The University of Melbourne
Neuroepidemiology Unit, Melbourne School Of Population & Global Health

Author Of 5 Presentations

Epidemiology Poster Presentation

P0463 - Healthy-lifestyle-scores associated with lower subsequent fatigue risk in multiple sclerosis using inverse probability treatment weighting (ID 290)

Speakers
Presentation Number
P0463
Presentation Topic
Epidemiology

Abstract

Background

Several lifestyle factors, including smoking, diet, physical activity, BMI, and smoking, have been associated with the onset and progression of multiple sclerosis (MS). Combining these lifestyle factors into scoring indices is an efficient way to assess their collective relationship with clinical outcomes.

Objectives

To examine the association of two lifestyle scores with clinically significant fatigue and change thereof over two years’ follow-up.

Methods

Data on sociodemographic, lifestyle and clinical characteristics surveyed from the international HOLISM cohort of people with MS at baseline and 2.5-year follow-up. Fatigue was defined by Fatigue Severity Scale (FSS), and healthy lifestyle by the Healthy Lifestyle Index Score (HLIS), and SNAP (Smoking, Nutrition, Alcohol, Physical Activity) score. Analyses by standard logistic and inverse probability treatment weighting (IPTW) models adjusted for age, sex, MS type, disability, comorbidity number, immunomodulatory medication use, prescription antifatigue medication use, and ongoing relapse symptoms; change in fatigue models also adjusted for baseline fatigue.

Results

1,160 participants completed the FSS questionnaire at both timepoints, and roughly 62% had fatigue at each timepoint. By logistic regression, baseline HLIS and SNAP were each associated with lower risk of being fatigued at follow-up, persisting on adjustment. Using doubly-robust IPTW these associations were attenuated but high (>11) HLIS (OR=0.91, 95% CI=0.83-1.00) and high (>3) SNAP (OR=0.82, 95% CI=0.74-0.91) were each associated with lower risk of fatigue at follow-up. Evaluating change in fatigue, while higher SNAP score was associated with lower risk of change in fatigue (OR=0.89, 95% CI=0.80-0.97), HLIS was not associated (OR=0.97, 95% CI=0.89-1.06).

Conclusions

In this sample of people with MS, healthy lifestyle scores were consistenyl associated with less fatigue 2.5 years later, though only SNAP score was associated with change in fatigue over this interval.

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Epidemiology Poster Presentation

P0512 - Vitamin-D-supplement use but not sun exposure associated with higher quality of life in multiple sclerosis (ID 208)

Speakers
Presentation Number
P0512
Presentation Topic
Epidemiology

Abstract

Background

Multiple sclerosis (MS) is an autoimmune condition of the central nervous system. Sun exposure and vitamin D are associated with MS onset and progression and may affect quality of life (QoL).

Objectives

To investigate the prospective relationship of sun exposure and vitamin D supplement use with QoL and change thereof from baseline to 2.5 years follow-up in an international cohort of people with MS.

Methods

Sun exposure and vitamin D supplement use were queried at both timepoints. QoL was assessed by MSQOL-54, estimating physical and mental health QoL composite scores, and subdomains within each. Characteristics of QoL at follow-up were assessed by linear regression, adjusted for age, sex, socioeconomic status, comorbidity number, MS type, disability, fatigue, prescription antidepressant medication use, and ongoing relapse symptoms. Baseline predictors of change in QoL were additionally adjusted for baseline QoL score.

Results

Mean baseline QoL composite scores were 61.99 for physical (n=1155) and 70.29 for mental (n=1316) QoL composite score, materially unchanged at follow-up. QoL scores were higher among those taking vitamin D supplements (physical: aβ=3.44, 95% CI=1.17-5.71; emotional: aβ=3.14, 95% CI=0.76-5.51); higher supplementation frequency and dose were more strongly associated with both. Baseline vitamin D supplementation was associated with greater increase in physical (aβ=1.06, 95% CI=0.26-1.86), but not mental health (aβ=0.16,95%CI=-0.96,1.28), QoL. Sun exposure was cross-sectionally associated with higher QoL scores but not with change in QoL.

Conclusions

Vitamin D supplementation, particularly average daily doses over 5000IU/d, were associated with higher QoL and with an increase in physical QoL.

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Observational Studies Poster Presentation

P0851 - Clinical & demographic determinants of self-reported diet program adherence in people living with multiple sclerosis (ID 288)

Speakers
Presentation Number
P0851
Presentation Topic
Observational Studies

Abstract

Background

A range of diets have been recommended for people living with MS, ranging from low or no-meat Swank-inspired diets, to the modified Palaeolithic Wahls diet. While the clinical efficacy of these diets to modulate MS progression is uncertain, the popularity of these diets amongst people living with MS is manifest.

Objectives

To assess the clinical and demographic characteristics of adherence to several diets recommended for people with MS.

Methods

Data derived from the 5-year review of the HOLISM international cohort study. Self-reported adherence to diets were queried, ranging 1-5. Adherence was restricted to ≥12months adherence, and then dichotomised: those reporting 4-5/5 adherence defined 2nd-most adherent, 3-5/5 adherence defined 3rd-most adherent. Determinants of adherence were evaluated by log-binomial regression, adjusted for age, sex, socioeconomic status (SES), education, and fatigue. Due to low numbers, only the Overcoming MS (OMS), Swank and Wahls diets were quantitatively evaluated.

Results

458/952 (48.1%) reported following MS-specific diets for ≥12months; 61.8% followed OMS, 12.7% Swank, 3.5% Wahls, 0.9% Ashton-Embry, 0.9% McDougal, 5.7% other. OMS adherence (2nd-most) was more common among males, higher SES, lower disability, less fatigue, and fewer comorbidities. Wahls adherence (2nd-most) was more common among participants with progressive MS or greater disability. Swank adherence (2nd-most) did not vary by any parameter. Analogous results were found using the 3rd-most adherent definition.

Conclusions

These results indicate that MS-specific diet adherence is common in this patient population, but uptake is highly heterogenous between demographic and clinical subgroups. Further study of diet uptake among MS patients is indicated, particularly as the efficacy of these diets in MS is yet uncertain.

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Observational Studies Poster Presentation

P0878 - Lifestyle characteristics of adherence to diet programs in an international cohort of people with MS (ID 289)

Speakers
Presentation Number
P0878
Presentation Topic
Observational Studies

Abstract

Background

Multiple sclerosis (MS) is a demyelinating condition of the central nervous system of complex aetiology. One such factor implicated in its onset and progression is diet and because of this a number of diet program have been proposed which their creators assert will improve MS.

Objectives

This study sought to investigate the prevalence and characteristics of adherence to several popular diets proposed for people with MS.

Methods

The international observational cohort study, the HOLISM Study, has measured lifestyle and clinical characteristics over 5 years of follow-up. At the 5-year review, 952 participants were queried as to their adherence to 6 diet programs – the Overcoming MS (OMS), Wahls Elimination, Swank, McDougall, Ashton Embry Best Bet, and Palaeolithic diets – adherence constrained to those doing so for at least 12 months. Adherence was defined by two dichotomisations of the 5-point Likert at 3 and 4 of 5. Lifestyle characteristics of adherence to each diet were assessed by log-binomial regression.

Results

OMS adherence was common, with roughly 30-40% adhering, while Swank (5-6%) and Wahls (2-3%) adherence was less frequent and other diets even less (<2%). Higher BMI and smokers were less likely to follow OMS, while participants who were more active, those consuming alcohol or using vitamin D/omega-3 supplements, and who meditated were more likely to adhere. OMS adherers were less likely to consume meat or dairy. Swank adherence was higher among those who were more active and less so among those of higher BMI, but otherwise did not differ by any lifestyle characteristics. Wahls adherence was more common among those consuming alcohol and those who consumed meat but less common among those consuming dairy.

Conclusions

OMS and to a lesser extent Swank and Wahls diets had material followings in this international cohort. Though it was expected all diet adherence would generally track with healthier lifestyle, there was some variability, suggesting that adherence to these diet programs is more likely in certain subgroups.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1059 - The effectiveness of mindfulness on quality of life in people with multiple sclerosis: a systematic review. (ID 774)

Speakers
Presentation Number
P1059
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Multiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system. MS manifests in a wide range of motor, sensory and other symptoms including fatigue, pain, and cognitive impairments, which may have significant negative impacts on quality of life (QoL). Mindfulness-Based Interventions (MBIs) have been shown to safely improve MS-specific predictors of reduced QoL, including fatigue, anxiety, stress, and depression, in people with MS (pwMS). However, the efficacy and long-term effects of MBIs on QoL, remain unclear.

Objectives

To systematically review the literature for evidence for the effectiveness of MBIs on QoL in pwMS and the long-term effects.

Methods

EMBASE, PsycINFO, and Medline were searched for studies, published from database inception to 2020, that assessed the association of MBIs on QoL in pwMS. Randomized controlled trials (RCTs), quasi-RCTs, and observational studies were included. Study quality was assessed using Cochrane Collaboration Risk of Bias tools.

Results

Of 181 studies identified, seven met the inclusion criteria; five were high-quality RCTs with moderate risks of bias, and two were observational studies with serious risks of bias. Three studies adopted non-active control, three used active control, and one had no control comparison. Interventions and QoL tools varied across studies, the most common being mindfulness-based stress reduction and multiple sclerosis quality of life – 54, respectively. All studies measured QoL pre- and immediate post-intervention. The follow-up periods were between 3-12 months in RCTs. Six of seven studies found MBIs improved overall QoL from baseline to post-intervention. Four studies additionally reported improved mental health QoL, and one reported improved physical QoL. RCTs assessed long-term effects, of which only three reported lasting positive effects of up to 12 months.

Conclusions

This review is the first to investigate the long-term effect of mindfulness in pwMS on QoL. It provides further evidence that MBIs are valuable methods to improve overall and mental health QoL in pwMS, effects which may be long-lasting. The differences in long term-effects may be due to many things, including adherence of mindfulness self-practice among pwMS. Future studies using consistent QoL tools and monitoring intervention adherence are needed.

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