Research Identifies Links Between Proinflammatory Diets and Increased Relapses, Lesion Volume in Multiple Sclerosis

Ingrid van der Mei, PhD, MSc

Using a cohort of patients with multiple sclerosis (MS) prospectively followed for 10 years, findings suggest that a more pro-inflammatory diet was associated with a higher hazard of relapse and greater FLAIR lesion volume in the periventricular region. No associations were observed with annualized Expanded Disability Status Scale (EDSS) change, or black hole lesion volume.

Senior investigator Ingrid van der Mei, PhD, MSc, principal research fellow, University of Tasmania, and colleagues concluded that, "While an anti-inflammatory diet does not replace anti-inflammatory medications in MS, this study provides evidence that an anti-inflammatory diet could contribute to the health and well-being of people with MS."

Published in the Multiple Sclerosis Journal, the trial featured 223 individuals presenting with a first clinical diagnosis of central nervous system demyelination (FCD). This included progressive-onset cases, relapse-onset cases with an FCD but with a prior undiagnosed historical first demyelinating event (FDE), and classic FDEs as relapse-onset cases with a first episode of clinical demyelination without preceding demyelinating events.

At baseline, 5- and 10-year reviews, Dietary Inflammatory Index (DII) scores and energy-adjusted DII (E-DII) scores were calculated and assessed as predictors of relapses, annualized change in disability, and 2 MRI measures of FLAIR lesion volume and black hole lesion volume. The final analyses only included those who converted to MS at the 10-year follow-up period (n = 190). Data were available for annualized EDSS in 98% (n = 186) of participants, total relapse count in 99.47% (n = 189) of participants, MRI outcome data in 81% (n = 154) of participants, and dietary data in 97% (n = 184) of the cohort.

Relative to baseline, the mean change between the 5-year and 10-year review for the DII and E-DII was +0.23 and –0.11, respectively. At the conclusion of the 10-year period, a 1-unit increase in the DII increased the rate of relapse by 18%. Those with an E-DII score in the highest quartile had a relapse hazard that was 2.24 times higher than those in the lowest quartile, with a dose response present and a significant test for trend (Ptrend = 0.03). Of note, there was no association between DII and E-DII with annualized EDSS change, even when limited to those with a classic FDE.

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Although there were no original associations between DII or E-DII score and total FLAIR lesion volume, the magnitude of effect increased and was more precise when analyses were limited to those with the same scanner and classic FDE at study entry. Following this, the evidence of association was found, such that those with a DII score in the highest quartile had a total FLAIR lesion volume 2.01 ml higher than those in the lowest quartile. This relationship was dose-dependent but the test for trend was not significant (P = .09).

Investigators observed similar relationships between E-DII and total FLAIR lesion volume; however, a plateau effect was evident from the median E-DII and above (P_trend = 0.10). When comparing the associations with lesion volume in the periventricular or juxtacortical regions, findings showed that the association in the periventricular region was stronger, although non-significant (highest vs lowest E-DII quartile: ß = 1.47; 95% CI, –0.03 to 2.98; P = .06).

"Pro-inflammatory food parameters of the DII include saturated fat, total fat, trans fat, total energy, cholesterol, vitamin B, and protein," the study authors concluded. "Further prospective studies, including randomized control trials, are important to confirm that anti-inflammatory diets are beneficial on relapse rate and MRI markers in people with MS. The top five anti-inflammatory food parameters of the DII are turmeric, fiber, flavones, isoflavones, and β-carotene."

REFERENCES
1. Saul AM, Taylor BV, et al. A pro-inflammatory diet in people with multiple sclerosis is associated with an increased rate of relapse and increased FLAIR lesion volume on MRI in early multiple sclerosis: a prospective cohort study. Mult Scler J. Published online May 6, 2023. doi:10.1177/13524585231167739