Body Mass Index in Multiple Sclerosis: Associations with CSF Neurotransmitter Metabolite Levels

Anthropometric indices, nutrient intakes and health-related characteristics of patients with multiple sclerosis: a cross-sectional study

BACKGROUND

Multiple sclerosis (MS) is accompanied by many health-related issues. This study aimed to evaluate the anthropometric indices, nutrient intakes and health-related characteristics of MS patients as well as their possible correlations.

METHODS

This cross-sectional study was performed on 283 MS patients in Shiraz, Iran, during 2018-2019. Body mass index (BMI) and body composition were measured for each participant. A food frequency questionnaire was used to determine the patients' nutrient intakes. The level of fatigue, disability and quality of life of the individuals were assessed by the modified fatigue impact scale (MFIS), the expanded disability status scale and the multiple sclerosis quality of life-54 questionnaires, respectively.

RESULTS

The results revealed that 43.11% of the patients were overweight or obese, and their %body fat (%BF) was 35.65 ± 7.63. Besides, intakes of vitamins A, E, D, folic acid, calcium, zinc and magnesium were significantly lower than recommendations in both genders, and sodium intake was significantly higher than the tolerable upper intake level in females. A significant positive linear correlation was observed between MFIS and BMI (r = 0.12, P = 0.045). Significant positive correlations were also found between psychosocial subscale of MFIS and both of %BF (r = 0.12, P = 0.049) and visceral fat area (r = 0.14, P = 0.02). Unexpectedly, the patients' quality of life showed significant negative correlations with fat free mass and skeletal muscle mass.

CONCLUSION

Being overweight, having a high %BF and poor nutrient intakes are common among MS patients. Improving the patients' lifestyle and dietary intake is recommended to reduce fatigue and increase their life quality.

Demographic and Clinical Predictors of Disease Severity in Patients With Multiple Sclerosis: A Retrospective Cross-Sectional Analysis

OBJECTIVES

Multiple sclerosis (MS) is a disease of the central nervous system (CNS). Several factors, including sex, body mass index (BMI), disease duration, and age of onset, have been identified as predictors of disease severity. This study investigated the association between the aforementioned factors and MS severity, measured by the number of hospital visits and admissions, length of stay, and frequency of methylprednisolone use.

METHODS

This retrospective cross-sectional analysis used data obtained from BESTCare at the King Abdulaziz Medical City (KAMC). A total of 272 patients with MS and their demographic and clinical characteristics were included.

RESULTS

The study population consisted of 68.75% (n = 187) females and 31.25% (n = 85) males. The regression analyses indicated that disease duration was a significant predictor of the number of hospital visits and admissions (p < 0.01). The study found a significant association between BMI (unstandardized beta (B) = -0.25, 95% confidence interval (CI) = -0.47, -0.02, p = 0.033), age at diagnosis (unstandardized beta (B) = 0.15, 95% CI = 0.001, 0.31, p = 0.048), and length of hospital stay. Additionally, there was a significant correlation between disease duration and the number of methylprednisolone doses (unstandardized beta (B) = 0.45, 95% CI = 0.01, 0.89, p = 0.045).

CONCLUSION

Disease duration was found to be a significant predictor of hospital visits, admissions, and methylprednisolone use, while sex and BMI did not contribute to the variation in these outcomes. However, BMI and age of onset were significantly associated with length of hospital stay.

Forskolin, an Adenylcyclase/cAMP/CREB Signaling Activator Restoring Myelin-Associated Oligodendrocyte Destruction in Experimental Ethidium Bromide Model of Multiple Sclerosis

Multiple sclerosis (MS) is a chronic neurodegenerative disease marked by oligodendrocyte loss, which results in central neuronal demyelination. AC/cAMP/CREB signaling dysregulation is involved in the progression of MS, including mitochondrial dysfunctions, reduction in nerve growth factors, neuronal inflammation, apoptosis, and white matter degeneration. Our previous research has shown that Forskolin (FSK), a naturally occurring direct adenylyl cyclase (AC)/cAMP/CREB activator, has neuroprotective potential to alleviate pathogenic factors linked with numerous neurological abnormalities. The current study intends to explore the neuroprotective potential of FSK at doses of 40 mg/kg and 60 mg/kg alone, as well as in combination with conventional medicines, such as Fingolimod (FNG), Donepezil (DON), Memantine (MEM), and Simvastatin (SIM) in EB-induced demyelinated experimental MS rats. Adult Wistar rats were divided into nine groups, and EB was infused stereotaxically in the rat brain’s intracerebropeduncle (ICP) area. Chronic gliotoxin EB treatment results in demyelination as well as motor and cognitive dysfunctions. FSK, combined with standard medications, improves behavioral dysfunctions, such as neuromuscular and motor deficits and memory and cognitive abnormalities. Following pharmacological treatments improved remyelination by enhancing myelin basic protein and increasing AC, cAMP, and CREB levels in brain homogenates. Furthermore, FSK therapy restored brain mitochondrial-ETC complex enzymes and neurotransmitter levels while decreasing inflammatory cytokines and oxidative stress markers. The Luxol fast blue (LFB) stain results further indicate FSK’s neuroprotective potential in preventing oligodendrocyte death. Therefore, the results of these studies contribute to a better understanding of the possible role that natural phytochemicals FSK could have in preventing motor neuron diseases, such as multiple sclerosis.

Impact of Body Mass Index on the Age of Relapsing-Remitting Multiple Sclerosis Onset: A Retrospective Study

A BACKROUND: Multiple sclerosis (MS) is a complex chronic disease of the central nervous system (CNS). Body mass index (BMI), a component of metabolic syndrome (MetS), is considered among the risk factors for MS. However, its role in MS remains ambiguous. OBJECTIVE: To examine the impact of BMI on the age of onset in patients with relapsing-remitting MS (RRMS) in a Greek cohort. METHODS: Data from 821 Greek patients with RRMS were collected. The BMI values were considered as quartiles. Comparisons for the demographic characteristics between the quartiles were made by Pearson’s chi-square test for the categorical variables and by ANOVA for the continuous variables. An overall p-value was calculated corresponding to trend for association. In case of significant association, further post-hoc analysis was performed in order to identify differences in demographic characteristics between specific BMI quartiles groups. Linear regression analyses were used to assess the relationship between BMI and age at onset of MS. RESULTS: Comparisons of participant characteristics by quartiles of BMI revealed that participants with the highest BMI had an older age of disease onset. Results from linear regression analysis showed that with each increase of 1 BMI unit, the age of RRMS onset increases by 0.255 (95% CI 0.136 to 0.374) years, p < 0.001. CONCLUSIONS: Patients with higher BMI, as a parameter of MetS, exhibit increased age of RRMS onset. Our results may present an alternative personalized approach for diagnosis, prognosis, and/or prevention of RRMS.

Serum leptin and body mass index in a sample of Egyptian multiple sclerosis patients

Background

The adipose tissues release pro-inflammatory cytokines such as leptin that can be considered a link between obesity and autoimmunity. This study aimed to investigate a possible correlation between BMI, serum leptin, and multiple sclerosis (MS).

Methods

This case-control study recruited consecutively 169 patients from our MS Unit and 50 healthy controls. Clinical history and examination with Expanded Disability Status Scale (EDSS) scoring were done for all patients. Calculation of body mass index (BMI) and measurement of serum leptin level were done for patients and controls.

Results

The case group had significantly higher BMI (mean of 26.85 ± 6.06 versus 19.55 ± 1.62; P < 0.001) and higher serum leptin levels (median [IQR] of 280 pgm/ml [175–525] versus 102.5 pgm/ml [80–125]; P < 0.001) compared to the control group. Serum leptin levels did not have a correlation with either disease activity or degree of disability.

Conclusions

MS patients had significantly higher BMI and higher serum leptin levels compared to controls.

Prevalence and Correlates of Body Image Dissatisfaction in Patients with Multiple Sclerosis

Background

Body image dissatisfaction (BID) strongly predicts undesirable outcomes, including disordered eating, depression, and low self-esteem. People with multiple sclerosis (MS) may have higher BID due to changes in mobility and functioning and high rates of depression; however, little research has explored BID in people with MS. Identifying factors predicting BID in people with MS would help providers become more aware of BID and its possible negative outcomes.

Methods

The sample included 151 adult patients with MS receiving care at the Cleveland Clinic Mellen Center for MS. The Body Shape Questionnaire was administered, and demographic information was collected from medical records. Data on MS-specific variables were collected via computerized testing. A one-sample t test, an independent-samples t test, and a hierarchical linear regression were conducted.

Results

Average scores on BID were not significantly different from the population mean. Patients with moderate/marked concern were more likely to be female and had higher body mass index values, Patient Health Questionnaire-9 scores, and Quality of Life in Neurological Disorders Stigma T-scores. There were no age differences. No MS-specific variables significantly predicted BID.

Conclusions

People with MS show approximately the same levels of BID as the general population. Higher BID was associated with being female and with higher body mass index, depression, and stigma. No MS-specific variables predicted higher BID after controlling for significant variables. Given the evidence in the literature of the negative effects of BID on health behaviors and mood, it is important to explore whether other factors affect BID in people with MS.

Behavioural phenotypes in the cuprizone model of central nervous system demyelination

The feeding of cuprizone (CPZ) to animals has been extensively used to model the processes of demyelination and remyelination, with many papers adopting a narrative linked to demyelinating conditions like multiple sclerosis (MS), the aetiology of which is unknown. However, no current animal model faithfully replicates the myriad of symptoms seen in the clinical condition of MS. CPZ ingestion causes mitochondrial and endoplasmic reticulum stress and subsequent apoptosis of oligodendrocytes leads to central nervous system demyelination and glial cell activation. Although there are a wide variety of behavioural tests available for characterizing the functional deficits in animal models of disease, including that of CPZ-induced deficits, they have focused on a narrow subset of outcomes such as motor performance, cognition, and anxiety. The literature has not been systematically reviewed in relation to these or other symptoms associated with clinical MS. This paper reviews these tests and makes recommendations as to which are the most important in order to better understand the role of this model in examining aspects of demyelinating diseases like MS.

Impact of Metabolic Syndrome on Neuroinflammation and the Blood-Brain Barrier

Metabolic syndrome, which includes diabetes and obesity, is one of the most widespread medical conditions. It induces systemic inflammation, causing far reaching effects on the body that are still being uncovered. Neuropathologies triggered by metabolic syndrome often result from increased permeability of the blood-brain-barrier (BBB). The BBB, a system designed to restrict entry of toxins, immune cells, and pathogens to the brain, is vital for proper neuronal function. Local and systemic inflammation induced by obesity or type 2 diabetes mellitus can cause BBB breakdown, decreased removal of waste, and increased infiltration of immune cells. This leads to disruption of glial and neuronal cells, causing hormonal dysregulation, increased immune sensitivity, or cognitive impairment depending on the affected brain region. Inflammatory effects of metabolic syndrome have been linked to neurodegenerative diseases. In this review, we discuss the effects of obesity and diabetes-induced inflammation on the BBB, the roles played by leptin and insulin resistance, as well as BBB changes occurring at the molecular level. We explore signaling pathways including VEGF, HIFs, PKC, Rho/ROCK, eNOS, and miRNAs. Finally, we discuss the broader implications of neural inflammation, including its connection to Alzheimer's disease, multiple sclerosis, and the gut microbiome.

Association of Pre-Disease Body Mass Index With Multiple Sclerosis Prognosis

Both high body mass index (BMI) and smoking tobacco are known risk factors for developing multiple sclerosis (MS). However, it is unclear whether BMI, like smoking, is a risk factor for the secondary progressive (SP) course. We, therefore, sought to determine if high/low BMI at age 20 is associated to risk of SP development, in the context of smoking status. Using data from MS patients with BMI and smoking information available, we examined relapsing onset patients with MS onset after 20 years of age. Cox regressions were conducted on smokers and non-smokers, with BMI as the main exposure. In total, 5,598 relapsing onset MS patients were included. The models demonstrated that BMI > 30 was associated to increased risk of SPMS in smokers (hazard ratio 1.50, p = 0.036). This association of obesity at age 20 with increased risk of SP was not observed in non-smokers (hazard rate 0.97, p = 0.900). Since the risk is confined to smokers, the interaction observed may give insight to disease driving mechanisms.

Seasonality of cerebrospinal fluid monoamine metabolite concentrations and their associations with meteorological variables in humans

Seasonal variations in neurotransmitter parameters have been previously reported in humans. However, these studies have involved small sample sizes and have not examined possible relationships with meteorological variables. We compared cerebrospinal fluid (CSF) concentrations of the major monoamine neurotransmitter metabolites (5-HIAA, HVA, and MHPG) in 188 healthy controls (80 men, 108 women) in relationship to age, sex, BMI, and available meteorological variables. All subjects had a lumbar puncture (LP) performed at 9 a.m. after overnight stay. Meteorological data for the day prior to LP were obtained from the National Climatic Association and included the photoperiod, percent sunshine, temperature (max, min, mean), barometric pressure, relative humidity, amount of precipitation and sky cover. Results revealed differences across seasons and cross-seasons for CSF 5-HIAA (p ≤ .05), with post-hoc differences emerging between spring versus summer and fall and between x-spring and x-summer (p ≤ .05). Differences were also found across seasons for CSF HVA (p ≤ .05) with post-hoc differences between spring versus fall. CSF 5-HIAA was significantly inversely correlated with maximum (r = -.28, p ≤ .02), minimum (r = -.24, p ≤ .04), and mean temperature (r = -.28, p ≤ .02) in men. In women, 5-HIAA (r = -.22, p ≤ .02) and HVA (r = -.28, p ≤ .003) were significantly correlated with relative humidity. These data confirm previous findings of variations in serotonin and dopamine metabolites across the year and highlight possible underlying mechanisms involving meteorological changes, which may result in alterations in neurophysiology and behavior.

Disease Specific Aspects of Malnutrition in Neurogeriatric Patients

Malnutrition in elderly patients is a common condition. Nevertheless, there is evidence on specific risk factors and problems of malnutrition in geriatric patients with neurological diseases. In this review, we summarize recent knowledge on malnutrition in different neurological diseases with a focus on elderly patients. This overview also provides strategies for a more specific and profound assessment of neurogeriatric patients to improve identification and treatment of malnutrition. Early and consequent treatment of malnutrition can lead to a decreased progression of the neurological disease and to a better quality of life in geriatric patients.

Machine-Learned Data Structures of Lipid Marker Serum Concentrations in Multiple Sclerosis Patients Differ from Those in Healthy Subjects

Lipid signaling has been suggested to be a major pathophysiological mechanism of multiple sclerosis (MS). With the increasing knowledge about lipid signaling, acquired data become increasingly complex making bioinformatics necessary in lipid research. We used unsupervised machine-learning to analyze lipid marker serum concentrations, pursuing the hypothesis that for the most relevant markers the emerging data structures will coincide with the diagnosis of MS. Machine learning was implemented as emergent self-organizing feature maps (ESOM) combined with the U*-matrix visualization technique. The data space consisted of serum concentrations of three main classes of lipid markers comprising eicosanoids (d = 11 markers), ceramides (d = 10), and lyosophosphatidic acids (d = 6). They were analyzed in cohorts of MS patients (n = 102) and healthy subjects (n = 301). Clear data structures in the high-dimensional data space were observed in eicosanoid and ceramides serum concentrations whereas no clear structure could be found in lysophosphatidic acid concentrations. With ceramide concentrations, the structures that had emerged from unsupervised machine-learning almost completely overlapped with the known grouping of MS patients versus healthy subjects. This was only partly provided by eicosanoid serum concentrations. Thus, unsupervised machine-learning identified distinct data structures of bioactive lipid serum concentrations. These structures could be superimposed with the known grouping of MS patients versus healthy subjects, which was almost completely possible with ceramides. Therefore, based on the present analysis, ceramides are first-line candidates for further exploration as drug-gable targets or biomarkers in MS.

Multiple Sclerosis: Implications of Obesity in Neuroinflammation

Since the discovery of the remarkable properties of adipose tissue as a metabolically active organ, several evidences on the possible link between obesity and the pathogenesis of multiple sclerosis (MS) have been gathered. Obesity in early life, mainly during adolescence, has been proposed as a relevant risk factor for late MS development. Moreover, once MS is initiated, obesity can contribute to increase disease severity by negatively influencing disease progress. Despite the fact that clinical data are not yet conclusive, many biochemical links have been recently disclosed. The "low-grade inflammation" that characterizes obesity can lead to neuroinflammation through different mechanisms, including choroid plexus and blood-brain barrier disruption. Furthermore, it is well known that resident immune cells of central nervous system and peripheral immune cells are involved in the pathogenesis of MS, and adipokines and neuropeptides such as neuropeptide Y may mediate the cross talk between them.

Multiple Sclerosis and Obesity: Possible Roles of Adipokines

Multiple Sclerosis (MS) is an autoimmune disorder of the Central Nervous System that has been associated with several environmental factors, such as diet and obesity. The possible link between MS and obesity has become more interesting in recent years since the discovery of the remarkable properties of adipose tissue. Once MS is initiated, obesity can contribute to increased disease severity by negatively influencing disease progress and treatment response, but, also, obesity in early life is highly relevant as a susceptibility factor and causally related risk for late MS development. The aim of this review was to discuss recent evidence about the link between obesity, as a chronic inflammatory state, and the pathogenesis of MS as a chronic autoimmune and inflammatory disease. First, we describe the main cells involved in MS pathogenesis, both from neural tissue and from the immune system, and including a new participant, the adipocyte, focusing on their roles in MS. Second, we concentrate on the role of several adipokines that are able to participate in the mediation of the immune response in MS and on the possible cross talk between the latter. Finally, we explore recent therapy that involves the transplantation of adipocyte precursor cells for the treatment of MS.

Serum leptin levels in treatment-naive patients with clinically isolated syndrome or relapsing-remitting multiple sclerosis

Several studies have investigated leptin levels in patients with multiple sclerosis (MS) with somewhat conflicting results. They have all focused on patients with established relapsing-remitting (RR) MS but have not specifically looked at patients with clinically isolated syndrome (CIS) suggestive of MS, in the early stages of disease. In this study, serum leptin levels were measured in 89 treatment-naïve patients with CIS (53 patients) or RRMS (36 patients) and 73 controls searching for differences between the groups and for associations with several disease parameters. The expected significant sexual dimorphism in leptin levels (higher levels in females) was observed in both MS patients and controls. Increased leptin levels were found in female patients with RRMS compared to female controls (P = .003) and female CIS patients (P = .001). Female CIS patients had comparable levels to controls. Leptin levels correlated positively to disease duration, but not to EDSS, in female patients with RRMS. The results of the present study do not indicate involvement of leptin in the early stages of MS. Normal leptin levels in patients with CIS suggest that leptin does not have a pathogenic role. The ratio leptin/BMI increases during disease course in female MS patients in a time-dependent and disability-independent manner.

Higher weight in adolescence and young adulthood is associated with an earlier age at multiple sclerosis onset

BACKGROUND

Growing evidence suggests an association between adolescent obesity and increased risk of multiple sclerosis (MS).

OBJECTIVE

The objective of this paper is to investigate whether weight or body mass index (BMI) in adolescence and young adulthood was associated with age at MS symptom onset.

METHODS

Our cohort is comprised of a sub-group of 184 women enrolled in the New York State MS Consortium registry. Individuals were asked to recall their weight at the time of first menstruation and at age 25. BMI was calculated accordingly for age 25. Regression analyses were carried out to investigate the association between weight or BMI and age at onset.

RESULTS

Weight at menarche was significantly related to younger age at symptom onset (β = -0.073, p = 0.001). These results were also found at age 25 for weight (β = -0.080, p < 0.001) and BMI (β = -0.448, p = 0.001). Significantly earlier disease onset (26.9 years ±9.9) was observed in individuals who were overweight at 25 compared to those who were not overweight (32.1 years ±9.2, p = 0.006).

CONCLUSIONS

Women who reported higher weight in adolescence and BMI in early adulthood were younger at MS onset. Future research should investigate whether there is a causal link between body weight and MS, as prevention lifestyle and dietary interventions could be implemented.