Dietary Attitudes and Behaviors of Male Veterans with Multiple Sclerosis (MS)
Authors: Hadidi Daniel , Brenner Lisa 
Published: November 2023

Background

Male Veterans with MS are an understudied population which has previously been shown to be of lower socioeconomic status than the broader MS population. Combined with a significant financial burden of healthcare and medications, this may affect their access to healthy dietary patterns and resultant clinical outcomes. The dietary attitudes and behaviors of this population are unknown and are key to the development of therapeutic dietary interventions.

Methods

Qualitative data on the dietary attitudes and behaviors of 40 male Veterans with MS will be presented. This data is part of a larger mixed‐methods cross‐sectional investigation into whether dietary factors, in particular Omega 3 fatty acid (N‐3) consumption, are associated with clinical outcomes in this population. Study measures include the North American Research Committee on Multiple Sclerosis enrollment questionnaire (NARCOMS), Multiple Sclerosis Quality of Life questionnaire (MSQOL) which is divided into domains of Mental‐ and Physical‐Health Quality of Life, and the Harvard Food Frequency Questionnaire (HFFQ). The NARCOMS has been modified to include four qualitative questions on food choices. The questions are: 1) “Where do you purchase or obtain the majority of your food?”; 2) “What do you take into consideration in selecting the source of where you get your food?”; 3) “Is the majority of the meat, eggs and dairy that you consume pasture‐raised/grass‐fed?”; and 4) “How important do you think the types of food you eat is to your health?” Questions 1, 2, and 4 were open‐ended and later coded into categories, whereas Question 3 was queried with options of “Yes,” “No,” or “I don't know.”

Results

9 of 40 (22.5%) reported an annual household income below $30,000 and 15 (37.5%) below $50,000, prior to deduction of potentially high healthcare costs. 29 of 40 (72.5%) purchased at grocery chains such as King Sooper's or Safeway, 19 (47.5%) at retail stores including grocery sections such as Target, Wal‐Mart or Sam's Club, and 3 (7.5%) at premium grocery chains such as Whole Foods or Sprout's Farmer's Market (multiple responses possible). Price was the most frequently reported motivation for food source at 21 of 40 (52.5%), followed by 17 reporting “Healthy,” (42.5%), 13 reporting “Quality” (32.5%), 7 reporting “Selection” (17.5%) and 5 reporting spousal decision (12.5%). 17 of 40 (42.5%) reported that they consumed primarily grass‐fed/pasture‐raised animal products, which provide significantly greater levels of anti‐inflammatory N‐3s and lower levels of pro‐inflammatory N‐6s, although several individuals conflated the terms “pasture‐raised” with “pasteurized.” 35 of 40 (87.5%) believed that their diet was very important to their health.

Conclusion

These results suggest that cost of food may be a barrier to access of healthier eating patterns in this population, despite a highly prevalent belief that food choices are very important to health and desire to maintain a healthy diet. Understanding of food labeling terminology may be a limiting factor in the selection of foods which are potentially more beneficial, especially in the context of MS.