Dr Meier GerdinghElisa Meier-Gerdingh, MD
Although no association was observed between overall diet quality and disability status in patients with multiple sclerosis (MS), new findings from a preliminary study suggest that there may be a link between sugar-sweetened beverages and greater disability status in MS.1

With respect to individual Dietary-Approaches-to-Stop-Hypertension (DASH) score factors, those in the highest quartile of sugar-sweetened beverage consumption displayed a higher risk for severe disability (odds ratio [OR] 5.01; 95% CI, 1.03- 24.37; P = .01) compared with mild-to-moderate disability.

The research will be presented at the 2019 American Academy of Neurology Annual Meeting in Philadelphia, Pennsylvania, May 4-10, 2019. 

Led by Elisa Meier-Gerdingh, MD, of St. Josef Hospital Bochum in Germany, the study included 135 patients with MS with a mean body mass index (BMI) of 24.5 (standard deviation [SD], 5.3), of which 30 had severe disability. DASH scores were compiled as a composite measurement of each individual’s quality of diet, favoring the intake of fruits, vegetables, nuts and legumes, whole-grains, and dairy. The composites unfavorably weigh the intake of sodium, sugar-sweetened beverages, and red and processed meats.

“The mechanisms in which diet and diet quality may impact symptoms and disability in MS are not fully understood,” Meier-Gerdingh told NeurologyLive®. “In the general population, a healthy diet can support a reduction of BMI and lowers cardiovascular risk factors, both of which are aspects that might be of relevance in MS, as people with MS are at increased risk of metabolic diseases.”

Meier-Gerdingh explained that the mechanisms in which diet modulates the immune system include the reduction of oxidative stress and the influence of the composition of the human gut microbiota.2-4 “Both of these examples show an impact on the pathomechanisms of MS,” she said.

None of the other DASH score components which were measured were associated with disability status in MS. The investigators noted that, despite the fact that previous research has been somewhat limited, there have been studies suggesting an association between diet and disease progression.5,6

They noted that longitudinal studies are still needed to evaluate if diet impacts future disability in MS, especially so that in the instance that the association exists, that nutritional guidelines or recommendations can be developed.

The DASH-based diet was chosen as it is a widely recommended regimen for those with hypertension—one of the most common metabolic disorders. There are no established risk or disease-modifying factors for MS, and as such, there is no specific score available to measure a patient's diet quality in regards to disease risk or disease course. The aforementioned association with metabolic disorder-risk and MS was also part of the reasoning for DASH’s use. 

Meier-Gerdingh noted that as sugar consumption was only evaluated in the context of sugar-sweetened beverages, investigators cannot say whether or not a link exists between overall sugar consumption and disability status in MS, even if “it seems reasonable.”

“In earlier studies, nutritional components like fish, diverse fats, or vitamin D have been discussed as potential influencing factors in context with MS,” she said. “Therefore, sugar-sweetened beverages or general sugar consumption were not yet in the focus. But with regard to the fact that, on one hand, sugar-sweetened beverages are rated as a component of an unhealthy diet that promotes the development of chronicle diseases like adiposity or hypertension. And on the other hand, people with MS are at increased risk of metabolic disorders, so a possible association might not be too far-fetched.”

“Earlier studies have shown that a healthy diet might be of benefit for people with MS, so if these findings get further affirmed, nutritional counseling in people with MS should be established,” Meier-Gerdingh said.

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REFERENCES
1. Meier-Gerdingh E, Fitzgerald K, Gold R, Hellwig K. Dietary Intake and the Effect on Disease Progression in People with Multiple Sclerosis. Presented at AAN 2019; Philadelphia, PA; May 4 to 9, 2019. indexsmart.mirasmart.com/AAN2019/PDFfiles/AAN2019-003248.pdf.
2. Gilgun-Sherki Y, Melamed E, Offen D. The role of oxidative stress in the pathogenesis of multiple sclerosis: The need for effective antioxidant therapy. J Neurol. 2004;251(3):261-8.
3. Dai J, Jones DP, Goldberg J, et al. Association between adherence to the Mediterranean diet and oxidative stress. Am J Clin Nutr. 2008;88(5):1364-70.
4. Haase S, Haghikia A, Gold R, Linker RA. Dietary fatty acids and susceptibility to multiple sclerosis. Mult Scler J. 2018;24(1):12-6. doi: 10.1177/1352458517737372.
5. Fitzgerald KC, Tyry T, Salter A, et al. Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology. 2018;90(1):e1-11. doi: 10.1212/WNL.0000000000004768; 
6. Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis. Nutr Neurosci. 2015;18(3):125-36. doi: 10.1179/1476830514Y.0000000117