Top

Open Access 27-04-2024 | Multiple Sclerosis | REVIEW

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

Authors: Shoroog Allogmanny, Yasmine Probst

Abstract

Purpose of Review

Metabolic comorbidities such as obesity, diabetes, hypertension, and dyslipidemia are common to multiple sclerosis (MS) and are associated with negative outcomes of the disease. Dietary intervention has the potential to improve MS co-morbidities; thus, it is a high priority for people living with MS to self-manage their disease. The present review aimed to summarize the recent evidence on the impacts of combining dietary modification with nutrition education and counseling on managing metabolic comorbidity markers in MS.

Recent Findings

Evidence suggests important roles for tailored dietary change strategies and nutrition education and counseling in managing metabolic comorbidities for MS. There is also indirect evidence suggesting a relationship between dietary fiber, the gut microbiome, and improved metabolic markers in MS, highlighting the need for more research in this area. For people living with MS, addressing both barriers and facilitators to dietary changes through behavior change techniques can help them achieve sustainable and tailored dietary behavior changes. This will support person-centered care, ultimately improving metabolic comorbidity outcomes.

Summary

Metabolic comorbidities in MS are considered modifiable diseases that can be prevented and managed by changes in dietary behavior. However, the impact of targeted dietary interventions on mitigating MS-related metabolic comorbidities remains inadequately explored. Therefore, this review has provided insights into recommendations to inform future best practices in MS. Further well-designed studies based on tailored dietary strategies applying behavior change theories are needed to address the underlying determinants of dietary practice in this population.

McGinley MP, Goldschmidt CH, Rae-Grant AD. Diagnosis and treatment of multiple sclerosis: a review. JAMA. 2021;325(8):765–79. https://doi.org/10.1001/jama.2020.26858.CrossRefPubMed

Lakin L, Davis BE, Binns CC, Currie KM, Rensel MR. Comprehensive approach to management of multiple sclerosis: addressing invisible symptoms—a narrative review. Neurology and therapy. 2021;10:75–98. https://doi.org/10.1007/s40120-021-00239-2.CrossRefPubMedPubMedCentral

Prineas JW, Barnard RO, Revesz T, Kwon EE, Sharer L, Cho E-S. Multiple sclerosis: pathology of recurrent lesions. Brain. 1993;116(3):681–93. https://doi.org/10.1093/brain/116.3.681.CrossRefPubMed

• Hauer L, Perneczky J, Sellner J. A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications. J Neurol. 2021;268(11):4066–77. https://doi.org/10.1007/s00415-020-10107-y. A global systematic review shows the worldwide prevalence and patterns of comorbid conditions, including metabolic in multiple sclerosis.CrossRefPubMed

Simpson RJ, McLean G, Guthrie B, Mair F, Mercer SW. Physical and mental health comorbidity is common in people with multiple sclerosis: nationally representative cross-sectional population database analysis. BMC Neurol. 2014;14(1):1–8. https://doi.org/10.1186/1471-2377-14-128.CrossRef

Hall SF. A user’s guide to selecting a comorbidity index for clinical research. J Clin Epidemiol. 2006;59(8):849–55. https://doi.org/10.1016/j.jclinepi.2005.11.013.CrossRefPubMed

Ciampi E, Uribe-San-Martin R, Soler B, Molnar K, Reyes D, Keller K, et al. Prevalence of comorbidities in multiple sclerosis and impact on physical disability according to disease phenotypes. Mult Scler Related Disorders. 2020;46.CrossRef

Maric G, Pekmezovic T, Tamas O, Veselinovic N, Jovanovic A, Lalic K, et al. Impact of comorbidities on the disability progression in multiple sclerosis. Acta Neurol Scand. 2022;145(1):24–9. https://doi.org/10.1111/ane.13516.CrossRefPubMed

Waliszewska-Prosół M, Nowakowska-Kotas M, Misiak B, Chojdak-Łukasiewicz J, Budrewicz S, Pokryszko-Dragan A. Allostatic load index in patients with multiple sclerosis: a case-control study. Psychoneuroendocrinology. 2022;142: 105788. https://doi.org/10.1016/j.psyneuen.2022.105788.CrossRefPubMed

10.

Overs S, Hughes CM, Haselkorn JK, Turner AP. Modifiable comorbidities and disability in multiple sclerosis. Curr Neurol Neurosci Rep. 2012;12:610–7. https://doi.org/10.1007/s11910-012-0293-4.CrossRefPubMed

11.

Marrie RA, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. Comorbidity delays diagnosis and increases disability at diagnosis in MS. Neurology. 2009;72(2):117–24. https://doi.org/10.1212/01.wnl.0000333252.78173.5f.CrossRefPubMedPubMedCentral

12.

Lo LMP, Taylor BV, Winzenberg T, Palmer AJ, Blizzard L, van der Mei I. Comorbidities contribute substantially to the severity of common multiple sclerosis symptoms. J Neurol. 2021;268:559–68. https://doi.org/10.1007/s00415-020-10192-z.CrossRefPubMed

13.

Magyari M, Sorensen PS. Comorbidity in multiple sclerosis. Front Neurol. 2020;11:851. https://doi.org/10.3389/fneur.2020.00851.CrossRefPubMedPubMedCentral

14.

Ponzio M, Monti MC, Mallucci G, Borrelli P, Fusco S, Tacchino A, et al. The economic impact of comorbidity in multiple sclerosis. Neurol Sci. 2023;44(3):999–1008. https://doi.org/10.1007/s10072-022-06517-7.CrossRefPubMed

15.

Fitzgerald KC, Damian A, Conway D, Mowry EM. Vascular comorbidity is associated with lower brain volumes and lower neuroperformance in a large multiple sclerosis cohort. Mult Scler J. 2021;27(12):1914–23. https://doi.org/10.1177/1352458520984746.CrossRef

16.

Karczewski J, Śledzińska E, Baturo A, Jończyk I, Maleszko A, Samborski P, et al. Obesity and inflammation European cytokine network. 2018;29:83–94. https://doi.org/10.1684/ecn.2018.0415.CrossRefPubMed

17.

Marrie RA. Comorbidity in multiple sclerosis: implications for patient care. Nat Rev Neurol. 2017;13(6):375–82. https://doi.org/10.1038/nrneurol.2017.33.CrossRefPubMed

18.

Kowalec K, McKay KA, Patten SB, Fisk JD, Evans C, Tremlett H, et al. Comorbidity increases the risk of relapse in multiple sclerosis: a prospective study. Neurology. 2017;89(24):2455–61. https://doi.org/10.1212/WNL.0000000000004716.CrossRefPubMedPubMedCentral

19.

Marrie RA, Horwitz R, Cutter G, Tyry T. Cumulative impact of comorbidity on quality of life in MS. Acta Neurol Scand. 2012;125(3):180–6. https://doi.org/10.1111/j.1600-0404.2011.01526.x.CrossRefPubMed

20.

Li Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH, et al. Impact of healthy lifestyle factors on life expectancies in the US population. Circulation. 2018;138(4):345–55. https://doi.org/10.1161/CIRCULATIONAHA.117.032047.CrossRefPubMedPubMedCentral

21.

Marck CH, Neate SL, Taylor KL, Weiland TJ, Jelinek GA. Prevalence of comorbidities, overweight and obesity in an international sample of people with multiple sclerosis and associations with modifiable lifestyle factors. PLoS ONE. 2016;11(2): e0148573. https://doi.org/10.1371/journal.pone.0148573.CrossRefPubMedPubMedCentral

22.

Ball L, Johnson C, Desbrow B, Leveritt M. General practitioners can offer effective nutrition care to patients with lifestyle-related chronic disease. J Prim Health Care. 2013;5(1):59–69. https://doi.org/10.1071/hc13059.CrossRefPubMed

23.

Moss BP, Rensel MR, Hersh CM. Wellness and the role of comorbidities in multiple sclerosis. Neurotherapeutics. 2017;14:999–1017. https://doi.org/10.1007/s13311-017-0563-6.CrossRefPubMedPubMedCentral

24.

Probst Y, Guan V, Van Der Walt A, Rath LM, Bonney A, Kent J. Patient self-management and empowerment for multiple sclerosis: the implications of dietary lifestyle management for primary care. Aus J Gen Pract. 2022;51(4):209–12. https://doi.org/10.31128/AJGP-09-21-6179.CrossRef

25.

Marck CH, Probst Y, Chen J, Taylor B, van der Mei I. Dietary patterns and associations with health outcomes in Australian people with multiple sclerosis. Eur J Clin Nutr. 2021;75(10):1506–14. https://doi.org/10.1038/s41430-021-00864-y.CrossRefPubMed

26.

Russell RD, Black LJ, Begley A. Navigating dietary advice for multiple sclerosis. Health Expect. 2021;24(3):853–62. https://doi.org/10.1111/hex.13226.CrossRefPubMedPubMedCentral

27.

Esposito S, Bonavita S, Sparaco M, Gallo A, Tedeschi G. The role of diet in multiple sclerosis: a review. Nutr Neurosci. 2018;21(6):377–90. https://doi.org/10.1080/1028415X.2017.1303016.CrossRefPubMed

28.

Evans E, Levasseur V, Cross AH, Piccio L. An overview of the current state of evidence for the role of specific diets in multiple sclerosis. Multiple Sclerosis and Related Disorders. 2019;36: 101393. https://doi.org/10.1016/j.msard.2019.101393.CrossRefPubMed

29.

Kirkland H, Campbell J, Reece J, Nag N, Probst Y, Neate S, et al. Higher diet quality is associated with short and long-term benefits on SF-6D health state utilities: a 5-year cohort study in an international sample of people with multiple sclerosis. Qual Life Res. 2023;32:1–14. https://doi.org/10.1007/s11136-023-03361-w.CrossRef

30.

Gong Q, Zhang P, Wang J, Ma J, An Y, Chen Y, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol. 2019;7(6):452–61. https://doi.org/10.1016/S2213-8587(19)30093-2.CrossRefPubMedPubMedCentral

31.

Gao X, Tian Z, Zhao D, Li K, Zhao Y, Xu L, et al. Associations between adherence to four a priori dietary indexes and cardiometabolic risk factors among hyperlipidemic patients. Nutrients. 2021;13(7):2179. https://doi.org/10.3390/nu13072179.CrossRefPubMedPubMedCentral

32.

• Suliga E, Brola W, Sobaś K, Cieśla E, Jasińska E, Gołuch K, et al. Dietary patterns and metabolic disorders in Polish adults with multiple sclerosis. Nutrients. 2022;14(9):1927. https://doi.org/10.3390/nu14091927. This study analyzed the dietary patterns of people with multiple sclerosis, and it found that an unhealthy dietary pattern was associated with the presence of some metabolic risk factors, such as abdominal obesity and low HDL-cholesterol levels.CrossRefPubMedPubMedCentral

33.

Vollmer TL, Nair KV, Williams IM, Alvarez E. Multiple sclerosis phenotypes as a continuum: the role of neurologic reserve. Neurol Clin Pract. 2021;11(4):342–51. https://doi.org/10.1212/cpj.0000000000001045.CrossRefPubMedPubMedCentral

34.

Dorothy V. Dietary patterns and metabolic disorders in multiple sclerosis. Neurosurg J. 2022;5(2):22–3.

35.

Ojo O. Nutrition and chronic conditions. Nutrients. 2019;11(2):459. https://doi.org/10.3390/nu11020459.CrossRefPubMedPubMedCentral

36.

Mitchell LJ, Ball LE, Ross LJ, Barnes KA, Williams LT. Effectiveness of dietetic consultations in primary health care: a systematic review of randomized controlled trials. J Acad Nutr Diet. 2017;117(12):1941–62. https://doi.org/10.1016/j.jand.2017.06.364.CrossRefPubMed

37.

Carey RN, Connell LE, Johnston M, Rothman AJ, De Bruin M, Kelly MP, et al. Behavior change techniques and their mechanisms of action: a synthesis of links described in published intervention literature. Ann Behav Med. 2019;53(8):693–707. https://doi.org/10.1093/abm/kay078.CrossRefPubMed

38.

Rimmer JH, Wang E, Pellegrini CA, Lullo C, Gerber BS. Telehealth weight management intervention for adults with physical disabilities: a randomized controlled trial. Am J Phys Med Rehabil. 2013;92(12):1084–94. https://doi.org/10.1097/PHM.0b013e31829e780e.CrossRefPubMed

39.

•• Afifi Z, Hassan A, Abdelrahman N, El Sayed A, Salem M. Impact of nutrition counseling on anthropometry and dietary intake of multiple sclerosis patients at Kasr Alainy Multiple Sclerosis Unit, Cairo, Egypt 2019–2020: randomized controlled clinical trial. Archives of Public Health. 2023;81(1):11. https://doi.org/10.1186/s13690-022-01013-y. This randomized controlled clinical trial examined the relationship between nutrition counselling on a healthy diet and body parameters in people with multiple sclerosis. It depicts how healthy dietary modification combined with nutrition counselling can significantly improve anthropometric measurements.CrossRefPubMedPubMedCentral

40.

•• Wingo BC, Rinker JR, Goss AM, Green K, Wicks V, Cutter GR, et al. Feasibility of improving dietary quality using a telehealth lifestyle intervention for adults with multiple sclerosis. Mult Scler Relat Disord. 2020;46: 102504. https://doi.org/10.1016/j.msard.2020.102504. This interventional study highlights the effectiveness of healthy behavioral dietary education delivered through telehealth in improving diet quality and reducing cardiometabolic risk in people with multiple sclerosis.CrossRefPubMed

41.

•• Papandreou P, Gioxari A, Daskalou E, Vasilopoulou A, Skouroliakou M. Personalized nutritional intervention to improve Mediterranean diet adherence in female patients with multiple sclerosis: a randomized controlled study. Dietetics. 2022;1(1):25–38. https://doi.org/10.3390/dietetics1010004. This randomized controlled clinical trial showed the significant effect of dietitian counseling and individualized dietary interventions on improving body composition measurements and serum glucose in people with multiple sclerosis.CrossRef

42.

Martínez-González MA, Gea A, Ruiz-Canela M. The Mediterranean diet and cardiovascular health: a critical review. Circ Res. 2019;124(5):779–98. https://doi.org/10.1161/CIRCRESAHA.118.313348.CrossRefPubMed

43.

Yadav V, Marracci G, Kim E, Spain R, Cameron M, Overs S, et al. Low-fat, plant-based diet in multiple sclerosis: a randomized controlled trial. Mult Scler Relat Disord. 2016;9:80–90. https://doi.org/10.1016/j.msard.2016.07.001.CrossRefPubMed

44.

Uzdil Z, Türker PF, Terzi M. Effects of nutrition education given to persons with multiple sclerosis and their families on diet quality and anthropometric and biochemical measurements. Revista de Nutrição. 2022. https://doi.org/10.1590/1678-9865202235e220153.CrossRef

45.

Trestini I, Sperduti I, Caldart A, Bonaiuto C, Fiorio E, Parolin V, et al. Evidence-based tailored nutrition educational intervention improves adherence to dietary guidelines, anthropometric measures and serum metabolic biomarkers in early-stage breast cancer patients: a prospective interventional study. The Breast. 2021;60:6–14. https://doi.org/10.1016/j.breast.2021.08.008.CrossRefPubMedPubMedCentral

46.

Xie L, Alam MJ, Marques FZ, Mackay CR. A major mechanism for immunomodulation: dietary fibres and acid metabolites. Semin Immunol. 2023;66: 101737. https://doi.org/10.1016/j.smim.2023.101737.CrossRefPubMed

47.

Cronin P, Joyce SA, O’Toole PW, O’Connor EM. Dietary fibre modulates the gut microbiota. Nutrients. 2021;13(5):1655. https://doi.org/10.3390/nu13051655.CrossRefPubMedPubMedCentral

48.

Stephen AM, Champ MM-J, Cloran SJ, Fleith M, Van Lieshout L, Mejborn H, et al. Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutr Res Rev. 2017. https://doi.org/10.1017/S095442241700004X.CrossRefPubMed

49.

Riccio P, Rossano R. Diet, gut microbiota, and vitamins D+ A in multiple sclerosis. Neurotherapeutics. 2018;15(1):75–91. https://doi.org/10.1007/s13311-017-0581-4.CrossRefPubMed

50.

Wang PX, Deng XR, Zhang CH, Yuan HJ. Gut microbiota and metabolic syndrome. Chin Med J (Engl). 2020;133(7):808–16. https://doi.org/10.1097/cm9.0000000000000696.CrossRefPubMed

51.

Dopkins N, Nagarkatti PS, Nagarkatti M. The role of gut microbiome and associated metabolome in the regulation of neuroinflammation in multiple sclerosis and its implications in attenuating chronic inflammation in other inflammatory and autoimmune disorders. Immunology. 2018;154(2):178–85. https://doi.org/10.1111/imm.12903.CrossRefPubMedPubMedCentral

52.

Yadav SK, Ito K, Dhib-Jalbut S. Interaction of the gut microbiome and immunity in multiple sclerosis: impact of diet and immune therapy. Int J Mol Sci. 2023. https://doi.org/10.3390/ijms241914756.CrossRefPubMedPubMedCentral

53.

Manche S, Probst Y. Exploring the socio-ecological factors impacting lifestyle management of multiple sclerosis: a scoping review. Multiple Sclerosis and Related Disorders. 2023;79: 104958. https://doi.org/10.1016/j.msard.2023.104958.CrossRefPubMed

54.

Silveira SL, Richardson EV, Motl RW. Desired resources for changing diet among persons with multiple sclerosis: qualitative inquiry informing future dietary interventions. International Journal of MS Care. 2022;24(4):175–83. https://doi.org/10.7224/1537-2073.2021-052.CrossRefPubMed

55.

Baker S, Auld G, Ammerman A, Lohse B, Serrano E, Wardlaw MK. Identification of a framework for best practices in nutrition education for low-income audiences. J Nutr Educ Behav. 2020;52(5):546–52. https://doi.org/10.1016/j.jneb.2019.12.007.CrossRefPubMed

56.

Deslippe AL, Soanes A, Bouchaud CC, Beckenstein H, Slim M, Plourde H, et al. Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature. Int J Behav Nutr Phys Act. 2023;20(1):1–25. https://doi.org/10.1186/s12966-023-01424-2.CrossRef

57.

Barnard E, Brown CR, Weiland TJ, Jelinek GA, Marck CH. Understanding barriers, enablers, and long-term adherence to a health behavior intervention in people with multiple sclerosis. Disabil Rehabil. 2020;42(6):822–32. https://doi.org/10.1080/09638288.2018.1510550.CrossRefPubMed

58.

Faraclas E, Merlo A, Lynn J, Lau JD. Perceived facilitators, needs, and barriers to health related quality of life in people with multiple sclerosis: a qualitative investigation. Journal of Patient-Reported Outcomes. 2022;6(1):89. https://doi.org/10.1186/s41687-022-00496-1.CrossRefPubMedPubMedCentral

59.

Dean C, Parks S, Titcomb TJ, Arthofer A, Meirick P, Grogan N, et al. Facilitators of and barriers to adherence to dietary interventions perceived by women with multiple sclerosis and their support persons. International journal of MS care. 2022;24(5):235–41. https://doi.org/10.7224/1537-2073.2021-051.CrossRefPubMedPubMedCentral

60.

Carter C, Harnett JE, Krass I, Gelissen IC. A review of primary healthcare practitioners’ views about nutrition: implications for medical education. Int J Med Educ. 2022;13:124–37. https://doi.org/10.5116/ijme.6271.3aa2.CrossRefPubMedPubMedCentral

61.

Kahan S, Manson JE. Nutrition counseling in clinical practice: how clinicians can do better. JAMA. 2017;318(12):1101–2. https://doi.org/10.1001/jama.2017.10434.CrossRefPubMed

Title: Dietary Modification Combined with Nutrition Education and Counseling for Metabolic Comorbidities in Multiple Sclerosis: Implications for Clinical Practice and Research
Authors: Shoroog Allogmanny
Yasmine Probst
Publication date: 27-04-2024
Publisher: Springer US
Keywords: Multiple Sclerosis
Nutrition
Published in: Current Nutrition Reports
Electronic ISSN: 2161-3311
DOI: https://doi.org/10.1007/s13668-024-00538-8

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com