Tredinnick Abbey R, Probst Yasmine C
School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.
Adv Nutr. 2020 Nov 16;11(6):1603-1615. doi: 10.1093/advances/nmaa063.
Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. The role of diet in the progression of MS and severity of symptoms remains unclear. Various systematic literature reviews (SRs) have reported the effects of single nutrients on MS progression or the role of dietary factors on specific symptoms of MS. Narrative reviews have examined the effects of various dietary patterns in MS populations. An umbrella review was undertaken to collate the findings from review articles and evaluate the strength of the scientific evidence of dietary interventions for people living with MS. Scientific databases including MEDLINE, PubMed, CINAHL, and The Cochrane Library were systematically searched up to April 2019. Review articles and meta-analyses were included if they examined the effect of any dietary intervention in adult populations with MS. Outcomes included MS progression indicated by relapses, disability, MRI activity and disease classification, and MS symptoms. Characteristics and findings from both review articles and their included primary studies were extracted and summarized. A total of 19 SRs and 43 narrative reviews were included. Vitamin D and PUFAs were the most commonly studied interventions. Across SR studies, vitamin D supplementation had no significant effect on relapses, MRI, or disability progression; however, an inverse association was found between vitamin D status and disability scores through observational studies. Effects of PUFA supplementation on major outcomes of MS progression were inconsistent across review articles. Other interventions less commonly studied included vitamin, mineral, and herbal supplementation and varying dietary patterns. Strong consistent evidence is lacking for dietary interventions in persons with MS. The body of evidence is primarily focused around the isolation of individual nutrients, many of which demonstrate no effect on major outcomes of MS progression. Stronger food-focused studies are required to strengthen the evidence.
多发性硬化症（MS）是一种中枢神经系统的慢性炎症性自身免疫疾病。饮食在MS进展和症状严重程度方面的作用仍不明确。各种系统文献综述（SRs）报告了单一营养素对MS进展的影响或饮食因素对MS特定症状的作用。叙述性综述研究了各种饮食模式对MS人群的影响。进行了一项伞状综述，以整理综述文章的研究结果，并评估针对MS患者饮食干预的科学证据强度。截至2019年4月，系统检索了包括MEDLINE、PubMed、CINAHL和考克兰图书馆在内的科学数据库。如果综述文章和荟萃分析研究了任何饮食干预对成年MS人群的影响，则将其纳入。结果包括以复发、残疾、MRI活动和疾病分类表示的MS进展以及MS症状。提取并总结了综述文章及其纳入的原始研究的特征和研究结果。共纳入19篇系统综述和43篇叙述性综述。维生素D和多不饱和脂肪酸（PUFAs）是研究最普遍的干预措施。在系统综述研究中，补充维生素D对复发、MRI或残疾进展没有显著影响；然而，通过观察性研究发现维生素D状态与残疾评分之间存在负相关。不同综述文章中，补充PUFAs对MS进展主要结果的影响并不一致。其他较少研究的干预措施包括维生素、矿物质和草药补充以及不同的饮食模式。对于MS患者的饮食干预，缺乏强有力的一致证据。证据主要集中在个别营养素的分离上，其中许多对MS进展主要结果没有影响。需要开展更有力的以食物为重点的研究来加强证据。
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