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Marrie RA, Patel R, Schaffer SA. Subclinical atherosclerosis in multiple sclerosis. Mult Scler J Exp Transl Clin 2024; 10:20552173241238627. [PMID: 38585500 PMCID: PMC10998495 DOI: 10.1177/20552173241238627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/22/2024] [Indexed: 04/09/2024] Open
Abstract
Background People with multiple sclerosis (MS) have an increased risk of ischemic heart disease as compared to people without MS after accounting for traditional vascular risk factors. Objective We assessed whether subclinical atherosclerosis, an inflammatory disease of arteries, occurs in persons with MS who do not have traditional vascular risk factors, and whether the Framingham Score (FRS) predicted carotid intima media thickness (CIMT) similarly in people with and without MS. Methods We recruited participants with and without MS who did not have vascular disease. Participants completed questionnaires, physical assessments, underwent an ultrasound (CIMT), and provided samples for HbA1c and lipid measurements. We defined subclinical atherosclerosis as an average CIMT ≥75th percentile, and tested the association between MS/not-MS, FRS, and atherosclerosis using logistic regression. Results We recruited 106 participants with MS 101 without MS. The average (SD) CIMT did not differ between the MS (0.60 [0.11]) and non-MS (0.61 [0.12]) cohorts (p = 0.69), nor did the proportion with atherosclerosis (MS: 11.3% vs. non-MS 13.4%, p = 0.58). On regression analysis a 1-point increase in the FRS was associated with 11% increased odds of having atherosclerosis (95%CI: 1.04, 1.19) but MS was not. Conclusion MS was not associated with subclinical atherosclerosis.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ronak Patel
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Stephen Allan Schaffer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Atabilen B, Akdevelioğlu Y, Acar Özen P, Tuncer A. Examining dietary habits in the context of multiple sclerosis: A comprehensive investigative approach. Mult Scler Relat Disord 2024; 83:105467. [PMID: 38301324 DOI: 10.1016/j.msard.2024.105467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
AIMS The aim of this study is to evaluate the nutritional status of patients with multiple sclerosis (MS) and to develop suggestions for changing eating habits in a healthy direction. METHODS The study was conducted on 171 participants (80.1 % female; 19.9 % male) diagnosed with MS between the ages of 18-60 who applied to Ankara Hacettepe University Hospital Neurology Outpatient Clinic between June 2021 and March 2023. Body weight, height, body composition, waist circumference, upper mid-arm circumference and hand grip strength were measured in accordance with the technique of anthropometric measurements. A three-day food consumption record was taken to evaluate the energy, macro, and micronutrient content of the diet. Mediterranean Diet Assessment Tool was used to assess adherence to diet. RESULTS Mean age of the participants was recorded as 35.2 ± 10.81 years. According to the body mass index (BMI) classification, 59.9 % of females were in normal limits, while 61.8 % of males were classified as overweight and obese. However, when evaluated in terms of body composition, body fat percentage was found to be above of normal limits in both genders. Also, 70.8 % of participants were sedentary. The percentage of patients who met their daily energy requirements in women with light and moderate activity was higher than in men, but it was not statistically significant. In participants with high activity level, the percentage of patients meeting energy requirements was below 50 % for both genders. Dietary fat and saturated fat intake were higher than the recommendations, while monounsaturated fatty acids and dietary fiber intake were less. The percentages of patients meeting their calcium requirement was below 50 % in both genders. Mean intake amounts of vegetables, fruits, legumes, nuts, and dairy products were below the Türkiye Nutrition Guideline recommendations. CONCLUSION This study shows the nutritional characteristic of patients with MS in detail with different aspects. Although most of the patients were in normal limits in terms of BMI, body fat percentages were found to be above normal limits in both genders. Total fat and saturated fat intakes were found to be high according to scientific recommendations while the intake of food groups required for a fibre-based diet and intake of dairy products were low.
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Affiliation(s)
- Büşra Atabilen
- Karamanoğlu Mehmetbey University Faculty of Health Sciences Department of Nutrition and Dietetics, Karaman, Türkiye.
| | - Yasemin Akdevelioğlu
- Gazi University Faculty of Health Sciences Department of Nutrition and Dietetics, Ankara, Türkiye
| | - Pınar Acar Özen
- Hacettepe University Faculty of Medicine Department of Neurology, Ankara, Türkiye
| | - Aslı Tuncer
- Hacettepe University Faculty of Medicine Department of Neurology, Ankara, Türkiye
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Rinaldo N, Pasini A, Straudi S, Piva G, Crepaldi A, Baroni A, Caruso L, Manfredini F, Lamberti N. Effects of Exercise, Rehabilitation, and Nutritional Approaches on Body Composition and Bone Density in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis. J Funct Morphol Kinesiol 2023; 8:132. [PMID: 37754965 PMCID: PMC10532597 DOI: 10.3390/jfmk8030132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
People with multiple sclerosis (pwMS) are affected by a wide range of disabilities, including a decrease in bone mineral density (BMD) and a worsening of body composition (BC), which negatively impact their quality of life quality. This study aims to analyze the effects of nonpharmacological interventions-in particular, physical activity, nutritional approaches, and rehabilitation-on BC and BMD in pwMS. This systematic review and meta-analysis was performed following the updated version of the PRISMA guidelines. In July 2022, five databases (MEDLINE, Embase, The Cochrane Library, Google Scholar, Web of Science) and gray literature were screened. Relevant articles published between 1 January 1990 and 1 September 2022 in any language were included. Outcomes of interest were anthropometric, BC measures, and BMD. The RoB 2.0 tool was used to assess the risk of bias. After duplicates elimination, 1120 records were screened, and 36 studies were included. A total of 25 articles were focused on physical activity and rehabilitation, 10 on nutrition, and 1 on multimodal intervention. One-third of the studies were judged to be at high risk of bias. The meta-analysis showed a high degree of heterogeneity due to the high variability in disease severity and intervention duration, intensity, frequency, and type. In general, no intervention showed consistent positive effects on BC. However, the most promising interventions seemed to be high-intensity training and ketogenic diets. Only a few studies considered BMD, and the results are inconsistent. Nevertheless, more studies are needed in order to confirm these results.
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Affiliation(s)
- Natascia Rinaldo
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
| | - Alba Pasini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
| | - Giovanni Piva
- Doctoral Program in Environmental Sustainability and Wellbeing, Department of Humanities, University of Ferrara, 44121 Ferrara, Italy;
| | - Anna Crepaldi
- Unit of Nephrology, University Hospital of Ferrara, 44124 Ferrara, Italy;
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Andrea Baroni
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
| | - Lorenzo Caruso
- Department of Environment and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44124 Ferrara, Italy; (N.R.); (A.P.); (S.S.); (A.B.); (F.M.)
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Jeng B, Huynh TLT, Feasel CD, Motl RW. Oxygen cost of walking and its relationship with body composition in multiple sclerosis. Int J Obes (Lond) 2023; 47:138-143. [PMID: 36517575 DOI: 10.1038/s41366-022-01244-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES This cross-sectional study examined the relationship between the oxygen (O2) cost of walking and body composition metrics, while considering potential covariates such as disability status, step length, and cadence, in persons with multiple sclerosis (MS). SUBJECTS/METHODS The sample included 63 persons with MS across a wide distribution of body mass index (BMI). O2 cost of walking was assessed using portable, indirect calorimetry, and percent body fat (%Fat), fat-free mass (FFM), bone mineral content, bone mineral density (BMD), and weight/FFM were determined from dual-energy x-ray absorptiometry. Other outcome measures included step length, cadence, physical activity, and disability status. RESULTS The O2 cost of walking had small-to-moderate associations with BMI (rs = -31, p = 0.015), %Fat (rs = -0.26, p = 0.041), and BMD (rs = -0.31, p = 0.013). O2 cost of walking was significantly associated with these outcomes even after controlling for age, sex, disability status, and gait outcomes. The O2 cost of walking was further significantly associated with shorter step length (rs = -0.40, p = 0.001), slower cadence (rs = -0.38, p = 0.002), and higher disability status (rs = 0.44, p < 0.001), but not physical activity. Body composition metrics were not associated with gait parameters, physical activity or disability status in our sample of persons with mild-to-moderate MS. CONCLUSIONS The results indicated that higher O2 cost of walking was associated with lower fat and worse bone health after taking factors such as disability status into consideration. Researchers may focus on interventions that change body composition, or perhaps gait profiles, as possible approaches for changing O2 cost of walking and its consequences such as disability status in persons with MS.
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Affiliation(s)
- Brenda Jeng
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA.
| | - Trinh L T Huynh
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Corey D Feasel
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
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Body Composition in Multiple Sclerosis Patients and Its Relationship to the Disability Level, Disease Duration and Glucocorticoid Therapy. Nutrients 2022; 14:nu14204249. [PMID: 36296931 PMCID: PMC9610927 DOI: 10.3390/nu14204249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Patients with multiple sclerosis (MS) have many potential factors (spasticity, immobilization, glucocorticoids use) for the deterioration of body composition. Aim: To assess the nutritional status (by classical anthropometry and by bioelectrical impedance analysis (BIA)) in MS patients and to correlate it with clinical state, MS duration time and the presence of glucocorticoid therapy in anamnesis (ever used). Methods: Anthropometrical (BMI and waist and hip circumferences, waist-to-height ratio (W/HtR), and waist-to-hip ratio (WHR)) and body composition (BIA) data were evaluated in 176 patients with MS. Fat mass (FM), and fat-free mass (FFM) were expressed as kilograms (kg), percentage (%) and indexes (FMI: fat mass index, FFMI: fat-free mass index) expressed in kg/m2. The median Expanded Disability Status Scale score was 4.5. Patients were then divided according to EDSS score as mild (EDSS 1.0−4.0) or moderate (EDSS 4.5−6.5) disability subgroup. Results: Waist c., WHtR, WHR, and FM% were significantly higher in the moderate MS group (p < 0.01; p < 0.001; p < 0.001; and p < 0.05, respectively). Whilst, FFM% was significantly lower (p < 0.05). BMI did not correlate significantly with any disability status score and MS time. Significant correlations were observed between EDSS, ΔEDSS and MS time and Waist c., WHtR, WHR, FM% and FFM%. WHtR had the strongest significance (p < 0.0001 vs. EDSS; p < 0.0001 vs. ΔEDSS; and p < 0.01 vs. MS time, respectively). After the adjustment to the MS time, only FM% was no longer significantly related to both EDSS and ΔEDSS. MS duration time, EDSS, ΔEDSS, WHtR, FM(kg), FM%, and FMI were significantly higher in the patients with a positive history of glucocorticoid therapy (all p < 0.05). Whilst, FFM% was significantly lower in MS patients treated with glucocorticoids (p < 0.01). Conclusions: Greater disability in MS patients is strongly related to lower fat-free mass and higher fat mass, especially with the abdominal distribution, irrespective of the duration time of the disease. Oral glucocorticoid therapy seems to have a negative impact on the body composition of MS patients. However, further prospective multifactorial studies in this field have to be done. For the proper assessment of nutritional status in MS patients, Waist c., WHtR, WHR, or body composition parameters seem to be of greater use than BMI.
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Bertapelli F, Silveira SL, Agiovlasitis S, Motl RW. Development and Cross-Validation of a Simple Model to Estimate Percent Body Fat in Persons with Multiple Sclerosis. Int J MS Care 2021; 23:193-198. [PMID: 34720758 DOI: 10.7224/1537-2073.2020-034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Persons with multiple sclerosis (MS) have higher body composition variability compared with the general population. Monitoring body composition requires accurate methods for estimating percent body fat (%BF). We developed and cross-validated an equation for estimating %BF from body mass index (BMI) and sex in persons with MS. Methods Seventy-seven adults with MS represented the sample for the equation development. A separate sample of 33 adults with MS permitted the equation cross-validation. Dual-energy x-ray absorptiometry (DXA) provided the criterion %BF. Results The model including BMI and sex (mean ± SD age: women, 49.2 ± 8.8 years; men, 48.6 ± 9.8 years) had high predictive ability for estimating %BF (P < .001, R2 = 0.77, standard error of estimate = 4.06%). Age, MS type, Patient-Determined Disease Steps score, and MS duration did not improve the model. The equation was %BF = 3.168 + (0.895 × BMI) - (10.191 × sex); sex, 0 = woman; 1 = man. The equation was cross-validated in the separate sample (age: women, 48.4 ± 9.4 years; men, 43.8 ± 15.4 years) based on high accuracy as indicated by strong association (r = 0.89, P < .001), nonsignificant difference (mean: 0.2%, P > .05), small absolute error (mean: 2.7%), root mean square error (3.5%), and small differences and no bias in Bland-Altman analysis (mean difference: 0.2%, 95% CI: -6.98 to 6.55, rs = -0.07, P = .702) between DXA-determined and equation-estimated %BF. Conclusions Health care providers can use this developed and cross-validated equation for estimating adiposity in persons with MS when DXA is unavailable.
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Affiliation(s)
- Fabio Bertapelli
- School of Medical Sciences, University of Campinas, Campinas, Brazil (FB).,Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA (FB, SLS, RWM)
| | - Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA (FB, SLS, RWM)
| | | | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA (FB, SLS, RWM)
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Albuquerque LDS, Damasceno NRT, Maia FN, Carvalho BMD, Maia CSC, D'Almeida JAC, Melo MLPD. Cardiovascular risk estimated in individuals with multiple sclerosis: A case-control study. Mult Scler Relat Disord 2021; 54:103133. [PMID: 34252839 DOI: 10.1016/j.msard.2021.103133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) had a 1.5-fold increase in cardiovascular diseases (CVD) mortality, compared with those without MS. Therefore, the aim of this study was to assess the CVD risk in MS patients by multiple cardiometabolic indexes and to investigate associated factors. METHODS The MS group included 57 patients matched for age and sex to 57 healthy controls. They were evaluated for physical activity, smoking, anthropometric indices, blood pressure, and plasma biomarkers. Framingham risk score (FRS) and multiple cardiovascular risk indexes were calculated. Clinical course of disease, age at onset, disease duration, disease-modifying therapy, relapse rate, EDSS, physical and functional impairment were investigated. RESULTS The mean age was 34.6 years old. The majority (89.5%) in the MS group had a RRMS clinical course and a mild level of disability (EDSS=1.0). WC (p = 0.022) and FM% (p = 0.007) were different between the MS and control groups. The FRS was higher in the MS group (10% versus 0%) and this was related with high prevalence of dyslipidemia (43.8% versus 36.8%). The atherogenic index of plasma (AIP) (0.013) and Castelli risk indexes I (CRI-I) (p = 0.017) and II (CRI-II) (p = 0.008) and non-HDL-C (p = 0.044) were higher in the MS group. CONCLUSION MS patients, with controlled disease course, have a higher cardiovascular risk than comparable healthy individuals. We emphasize that the use of FRS, and the monitoring of CRI-I and II, as well as AIP, are important lipid markers to manage CVD risk in individuals with MS.
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Affiliation(s)
| | - Nágila Raquel Teixeira Damasceno
- Postgraduate Program in Applied Human Nutrition (PRONUT), Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, Brazil
| | - Fernanda Nunes Maia
- Postgraduate Program in Nutrition and Health, Ceara State University (UECE), Fortaleza, Brazil
| | | | - Carla Soraya Costa Maia
- Postgraduate Program in Nutrition and Health, Ceara State University (UECE), Fortaleza, Brazil
| | - José Artur Costa D'Almeida
- Multiple Sclerosis Interdisciplinary Center, Neurology Department, Fortaleza General Hospital (HGF-SUS), Fortaleza, Brazil
| | - Maria Luísa Pereira de Melo
- Postgraduate Program in Nutrition and Health, Ceara State University (UECE), Fortaleza, Brazil; Postgraduate Program in Applied Human Nutrition (PRONUT), Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, Brazil; Multiple Sclerosis Interdisciplinary Center, Neurology Department, Fortaleza General Hospital (HGF-SUS), Fortaleza, Brazil.
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So WY, Kalron A. The Association between Body Mass Index and Leisure-Time Physical Activity in Adults with Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030920. [PMID: 32024246 PMCID: PMC7037989 DOI: 10.3390/ijerph17030920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 01/01/2023]
Abstract
(1) Purpose: Conflicting information exists regarding the relationship between obesity, leisure-time physical activity (PA), and disability in people with multiple sclerosis (PwMS). We aimed to investigate the association between leisure-time PA and weight status in a relatively large cohort of PwMS. Furthermore, we examined this relationship according to the level of neurological disability. (2) Methods: The study included 238 PwMS (138 women) with a mean Expanded Disability Status Scale (EDSS) score of 2.5 (standard deviation [SD] = 1.7), mean disease duration of 6.4 (SD = 8.2) years, and mean age of 40.5 (SD = 12.9) years. Obesity was defined using two different metrics, each based on body mass index (BMI). Leisure-time PA was determined by the Godin-Shephard leisure-time PA questionnaire. Statistical analyses included multivariate logistic regression, the chi-square test, and Pearson coefficient correlations. (3) Results: The unadjusted odds ratio (OR) between leisure-time PA and BMI based on the World Health Organization's (WHO) definition was 1.070 (p = 0.844) for overweight and 1.648 (p = 0.254) for obesity. The adjusted OR was 1.126 (p = 0.763) for overweight and 1.093 (p = 0.847) for obesity after adjustment for age, gender, and disability status. Chi-square analysis revealed no significant correlation between leisure-time PA and obesity (p = 0.564) according to the BMI threshold for PwMS. The unadjusted OR (95% confidence interval [CI]) between disability level and BMI based on the WHO definition was 1.674 (p = 0.220) for overweight and 0.618 (p = 0.460) for obesity. The adjusted OR was 1.130 (p = 0.787) for overweight and 0.447 (p = 0.234) for obesity after adjustment for age, gender, and leisure-time PA. Similarly, chi-square analysis revealed no significant correlation between disability level and obesity (p = 0.701) per the BMI threshold for PwMS. (4) Conclusions: No association was found between leisure-time PA and BMI in PwMS. An additional finding was the absence of any association between obesity and neurological disability level in the multiple sclerosis cohort.
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Affiliation(s)
- Wi-Young So
- Sports and Health Care Major, College of Humanities and Arts, Korea National University of Transportation, Chungju-si 27469, Korea;
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-9-9512726
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Functional Mobility and Basic Motor Skills in Patients with Multiple Sclerosis and Its Relation to the Anthropometrical Status and Body Composition Parameters. ACTA ACUST UNITED AC 2019; 55:medicina55120773. [PMID: 31817216 PMCID: PMC6956185 DOI: 10.3390/medicina55120773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/1970] [Revised: 11/24/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
Background and objectives: Patients with multiple sclerosis (MS) have many potential risk factors (spasticity, immobilization, glucocorticoids use) which can deteriorate the anthropometrical status and body composition and may have a potential negative impact on functional mobility and basic motor skill improvement after physiotherapy. The aim of the study was to assess the functional mobility and basic motor skills in patients with MS and to correlate them with disability and anthropometrical status and body composition parameters. Materials and Methods: Timed Up-and-Go Test (TUG) and six-min walk test (6MWT) were performed in 36 patients with MS before and after 4 weeks of physiotherapy. Body mass index (BMI), waist-to-height ratio (W/HtR), and waist-to-hip ratio (WHR) were assessed in this group. Body composition was evaluated by bioelectrical impedance analysis (BIA) and fat mass (FAT), fat free mass (FFM), total body water (TBW), and predicted muscle mass (PMM) were expressed as percentage of body mass. Clinical status was assessed by Expanded Disability Status Scale (EDSS) and Ambulatory Index (AI) scales. Results: After physiotherapy, there was a significant improvement in functional mobility and basic motor skills assessed by total distance in 6MWT (p < 0.001) and in TUG trials (p < 0.001). Positive significant correlations were found between the results obtained in both tests (either before and after physiotherapy) vs. FFM, TBW, and PMM, whilst worse results in functional mobility and basic motor skills correlated significantly with higher WHtR, WHR, and FAT (p < 0.05). Clinical status (EDSS) was significantly related to the WHtR and body composition parameters with the same manner as the results in the either 6MWT and TUG. However, there were no significant relationships between BMI vs. either clinical status (EDSS, AI) or functional mobility tests results in patients with MS. Conclusions: Functional mobility and basic motor skills may be significantly improved during physiotherapy, but they are related to the anthropometrical status and body composition of MS patients. Moreover, disability status is also significantly related to these parameters. Body composition deterioration seems to be the important target for the therapeutic intervention in MS patients. For proper nutritional status assessment in patients with MS, body composition analysis or WHtR instead BMI should to be used.
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Chen X, Fan R, Peng F, Liu J, Huang J, Chen Z, Chen Y, Jiang Y. Blood pressure and body fat percent in women with NMOSD. Brain Behav 2019; 9:e01350. [PMID: 31376237 PMCID: PMC6749597 DOI: 10.1002/brb3.1350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/03/2019] [Accepted: 06/08/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hypertension is a prevalent and impactful comorbid condition among patients with multiple sclerosis (MS). High level of body mass index (BMI) is associated with the risk and poor outcomes of neuromyelitis optica spectrum disorder (NMOSD) in women. However, the clinical implication of blood pressure (BP) and body fat percent (BF%) based on the Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) in NMOSD has not been investigated thus far. METHODS Case data were collected from 47 NMOSD and 28 MS patients at acute phase, 21 NMOSD and 25 MS patients at stable phase, and 68 age- and sex-matched HCs. Four BP measures including systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP); BMI; and BF% between NMOSD, MS, and healthy controls were determined. RESULTS Comparing NMOSD patients with MS patients, the former have significantly higher SBP (p < 0.001), DBP (p < 0.001), PP (p < 0.001), MAP (p < 0.001), BF% (p = 0.001), and BMI (p < 0.001) levels at acute phase after adjusting for age. Acute myelitis (OR 3.719, 95% CI 1.110-12.453) is more likely to occur in NMOSD patients with high BF% (≥30%) at acute phase. BF% was negatively correlated with 1/AQP4 titer in NMOSD at acute phase (r = -0.522, p = 0.004). CONCLUSIONS Women with NMOSD are probably more prone to have an increased BP and fat mass compared to MS.
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Affiliation(s)
- Xiaohong Chen
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangdong, China
| | - Rong Fan
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangdong, China
| | - Fuhua Peng
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangdong, China
| | - Jia Liu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangdong, China
| | - Jing Huang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zhigang Chen
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangdong, China
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ying Jiang
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangdong, China
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Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA. Measures of general and abdominal obesity and disability severity in a large population of people with multiple sclerosis. Mult Scler 2019; 26:976-986. [DOI: 10.1177/1352458519845836] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Metabolic comorbidity is overrepresented in people with multiple sclerosis (MS) and is associated with adverse MS outcomes. Excess visceral adiposity, approximated using waist circumference (WC), is a risk factor for metabolic comorbidity and predicts poorer outcomes in other neurologic diseases. Objective: To evaluate the association between WC and clinical and disease characteristics in people with MS. Methods: North American Research Committee on MS (NARCOMS) registry participants reported height and weight (used to calculate body mass index (BMI)) and were mailed a tape measure with instructions to measure WC. We considered WC continuously and used cut-points derived from the abdominal obesity criteria for the metabolic syndrome (men: WC ⩾ 40 in; women: WC ⩾ 35 in). We assessed the association between WC and disability (Patient-Determined Disease Steps) and symptom severity (validated scales) using multivariable-adjusted multinomial models. Results: Of 6367 responders with MS, we included 5832 (92%). Of these, 3181 (55%) reported WC meeting criteria for the abdominal obesity component of metabolic syndrome. In multivariable models adjusting for overall obesity status, WC was associated with 47% increased odds of severe versus mild disability (odds ratio (OR): 1.47; 95% confidence interval (CI): 1.22–1.78). Conclusions: Increased WC is associated with more severe disability, even after adjusting for overall obesity in this large cross-sectional survey.
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Affiliation(s)
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Tuula Tyry
- Dignity Health, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Mokhtarzade M, Agha-Alinejad H, Motl RW, Negaresh R, Baker JS, Zimmer P. Weight control and physical exercise in people with multiple sclerosis: Current knowledge and future perspectives. Complement Ther Med 2019; 43:240-246. [DOI: 10.1016/j.ctim.2019.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/21/2018] [Accepted: 02/07/2019] [Indexed: 01/24/2023] Open
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Pilutti LA, Motl RW. Body composition and disability in people with multiple sclerosis: A dual-energy x-ray absorptiometry study. Mult Scler Relat Disord 2019; 29:41-47. [PMID: 30658263 DOI: 10.1016/j.msard.2019.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Body composition refers to the relative distribution of different tissue types within the body, including fat, lean, and bone tissues. There is evidence for associations between body composition and the development of multiple sclerosis (MS). The relationship between body composition and disease progression and disability accumulation, however, is unclear. OBJECTIVES To examine: a) differences in overall and regional body composition by disability status in persons with multiple sclerosis (MS); and b) the relationship between body composition and other outcomes reflecting impairments and limitations due to MS. METHODS Cross-sectional investigation of 47 ambulatory persons with relapsing remitting MS who were grouped by Expanded Disability Status Scale (EDSS) scores as having mild (1.0-4.0; n = 26) or moderate (4.5-6.5; n = 21) disability. Main outcome measures were whole-body and regional soft tissue composition (%body fat (BF), fat mass (FM), and fat-free soft tissue mass (FFM)), bone mineral content (BMC), and bone mineral density (BMD) determined from dual-energy X-ray absorptiometry (DXA). Other outcomes included physical fitness, mobility, cognitive processing speed, symptoms, and health-related quality of life (HRQOL). RESULTS Whole-body and regional %BF and FM were significantly higher, and whole-body and appendicular BMC and BMD were significantly lower in participants with moderate disability than those with mild disability (all p < .05). There were no significant differences in whole-body or regional FFM by disability status. In the overall sample, body fat correlated significantly with cardiorespiratory fitness (prs = -.52 to -.56), pain symptoms (prs = .32), and psychological HRQOL (prs = .34). FFM (prs = .38-.48) and BMC (prs = .53-.69) correlated primarily with measures of muscular strength. CONCLUSIONS Persons with MS who have greater disability present with higher body fat and lower bone tissue content and density than those with mild disability. These findings highlight the need for strategies that address potential changes in body composition with disability accumulation.
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Affiliation(s)
- Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, 200 Lees Avenue, Ottawa, ON K1N 6N5, Canada.
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, 1705 University Blvd., Birmingham, AL 35233-1212, USA
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14
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Exploring the role of physical activity and exercise for managing vascular comorbidities in people with multiple sclerosis: A scoping review. Mult Scler Relat Disord 2018; 26:19-32. [DOI: 10.1016/j.msard.2018.08.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 01/06/2023]
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15
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Sebastião E, Motl RW. Body mass index and cardiorespiratory fitness in persons with multiple sclerosis. Acta Neurol Scand 2018; 138:315-319. [PMID: 29748963 DOI: 10.1111/ane.12959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study examined body fatness and its association with cardiorespiratory fitness (CRF) in persons with multiple sclerosis (pwMS) accounting for disability status. MATERIALS AND METHODS This study involved a secondary data analysis from a previous study of 62 pwMS. Body fatness was indirect measured as body mass index (BMI), and CRF was measured as peak oxygen consumption from an incremental exercise test with spirometry. Participants were allocated into 3 different groups based on established BMI categories (ie, normal, overweight, and obese), and data were analyzed using SPSS. RESULTS The average BMI was 27.0 (6.7) kg/m2 , and CRF was 19.5 (7.2) mL/kg/min. There was an inverse correlation (pr = -.38 [-.57; -.14]; P = .003) between BMI and CRF controlling for age, sex, disease duration, and disability level. ANCOVA with linear contrast analysis revealed a statistical significant reduction in CRF between groups of different BMI categories; normal weight 20.8 (0.85); overweight 19.8 (1.13); and obese 16.9 (1.73) mL/kg/min; F (2, 55) = 3.33, P = .043; η2 = .11. CONCLUSIONS The findings suggest that BMI has a negative impact on CRF in pwMS, with a marked reduction in CRF for those classified as obese compared to those in the normal and overweight category.
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Affiliation(s)
- E. Sebastião
- Department of Kinesiology and Physical Education; Northern Illinois University; DeKalb IL USA
| | - R. W. Motl
- Department of Physical Therapy; University of Alabama; Birmingham AL USA
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16
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Measures of adiposity differentially correlate with C-reactive protein among persons with multiple sclerosis. Mult Scler Relat Disord 2018; 25:1-4. [PMID: 30014875 DOI: 10.1016/j.msard.2018.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/06/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND While MS is considered, in part, an inflammatory disease, the relationship between measures of adiposity and MS have not been well studied. This is important considering the strength of the association between adiposity and inflammation reported in the general population, and the resultant increased risk for cardiovascular and metabolic disease. Evidence demonstrates MS is associated with higher prevalence rates of cardiovascular disease than the general population, which provides an impetus to examine how measures of adiposity and systemic inflammation are related in individuals with MS. OBJECTIVE To examine the association between measures of adiposity and systemic inflammation, specifically using the global marker C-reactive protein (CRP), among persons with MS compared with a control group without MS. METHODS Persons with MS and a control group (n = 33/group) had measures of adiposity (body mass index, total body fat, and trunk fat) correlated and regressed to CRP. RESULTS Differential relationships between CRP and adiposity measures were observed between the MS group and the control group. Within the MS group, when adjusted for sex, age, and physical activity level, only whole body percent fat explained a significant portion of the variance in CRP (adjusted R2 = 0.095, p < 0.05), whereas all of the adiposity measures explained a significant degree of variance within the control group (p < 0.05), with trunk fat mass having the strongest correlation. CONCLUSIONS The differential relationships observed between the MS and control groups suggests that whole body fat may be a more important factor related to whole body inflammation in MS, rather than other adiposity markers, such as BMI or trunk fat. This differential association should be taken into account in future research examining body fatness/obesity and CRP.
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Wingo BC, Young HJ, Motl RW. Body composition differences between adults with multiple sclerosis and BMI-matched controls without MS. Disabil Health J 2017; 11:243-248. [PMID: 29074384 DOI: 10.1016/j.dhjo.2017.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/08/2017] [Accepted: 10/04/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Persons with multiple sclerosis (MS) have many health conditions related to overweight and obesity, but little is known about how body composition among those with MS compares to those without MS at the same weight. OBJECTIVE To compare differences in whole body and regional body composition between persons with and without MS matched for sex and body mass index (BMI). METHODS Persons with MS (n = 51) and non-MS controls (n = 51) matched for sex and BMI. Total mass, lean mass, fat mass, and percent body fat (%BF) of total body and arm, leg, and trunk segments were assessed using dual-energy X-ray absorptiometry (DXA). RESULTS Men with MS had significantly less whole body lean mass (mean difference: 9933.5 ± 3123.1 g, p < 0.01) and higher fat mass (mean difference: 6079.0 ± 2137.4 g, p = .01) and %BF (mean difference: 9.43 ± 2.04%, p < 0.01) than BMI-matched non-MS counterparts. Further, men with MS had significantly lower lean mass in the arm (p = 0.02) and leg (p < 0.01) and higher fat mass in the arm (p = 0.01), leg (p = 0.03) and trunk (p = 0.03) than men without MS. Men with MS had significantly higher %BF in all three regions (p < 0.01) than men without MS. There were no differences between women with and without MS. CONCLUSIONS We observed significant differences in whole body and regional body composition between BMI-matched men with and without MS. Additional research is needed to further explore differences in body composition, adipose distribution, and the impact of these differences on the health and function of men with MS.
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Affiliation(s)
- Brooks C Wingo
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; UAB/Lakeshore Research Collaborative, Birmingham, AL, USA.
| | - Hui-Ju Young
- UAB/Lakeshore Research Collaborative, Birmingham, AL, USA
| | - Robert W Motl
- UAB/Lakeshore Research Collaborative, Birmingham, AL, USA; Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Elevated cardiovascular risk factors in multiple sclerosis. Mult Scler Relat Disord 2017; 17:220-223. [DOI: 10.1016/j.msard.2017.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/21/2017] [Accepted: 08/16/2017] [Indexed: 11/19/2022]
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Abstract
Multiple sclerosis (MS) is a demyelinating and neurodegenerative disorder of the central nervous system, for which disease modifying therapies (DMTs) are the mainstay treatment approach to reduce inflammatory disease activity and slow worsening disability. In addition to conventional pharmacologic therapy, there is growing interest in the use of lifestyle strategies to support wellness and mitigate disease-related complications in MS. This interest stems from a growing appreciation of the role of certain comorbidities and lifestyle factors on disease activity, disability, mortality, and overall quality of life. While the current literature is not conclusive, there is evidence to suggest a potential role for vitamin D supplementation, tobacco smoking cessation, routine exercise, a plant-based, anti-inflammatory diet, and maintenance of emotional well-being as adjunct therapies to DMTs. In addition to DMTs, lifestyle strategies should be emphasized as part of a management plan focused on overall health and well-being.
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Affiliation(s)
- Brandon P Moss
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Mary R Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Carrie M Hersh
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA
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20
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Relationship of Obesity With Gait and Balance in People With Multiple Sclerosis. Am J Phys Med Rehabil 2017; 96:140-145. [PMID: 27323326 DOI: 10.1097/phm.0000000000000552] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship of obesity with walking and balance in people with multiple sclerosis. DESIGN This was a cross-sectional study performed at the Multiple Sclerosis Center, Sheba Medical Center, Israel. Four hundred thirty-six people with multiple sclerosis were divided into obese (n = 178) and normal-weight (n = 258) groups. Spatiotemporal parameters of gait, 2-Minute Walk test, 6-Minute Walk test, Timed Up and Go test, Timed 25-Foot Walk test, Multiple Sclerosis Walking Scale self-reported questionnaire, and posturography measures were determined. RESULTS Compared with normal-weight patients, obese subjects walked significantly slower [98.7 (SD, 29.2) m/s vs. 106.4 (SD, 29.2) m/s; P = 0.01], with shorter step lengths [54.8 (SD, 11.6) cm vs. 58.1 (SD, 10.7) cm; P = 0.003] and a wider step width [12.1 (SD, 3.7) cm vs. 10.9 (SD, 4.6) cm; P = 0.01]. Furthermore, the obese group walked a shorter distance on the 6-Minute Walk test [378.2 (SD, 145.5) m vs. 426.1 (SD, 129.8) m; P ≤ 0.001] and slower on the Timed 25-Foot Walk test [9.0 (SD, 8.0) seconds vs. 7.2 (SD, 2.4) seconds; P = 0.006] and the Timed Up and Go test [9.2 (SD, 6.3) seconds vs. 10.0 (SD, 6.1) seconds; P = 0.002]. No significant differences between groups were noted in the Multiple Sclerosis Walking Scale self-reported questionnaire and postural control measures. CONCLUSION Obesity affects walking but not postural control in people with multiple sclerosis despite the level of neurological disability.
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Tettey P, Simpson S, Taylor B, Ponsonby AL, Lucas RM, Dwyer T, Kostner K, van der Mei IA. An adverse lipid profile and increased levels of adiposity significantly predict clinical course after a first demyelinating event. J Neurol Neurosurg Psychiatry 2017; 88:395-401. [PMID: 28320766 DOI: 10.1136/jnnp-2016-315037] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/23/2017] [Accepted: 02/21/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the prospective associations between adiposity and lipid-related variables and conversion to multiple sclerosis (MS), time to subsequent relapse and progression in disability. METHODS A cohort of 279 participants with a first clinical diagnosis of central nervous system demyelination was prospectively followed to 5-year review. Height, weight, waist and hip circumference were measured, and serum samples taken for measurement of lipids and apolipoproteins. Survival analysis was used for conversion to MS and time to relapse, and linear regression for annualised change in disability (Expanded Disability Status Scale). RESULTS Higher body mass index (BMI; adjusted HR (aHR): 1.22 (1.04 to 1.44) per 5 kg/m2 increase), hip circumference (aHR: 1.32 (1.12 to 1.56) per 10 cm increase) and triglyceride levels (aHR: 1.20 (1.03 to 1.40) per unit increase) were associated with increased risk of subsequent relapse, while adiposity and lipid-related measures were not associated with conversion to MS. In addition, higher BMI (β: 0.04 (0.01 to 0.07) per 5 kg/m2 increase), hip circumference (β: 0.04 (0.02 to 0.08) per 10 cm increase), waist circumference (β: 0.04 (0.02 to 0.07) per 10 cm increase), total cholesterol to high-density lipoprotein ratio (TC/HDL ratio; β: 0.05 (0.001 to 0.10) and non-HDL; β: 0.04 (0.001 to 0.08) at study entry) were associated with a higher subsequent annual change in disability. CONCLUSIONS Higher levels of adiposity, non-HDL and TC/HDL ratio were prospectively associated with a higher rate of disability progression, and higher adiposity and triglycerides were associated with relapse but not with conversion to MS. Improving the lipid profile and losing weight into the healthy range could reduce the accumulation of disability.
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Affiliation(s)
- Prudence Tettey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Turning Point, Monash University, Fitzroy, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Terence Dwyer
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Karam Kostner
- Mater Hospital, University of Queensland, Queensland, Australia
| | | | - Ingrid Af van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Kawada T. Prediction of Adiposity by Body Mass Index in Patients With Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:1598-1599. [PMID: 27569037 DOI: 10.1016/j.apmr.2016.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
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