Evaluation of Dietary Nutrients on Clinical Outcomes in Subjects with Chronic‐Progressive Multiple Sclerosis
Authors: Grossmann Ruth E , Perkhounkova Elena , Bisht Babita , Wahls Terry 
Published: November 2023

Objective

To identify components of a modified Paleolithic diet which may be related to patient outcomes in individuals with chronic‐progressive multiple sclerosis (MS). Outcomes evaluated were fatigue and quality of life, evaluated by Fatigue Severity Score (FSS) and Short‐Form 36 (SF36), respectively.

Methods

This is a secondary analysis of nutrition data from a multimodal intervention study which demonstrated significantly reduced fatigue and improved physical functioning in subjects with MS (n=19). Data were obtained from Food Frequency Questionnaires, and patient reported exercise/electrical stimulation (exer/e‐stim) and stress reduction activities at baseline and 12 months.

Multiple linear regression models were developed for 12‐month changes in FSS, SF‐Physical and SF‐Mental (components of SF36). Linear regression was used to select potential covariates for inclusion in the models. Bivariate relationships were considered between the outcomes and the following variables at 12 months: minutes/day of exer/e‐stim and stress reduction; intake of fiber, saturated fat, omega‐3 fatty acids, calcium, iodine, potassium, retinol, carotene, and choline; and vitamins: B1, B2, B3, B5, B6, B9, B12, K, C, A, and D. Variables correlated with total energy intake were adjusted. Age, years with MS, and change in BMI were considered as moderators by testing relevant interactions. C‐reactive protein was also tested. Interactions and covariates related to the outcomes at <.10 significance level in the bivariate analysis were considered for inclusion in the models, using a sequential approach. Interactions and covariates significant at <.05 level were included in the final models. Some covariates were included because they were part of a significant interaction. All statistical analyses used SAS 9.4.

Results

Final models are shown in the attached table. The model for FSS included omega‐3 intake and minutes per day in exer/e‐stim, both moderated by age (R2=.65, R2adj=.51). Exer/e‐stim >100min/day and greater intake of omega‐3 were associated with a larger decrease in FSS in younger subjects, compared to older subjects.

The final model for SF‐Physical included vitamin K, adjusted for caloric intake; age; and CRP (R2=.68, R2adj=0.58). Greater improvements in SF‐Physical score were associated with younger age, lower CRP, and reduced intake of vitamin K, relative to total caloric intake.

The final model for SF‐Mental included baseline SF‐Mental; fiber, adjusted for caloric intake; and omega‐3 moderated by age (R2=.79, R2adj=.68). Greater improvements in SF‐Mental were associated with lower baseline SF‐Mental score and reduced intake of fiber relative to total caloric intake. Also improvement in SF‐Mental was associated with greater intake of omega‐3 in younger subjects.

Conclusions

This analysis suggests exer/e‐stim, omega‐3 fatty acids, vitamin K and fiber may be associated with clinical outcomes in MS patients. Age appears an important variable as younger adults may benefit more from this intervention than older adults. Findings of this study are preliminary being limited by a small sample and multiple covariates. Therefore findings are preliminary and subject to confirmation by future research.

Support or Funding Information

NIH 1K01GM109309

Multiple Regression Models for 12‐Month Changes in Fatigue, Physical and Mental Health Outcomes Results from the analysis of a 1‐year multimodal intervention including a dietary component in subjects with chronic progressive MS

b
95% CI
p > /t/
ω̂2

FSS, F(5, 13) = 4.81, p = .01, R2 = .65, adjusted R2 = .51

Intercept
15.39
[−2.60, 33.38]
.09

Age
−0.35
[−0.72, 0.01]
.06
.22

Exercise/elec. stim(<100 min vs. ≥100 min)
11.18
[0.97, 21.39]
.03
.12

Omega‐3
−27.50
[−46.33, −8.67]
.01
.24

Exercise/elec. stim* age (interaction)
−0.21
[−0.41, −0.01]
.04
.11

Omeqa‐3* Age (interaction)
0.54
[0.17, 0.92]
.01
.23

SF36, Physical, F(4, 14) = 7.34, p = .002, R2 = .65, adjusted R2 = .58

Intercept
113.37
[60.44, 166.30]
<.001

Age
−1.49
[−2.42, −0.57]
.004
.25

Vitamin K (adjusted for caloric intake)
−0.05
[−0.09, −0.01]
.02
.15

Total caloric intake
−0.01
[−0.03, 0.00]
.08
.06

C‐Reactive protein
−7.19
[−10.99, −3.40]
.001
.35

SF36 Mental, F(6, 12) = 7.36, p = .002, R2 = .79, adjusted R2 = .68

Intercept
−210.91
[−394.69, −27.14]
.03

Age
5.14
[1.76, 8.52]
.01
.17

SF36 Mental baseline score
−0.73
[−1.10, −0.35]
.001
.30

Fiber (adjusted for caloric intake)
−2.01
[−3.81, −0.21]
.03
.09

Omega‐3
344.76
[145.41, 544.10]
.003
.23

Omeqa‐3* age (interaction)
−6.77
[−10.66, −2.88]
.003
.23

Total caloric intake
0.004
[−0.02, 0.02]
.65
−.01

Note b = unstandardized regression coefficient estimate; p > /t/ is p‐value for t‐test of b = 0; 95% CI = 95% confidence interval for b = 0; ω̂2 = semipartial correlation coefficient FSS = Fatigue Severity Score. SF36 Physical = Short‐Form 36 Physical Health Section SF36 Mental = Short‐ Form 36 Mental Health Section.