Screening Shows Significant Risk of Malnutrition in Neuromyelitis Optica Spectrum Disorder

Recently published in Multiple Sclerosis & Related Disorders, findings from a cross-sectional observational study showed a high risk of malnutrition in patients with neuromyelitis optica spectrum disorder (NMOSD) with Mini Nutritional Assessment (MNA) screening.¹ These results suggest that nutritional screening is critical, and that a multifaceted, personalized treatment approach is essential to improve the prognosis of NMOSD in patients.

In the analysis, the mean MNA score of those with NMOSD was 20.4 (SD, ±3.3) which was significantly lower compared with the healthy controls (HCs; 23.3; SD, ±2.5; P = 0.002), specifically for the proportions of global evaluation and anthropometric assessment. Among 70 patients with NMOSD and 66 HCs, nearly 85% of patients were at risk of malnutrition (74.3%) or had definite malnutrition (11.4%) according to the MNA screening, which positively correlated with quality of life (P <.01).

Senior author Lili Yang, PhD, a postdoctoral researcher in the department of neurology at Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital of the University of Electronic Science and Technology of China, and colleagues wrote, “Nutrition status was directly correlated with the patient's quality of life. The factors associated with an increased risk of malnutrition were female, more attacks, longer disease duration, more severe anxiety/depression, more severe sleep disturbances, and more severe fatigue.”¹

In this study, Yang et al explored the impacts of nutrition on patients' quality of life and identified the factors associated with the nutritional status among patients living with NMOSD. Patients with NMOSD were recruited from Sichuan Provincial People's Hospital and the HCs were recruited from the Department of Medical Examination Center at Sichuan Provincial People's Hospital. Researchers assessed demographics, features of the disease, and composite evaluations of life status to perform their statistical analyses. These life status assessments included nutrition (MNA), sleep (Pittsburgh Sleep Quality Index), anxiety/depression (Hospital Anxiety and Depression Scale), fatigue (Brief Fatigue Inventory), and quality of life (36-item short-form health survey).

The findings demonstrated that low MNA scores correlated with gender (women, P = .02), longer disease duration (P <.001) and more severe anxiety (P = .004). Additionally, having a lower MNA score was associated with more severe depression (P = .003), more severe sleep disturbances (P <.001), and more severe fatigue (P = .01). Notably, sleep disturbance was revealed as a significant independent factor for the patients' malnutritional risk, those with NMOSD (P = .001).

“The supplemental analysis of the HC group suggests that the association of sex with nutritional status was disease-specific and did not exist in HCs. This specificity had not yet been identified in previous studies. Female was further revealed to be an independent factor associated with dietetic and subjective assessments,” Yang et al wrote.¹ “Thus, female NMOSD patients were more likely to develop malnutrition, possibly due to their dietary structure and emotional state. Social psychological factors might contribute, such as dieting for weight control purposes or being more likely to accompany anxiety/depression.”

Some of the limitations of this study include that it did not assess the impact of nutritional status on disease prognosis. Also, the MNA was used for rapid assessment although it lacked data related to nutritional statuses, therefore it was not comprehensive enough for assessing nutritional assessment, according to the authors. The study also had a limited sample size, patients with dysphagia were not excluded, and the samples of patients with NMOSD with old age or high disability were few. The authors noted that further research of a larger sample and use of more nutritional assessments to validate the knowledge on the nutritional status in patients with NMOSD.

“The malnutrition of NMOSD is caused by the combination of various social, physiological, and psychological changes. Special attention needs to be paid to the nutritional status of female patients, patients with more attacks, or patients with longer disease duration. The nutritional status of NMOSD is closely related to sleep quality from the perspective of clinical observation, although further research is needed to reveal the underlying mechanism,” Yang et al wrote.¹

REFERENCES
1. Huang R, Huang X, Wang Y, et al. The nutritional risk in patients with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord. 2023;77:104900. doi:10.1016/j.msard.2023.104900