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Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis
Saeedeh Azary1, Teri Schreiner2, Jennifer Graves1
1Department of Neurology, UCSF Regional Pediatric MS Center, San Francisco, California, USA.
Insights
High-fat diets, particularly those rich in saturated fats, may increase relapse risk in pediatric multiple sclerosis (MS) patients. Conversely, increased vegetable intake appears protective against relapses in children with MS.
Area of Science:
- Pediatric Neurology
- Nutritional Science
- Epidemiology
Background:
- The influence of diet on the course of multiple sclerosis (MS) is not well understood.
- Children with MS experience a higher relapse rate than adults, making them a key population for dietary studies.
Purpose of the Study:
- To investigate the association between dietary intake and relapse rates in children diagnosed with multiple sclerosis.
- To identify specific dietary components that may influence disease activity in pediatric MS.
Main Methods:
- A multicenter study involving 219 pediatric patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome (CIS) in the USA.
- Dietary intake was assessed using the Block Kids Food Screener, focusing on the week prior to enrollment.
- The primary outcome measured was the time to the next relapse after enrollment.
Main Results:
- A 10% increase in energy intake from fat was associated with a 56% increased hazard of relapse (aHR 1.56).
- A 10% increase in saturated fat intake tripled the hazard of relapse (aHR 3.37).
- Each cup equivalent of vegetable intake decreased the hazard of relapse by 50% (aHR 0.50), independent of vitamin D levels.
Conclusions:
- High fat intake, especially saturated fat, is linked to an increased risk of relapse in pediatric MS.
- Increased vegetable consumption may offer independent protection against relapses in children with MS.
- Dietary modifications, focusing on reduced fat and increased vegetable intake, could be a potential strategy in managing pediatric MS.
Objective:
The role of diet in multiple sclerosis (MS) course remains largely unknown. Children with MS have a higher relapse rate compared with MS in adults. Thus, studying the effect of diet on relapse rate in this age group is likely to provide more robust answers.
Methods:
This is a multicentre study done at 11 paediatric MS centres in the USA. Patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome (CIS) with disease onset before 18 years of age and duration of less than 4 years were included in this study. Dietary intake during the week before enrolment was assessed with the validated Block Kids Food Screener. The outcome of the study was time from enrolment to the next relapse. 219 patients with paediatric RRMS or CIS were enrolled. Each 10% increase in energy intake from fat increased the hazard of relapse by 56% (adjusted HR 1.56, 95% CI 1.05 to 2.31, p=0.027), and in particular each 10% increase in saturated fat tripled this hazard (adjusted HR: 3.37, 95% CI 1.34 to 8.43, p=0.009). In contrast, each additional one cup equivalent of vegetable decreased the hazard of relapse by 50% (adjusted HR: 0.50, 95% CI 0.27 to 0.91, p=0.024). These associations remained with mutual adjustment and persisted when adjusting for baseline 25(OH) vitamin D serum level. Other studied nutrients were not associated with relapse.
Conclusions:
This study suggests that in children with MS, high energy intake from fat, especially saturated fat, may increase the hazard to relapse, while vegetable intake may be independently protective.