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Efficacy of Diet on Fatigue and Quality of Life in Multiple Sclerosis: A Systematic Review and Network Meta-analysis of Randomized Trials
Journal article   Open access   Peer reviewed

Efficacy of Diet on Fatigue and Quality of Life in Multiple Sclerosis: A Systematic Review and Network Meta-analysis of Randomized Trials

Linda Snetselaar, Joshua J Cheek, Sara Shuger Fox, Heather S Healy, Marin L Schweizer, Wei Bao, John Kamholz and Tyler J Titcomb
Neurology, Vol.100(4), pp.e357-e66
01/24/2023
DOI: 10.1212/WNL.0000000000201371
PMID: 36257717
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC12326367/pdf/WNL-2022-201255.pdfView
Open Access

Abstract

BACKGROUND Emerging evidence suggests a role for diet in multiple sclerosis (MS) care; however, due to methodological issues and heterogeneity of dietary interventions in preliminary trials, the current state of evidence does not support dietary recommendations for MS. OBJECTIVE To assess the efficacy of different dietary approaches on MS-related fatigue and quality of life (QoL) through a systematic review of the literature and network meta-analysis (NMA). METHODS Electronic database searches were performed in May 2021. Inclusion criteria were: 1) randomized trial with a dietary intervention; 2) adults with definitive MS based on McDonald criteria; 3) patient-reported outcomes for fatigue and/or QoL; and 4) minimum intervention period of 4 weeks. For each outcome, standardized mean differences (SMDs) were calculated and included in random effects NMA to determine the pooled effect of each dietary intervention relative to each of the other dietary interventions. The protocol was registered at PROSPERO (CRD42021262648). RESULTS Twelve trials comparing 8 dietary interventions (low-fat, Mediterranean, ketogenic, anti-inflammatory, Paleolithic, fasting, calorie restriction, and control [usual diet]), enrolling 608 participants, were included in the primary analysis. The Paleolithic (SMD: -1.27; 95% CI: -1.81, -0.74), low-fat (SMD: -0.90; 95% CI: -1.39, -0.42), and Mediterranean (SMD: -0.89; 95% CI: -1.15, -0.64) diets showed greater reductions in fatigue compared to control. The Paleolithic (SMD: 1.01; 95% CI 0.40, 1.63) and Mediterranean (SMD: 0.47; 95% CI 0.08, 0.86) diets showed greater improvements in physical QoL compared to control. For improving mental QoL, the Paleolithic (SMD: 0.81; 95% CI 0.26, 1.37) and Mediterranean (SMD: 0.36; 95% CI 0.06, 0.65) diets were more effective compared to control. However, the NutriGRADE credibility of evidence for all direct comparisons is very low due to most of the included trials having high or moderate risk of bias, small sample sizes, and the limited number of studies included in this NMA. DISCUSSION Several dietary interventions may reduce MS-related fatigue and improve physical and mental QoL; however, due to the limitations of this NMA, which are driven by the low quality of the included trials, these findings must be confirmed in high quality, randomized, controlled trials.

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