title: Dietary salt intake and time to relapse in paediatric multiple sclerosis.
abstract: Salt intake was reported to be associated with increased clinical and MRI activity in adult patients with relapsing-remitting multiple sclerosis (MS).
  
  
  
  To determine if salt intake is associated with time to relapse in patients with paediatric-onset MS.
  
  
  
  Paediatric-onset MS and patients with clinically isolated syndrome (CIS) within 4 years of disease onset were recruited from 15 paediatric MS centres in the USA as part of a case-control study. Patients with available prospective relapse data subsequent to enrolment were included in this project. Dietary sodium intake was assessed by self-report questionnaire using the validated Block Kids Food Screener. Cox proportional-hazards regression models were employed to determine the association of sodium density, excess sodium intake and sodium density tertiles with time to relapse following study enrolment, adjusting for several confounders.
  
  
  
  174 relapsing-remitting MS/CIS patients were included in this analysis (mean age of 15.0 years, and 64.9% females). Median duration of follow-up was 1.8 years. In an unadjusted analysis, density of daily sodium intake was not associated with time to relapse, and patients with excess sodium intake had no decrease in time to relapse as compared with patients with non-excess sodium intake. The multivariable analysis demonstrated that patients in the medium and high tertile of sodium density had a HR of 0.69 (95% CI 0.37 to 1.30, p=0.25) and 1.37 (95% CI 0.74 to 2.51, p=0.32) compared with patients in the lowest tertile, respectively.
  
  
  
  Higher salt intake was not associated with decreased time to relapse in patients with paediatric-onset MS.
authors.affiliation: UCSF Regional Paediatric MS Center, San Francisco, California, USA.
authors.forename: Bardia
authors.initials: B
authors.lastname: Nourbakhsh
authors.affiliation: UCSF Regional Paediatric MS Center, San Francisco, California, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Graves
authors.affiliation: Department of Paediatrics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: T Charles
authors.initials: TC
authors.lastname: Casper
authors.affiliation: UCSF Regional Paediatric MS Center, San Francisco, California, USA.
authors.forename: Sabeen
authors.initials: S
authors.lastname: Lulu
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Waldman
authors.affiliation: Department of Neurology, SUNY Stony Brook, Stony Brook, New York, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Belman
authors.affiliation: Department of Neurology, UT Southwestern, Dallas, Texas, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Greenberg
authors.affiliation: The Paediatric MS Center at the Jacobs Neurological Institute, SUNY Buffalo, New York, USA.
authors.forename: Bianca
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.affiliation: Department of Child Neurology, Loma Linda University, Loma Linda, California, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Aaen
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jan-Mendelt
authors.initials: JM
authors.lastname: Tillema
authors.affiliation: UCSF Regional Paediatric MS Center, San Francisco, California, USA.
authors.forename: Janace
authors.initials: J
authors.lastname: Hart
authors.affiliation: Alabama Paediatric MS Center, Birmingham, Alabama, USA.
authors.forename: Jayne
authors.initials: J
authors.lastname: Ness
authors.affiliation: Department of Paediatric Neurology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rubin
authors.affiliation: Department of Neurology, New York University, New York, New York, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Krupp
authors.affiliation: Partners Paediatric MS Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Gorman
authors.affiliation: Partners Paediatric MS Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Benson
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Moses
authors.initials: M
authors.lastname: Rodriguez
authors.affiliation: Partners Paediatric MS Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Tanuja
authors.initials: T
authors.lastname: Chitnis
authors.affiliation: Department of Neurology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: John
authors.initials: J
authors.lastname: Rose
authors.affiliation: Department of Epidemiology, UC Berkeley, Berkeley, California, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Barcellos
authors.affiliation: UCSF Regional Paediatric MS Center, San Francisco, California, USA.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Waubant
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000209:etiology*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012982:Sodium, Dietary / Q000008:administration & dosage* / Q000009:adverse effects*; D014481:United States
chemical_list: D012982:Sodium, Dietary