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NEU Research papers

Find out more about the peer-reviewed research studies that has been conducted on the Overcoming MS Program.

The studies referred to here have all been published in high impact, MEDLINE-indexed, peer-reviewed medical journals that cut across many different medical specialties, including neurology, endocrinology, immunology, biology, general medicine, epidemiology, genetics, public health, pharmacology and many others.


HOLISM

Research papers

Paper: Sociodemographic and clinical characteristics of diet adherence and relationship with diet quality in an international cohort of people with multiple sclerosis.

Journal: Multiple Sclerosis and Related Disorders

Conclusions

Dietary factors have been associated with the onset and progression of multiple sclerosis (MS). Multiple diets, varying in recommendations, have been proposed as beneficial. The characteristics of those who follow specific diet programs and the relationships of these diet programs with diet quality are under-explored.  Greater adherence to MS-specific diets was associated with higher Socioeconomic status and higher quality of life. Following any diet program was associated with higher overall diet quality, with those adhering to the Overcoming MS diet having the highest diet quality.

Description

This study assessed the relationships between diet, and disability, fatigue, and depression risk in people with MS.  The results showed that better quality of diet, as well as not consuming meat, were associated with reduced disability progression in people with MS.

Conclusions

Sun exposure and vitamin D, including intake and serum levels, have been associated with reduced risk of MS onset and less progression and may affect quality of life (QoL).  Self-reported vitamin D supplement use was cross-sectionally associated with higher physical and mental QoL, and prospectively with increased physical QoL.

Description

Fatigue is among the most prevalent symptoms for people with multiple sclerosis (pwMS) and is significantly detrimental to mental health-related (mental) quality of life (QoL). This paper examined the role of depression and physical activity as mediators in the fatigue-QoL relationship in pwMS.  Depression accounted for the majority of the fatigue-mental QoL relationship, while physical activity had only a minor role.

Conclusions

Assessing how the level of engagement with selected health information is associated with the adoption and maintenance of lifestyle behaviours at a 5-year follow-up in people with multiple sclerosis (MS).

Paper: Mastery is associated with greater physical and mental health-related quality of life in two international cohorts of people with multiple sclerosis.

Journal: Multiple Sclerosis and Related Disorders

Description

Mastery is the sense of being in control of one’s life and improvement in mastery may help to enhance quality of life. Little research has explored mastery in people with MS, including its association with quality of life.

Greater mastery is associated with better physical and mental quality of life. Efforts to improve the sense of self control and agency of people with MS may have benefits for their quality of life, even despite clinical features of the illness.

Conclusions

Emerging evidence links modifiable lifestyle risk factors to disease progression in MS.  Healthier lifestyle has strong associations with disability in this large international sample of people with MS, supporting further investigation into the role of lifestyle risk factors in MS disease progression.

Description

A growing evidence base implicates vitamin D, sun exposure and latitude in the aetiology of multiple sclerosis (MS), however there are less data on the associations of these variables with disease outcomes.  The results demonstrated significant associations between latitude, deliberate sun exposure and vitamin D supplementation and health outcomes of this large group of people with MS. Vitamin D is likely to have a key role in these associations and its role in the health outcomes of people with MS urgently requires further study.

Conclusions

Exploring the association between dietary factors including fat, fruit and vegetable intake, dairy and meat consumption, and health-related quality of life (HRQOL), disability and relapse rate in a large international sample of people with MS.  This study supports significant associations of healthy dietary habits with better physical and mental HRQOL and a lower level of disability.

Description

There is increasing interest in patient-centred approaches to chronic disease management and prevention. For people with MS, patient empowerment plays a role in improving a range of health-related outcomes. This study aimed to compare health-related quality of life (HRQOL), fatigue, and depression risk between people who have and have not attended a week-long physician-led residential educational retreat or accessed other self-help resources (a book and online content) that foster patient empowerment including the adoption of healthy lifestyle behaviours.  Analysis showed that, controlling for age and gender, compared to the highest level of engagement, no engagement with the resources was associated with nearly threefold higher odds of clinically significant fatigue, tenfold higher odds of depression risk, and physical and mental HRQOL scores 19.5 and 15.6 points lower, respectively.  They strongly support a role for patient engagement in resources promoting lifestyle modification.

Conclusions

This study investigated the associations between physical activity and quality of life, relapse rate, disability, and demographic variables in PwMS with varying disability.  For PwMS, regardless of disability level, increased PA is related to better HRQOL in terms of energy, social functioning, mental and physical health.

Description

Those consuming fish more frequently and those taking omega 3 supplements had significantly better quality of life, in all domains, and less disability. For fish consumption, there was a clear dose–response relationship for these associations. There were also trends towards lower relapse rates and reduced disease activity; flaxseed oil supplementation was associated with over 60% lower relapse rate over the previous 12 months.

Conclusions

Modifiable risk factors such as smoking and sedentary lifestyle adversely affect multiple sclerosis (MS) progression. Few multimodal behavioural interventions have been conducted for people with MS, and follow-up beyond 1 year is rare for lifestyle interventions. This study assessed adoption and adherence to healthy lifestyle behaviours and health outcomes 3 years after a lifestyle modification intervention.  The results provide evidence that lifestyle risk factor modification is feasible and sustainable over time, in a small self-selected and motivated sample of people with MS. Furthermore, participation in a lifestyle intervention is not associated with a decrease in MS medication use.

Conclusions

There is a strong body of evidence that supports the use of non-drug therapies in the management of people with multiple sclerosis (MS). A 5-day residential retreat for people with MS in Victoria, Australia, promotes lifestyle modification within a patient-centred model of care. Attendance at a retreat promoting lifestyle modification for the integrated management of MS appears to have positive effects on short and medium-term HRQOL. Non-drug therapies should be considered as part of any comprehensive treatment plan for people with MS.

Paper: Effect of a residential retreat promoting lifestyle modifications on health-related quality of life in people with multiple sclerosis.

Journal: Quality in Primary Care

Description

The effects of a residential retreat on promoting lifestyle modification for the health related quality of life (HRQOL) of people with MS. Of 188 participants 109 (58%) completed the questionnaire. The cohort showed a significant improvement in HRQOL at one year and 2.5 year follow-up.

OTHER RESEARCH PAPERS:

Omega 3 and fish consumption association with MS disease outcomes

Journal: International Journal of Neuroscience

Description

The role of fish consumption and omega 3 supplementation in multiple sclerosis (MS) is controversial, although there is some evidence to support a beneficial effect. Univariate and multivariate analyses were undertaken. Of 2,469 respondents, 1493 (60.5%) had relapsing-remitting MS. Those consuming fish more frequently and those taking omega 3 supplements had significantly better quality of life, in all domains, and less disability. Flaxseed oil supplementation was associated with over 60% lower relapse rate over the previous 12 months. 

Paper: Smoking and alcohol association with MS disease outcomes

Journal: Journal of the Neurological Sciences

Conclusions

This cross-sectional study supports previous research showing a link between morbidity indicators in MS and alcohol use and smoking. Smokers had significantly worse quality of life and more disability than non-smokers.

Paper: Dietary factors and MS

Journal: Nutritional Neuroscience

Conclusions

Of 2,469 participants with confirmed MS, 2087 (84.5%) provided complete data on their dietary habits (DHQ total score). Multivariate regression models demonstrated that every 10-point increase on the DHQ total score was associated with nearly a six-point and five-point increase in physical and mental HRQOL, respectively, and 30% reduced likelihood of higher disability. ‘Healthy’ consumption of fruit and vegetables and dietary fat predicted better quality of life and less likelihood of higher disability when compared to respondents with a ‘poor’ diet. For those with relapsing-remitting MS, the DHQ total significantly predicted a lower relapse rate.

Paper: Depression and MS

Journal: BMC Psychiatry

Conclusions

 In total, approximately one fifth (19.3%) of our sample screened positive for depression (PHQ-2 score ≥3). Regression analyses showed that poor diet, low levels of exercise, obesity, smoking, marked social isolation and taking interferon were associated with greater depression risk. Participants who supplemented with omega 3s, particularly flaxseed oil, had frequent fish consumption, supplemented with vitamin D, meditated, and had moderate alcohol consumption had significantly reduced depression risk.

Paper: Exercise and MS

Journal: BMC Neurology

Conclusions

For people with MS, regardless of disability level, increased physical activity was related to better quality of life in terms of energy, social functioning, mental and physical health.

Paper: Fatigue and MS

Journal: PLoS ONE

Conclusions

This study supports strong and significant associations between clinically significant fatigue and modifiable lifestyle factors. Specifically, there were increased odds of fatigue associated with obesity, DMD use, poor diet, and reduced odds of fatigue with exercise, fish consumption, moderate alcohol use, and supplementation with vitamin D and flaxseed oil.

Paper: Sunlight, vitamin D, latitude and MS

Journal: BMC Neurology

Conclusions

We detected significant associations between latitude, deliberate sun exposure and vitamin D supplementation and health outcomes of this large group of people with MS. Quality of life was related to vitamin D supplementation in a direct, dose-response relationship, and latitude with disability.

Paper: Engagement with Overcoming MS resources and MS

Journal: Neurological Sciences

Conclusions

People with MS attending residential retreats and actively engaged in resources that promote lifestyle modification had better mental and physical quality of life, and a markedly lower prevalence of clinically significant fatigue and depression. Physicians should support and encourage people with MS to play a more active role in their health and to adopt healthy lifestyle behaviors.

Conclusions

Obese participants were more likely to have other chronic conditions, including a five-fold higher risk of diabetes and high blood pressure but also twice the risk of depression. Being overweight, obese, or a former, or current smoker was associated with an increase in the number of chronic conditions; while healthy diet, exercise and moderate alcohol consumption were associated with decreased number. Increasing number of other chronic conditions was related to worse quality of life, increased likelihood of disability and relapses. Obese people with MS had higher risk of disability and lower quality of life. This lends strong support to the healthy lifestyle approach of Overcoming MS.

Paper: Determinants of quality of life in people with MS

Journal: BMC Neurology

Conclusions

 Factors associated with better physical health quality of life were: exercise, non-smoking compared to current smoking, better diet, normal body mass index (BMI) versus overweight or obese, fewer other chronic conditions, and not taking a disease-modifying drug (DMD). Better mental health quality of life determinants were: exercise, non-smoking compared to current, normal BMI versus overweight or obese, meditating regularly, and no DMD use. Again, strong support was provided for the Overcoming MS approach in terms of improved quality of life.

Paper:  Determinants of disability in people with MS

Journal: PLoS ONE

Conclusions

There was significantly lower risk of disability for those people with MS who had better diet, never smoked, exercised at least moderately, lived closer to the equator), took flaxseed oil, and had fewer other chronic conditions. The study also bore out what has been shown in clinical trials, that is, those taking disease-modifying medications had significantly less disability. While cross-sectional in nature, the study lent more support to the Overcoming MS approach in respect of disability prevention.