title: The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis.
abstract: OBJECTIVE
  To explore the association between dietary factors including fat, fruit and vegetable intake, dairy and meat consumption, and health-related quality of life (HRQOL), disability and relapse rate in a large international sample of people with multiple sclerosis (MS).
  
  
  METHODS
  Participants with MS were recruited to the study via Web 2.0 platforms and completed a comprehensive survey measuring demographic and clinical characteristics, HRQOL, disability, relapse rate, and the Diet Habits Questionnaire (DHQ).
  
  
  RESULTS
  Of 2469 participants with confirmed MS, 2087 (84.5%) provided complete data on their dietary habits (DHQ total score). Multivariate regression models demonstrated that every 10-point increase on the DHQ total score was associated with nearly a six-point and five-point increase in physical and mental HRQOL, respectively, and 30.0% reduced likelihood of a higher level of disability. After controlling for age and gender, and the other dietary covariates, 'healthy' consumption of fruit and vegetables and dietary fat predicted better quality of life and less likelihood of higher disability when compared to respondents with a 'poor' diet. For those with relapsing-remitting MS, the DHQ total significantly predicted a lower relapse rate and reduced odds of increasing disease activity, but the model fit was poor and the predicted change only marginal.
  
  
  CONCLUSIONS
  This study supports significant associations of healthy dietary habits with better physical and mental HRQOL and a lower level of disability. Further research is urgently required to explore these associations including randomized controlled trials of dietary modification for people with MS.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Hadgkiss
authors.forename: George A
authors.initials: GA
authors.lastname: Jelinek
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Weiland
authors.forename: Naresh G
authors.initials: NG
authors.lastname: Pereira
authors.forename: Claudia H
authors.initials: CH
authors.lastname: Marck
authors.forename: Dania M
authors.initials: DM
authors.lastname: van der Meer
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004032:Diet; D004185:Disability Evaluation; D018450:Disease Progression; D005247:Feeding Behavior; D005260:Female; D006304:Health Status; D006801:Humans; D038622:Internationality; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012008:Recurrence; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Diet; Disability; Multiple sclerosis; Quality of life; Relapse