Research Article| Volume 56, 103233, November 2021

Dietary risk factors of primary progressive multiple sclerosis: A population-based case-control study

Published:August 30, 2021DOI:


      • Dietary pattern during adolescence could be a predictor factor for adult-onset PPMS.
      • There was inverse association between dairy, sea food and nuts groups with PPMS risk.
      • The inverse relation was also founded for vegetables, fruits, red meat and poultry.
      • Vitamin B12, B9 and C supplementation were associated with reduced risk of PPMS.
      • There was inverse association for calcium and iron supplementation with PPMS risk.



      There are growing evidences on the role of nutritional factors in multiple sclerosis (MS) occurrence. But dietary data are limited in primary progressive type of MS (PPMS). We assessed the role of dietary factors during adolescence in PPMS risk.


      An incident case-control study on 143 PPMS cases with definite diagnosis and 400 controls were conducted in Sina hospital, Tehran, Iran. Demographic data were collected. Data on nutritional habits during adolescence were obtained using questionnaire designed for multinational case–control studies of environmental risk factors for multiple sclerosis (EnvIMS-Q). Logistic regression models were run to evaluate the role of diet in PPMS risk.


      A significant association was founded between higher intake of dairy, seafood, red meat, poultry, vegetable, fruit and nut and lower risk of PPMS (P< 00.5). This association was dose dependent for all mentioned food groups except fruit. In the fully adjusted model, more intake of dairy (OR: 0.27; 95%CI: 0.14-0.53), seafood (OR: 0.21; 95%CI: 0.10-0.44), red meat (OR:0.44; 95%CI: 0.22-0.90), vegetable (OR: 0.19; 95%CI: 0.09-0.39), fruit (OR: 0.47; 95%CI: 0.22-0.99) and nut (OR: 0.29; 95%CI: 0.15-0.56) in the third tertiles resulted in significant reduction in PPMS risk. In case of poultry consumption, the association was meaningful just in the third tertile of crude model (OR: 0.54; 95%CI: 0.30-0.95). Nutrient supplementation with calcium, iron, folic acid, vitamin B12 and C were also related with more than 84% lower risk of PPMS.


      Our data proposed that adequate intake of food groups and nutrient supplementation during adolescence may be effective in reducing adult-onset PPMS risk.


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