Nutrition and multiple sclerosis severity: how diet and lifestyle choices shape disease course

In recent decades there is an interest in the effect of diet and lifestyle on Multiple Sclerosis (MS) symptoms and disease activity. Modulation of inflammation through modifiable factors, such as diet and lifestyle habits potentially related to the incidence of MS and its complications. Objective — to explore the association of nutrition and lifestyle with the MS course and investigate dietary habits and meeting recommended dietary intake in patients with MS in Ukraine. Materials and methods. A total of 28 patients diagnosed with MS, aged 18 years and older receiving inpatient and outpatient care in Kyiv City Clinical Hospital # 4, participated in this single­center cross­sectional study. Data were collected from validated and adapted EPIC­Norfolk Food Frequency Questionnaire (FFQ) obtained from participants, medical records and neurological exam during November 2024 — January 2025. Nutrient data analysis was performed via the FETA software (developed by the MRC Epidemiology Unit, University of Cambridge). As a reference for recommended dietary intake, data from the Dietary Guidelines for Americans, 2020—2025, were used. The one­sample t­test, t­test, Wilcoxon signed­rank test for one sample were used to assess the differences between the sample and the reference data. Mann—Whitney tests were used for assessing differences between nutrient item and disability and severity score among MS patients. The chi­squared test was used to analyse categorical data. Results and discussion. The study encompassed a cohort of 28 patients with MS, consisting of 18 (64.3 %) women and 10 (35.7 %) men, median age — 34 (IQR 31.4—36.6). ). This study demonstrates that the total energy value of the diet in the study group was lower from the recommended values based on age and level of physical activity (p < 0.001). The study showed that protein ((91.07 ± 51.56) g/day) intake among participants was significantly higher than the recommended, p < 0.0001. On micronutrient level, we also found that patients had significantly reduced dietary intake of vitamin D compared to recommended values p < 0.0001. Sodium intake among all participants ((2747.13 ± 1272.51) mg/day) was significantly higher than the recommended 2300 mg/day. Furthermore, a trend was observed suggesting that sweet consumption may influence disease severity (moderate effect size, r = – 0.32, 95% CI [– 0.65, 0.11]), and that smoking may be moderately associated with disability (effect size r = – 0.30, 95 % CI [– 0.63, 0.12]). However, neither trend reached statistical significance (p = 0.14 and p = 0.12), indicating the need for further research in larger cohorts to confirm these preliminary findings. Conclusions. The study results indicate that the total dietary energy intake among MS patients was lower than the values recommended for their age and physical activity. We found that protein and sodium intakes in MS patients are significantly higher than recommended value and the consumption of vitamin D through food is below recommended standard.