The Association of Dietary Acid Load with Fatigue, Quality of Life, and Nutrient Adequacy Ratio in Multiple Sclerosis Patients

Background: Multiple sclerosis (MS) is associated with many healthrelated problems and changes in diet were shown to help the patients reduce some symptoms. This cross sectional study investigated the relationship between dietary acid load with fatigue, quality of life, and nutrient adequacy ratio in MS patients.Methods: Totally, 283 MS patients were enrolled in Shiraz, Iran between June 2018 and February 2019. Dietary acid load indices including potential renal acid load (PRAL) and net endogenous acid production (NEAP) were determined for the patients. The level of fatigue and quality of life of the individuals were evaluated by the modified fatigue impact scale (MFIS) and the multiple sclerosis quality of life-54 questionnaires (MSQoL-54), respectively. Nutrient intake was determined to calculate the mean adequacy ratio (MAR) using a food frequency questionnaire (FFQ).Results: The mean score of MAR, NEAP, and PRAL was 0.9±0.18, 87.71±44.86, and 36.27±33.81, respectively. After adjusting for confounders, a significant, negative and very weak association was observed between physical health composite (PHC) of the quality of life and NEAP (p=0.003) and PRAL (p=0.007). Also, a significant, negative, and very weak correlation was found between MAR and NEAP (p=0.006) and PRAL (p=0.028) in a crude model. Furthermore, after adjusting for confounders, the association between MAR and NEAP remained significant (p=0.003).Conclusion: Our findings revealed that there might be an association between dietary acid load indices, physical dimension of MSQoL-54 and MAR.