A Mediterranean-type diet improved systemic inflammation in multiple sclerosis patients, as compared to the traditional Iranian diet: A single-center randomized controlled trial

Article type: Research Article

Authors: Mirashrafi, Shahrzad^{a; 1} | Borzoo-Isfahani, Mohammad^{b; 2} | Namjoo, Iman^{b; 3} | Hojjati Kermani, Mohammad Ali^{c; 4} | Moravejolahkami, Amir Reza^{a; *}

Affiliations: [a] Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran | [b] Department of Community Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran | [c] Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

Correspondence: [*] Corresponding author: Mr. Amir Reza Moravejolahkami, Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Hezar-Jerib Ave, Isfahan, IR, P.O. Box 81746-73461, Iran. Tel.: +98 31 33354453 / +989136448771; Fax: +98 31 36681378; E-mails: a.moravej@mail.mui.ac.ir and amimohs@gmail.com. ORCID: https://orcid.org/0000-0001-9707-0352.

Note: [1] ORCID: https://orcid.org/0000-0003-2598-714X

Note: [2] ORCID: https://orcid.org/0000-0003-2020-9920

Note: [3] ORCID: https://orcid.org/0000-0002-1889-2866

Note: [4] ORCID: https://orcid.org/0000-0002-2364-3696

Abstract: BACKGROUND:There is overwhelming scientific evidence that dietary modifications is beneficial in neurodegenerative diseases like Multiple Sclerosis (MS). OBJECTIVE:The goal of this study was to explore the effects of modified Mediterranean Diet (mMeD) on systemic inflammation, anthropometric indices, and relapse rate in MS patients. METHODS:This single-center, randomized controlled trial compared mMeD and traditional Iranian diet (as control) during six months in 180 Relapsing-Remitting MS (RRMS) patients. Serum high sensitivity C Reactive Protein (hs-CRP), body weight, Body Mass Index (BMI), percent body fat, and relapse rate were evaluated at baseline, and 3 and 6 months later. Multivariate analysis of covariance test (MANCOVA; conducted by SPSS 24) was adjusted for age, gender, family history, duration of MS and education level. RESULTS:Of 261 screened patients (July 2018-February 2019), 180 patients were eligible; 68/90 as mMeD and 79/90 as control group completed the study. Self-reported adherence was excellent (95%). The mean change on the relapse rate was –0.54±0.9 compared to –0.03±0.4 for control group (P = 0.004). In addition, hs-CRP levels decreased in the mMeD group (–2.9±3.3 mg/L; P < 0.001) and mean changes were significant between two groups (P < 0.001). Anthropometric indices were modified in mMeD group, whereas between-group comparisons were not statistically different. CONCLUSIONS:Overall, mMeD improved inflammatory status and relapse rate in RRMS patients. Future trials with larger scale and longer duration should be conducted to confirm the role of diet as a disease-modifier in MS.

Keywords: Mediterranean diet, hs-CRP, inflammation, relapse rate, anthropometric, multiple sclerosis

DOI: 10.3233/MNM-210557

Journal: Mediterranean Journal of Nutrition and Metabolism, vol. 14, no. 3, pp. 289-304, 2021