Research Summary: An adverse lipid profile and increased levels of adiposity significantly predict clinical course after a first demyelinating event

An increasing emphasis is being placed on how lifestyle modifications can be used to manage multiple sclerosis (MS).  It is well known that everyone benefits from having a healthy diet and undertaking regular exercise.  These findings are being supported in people with MS with studies showing that there are positive impacts on both overall health and MS related symptoms.

However, the impacts of an unhealthy diet or lower exercise levels (specifically increased weight and bad fat levels in the blood) are not well known in people with MS.  Body mass index (BMI) is a way of measuring the amount of body fat on an individual.  The BMI values can be used to classify whether a person is in a healthy weight range, overweight or obese.  It has previously been shown that a higher BMI during childhood and adolescence increases the risk of developing MS.

In this study (a collaboration between the Menzies Institute for Medical Research, the Murdoch Childrens Research Institute and The University of Queensland), 190 people were monitored from disease onset to 5 years.  Across this time, their BMI, as well as hip and waist circumference were recorded.  Blood samples were also taken to measure the levels of different types of lipids (fats).  Using this information, they asked the following questions and found the following answers:

Do serum lipid levels, BMI or waist/hip circumference measures predict conversion to MS?

No.  They looked at these different factors and checked to see whether there was any association between them and the transition from the first demyelinating event to multiple sclerosis.  By doing this, they found that no association existed.

Do serum lipid levels, BMI or waist/hip circumference measures associate with relapses?

Yes.  They found that triglyceride levels did correspond to an increased risk of relapses.  Individuals with triglyceride levels that would rank them as a high-risk for cardiovascular disease had double the risk of relapses.  Similarly, an increased BMI (as well as hip circumference) was also associated with a higher number of relapses.  In fact, the higher the BMI, the greater the number of relapses.

Do serum lipid levels, BMI or waist/hip circumference measures associate with progression?

Yes. It was found that BMI (as well as waist/hip circumference) at onset was associated with disease progression.  People who were obese or overweight at the beginning of the study had a 60% greater risk of having a 0.5 increase in EDSS after 5 years.  This was also reflected in the levels of certain fats.  Non-High Density Lipoprotein (Non-HDL) levels and the total cholesterol to HDL ratio were both found to associate with a greater 5 year change in EDSS.

So what does this mean?

While many studies have shown that making positive changes to lifestyle can lead to benefits, I think this research indicates that a higher BMI (e.g. being overweight/obese) and adverse fat levels can actually result in multiple sclerosis progression.  In this way, it provides further support to the use of diet and exercise as part of a multiple sclerosis management plan.

In my opinion, it would now be interesting to see what happens to disease progression in people with MS who may have been overweight at disease onset, but then initiated these lifestyle changes.  As an example, for the people who showed an increased relapse rate or EDSS at 5 years, what would happen to them now if they could reduce their BMI and levels of bad fats in their blood?  Hopefully this is the next stage of the research, as it would provide really strong evidence to highlight the benefits of such an approach.

As well as this, I think the researchers will now try and establish why these factors have these effects.  Currently, it is still unknown, however, the authors did suggest that it could be directly through fat metabolism pathways, side-effects of reduced exercise levels/activity or potentially through interaction with Vitamin D.  We will keep you updated on any further progress in this area, as we know that it’s of huge interest to many people in the MS community.

The abstract for this study can be read in full here, while a second summary of the same study can be read on the MS Research Australia website here.

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