A Scoping Review of Modifiable Risk Factors in Pediatric Onset Multiple Sclerosis: Building for the Future.

Julie Pétrin,Prenitha Doss,Max Fiander,E Yeh

doi:10.3390/children5110146

Abstract

Knowledge of the effect of modifiable lifestyle factors in the pediatric multiple sclerosis (MS) population is limited. We therefore conducted a scoping review, following the framework provided by Arksey and O’Malley. Four databases were searched for pediatric MS and modifiable lifestyle factors using index terms and keywords, from inception to May 2018. All quantitative and qualitative primary articles were included and limited to English and full text. Of the 7202 articles identified and screened, 25 full-text articles were relevant to our objective and were included. These articles focused on diet obesity, physical activity, and sleep. In cross-sectional analyses, these lifestyle factors were associated with increased risk of pediatric onset MS (POMS), and increased disease activity. Diet, particularly vitamin D and vegetable intake, was associated with reduced relapse rate. Obesity was linked to increased risk of POMS, and physical activity was associated with reduced relapse rate and sleep/rest fatigue. Thus, available studies of lifestyle related outcomes in pediatric MS suggest specific lifestyle related factors, including obesity, higher vitamin D levels, and higher physical activity may associate with lower disease burden in POMS. Studies reviewed are limited by their observational designs. Future studies with longitudinal and experimental designs may further clarify the role of modifiable lifestyle factors in this population.

Highlights

Onset of multiple sclerosis (MS) prior to age 18 [1] occurs in 3–5% of cases of multiple sclerosis and has been increasingly recognized over the past 15 years [2,3]
Information on lifestyle modification is relevant to individuals with pediatric onset MS (POMS) and their families
This review emphasizes the small number of observational studies that have been conducted on modifiable lifestyle factors and their relationship to risk of POMS or POMS

Summary

Introduction

Onset of multiple sclerosis (MS) prior to age 18 [1] occurs in 3–5% of cases of multiple sclerosis and has been increasingly recognized over the past 15 years [2,3]. Pediatric onset MS (POMS) patients experience a higher relapse rate [4], higher MRI disease burden [5], and disability at an earlier age than those with adult-onset MS [6] They may experience significant decreases in quality of life and functional outcomes over their lifespan [7]. Because of the young age of POMS patients, environmental factors may play an even more important role in POMS relative to adult-onset MS [9]. Both medical and patient communities have recognized the potential role lifestyle factors may play in modifying the disease course and severity of symptoms [10,11]. Improving the body of literature on modifiable lifestyle factors in pediatric MS with the goal of creating guidelines that will help POMS patients and their parents deal with these difficult decisions is needed [14,15]

Methods

Results

Conclusion