gms | German Medical Science

Background/research question: Dietary factors have been discussed to influence risk or disease course of multiple sclerosis (MS) and specific diets and dietary supplements are widely used among people with MS (PwMS). Therefore, we aimed to assess PwMS’ dietary habits and information needs in order to develop and pilot-test an evidence based patient education programme on nutrition in MS.

Methods: We performed a systematic literature search in 9/2010 with an update in 6/2015 on the effectiveness of dietary interventions in PwMS. In a next step, a web-based survey among n= 337 PwMS and n=136 healthy controls assessed knowledge, dietary habits and information needs using a self-developed questionnaire. Based on the results an interactive group education programme was developed and piloted.

Results: Fifteen randomised-controlled trials (RCTs) were included in the systematic review of which nine studies assessed fatty acid intake and six Vitamin D supplementation. Overall, quality of evidence was low and no clear benefit could be seen for either treatment. Of the 337 PwMS who completed the survey, 143 (42%) had tried special diets for PwMS. Main reasons were: improving overall wellbeing (78%) and prevention of disease progression (73%). 30% of PwMS reported to adhere to a `Mediterranean Diet` compared to 14% of healthy controls (p<0.001), but less often to a `Mixed Diet´ (PwMS: 42%, controls: 60%, p<0.001). Most important information needs addressed effectiveness of MS diets (44%) and relation between nutrition and MS (43%).The newly developed evidence-based patient education programme comprised basic knowledge on research methodology, relevant outcome measures of MS studies, information on widespread MS-diets and results of RCTs on diet and MS. A pilot test with 13 participants showed very good comprehensibility. Participants rated the amount of information as adequate and the MS-specific content as very important. However, the poor evidence base for MS diets was perceived as disillusioning.

Conclusions: There is no conclusive evidence on dietary interventions for PwMS. Nevertheless many PwMS use special diets which are widely advertised. The weak evidence base is disappointing for PwMS, but is acknowledged as important information. Based on the results of the pilot study, a web-based intervention should be developed and evaluated.