Small Thai study finds high malnutrition risk rate in MS patients
Malnourishment or the risk of it appear tied to greater disability
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About four out of 10 people with multiple sclerosis in Thailand were found to be either at risk of malnutrition or already malnourished, a single-center study shows. (Photo from iStock)
- About 42% of MS patients in a Thai study were malnourished or at risk of malnutrition.
- Poor nutritional status was found to be significantly associated with more severe neurological disability.
- Researchers recommend making routine nutritional screenings an essential component of standard MS clinical care.
About four out of 10 people with multiple sclerosis (MS) in Thailand were found to be either at risk of malnutrition or already malnourished, which appear to be associated with more severe disability, a single-center study shows.
Data also showed that a significant proportion of people with two related autoimmune disorders, neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), were also found to be malnourished, at risk of malnourishment, or both.
“The alarming prevalence of malnutrition risk necessitates targeted interventions,” researchers wrote, adding that “routine nutritional screening is an essential component of standard care for this population.”
The study, “Nutritional Status in Multiple Sclerosis, Neuromyelitis Optica Spectrum Disorder, and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease,” was published in the Journal of Clinical Medicine Research.
Earlier studies suggest nutritional problems may be common in MS
MS, NMOSD, and MOGAD are part of a group of inflammatory demyelinating diseases that involve loss of the myelin sheath, the protective sheath around nerve fibers, caused by an abnormal immune attack.
Depending on the location and extent of myelin damage, patients may develop sensory, movement, vision, and cognitive problems that may substantially affect quality of life.
Previous studies have suggested that nutritional problems may be common in MS, although estimates vary considerably depending on the population and the method used. Nutritional problems have also been reported in related demyelinating disorders, providing an opportunity to compare patterns across diseases.
Differences in body composition and dietary patterns, such as those between Western and Asian populations, highlight the importance of examining nutritional status with these differences in mind.
Mean MNA scores indicate malnutrition risk in all 3 disease groups
In this study, researchers assessed nutritional status and quality of life in 222 adults with inflammatory demyelinating diseases and 100 age- and sex-matched healthy people who were recruited at a single center in Thailand.
The patient group included 100 MS patients, 105 NMOSD patients, and 17 MOGAD patients. The team also set out to examine clinical factors potentially associated with poorer nutrition across the three disorders.
In the MS group, patients’ mean age was 40 years, 76% were women, and their median Expanded Disability Status Scale (EDSS) score was one, indicative of no disability and minimal abnormal signs on neurological examination.
Nutritional health was measured using the Mini Nutritional Assessment (MNA). Scores of 24 or higher indicate normal nutrition, scores from 17 to 23.5 indicate risk of malnutrition, and scores below 17 indicate malnutrition.
The mean MNA score was significantly higher in healthy controls (26.07) than in people living with MS (23.25), NMOSD (22.84), and MOGAD (22.03) — all of which were below the normal range.
MOGAD diagnosis associated with greater malnutrition risk
In the MS group, 35 patients (35%) were considered at risk of malnutrition and seven (7%) were malnourished. Generally comparable proportions were found in the NMOSD group. In contrast, MOGAD patients showed the highest proportion of patients at risk of malnutrition (70.6%), and the lowest proportion of malnourished patients (0%).
By comparison, 89% of healthy individuals had normal nutritional status and 11% were at risk. None were reported to be malnourished.
Statistical analyses adjusted for potential influencing factors showed that a MOGAD diagnosis was significantly associated with a greater risk of malnutrition, by twofold, compared with an MS diagnosis.
Also, a poorer nutritional status was significantly associated with a lower body mass index (BMI) and greater EDSS-assessed disability. BMI is a ratio of height and weight that is commonly used as a proxy of body fat. Because these analyses combined all patient groups, they cannot establish the same associations specifically within the MS subgroup.
Future studies should explore the underlying causes of nutritional deficiencies in these populations and develop customized diet strategies to mitigate these risk.
Among the study limitations, the team noted its single center nature, as well as its cross-sectional design, meaning patients were evaluated at one point in time. As a result, there can be no conclusion as to whether poor nutrition contributes to disability or results from it.
“Additionally, dietary habits and the lower average BMI in the general Thai population compared to Western or Middle Eastern [populations] may influence the … MNA, which was developed and validated primarily in elderly Western populations,” the researchers wrote. “The lower … MNA scores observed in our study may partially reflect the baseline population rather than [disease-associated] malnutrition alone.”
Still, the findings that 42% of the MS group had evidence of malnutrition or nutritional risk supports giving closer attention to nutrition during routine MS care.
Also, “future studies should explore the underlying causes of nutritional deficiencies in these populations and develop customized diet strategies to mitigate these risks,” the researchers concluded.
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