Co-supplementation of synbiotics and anti-inflammatory-antioxidant rich diet in patients with progressive forms of multiple sclerosis: A single-center, randomized clinical trial

Article type: Research Article

Authors: Moravejolahkami, Amir Reza^{a; 1} | Chitsaz, Ahmad^{b; 2} | Hassanzadeh, Akbar^{c; 3} | Paknahad, Zamzam^{d; *}

Affiliations: [a] Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran | [b] Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran | [c] Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran | [d] Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

Correspondence: [*] Corresponding author: Prof. Zamzam Paknahad, Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Hezar-Jerib Ave, Isfahan, IR Iran. P.O. Box 81746-73461, Tel.: +98 31 37923166; Cell phone: +989136448771; Fax: +98 31 36681378; E-mail: paknahad@hlth.mui.ac.ir; ORCID ID: 0000-0002-1864-2576.

Note: [1] ORCID ID: 0000-0001-9707-0352

Note: [2] ORCID ID: 0000-0001-7983-2122

Note: [3] ORCID ID: 0000-0002-4555-0992

Abstract: BACKGROUND:The relationship between dietary modification and Multiple Sclerosis (MS)-related disability has been emphasized in several researches. AIMS:To determine whether a co-administration of anti-inflammatory-antioxidant rich diet and synbiotics might improve clinical manifestations in progressive MS patients. METHODS:The study involved 70 patients with progressive MS (primary-progressive, secondary-progressive, and progressive-relapsing) who were randomized to receive either intervention (synbiotics capsule plus an anti-inflammatory-antioxidant-rich diet) or placebo. Quality of Life (QOL), Expanded Disability Status Scale (EDSS), and depression-anxiety scores were evaluated before and after the follow-up. Analysis of covariance was performed for final analysis (SPSS v.14). RESULTS:Significant reductions were seen in EDSS (2.6±1.1 to 2.4±1.0, P < 0.001), State Anxiety Inventory (53.7±10.3 to 47.8±10.6, P < 0.001), and QOL scores after four months of intervention. No significant difference was seen across the depression severity (Δ for intervention = –2.2±5.5 vs. Δ for control = –0.6±5.7; P = 0.264). CONCLUSION:This study demonstrates that a combination of synbiotics and diet could be a promising strategy to improve severity and clinical manifestations of progressive MS.

Keywords: Synbiotics, anti-inflammatory agents, antioxidants, microbiota, progressive multiple sclerosis, randomized controlled trial

DOI: 10.3233/MNM-230098

Journal: Mediterranean Journal of Nutrition and Metabolism, vol. 17, no. 2, pp. 133-147, 2024