Dietary Interventions in Multiple Sclerosis: Development and Pilot-Testing of an Evidence Based Patient Education Program.

Karin Riemann-Lorenz,Marlene Eilers,Gloria Von Geldern,Christoph Heesen,Sascha Köpke,Karl-Heinz Schulz,Etsuro Ito

doi:10.1371/journal.pone.0165246

Abstract

BackgroundDietary factors have been discussed to influence risk or disease course of multiple sclerosis (MS). Specific diets are widely used among patients with MS.ObjectiveTo design and pilot-test an evidence based patient education program on dietary factors in MS.MethodsWe performed a systematic literature search on the effectiveness of dietary interventions in MS. A web-based survey among 337 patients with MS and 136 healthy controls assessed knowledge, dietary habits and information needs. An interactive group education program was developed and pilot-tested.ResultsFifteen randomised-controlled trials (RCTs) were included in the systematic review. Quality of evidence was low and no clear benefit could be seen. Patients with MS significantly more often adhered to a `Mediterranean Diet`(29.7% versus 14.0%, p<0.001) compared to controls. 143 (42%) of the patients with MS had tried special MS diets. Important information needs addressed effectiveness of MS diets (44%) and relation between nutrition and MS (43%). A pilot test of our newly developed patient education program with 13 participants showed excellent comprehensibility and the MS-specific content was judged as very important. However, the poor evidence base for dietary approaches in MS was perceived disappointing.ConclusionsDevelopment and pilot-testing of an evidence-based patient education program on nutrition and MS is feasible. Patient satisfaction with the program suffers from the lack of evidence. Further research should focus on generating evidence for the potential influence of lifestyle habits (diet, physical activity) on MS disease course thus meeting the needs of patients with MS.

Highlights

Patients with Multiple sclerosis (MS) significantly more often adhered to a ‘Mediterranean Diet‘(29.7% versus 14.0%, p
Further research should focus on generating evidence for the potential influence of lifestyle habits on MS disease course meeting the needs of patients with MS
About one third of patients with MS (PwMS) in our survey believed dietary factors to have an influence on the development of multiple sclerosis and about 60% believed that the course of disease can be influenced by dietary factors

Summary

Introduction

High level evidence from randomized controlled trials on the influence of dietary factors on disease progression is scarce. Jagannath et al (2010) [10] only reported on one small trial with 49 participants in their Cochrane Review on Vitamin D treatment in MS Another Cochrane Review from 2012 included all randomised or controlled clinical trials on specific dietary interventions, diet plans or dietary supplementation except for vitamin D supplementation. Evidence on the efficacy of dietary interventions is poor, patients with MS (PwMS) have a strong interest in dietary recommendations and many adhere to special diets. Being aware of the large gap between scientific evidence on the effectiveness of dietary interventions in MS and dietary behaviour of PwMS, we hypothesized that there is a need for an evidence based patient education program. Dietary factors have been discussed to influence risk or disease course of multiple sclerosis (MS).

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Results

Conclusion