized Controlled Trial

“…A CDSS platform was used for the delivery of the patient education, as previously detailed [ 41 , 42 ]. The specific CDSS was developed during 2016 and has been used in clinical practice as a complementary tool for the hospital’s dieticians and as a patient nudge tool [ 41 , 43 ].…”

Dietary Modification Combined with Nutrition Education and Counseling for Metabolic Comorbidities in Multiple Sclerosis: Implications for Clinical Practice and Research

“…After the intervention, participants with MS ( n = 18) exhibited an improvement in cardiometabolic risk, including HbA1c, fasting blood glucose, blood pressure, and body composition. Another study by Papandreou et al [ 41 ••] evaluated a 3-month dietitian education and counseling program that included individualized dietary interventions based on the Mediterranean diet (MedDiet) for 20 women living with MS. A significant ( p < 0.001) decrease in BW, BMI, fat mass, and serum glucose was observed compared to the baseline, which was negatively correlated with cholesterol intake levels ( p < 0.05). The MedDiet pattern is based on a high intake of fruits, vegetables, whole grains, olive oil, seeds, and legumes, a moderate intake of dairy products, and a low intake of animal fats [ 42 ].…”