Original article| Volume 65, 104016, September 2022

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Lifestyle factors in multiple sclerosis disability progression and silent brain damage: A cross-sectional study


      • Despite current treatment options, disability progression cannot always be halted in MS.
      • A healthy lifestyle may be crucial in increasing brain reserve and delaying disability in MS.
      • Blood pressure, weight and measures for physical activity and cognitive reserve showed associations with the multiple sclerosis severity score.



      To determine the association between lifestyle risk factors with 1/ the Multiple Sclerosis Severity Score (MSSS) and 2/ ongoing subclinical brain damage in non-active MS patients on high-efficacy treatment.


      Cross-sectional study in persons with Multiple Sclerosis (PwMS) investigating lifestyle factors including cognitive reserve (CR), physical activity (PA), smoking status, alcohol use, dietary habits, body mass index (BMI), blood pressure (BP) and cholesterol ratio. Data were collected through validated questionnaires, clinical and laboratory examination. Serum Neurofilament light chain (sNfL) levels were used as a proxy for ongoing brain damage in a subgroup of persons with non-active MS on high-efficacy treatment. Multiple regression analysis (MRA) models explored the relationship between lifestyle factors with the MSSS score and sNfL.


      351 PwMS were included (43.04 ± 11.77 years, 69.8% female). Higher CR and PA were associated with a lower MSSS; overweight or obesity and higher systolic BP with a higher MSSS. The MRA model explained 22.2% of the variance for MSSS (R².255, adjusted R².222). Higher BMI and BP were related to lower sNfL. Twenty-3% (R².279, adjusted R².230) of the variance was explained in the MRA model for sNfL.


      Our study suggests an association between a ‘brain healthy lifestyle’ with disability progression in MS. A cognitive and physical active lifestyle alongside a normal body weight and blood pressure may help to prevent future disability in MS. Longitudinal and interventional research is necessary to gain insight in the causal pathway of these risk factors in preventing disability progression in MS.



      AH (antihypertensive drugs), BMI (body mass index), BP (blood pressure), CI (confidence Interval), CNS (central nervous system), CR (cognitive reserve), CRIq (cognitive reserve index questionnaire), DMT (disease modifying treatment), EDSS (expanded disabilitystatus scale), HDL (high-density lipoprotein IPAQ, international physical activity questionnaire), MD (Mediterranean diet), Medi-Lite (literature based adherence to the MediterraneanDiet score), MRA (multiple regression analysis), MS (multiple sclerosis), MSSS (multiple sclerosis severity scale), PA (physical activity), PIRA (progression independent from relapses), PwMS (persons with MS), sNfL (serum neurofilament light), sNfLz (serum neurofilament light Z-score), UZA (Antwerp University Hospital), UZG (Ghent University Hospital), VIF (variance inflation factor)
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