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Obesity Affects Disease Activity and Progression, Cognitive Functioning, and Quality of Life in People With Multiple
Jing Wu1, Lars Alfredsson1, Tomas Olsson1
1From the Aging Research Center (J.W.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University; Institute of Environmental Medicine (L.A.), Karolinska Institutet; Centre for Occupational and Environmental Medicine (L.A.), Region Stockholm; and Department of Clinical Neuroscience (L.A., T.O., J.A.H., A.K.H.), Karolinska Institutet, Stockholm, Sweden.
Background And Objectives:
While obesity is a known risk factor of the development of multiple sclerosis (MS), its impact on MS disease progression remains unclear. We aimed to investigate the influence of body mass index (BMI) on disease activity and progression, cognitive performance, and health-related quality of life in patients with MS.
Methods:
Patients from an incident population-based case-control study (n = 3,249) were categorized based on BMI status at diagnosis and followed up after diagnosis through the Swedish MS registry. Outcomes included changes in the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale 29, and Symbol Digit Modalities Test. The mean follow-up time was 10.6 years (SD 6.1). Linear mixed models were used to analyze long-term changes while Cox regression models assessed the risk of 24-week confirmed disability worsening, time to reach EDSS score 3 and EDSS score 4, the appearance of new lesions on MRI, patient-reported physical and psychological worsening, and processing speed worsening.
Results:
Obesity, compared with healthy weight, was associated with a 0.02-point faster annual increase in the EDSS score (β for EDSS score x time 0.02, 95% CI 0.00-0.04). In addition, obesity was linked to a higher risk of reaching EDSS score 3 (HR 1.43, 95% CI 1.17-1.75) and EDSS score 4 (HR 1.40, 95% CI 1.07-1.73) and an increased risk of physical and psychological worsening. New lesions on MRI were more frequent among those with overweight and obesity, compared with those with healthy weight (HR 1.21, 95% CI 1.02-1.44 and HR 1.29, 95% CI 1.03-1.62, respectively). Among those who had not changed BMI group during follow-up, the associations between obesity and unfavorable outcomes became more pronounced, and the HR of cognitive disability worsening was 1.51 (95% CI 1.09-2.09) among those with obesity, compared with nonobese participants.
Discussion:
In participants with MS, obesity was associated with faster disease progression, poorer health-related quality of life, and more rapid cognitive decline. Both overweight and obesity were associated with higher MRI activity.
Insights
Obesity is linked to faster multiple sclerosis (MS) progression, worsening quality of life, and cognitive decline. Overweight and obesity also increase MRI activity in MS patients.
Area of Science:
- Neurology
- Immunology
- Epidemiology
Background:
- Obesity is a known risk factor for multiple sclerosis (MS) development.
- The impact of body mass index (BMI) on MS disease progression is not fully understood.
Purpose of the Study:
- To investigate how BMI influences MS disease activity and progression.
- To assess the effect of BMI on cognitive performance and health-related quality of life in MS patients.
Main Methods:
- A population-based case-control study of 3,249 MS patients categorized by BMI at diagnosis.
- Follow-up through the Swedish MS registry for over 10 years.
- Analysis of Expanded Disability Status Scale (EDSS), MS Impact Scale 29, Symbol Digit Modalities Test, and MRI data using linear mixed and Cox regression models.
Main Results:
- Obesity correlated with a faster annual increase in EDSS scores and a higher risk of reaching EDSS 3 and 4.
- Overweight and obesity were associated with increased MRI lesion activity and higher risks of physical and psychological worsening.
- Obesity was linked to a 1.51-fold increased risk of cognitive disability worsening.
Conclusions:
- Obesity is associated with accelerated MS disease progression.
- Higher BMI negatively impacts health-related quality of life and cognitive function in MS.
- Overweight and obesity contribute to increased disease activity, evidenced by MRI findings.
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