Abstract
Background: Multiple Sclerosis (MS) is an autoimmune disease affecting the central nervous system. At present there is no known medical or dietary intervention which can significantly improve MS. However, other health issues (CVD, obesity, malnutrition) can be influenced by diet and have been frequently reported in the MS population. Symptoms such as; walking impairment, bladder and bowel dysfunction, depression, visual impairment, pain, fatigue, tremors and muscle weakness can interfere with the ability to prepare meals. This means that some individuals require assistance with meal preparation. Therefore, the primary aim of this study is to investigate the current dietary patterns of people with MS. It will also investigate if differences exist in the dietary patterns of those who prepare meals independently or with assistance, the prevalence of alternative diets and the impact of dietary patterns. Finally, this study will look at where individuals with MS obtain their nutritional advice.
Design: Participants (n=145) were recruited through the 18 MS societies in New Zealand. Participants completed an anonymous, self-administered, online questionnaire. This included demographics questions, a 57-item Food Frequency Questionnaire (FFQ) and questions surrounding meal preparation (prepared independently or with assistance), alternative diet use and sources of dietary information. Principal component analysis (PCA) was used to determine dietary patterns and independent samples t-test was used to identify associations with meal preparation behaviour and alternative diets tried.
Results: The three main dietary patterns identified were; ‘fast foods and processed meat’, ‘lean meat, fruit and vegetables’ and ‘sweet foods, sweet drinks and alcohol’. The fast foods and processed meats pattern was significantly more likely to be consumed by individuals who had lunch (p=0.024) and snacks (p=0.005) with preparation assistance. Conversely, the sweet foods, sweet drinks and alcohol pattern was significantly more likely to be consumed by individuals who prepared snacks independently (p=0.030). At least 71% of the study population had tried an alternative diet. The fast foods and processed meats pattern was significantly less likely to be consumed by individuals who had tried a dairy free diet (p=<0.001), gluten free diet (p=0.024), MS recovery diet (p=0.003), vegan diet (p=0.005), vegetarian diet (p=0.007) and/or Swank diet (p=0.042). Those who tried the Swank diet were significantly more likely to consume the sweet foods, sweet drinks and alcohol pattern (p=0.048). Internet was the leading source of dietary advice (43%), followed by MS society (36%), family/friends (30%) and dietitian/nutritionist (21%).
Conclusion: This study indicates that individuals with MS in NZ have different dietary patterns depending on who was involved in meal preparation. It appears that meals prepared with assistance for lunch and snacks are high in fat, sugar and unrefined carbohydrates and care assistants should be involved in nutrition intervention. There is a need for dietary advice for both those who prepare meals independently and with assistance, but with a different emphasis. Individuals following alternative diets are less likely to consume the foods from the fast foods and processed meats pattern. This is possibly because they are more health conscious, educated and interested in nutrition. Individuals consuming the Swank diet could possibly benefit from nutrition advice as it appears that consumption of high fat foods is decreased, and the consumption of sugar dense foods is increased. Internet and family/friends could be potential sources of misleading or confusing information, but MS societies could be an appropriate channel for nutrition advice. The present study contributes to the development of foundations for investigating the dietary intakes and generating targeted health education messages in the NZ MS population.