Esposito S, Sparaco M, Maniscalco G T, Signoriello E, Lanzillo R, Russo C, Carmisciano L, Cepparulo S, Lavorgna L, Gallo A, Trojsi F, Brescia Morra V, Lus G, Tedeschi G, Saccà F, Signori A, Bonavita S
First Division of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy.
Multiple Sclerosis Center, Second Division of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy.
Mult Scler Relat Disord. 2021 Jan;47:102636. doi: 10.1016/j.msard.2020.102636. Epub 2020 Nov 22.
BACKGROUND/OBJECTIVES: Several studies supported the beneficial effects of the Mediterranean diet (MeDi) on chronic diseases. In Multiple Sclerosis (MS), the MeDi might interfere with systemic inflammatory state, gut microbiota, and comorbidities. The Med Diet Score (MDS) estimates the adherence to the MeDi and the cardiovascular (CV) risk. Aims of our study were i) to photograph lifestyle and diet habits of a southern Italy cohort of people with MS (pwMS), and ii) to investigate the impact of the MeDi on MS clinical outcomes.
SUBJECTS/METHODS: We conducted a multi-center, cross-sectional study, enrolling 435 consecutive consenting pwMS, attending the outpatient clinics for routine follow-up visits. Participants underwent a clinical examination and a 29-item self-administered questionnaire on life and dietary habits. Disease phenotype, Expanded Disability Status Scale (EDSS), MS Severity Score (MSSS), waist circumference (WC), Body Mass Index (BMI), therapies, and comorbidities, were updated. MDS was assessed and correlated with current and retrospective clinical data.
75.8% of respondents were interested in nutrition, 72.8% were non-smokers, 52.9% performed physical activity, and 45.6% used food supplements. MDS was higher in pwMS with normal WC (p = 0.031), and inversely correlated with MSSS (p = 0.013) and EDSS (p = 0.012) at survey time. MDS did not correlate with the total number of relapses (before and after diagnosis) (p = 0.372). Metabolic comorbidities were associated with an increased 10-year CV risk (r = 0.85, p = 0.002).
Our findings suggest a putative beneficial effect of the MeDi on WC, MS course and disability. Given the role of chronic systemic inflammation in maintenance of autoimmunity and secondary neurodegeneration, both involved in long-term disability, we may suppose a beneficial effect of the MeDi on MS long-term disability outcomes, probably mediated by a modulation of the gut microbiota and the low-grade chronic systemic inflammation.
背景/目的：多项研究证实地中海饮食（MeDi）对慢性疾病具有有益作用。在多发性硬化症（MS）中，地中海饮食可能会影响全身炎症状态、肠道微生物群及合并症。地中海饮食评分（MDS）用于评估对地中海饮食的依从性以及心血管（CV）风险。我们研究的目的是：i）拍摄意大利南部多发性硬化症患者（pwMS）队列的生活方式和饮食习惯；ii）研究地中海饮食对MS临床结局的影响。
受试者/方法：我们开展了一项多中心横断面研究，连续纳入435名同意参与的pwMS患者，他们前往门诊进行常规随访。参与者接受了临床检查以及一份关于生活和饮食习惯的29项自填式问卷。更新了疾病表型、扩展残疾状态量表（EDSS）、MS严重程度评分（MSSS）、腰围（WC）、体重指数（BMI）、治疗方法及合并症。评估了MDS，并将其与当前及回顾性临床数据进行关联分析。
75.8%的受访者对营养感兴趣，72.8%为非吸烟者，52.9%进行体育锻炼，45.6%使用膳食补充剂。WC正常的pwMS患者的MDS更高（p = 0.031），且在调查时与MSSS（p = 0.013）和EDSS（p = 0.012）呈负相关。MDS与（诊断前后的）复发总数无关（p = 0.372）。代谢合并症与10年心血管风险增加相关（r = 0.85，p = 0.002）。
我们的研究结果表明地中海饮食对WC、MS病程及残疾可能具有有益作用。鉴于慢性全身炎症在自身免疫维持及继发性神经变性中所起的作用，二者均与长期残疾有关，我们推测地中海饮食对MS长期残疾结局可能具有有益作用，这可能是通过调节肠道微生物群及低度慢性全身炎症介导的。
