Eating Hubs in Multiple Sclerosis: Exploring the Relationship Between Mediterranean Diet and Disability Status in Italy

Background: Multiple Sclerosis (MS) is a complex disease in which multiple factorscontribute to disability accrual. Mediterranean Diet (MeDi) has shown beneficial effectsacross neurodegenerative diseases. We hypothesize that specific food habits, rather thanglobal adherence to MeDi, might impact on MS. We aimed to (i) evaluate differences inadherence to MeDi between people living with MS (PwMS) and healthy controls (HC);(ii) characterize eating patterns in PwMS and HC, identifying the most influential MeDiitems for each group by the use of network analysis; (iii) explore the relationship betweenpatients’ eating habits and disability.Materials and Methods: In this cross-sectional study, we consecutively recruited 424PwMS and 165 matched HC. Data were obtained through the administration of self-reported questionnaires. Expanded Disability Status Scale (EDSS) and Fatigue SeverityScale (FSS) were evaluated in the MS population. We performed between-groupscomparisons via unpaired two-sample t-test and X2 test as appropriate. We calculatedfood networks in both MS cases and HC using and tested the associationbetween hub nodes and disability. Finally, we conducted a post-hoc analysis,investigating the relationship between food items, lifestyle factors (smoking, exercise)and clinical outcomes.Results: Most participants adhered sufficiently to MeDi. Exploring each groupseparately, fruit, vegetables, cereal, and fish were identified as hubs in PwMS, whilemeat and alcohol were identified as hubs in HC. Hubs were all inter-correlated, indicatingthat eating habits of PwMS include a large intake of all the foods identified as hubs.EDSS was predicted by the intake of vegetables (beta = −0.36, p < 0.03) and fish(beta = −0.34, p < 0.02). The model including smoking pack/year, InternationalPhysical Activity Questionnaire (IPAQ) score and intake of “negative foods” predicted6% of the variance in EDSS (p < 0.001), while the model including smokingpack/year and IPAQ score predicted 4% of the variance in FSS (p < 0.001).Felicetti et al. Eating Hubs in Multiple SclerosisConclusions: We identified a sufficient adherence to MeDi in our population. PwMSshowed overall a healthier dietary pattern than HC. Vegetables and fish intake wereassociated with disability outcomes. Future longitudinal studies applying integratedapproaches are needed to understand lifestyle added value to the use of standardpharmacological therapies.