Fatigue, depressive symptoms, and Mediterranean diet adherence among Greek adults with multiple sclerosis

Fatigue and depressive symptoms are common among individuals with multiple sclerosis (MS) and impose a substantial burden on daily functioning and overall well-being. Lifestyle factors, including dietary patterns, may contribute to symptom burden, although evidence remains inconsistent. This cross-sectional study aimed to examine fatigue and depressive symptoms in adults with MS and explore their associations with adherence to the Mediterranean diet and individual dietary components. Mediterranean diet adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS). Fatigue severity was measured with the Fatigue Severity Scale (FSS), and depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D). Associations were examined using non-parametric tests, Spearman correlation, and multivariable linear regression. A total of 112 adults with MS (mean age 45.26 ± 9.9 years) were included. Clinically significant fatigue (FSS ≥ 4) was present in 92.0%, while 89.9% were at high risk for depressive symptoms (CES-D ≥ 16). Low adherence to the Mediterranean diet was observed in 51.8% of participants. Fatigue severity differed according to Mediterranean diet adherence, with lower adherence associated with greater fatigue severity (p = 0.035). Depressive symptoms were not associated with dietary adherence but were strongly correlated with fatigue severity (ρ = 0.600, p < 0.001) and remained independently associated with fatigue severity in multivariable analysis, while female sex was associated with lower fatigue severity. Additional associations were observed between specific dietary components, including red meat, fruit juice, and olive oil, and symptom severity. The study revealed a high burden of depressive symptoms and fatigue among individuals with MS, alongside generally suboptimal adherence to the Mediterranean diet. Lower adherence was associated with higher fatigue severity. Fatigue and depressive symptoms were strongly interrelated. These findings underscore the importance of addressing both overall well-being and diet in the comprehensive management of individuals with MS.