The MS community has a high interest in whether diet can act as a disease-modifier. Mediterranean diet score is associated with structural brain metrics and clinical outcomes in cognitive aging, suggesting potential neuroprotection. We have previously noted a relationship between a similar score (MIND, Mediterranean-DASH Intervention for Neurodegenerative Delay) and thalamic volume in early MS. Here we evaluated the relationship between Mediterranean diet score and MS-related disability in a representative clinical MS cohort.

To evaluate relationships between Mediterranean diet score and disability in multiple sclerosis (MS)

Persons with MS (n=500; 70% women; aged 43.8±11.6 years) completed the Mediterranean Diet Adherence Screener (MEDAS) and the Multiple Sclerosis Functional Composite (MSFC) evaluation of cognition, upper extremity coordination, and gait speed. We measured third ventricle width (TVW) on axial T1 images from clinical MRIs as a validated estimate of cerebral atrophy. Multiple regressions investigated the independent contribution of MEDAS to MSFC and TVW controlling for age, sex, race, ethnicity, socioeconomic status, BMI, physical exercise, sleep disturbance, and a cardiovascular risk (CVR) index (hypertension, diabetes, hyperlipidemia, cardiac conditions, smoking).

After controlling for important potential confounders, a significant association remains between Mediterranean diet score and MS-related disability. The strength of the relationship in progressive disease and partial mediation by third ventricle width suggests the possibility of a neuroprotective mechanism. Longitudinal studies and interventional clinical trials are needed.