Lifestyle and health of individuals with multiple sclerosis according to body mass index: initial results

Abstract

Introduction: Increased body mass index (BMI) correlates with an increased risk of many diseases and is thought to be a risk factor in multiple sclerosis (MS). Aim of the research: To assess the lifestyle and health of adult individuals with MS, according to their relative BMI. Material and methods: The study participants comprised 115 individuals with MS. The participants underwent anthropometric measurements, functional tests, lifestyle assessments, and a biochemical blood parameter analysis that included the fasting glucose, triglyceride, HDL-cholesterol, vitamin D, and biotin concentrations. Results: In total, 40.9% of the participants were overweight or obese. The compared groups did not differ significantly in terms of the degree of their physical disability. The overweight group showed a higher functional ability of the lower limbs than the underweight group. Conversely, the underweight and the normal-weight group showed a higher relative hand grip strength than individuals with overweight and obesity (p < 0.05). Metabolic syndrome was more prevalent in the overweight and obese participants (p < 0.05). The obese individuals drank sweetened carbonated or still drinks significantly more often than the other individuals. They also consumed potatoes more often and other vegetables less often than the other participants (p < 0.05). Conclusions: Individuals with MS differed in terms of the values of their metabolic parameters, functional ability of the lower limbs, and relative hand grip strength, depending on their BMI. The occurrence of obesity may have resulted, at least partially, from differences in diet and physical activity. Streszczenie Wprowadzenie: Podwyższony wskaźnik masy ciała (BMI) wiąże się z większym ryzykiem rozwoju wielu chorób. Jest uznawany także za czynnik ryzyka wystąpienia stwardnienia rozsianego (MS). Cel pracy: Ocena stylu życia i stanu zdrowia dorosłych chorych na SM w zależności od ich względnej masy ciała (BMI). Materiał i metody: Badaniami objęto 115 chorych na MS. Przeprowadzono pomiary antropometryczne, testy funkcjonalne, ocenę stylu życia i analizę parametrów biochemicznych krwi, oznaczając stężenia: glukozy na czczo, triglicerydów, cholesterolu HDL, witaminy D i biotyny. Wyniki: Nadwagę i otyłość stwierdzono łącznie u 40,9% osób. Porównywane grupy nie różniły się istotnie pod względem stopnia niepełnosprawności ruchowej. W grupie osób z nadwagą odnotowano większą sprawność funkcjonalną kończyn dolnych niż w grupie pacjentów z niedowagą. Wartości względnej siły mięśni dłoni okazały się wyższe u uczestników z niedowagą i z prawidłowym BMI niż u tych z nadwagą i otyłością (p < 0,05). W grupie pacjentów z nadwagą i otyłością istotnie częściej występował zespół metaboliczny (p < 0,05). Osoby z otyłością istotnie częściej piły słodzone napoje gazowane lub niegazowane, częściej spożywały ziemniaki, natomiast rzadziej – inne warzywa (p < 0,05). Wnioski: U chorych z MS stwierdzono różnice w wartościach parametrów metabolicznych, sprawności funkcjonalnej kończyn dolnych oraz względnej sile mięśni dłoni w zależności od ich BMI. Występowanie otyłości, przynajmniej częściowo, może wynikać z różnic w sposobie żywienia i aktywności fizycznej. 141 Lifestyle and health of individuals with multiple sclerosis according to body mass index: initial results Medical Studies/Studia Medyczne 2022; 38/2 Introduction Multiple sclerosis (MS) is defined as a progressive, inflammatory, and demyelinating disease of the central nervous system. It is one of the most common neurological diseases diagnosed in young adults, which causes progressive disability. The prevalence of MS in Poland amounts to over 120 cases per 100,000 individuals [1, 2]. A key pathogenic factor in MS is the autoimmune process [3]. An increased body mass index (BMI) correlates with an increased risk of many chronic diseases, such as type 2 diabetes, cardiovascular diseases, and cancer. It is also associated with an increased mortality rate due to these diseases [4, 5] and an increased risk of inflammatory and autoimmune diseases [6]. Many authors also consider an increased BMI to be an important and potentially modifiable risk factor of MS [7–9]. Mokry et al. reported that an increase in the BMI by 1 SD was associated with an increase in the risk of MS by 41% [7]. The mechanisms underlying the increased risk of MS caused by overweight and obese conditions are still not fully explained. Nonetheless, the research indicates that obesity may constitute a factor in the development of MS by means of at least 3 common pathophysiological pathways: chronic inflammation related to increased concentrations of many pro-inflammatory cytokines (e.g. IL-6, IL-1β, TNF-α, IFN-γ, and CRP); disrupted adipokine production (e.g. leptin and adiponectin); and changes in the intestinal microbiome [10–12]. Furthermore, some authors have indicated that obesity may increase the risk of MS, leading to a decreased bioavailability of vitamin D, while in turn, a low concentration of vitamin D correlates with a pro-inflammatory state [13, 14]. However, other studies have not confirmed this relationship [15]. Marck et al. stated that the correlations between the BMI, comorbidities, and health results in individuals with MS may be bidirectional and related to the person’s lifestyle [16]. Consequently, an increased BMI may result from limited physical activity due to the progressive physical disability in patients with MS [17]. Aim of the research The aim of this study was to assess the lifestyle and health of adult individuals with MS, according to their relative body mass (BMI). Material and methods The study participants comprised 115 individuals with MS aged 20–65 years, including 87 (75.8%) women. The study was conducted at the Neurological Clinic in Kielce, Poland between October 2020 and January 2021. The study encompassed anthropometric measurements, an analysis of the biochemical blood parameters, functional tests, and an assessment of each of the participant’s lifestyle. The study was conducted with the approval of the Bioethics Committee of the Collegium Medicum at the Jan Kochanowski University in Kielce No. 24/2020 from 25 April 2020. The information about the form of MS, age of diagnosis, and comorbidities (including autoimmune diseases, cardiovascular diseases, and diabetes, as well as their treatment) was obtained from the participants’ medical records. The glucose concentration in the blood serum was determined by the enzymatic method with glucose oxidase. The concentration of triglycerides was determined by means of the phosphogliceride oxidaseperoxidase method and HDLcholesterol – by direct method with polyethylene glycol-modified enzymes. The laboratory tests were performed with a BS-200E MINDRAY instrument. Serum biotin and 25(OH)D concentrations were determined by enzyme immunoassay method with an Access 2 Beckman Coulter analyser. Blood pressure was measured with an Omron blood pressure monitor (model M3 Intellisense). The test was carried out on the artery of the right upper limb, when seated, and the average of 2 measurements was used in analyses. The measurements of body weight were done by means of an electronic scale (Tanita MC-780MA-N). Body height measurements were done by means of the scale’s stadiometer. Non-elastic tape was used to measure waist circumference (WC) at a point midway between the lowest rib and the upper iliac crest. The Expanded Disability Status Scale (EDSS) was used to measure the degree of disability [18], and the participants were divided into 2 groups: < 4 points and ≥ 4 points (up to 6.5 points). The functional ability of the lower limbs was assessed using the timed 25-foot walk (T25FW). For the T25-FW, patients were instructed to walk as fast as they could in a safe manner along a marked 25-foot (7.6-m) course. This test was performed twice, and the obtained times were averaged. The functional ability of the upper limbs was assessed using the 9-hole peg test (9-HPT), in which each participant inserted 9 pegs into holes in a container and then pulled them out one by one as quickly as possible. Hand grip strength was measured in a sitting position, with the arm flexed at the elbow. The test was performed twice with each hand, and the absolute score (the sum of the strength of the right and left hand) and relative strength (strength relative to the body mass) were used for the analysis. The test was performed using a 290-lb/90-kg Kyto handheld dynamometer. The dietary habits of the participants were assessed using the KomPAN questionnaire, which is validated for individuals aged 15–65 years [19]. Thirty-four questions concerning how frequently the participants consumed 34 different food products, including drinks and alcohol, were used in the analysis. Each of the 6 categories of answers (from the lowest to the highest frequency of consumption) was transformed and presented as the number of times per day, Edyta Suliga, Elżbieta Cieśla, Elżbieta Jasińska, Katarzyna Gołuch, Stanisław Głuszek 142 Medical Studies/Studia Medyczne 2022; 38/2 in accordance with the procedure proposed by the authors of the questionnaire. Data concerning lifestyle and socioeconomic status were also collected using the KomPAN questionnaire. The declared sleep time was classified as ≤ 6, 7–8, or ≥ 9 h per day. Physical activity was assessed using the short version of the International Physical Activity Questionnaire (IPAQ). The participants were asked about the number of days and the time they had spent performing physical activity of different intensities (vigorous, moderate, and light) and sitting during the preceding 7 days. In accordance with the recommended protocol for the data analysis, the intensity of physical activity was expressed in units of the metabolic equivalent of task (MET) by multiplying the coefficient ascribed to each activity by the related number of minutes and days (MET-min/week). Afterwards, the participants were cl