Fiorella Sandrine, Agherbi Hanane, El Houjeiry Emilia, Castelnovo Giovanni, Renard Dimitri, Privat Pauline, Santamaria Elodie, Vallayer Virginie, Alonso Sandrine, Chevallier Thierry, Bancal Candice, Laurent-Chabalier Sabine, Thouvenot Eric
Department of Neurology, CHU Nîmes, University of Montpellier, Montpellier, France.
Unité Transversale de Nutrition Clinique, CHU Nîmes, University of Montpellier, Montpellier, France.
Front Nutr. 2023 Jan 17;9:919336. doi: 10.3389/fnut.2022.919336. eCollection 2022.
Multiple sclerosis (MS) is associated with osteoporosis, possibly due to neurological disability and decreased calcium intake. The objective of this study was to evaluate the efficacy of a personalized nutritional advice program by a dietitian compared to the delivery of a standard advice form to optimize dietary calcium intake in outpatients with MS.
We performed a randomized, controlled, parallel trial comparing the efficacy of a personalized dietary advice (PDA) program to standard advice form (SAF) to increase daily calcium intake in MS patients. The study population was composed by patients with relapsing-remitting MS aged 18-69 years old. PDA program consisted in dietary advice delivered by a dietitian at baseline, 1 month, and 3 months. Calcium and nutrient intake in patients from both groups was evaluated at baseline and 6 months using a dietary survey.
Of the 194 patients screened for inclusion, 182 patients were included (79% female, median age of 42 years, and median EDSS of 2.0), and randomized to SAF ( = 92) or PDA ( = 90). At 6 months, median calcium intake increased by 241 mg/day in the PDA group and decreased by 120 mg/day in the SAF group ( < 0.0001). However, the median calcium intake was 947 mg/day in the SAF group and 778 mg/day in the PDA group at baseline ( = 0.0077), potentially favoring the effect of dietary advice. Complementary analyses focusing on patients with insufficient calcium intakes at baseline revealed comparable values in both groups ( = 0.69). Of those, patients included in the PDA group obtained significantly higher calcium intakes at 6 months than patients from the SAF group ( = 0.0086) independently of EDSS, PASAT, HADS and EQ-5D scores.
This work shows the efficacy of dietary management based on personalized advice program over 3 months to durably increase calcium consumption in MS patients with insufficient calcium intake.
clinicaltrials.gov, identifier NCT02664623.
多发性硬化症（MS）与骨质疏松症相关，可能是由于神经功能障碍和钙摄入量减少所致。本研究的目的是评估营养师提供的个性化营养建议方案与提供标准建议表格相比，在优化MS门诊患者膳食钙摄入量方面的效果。
我们进行了一项随机对照平行试验，比较个性化膳食建议（PDA）方案与标准建议表格（SAF）在增加MS患者每日钙摄入量方面的效果。研究人群由年龄在18 - 69岁的复发缓解型MS患者组成。PDA方案包括营养师在基线、1个月和3个月时提供的膳食建议。使用膳食调查在基线和6个月时评估两组患者的钙和营养素摄入量。
在筛选纳入的194例患者中，182例患者被纳入（79%为女性，中位年龄42岁，中位扩展残疾状态量表[EDSS]评分为2.0），并随机分为SAF组（n = 92）或PDA组（n = 90）。在6个月时，PDA组的钙摄入量中位数每天增加241毫克，SAF组减少120毫克（P < 0.0001）。然而，基线时SAF组的钙摄入量中位数为每天947毫克，PDA组为778毫克（P = 0.0077），这可能有利于膳食建议发挥作用。针对基线时钙摄入量不足的患者进行的补充分析显示，两组数值相当（P = 0.69）。其中，PDA组的患者在6个月时的钙摄入量显著高于SAF组的患者（P = 0.0086），且不受EDSS、PASAT、医院焦虑抑郁量表（HADS）和EQ - 5D评分的影响。
这项研究表明，基于个性化建议方案的膳食管理在3个月内对钙摄入量不足的MS患者持久增加钙消耗量具有效果。
clinicaltrials.gov，标识符NCT02664623。
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