Obesity management likely improves the clinical outcome of MS

Obesity management likely improves the clinical outcome of MS

Carrying far too much weight when diagnosed with MS (multiple sclerosis) is associated with higher current and later levels of disability within a relatively short period of time, according to a study published online in the Journal of Neurology Neurosurgery & Psychiatry.

Returning to a healthy weight may improve clinical outcomes for obese patients with MS, the researchers suggest.

Obesity in childhood and adolescence is associated with an increased risk of developing MS, independent of other potential environmental triggers. However, it is not clear whether this might also be associated with faster disability progression after diagnosis.

To find out, researchers recruited 1,066 participants with relapsing-remitting MS from across Germany who took part in The German National MS (NationMS) study. More than a quarter (29.5%, 315) of these were men with an average age of 33 years.

At the time of MS diagnosis, 159 patients (15%) were obese with a BMI of at least 30. Obesity-related comorbidities (type 2 diabetes, hypertension) were reported in 68 patients (almost 6.5%).

Their disability level was monitored every 2 years for a total of 6 years using the Expanded Disability Status Scale (EDSS). This ranges from 0 to 10 in increments of 0.5 units.

Obesity at the time of diagnosis was not associated with a higher annual relapse rate or greater increase in nerve damage as seen on MRI brain scans during the 6-year observation period.

But the level of disability was higher at the time of diagnosis and at each of the following three time points, after adjusting for age, gender and smoking. And the average time it took obese patients to accumulate higher levels of disability was shorter. They reached EDSS 3 in just under 12 months on average, compared to almost 18 months for those who were not obese.

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Obese patients were also more than twice as likely to achieve EDSS 3 within 6 years, regardless of what type of drug treatment they received.

Complete health data was available for 81 (51%) of the obese MS patients and for 430 (almost 47.5%) of the others.

The risk of achieving EDSS 3 within 6 years in this group was again more than twice as high in obese patients as in those who were not, falling to an 84% increased risk after accounting for gender, age and smoking.

Importantly, being overweight (BMI 25–29.9) at diagnosis was not significantly associated with greater disability then or later or with an increased risk of achieving an EDSS of 3 at 6 years.

This is an observational study and therefore cannot determine cause. And the researchers acknowledge that BMI was measured only once at the start of the study, while co-existing medical conditions were limited to type 2 diabetes and high blood pressure and the number of those affected was small.

But previous research has linked a reduction in gray matter in the brain to obesity, they point out.

“Our finding that obesity, but not overweight, is associated with worse outcome in MS patients suggests a threshold effect of body mass on the accumulation of disability in MS,” they write, adding that obesity is a modifiable risk factor.

“These data suggest that targeted management of obesity should be evaluated for its potential benefit in improving long-term clinical outcomes in patients diagnosed with MS,” they conclude.

Source:

BMJ

Reference:

Lutfullin, I., et al. (2022) Association of obesity with disease progression in multiple sclerosis. Journal of Neurology Neurosurgery & Psychiatry. doi.org/10.1136/jnnp-2022-329685.

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