Julia Pakpoor1, Brandon Seminatore2, Jennifer S Graves2, Teri Schreiner3, Amy T Waldman4, Timothy E Lotze5, Anita Belman6, Benjamin M Greenberg7, Bianca Weinstock-Guttman8, Gregory Aaen9, Jan-Mendelt Tillema10, Jamie C McDonald2, Janace Hart11, Jayne M Ness12, Yolanda Harris12, Jennifer Rubin13, Meghan Candee14, Lauren Krupp6, Mark Gorman15, Leslie Benson15, Moses Rodriguez10, Tanuja Chitnis16, Soe Mar17, Ilana Kahn18, John Rose19, Suzan L Carmichael20, Shelly Roalstad14, Michael Waltz14, T Charles Casper14, Emmanuelle Waubant21. 1. Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 2. Multiple Sclerosis Center, University of California, San Francisco, San Francisco, CA, USA. 3. Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA. 4. Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 5. Department of Child Neurology, Texas Children's Hospital, Houston, TX, USA. 6. Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA. 7. Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 8. Department of Neurology, State University of New York, Buffalo, NY, USA. 9. Department of Neurology, Loma Linda University, Loma Linda, CA, USA. 10. Department of Neurology, Mayo Clinic, Rochester, MN, USA. 11. Department of Neurology, Regional Pediatric MS Center, University of California, San Francisco, San Francisco, CA, USA. 12. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA. 13. Division of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. 14. Department of Pediatrics, University of Utah, Salt Lake City, UT, USA. 15. Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA, USA. 16. Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA. 17. Department of Neurology, Washington University in St. Louis, St Louis, MO, USA. 18. Children's National Medical Center, Washington, DC, USA. 19. Department of Neurology, University of Utah, Salt Lake City, UT, USA. 20. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA. 21. Multiple Sclerosis Center, University of California, San Francisco, San Francisco, CA, USA/Department of Neurology, Regional Pediatric MS Center, University of California, San Francisco, San Francisco, CA, USA.
Abstract
BACKGROUND: The role of diet in multiple sclerosis (MS) is largely uncharacterized, particularly as it pertains to pediatric-onset disease. OBJECTIVE: To determine the association between dietary factors and MS in children. METHODS: Pediatric MS patients and controls were recruited from 16 US centers (MS or clinically isolated syndrome onset before age 18, <4 years from symptom onset and at least 2 silent lesions on magnetic resonance imaging). The validated Block Kids Food Screener questionnaire was administered 2011-2016. Chi-squared test compared categorical variables, Kruskal-Wallis test compared continuous variables, and multivariable logistic regression analysis was performed. RESULTS: In total, 312 cases and 456 controls were included (mean ages 15.1 and 14.4 years). In unadjusted analyses, there was no difference in intake of fats, proteins, carbohydrates, sugars, fruits, or vegetables. Dietary iron was lower in cases ( p = 0.04), and cases were more likely to consume below recommended guidelines of iron (77.2% of cases vs 62.9% of controls, p < 0.001). In multivariable analysis, iron consumption below recommended guidelines was associated with MS (odds ratio = 1.80, p < 0.01). CONCLUSION: Pediatric MS cases may be less likely to consume sufficient iron compared to controls, and this warrants broader study to characterize a temporal relationship. No other significant difference in intake of most dietary factors was found.
BACKGROUND: The role of diet in multiple sclerosis (MS) is largely uncharacterized, particularly as it pertains to pediatric-onset disease. OBJECTIVE: To determine the association between dietary factors and MS in children. METHODS: Pediatric MS patients and controls were recruited from 16 US centers (MS or clinically isolated syndrome onset before age 18, <4 years from symptom onset and at least 2 silent lesions on magnetic resonance imaging). The validated Block Kids Food Screener questionnaire was administered 2011-2016. Chi-squared test compared categorical variables, Kruskal-Wallis test compared continuous variables, and multivariable logistic regression analysis was performed. RESULTS: In total, 312 cases and 456 controls were included (mean ages 15.1 and 14.4 years). In unadjusted analyses, there was no difference in intake of fats, proteins, carbohydrates, sugars, fruits, or vegetables. Dietary iron was lower in cases ( p = 0.04), and cases were more likely to consume below recommended guidelines of iron (77.2% of cases vs 62.9% of controls, p < 0.001). In multivariable analysis, iron consumption below recommended guidelines was associated with MS (odds ratio = 1.80, p < 0.01). CONCLUSION: Pediatric MS cases may be less likely to consume sufficient iron compared to controls, and this warrants broader study to characterize a temporal relationship. No other significant difference in intake of most dietary factors was found.
Entities:
Keywords:
Case control studies; all pediatric; multiple sclerosis; neurology; nutritional; risk factors in epidemiology
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