A survey of dietary characteristics in a large population of people with multiple sclerosis☆
Introduction
Multiple sclerosis (MS) is a potentially devastating inflammatory and neurodegenerative disease whose prevalence has risen over the past several decades (Marrie et al., 2010); it's the most common non-traumatic cause of progressive neurologic disability in young adults (Frohman et al., 2006). Diet, which has also changed markedly in recent decades, may influence immune function, oxidative stress, and mitochondrial function, all of which may play a role in MS, and has been proposed for decades as a potential disease-modifying agent. In addition, the possible role of diet as it relates to MS is also interesting given recent data suggesting childhood obesity is a risk factor for MS (Langer-Gould et al., 2013), and the growing number of studies suggesting people with MS have an increased risk of cardio-metabolic comorbidities (e.g. hyperlipidemia) and that these comorbidities may adversely affect outcomes (Marrie et al., 2015, Marrie et al., 2012). Furthermore, in one recent survey, over 90% of responders expressed interest in dietary modifications as a means to treat or improve their MS (Brenton and Goldman, 2016).
In one survey from South Australia responses suggested that the most common dietary changes made by people with MS included an adoption of low fat diets or, less commonly, adherence to a gluten-free diet (Leong et al., 2009). Another large survey investigated dietary habits of people with MS and found that higher quality diets, that is, a diet high in fruits and vegetable and low in processed foods, were associated with better health-related quality of life (Hadgkiss et al., 2015). However, the existing studies did not provide detailed information on dietary composition among those following specialized diets vs. those with no restrictions, did not evaluate the associations of dietary composition with sociodemographic factors, and did not evaluate whether diet composition differed from findings in the general population.
Therefore, in a large, diverse sample of adults with MS, we characterized overall dietary quality and individual diet components, and compared them with estimates from a nationally representative sample of healthy adults in the United States. We also characterized the prevalence, dietary quality and sociodemographic characteristics of responders who reported following any of the specialized diets list.
Section snippets
Source population
In 2015, we conducted a cross-sectional study of participants in the North American Research Committee on MS (NARCOMS), a voluntary registry for persons with MS. The registry includes over 38,000 unique participants enrolled since 1996 of whom 11,011 were considered active participants in 2015 because they had responded to at least one questionnaire in the past 2 years (Marrie et al., 2007). Participants provide demographic and clinical information at the time of enrollment including date of
Responders
Of the 7639 (69%) responders, we excluded individuals who reported that they did not have physician-confirmed MS (n = 47) or who were unsure of their MS diagnosis type or reported having other diseases (n = 174), and individuals who did not answer the special section on diet (n = 423). In total, 6990 participants were included in the analysis. As compared to non-responders, responders tended to be older (Supplemental Table 1; responders: mean [SD] 59.5 [13.1] years vs. non-responders: 56.0
Discussion
In this large survey of people with MS, we found that overall diet was not appreciably different from dietary trends in an age-matched sample of the US population. In both populations, intake of fruits, vegetables and legumes was generally low (roughly < 3 servings/day or 21 servings/week) for all age groups and considerably less than the USDA dietary guidelines (2015–2020 Dietary Guidelines for Americans), which recommend that individuals following a 2000 kcal/day diet consume roughly 5.2
Role of the funding source
NARCOMS is supported in part by the Foundation of the Consortium of Multiple Sclerosis Centers (CMSC). The study was supported by a fellowship grant to Dr. Fitzgerald from the CMSC's NARCOMS Postdoctoral Fellowship. All authors meet criteria for authorship, and the funding source did not play a role in the design of the study, analysis of the data or interpretation of the results.
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Support: NARCOMS is supported in part by the Foundation of the Consortium of Multiple Sclerosis Centers. The study was supported by a fellowship grant to KCF from the CMSC's NARCOMS postdoctoral fellowship.