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Research paper
Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis
  1. Saeedeh Azary1,
  2. Teri Schreiner2,
  3. Jennifer Graves1,
  4. Amy Waldman3,
  5. Anita Belman4,
  6. Bianca Weinstock Guttman5,
  7. Gregory Aaen6,
  8. Jan-Mendelt Tillema7,
  9. Soe Mar8,
  10. Janace Hart1,
  11. Jayne Ness9,
  12. Yolanda Harris9,
  13. Lauren Krupp10,
  14. Mark Gorman11,
  15. Leslie Benson11,
  16. Moses Rodriguez7,
  17. Tanuja Chitnis11,
  18. John Rose12,
  19. Lisa F Barcellos13,
  20. Tim Lotze14,
  21. Suzan L Carmichael15,
  22. Shelly Roalstad16,
  23. Charles T Casper16,
  24. Emmanuelle Waubant1
  1. 1 Department of Neurology, UCSF Regional Pediatric MS Center, San Francisco, California, USA
  2. 2 Department of Neurology, University of Colorado, Aurora, Colorado, USA
  3. 3 Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4 Department of Neurology, SUNY Stony Brook, Stony Brook, New York, USA
  5. 5 Department of Neurology, The Pediatric MS Center at the Jacobs Neurological Institute, SUNY, Buffalo, New York, USA
  6. 6 Department of Child Neurology, Loma Linda University, Loma Linda, California, USA
  7. 7 Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  8. 8 Division of Pediatric Neurology, Washington University, St. Louis, Missouri, USA
  9. 9 Department of Neurology, Alabama Pediatric MS Center, Birmingham, Alabama, USA
  10. 10 Department of Neurology, New York University, New York City, New York, USA
  11. 11 Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, USA
  12. 12 Department of Neurology, University of Utah, Salt Lake City, Utah, USA
  13. 13 Division of Epidemiology, UC Berkeley, Berkeley, California, USA
  14. 14 Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
  15. 15 Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
  16. 16 Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
  1. Correspondence to Dr Emmanuelle Waubant, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA; emmanuelle.waubant{at}


Objective The role of diet in multiple sclerosis (MS) course remains largely unknown. Children with MS have a higher relapse rate compared with MS in adults. Thus, studying the effect of diet on relapse rate in this age group is likely to provide more robust answers.

Methods This is a multicentre study done at 11 paediatric MS centres in the USA. Patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome (CIS) with disease onset before 18 years of age and duration of less than 4 years were included in this study. Dietary intake during the week before enrolment was assessed with the validated Block Kids Food Screener. The outcome of the study was time from enrolment to the next relapse. 219 patients with paediatric RRMS or CIS were enrolled. Each 10% increase in energy intake from fat increased the hazard of relapse by 56% (adjusted HR 1.56, 95% CI 1.05 to 2.31, p=0.027), and in particular each 10% increase in saturated fat tripled this hazard (adjusted HR: 3.37, 95% CI 1.34 to 8.43, p=0.009). In contrast, each additional one cup equivalent of vegetable decreased the hazard of relapse by 50% (adjusted HR: 0.50, 95% CI 0.27 to 0.91, p=0.024). These associations remained with mutual adjustment and persisted when adjusting for baseline 25(OH) vitamin D serum level. Other studied nutrients were not associated with relapse.

Conclusions This study suggests that in children with MS, high energy intake from fat, especially saturated fat, may increase the hazard to relapse, while vegetable intake may be independently protective.

  • Pediatric
  • Multiple sclerosis
  • relapse
  • Diet
  • Fat intake
  • Vegetable intake

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  • Contributors SA helped on preparing the plan of analysis and first draft of the manuscript. EW designed the study, obtained funding, edited the plan of analysis and the first and subsequent drafts of the manuscript. She helped with case recruitment and interpretation of the findings. TS, JG, AW, TL, AB, BWG, GA, J-MT, JH, JN, YH, LK, MG, LB, MR, TC and SM enrolled cases and edited the manuscript. JR, SR and CTC provided support to coordinate the study, prepared plan of analysis, analysed data and edited the manuscript. LFB helped with design of the study. SLC helped with the interpretation and analyses of the data.

  • Funding The National Institutes of Health NS071463 (PI Waubant) and the National MS Society HC 0165 (PI Casper).

  • Competing interests Dr JG was supported by grants from Race to Erase MS, NMSS, Biogen and Genentech during this work. Dr AW is funded by the NIH (NINDS, K23NS069806) and has received research funding from Biogen Idec. Dr CTC has been supported by the National MS Society and the NIH (R01NS071463). He is an ad hoc consultant for Biovest International, Inc. Dr EW is funded by the National MS Society, the NIH and the Race to Erase MS. She volunteers on an advisory board for a clinical trial of Novartis. Dr LK is supported by the National MS Society, NIH, Robert and Lisa Lourie Foundation, Department of Defense. She has received honoraria, consulting payments, grant support or royalties from Biogen, Medimmune, Novartis, Teva Neuroscience, Sanofi-Aventis and EMD Serono. Dr BWG received honoraria for serving in advisory boards and educational programmes from Teva Pharmaceuticals, Biogen Idec, Novartis, Acorda EMD Serono, Novartis, Genzyme and Sanofi. She also received support for research activities from the National Institutes of Health, National Multiple Sclerosis Society, National Science Foundation, Department of Defense, EMD Serono, Biogen Idec, Teva Neuroscience, Novartis, Acorda, Genzyme and the Jog for the Jake Foundation. Dr TC has served as a consultant for Biogen Idec, Teva Neurosciences, Novartis and Sanofi-Aventis and has received grant support from NIH, National MS Society, Guthy-Jackson Charitable Foundation, CMSC and Merck-Serono, Novartis, and Biogen and Verily. Dr JR has research funding from Teva Neuroscience and Biogen. He is a member of the Medical Advisory Board for the DECIDE trial, which is funded by Biogen and AbbVie. Dr GA has received research support from Biogen-Idec. Drs AB, JN, MG, TL, MR and GA have no disclosures. JH has no disclosures. Dr J-MT received funding from the NIH (NCATS) during this work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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