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High-Quality Diet, Healthy Lifestyle May Reduce Multiple Sclerosis Disability

High-quality diets with large intakes of fruits, vegetables, and whole grains and low intakes of sugar and red meat are associated with lower levels of disability in people with multiple sclerosis (MS), a new large registry study shows. In addition, a generally healthy lifestyle was also linked to lower prevalence of severe depression, pain, fatigue, and cognitive problems. The current study was part of the North American Research Committee on MS (NARCOMS) registry. For the study, conducted in 2015, 11 000 active participants were sent a dietary questionnaire and were asked to evaluate MS symptoms and disability levels using the Patient-Determined Disease Steps scoring system, developed and validated by the NARCOMS group.




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A diet quality score was constructed for each individual based on intake of fruits, vegetables, legumes, whole grains, added sugars, and red/processed meats, with higher scores denoting a healthier diet. Associations between diet quality score and MS symptoms and disability levels were estimated by using proportional odds models, adjusting for age, sex, income, body mass index, smoking status, and disease duration.


Results showed that 6989 patients responded to the survey and provided dietary information. Participants with diet quality scores in the highest quintile had 20% lower levels of "more severe disability" than those in the lowest quintile of diet quality scores: proportional odds ratio (OR), 0.80 (95% confidence interval, 0.69-0.93). Patients in the highest dietary score quintile also had lower depression scores (OR, 0.82; 95% confidence interval, 0.70-0.97), but diet quality was not associated with severity of fatigue, pain, or cognitive symptoms.


Because poor dietary quality tends to correlate with other unhealthy lifestyle characteristics, the researchers assessed whether a similar association existed in people with MS using indicators of a composite healthy lifestyle, defined as maintaining a healthy weight (body mass index, <25 kg/m2), routine physical activity, no smoking, and having a better than average diet (above the median diet quality score).


Results of this analysis suggest that individuals who adhered to a composite healthy lifestyle were at substantially lower odds of severe depression (OR, 0.53), pain (OR, 0.56), fatigue (OR, 0.69), and cognitive symptoms (OR, 0.66) after adjustment for disease duration, disability level, age, and sex. A composite healthy lifestyle was also associated with lower odds of severe disability (OR, 0.45).


The researchers caution that causal inferences cannot be made from this study because poor physical or mental health may lead to poorer diet quality, food choices, or other lifestyle factors. They add that longitudinal studies are needed to gain a better understanding of the directionality of the association between diet, a composite healthy lifestyle, and disease outcomes.


Source: Fitzgerald KC, et al. Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology December 2017, 10.1212/WNL.0000000000004768; DOI: 10.1212/WNL.0000000000004768



Macronutrients are an athlete's best friend. Carbohydrates and fat provide athletes with fuel and energy, but protein is what allows their bodies to recover from the physical demands of sports and exercise. So, how much protein do active females need to recover from exercise?


A new study suggests it's 50% more than men who are not active. The study was published last month in the American College of Sports Medicine's Medicine & Science in Sports & Exercise.


The current recommended dietary allowance for protein is set at 0.8 g/kg per day for the general population; however, these guidelines don't take into account the effect of regular exercise on minimum protein requirements. The American College of Sports Medicine recommends that athletes should consume between 1.2 and 2.0 g/kg of protein per day, but the broad range may not capture the specific needs of different athletes in light of their unique exercise demands.


These recommendations are primarily based on athletes performing exclusively weightlifting or endurance exercises, which lie on opposite ends of the strength-endurance continuum of exercise. That leaves team sport athletes, such as basketball, hockey, or soccer players, who have to have high levels of endurance but also perform stops and starts with high muscle forces, trying to guess what their optimal protein intake may be. To further complicate matters, studies examining the protein requirements of different active populations almost exclusively study males, which may limit the ability to translate these findings to active females.


The study participants, 6 healthy active young women, performed a modified version of the Loughborough Intermittent Shuttle Test, which simulates the stop-and-go activity in soccer.


Following the exercise, they each consumed a series of meals containing a tracer, a protein building block, which is containing an amino acid tracer that is a little bit heavier than those naturally occurring in our bodies. If the tracer appears in the breath after it has been ingested, that's a sign that we haven't used it to build new body proteins. By tracking it in the breath and urine samples of the study participants, the researchers were able to determine how much of the protein in their diet was being used to build new protein, which is important for athletes to help them recover from demanding exercise. The study demonstrated that variable-intensity exercise, such as soccer, increases the safe protein intake in female athletes to 1.71 g/kg per day, which is above the current daily recommendation of 0.8 g/kg per day for the general population and the range of 0.93 to 1.2 g/kg per day for nonexercising males, but within the upper range of 1.2 to 2.0 g/kg per day recommended for athletes by the American College of Sports Medicine.


While more research is needed, the study results can serve to provide a more refined athlete-specific recommendation for females engaged in team sports, which is especially significant given the tendency of female athletes to eat less than their male counterparts and in the case of some female soccer players to consume protein below the present recommendations. More broadly, this shows the importance for dietary protein requirements to be population specific.


Source: Wooding DJ, et al. Increased protein requirements in female athletes after variable-intensity exercise. Med Sci Sports Exerc. 2017;49(11):2297-2304.



People whose genetic makeup triggers a later-than-average start to puberty have lower bone mineral density, especially in their lower spine. Because adolescence is a critical period for accruing bone, this effect may increase a person's risk of osteoporosis and bone fractures later in life. According to the researchers, if an individual is genetically programmed for later puberty, researchers found that he/she tends to have lower bone mineral density during childhood as well as in adulthood. Scientists already knew that later puberty was linked to lower bone mineral density and that both are risk factors for osteoporosis but this study was the first to analyze the associations between genetic determinants of puberty timing and measurements of bone mineral density.


The researchers drew on data from the Bone Mineral Density in Childhood Study, funded by the National Institutes of Health. That study included sophisticated bone and growth measurements during annual visits for up to 7 years in more than 2000 healthy children, adolescents, and young adults during 2002 to 2010. In the current research, the study team used a relatively new tool called a "genetic risk score," which enables collective study of a group of genetic variants in 1 go. They based the score on hundreds of genetic variants associated with later puberty in children and looked for associations with bone mineral density measurements. The researchers performed these analyses separately in boys and girls and also in publicly available corresponding genetic data on bone mineral density in adults.


For both boys and girls, the genetic risk score for later puberty was associated with lower bone mineral density in both a longitudinal cohort of 933 individuals who each had up to 7 assessments and in a cross-sectional cohort of 486 individuals. The results varied according to the part of the skeleton where bone mineral density was measured, with lowest density in the lower back and hip bones. In a separate analysis called "Mendelian Randomization," the study team found that later puberty was associated with lower bone mineral density in both adult men and adult women. They also detected a strong causal effect in adolescent girls, while finding no causal relationship for adolescent boys. The researchers point out that the number of boys in their analysis may not have been large enough to show a significant effect.


Other researchers have previously shown an epidemiological link between later puberty and the risk of bone fracture and osteoporosis late in life. The current study did not include data from elderly people and so could not directly perform a genetic analysis of osteoporosis risk. Future studies will address this question by using data from older research subjects. Being aware of the risks to lifelong bone health if someone is genetically predisposed to later puberty can allow them to work on strategies such as promoting weight-bearing physical activity, to optimize bone density during skeletal development.


Source: Cousminer DL, et al. Genetically determined later puberty impacts lowered bone mineral density in childhood and adulthood. J Bone Mineral Res. Published online ahead of print October 24, 2017.