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Gauthier H, Zedet M, Wahab A, Baldé S, Bapst B, Lafont C, Créange A. Metabolic syndrome and the phenotype of multiple sclerosis. Rev Neurol (Paris) 2024; 180:673-681. [PMID: 38729781 DOI: 10.1016/j.neurol.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Comorbidities, particularly vascular comorbidities, have been shown to exacerbate the progression of disability in multiple sclerosis (MS). Metabolic syndrome (MetS) is a cluster of conditions including abdominal obesity, insulin resistance, atherogenic dyslipidemia, and vascular dysfunction, which contribute to vascular morbidity and chronic inflammation. OBJECTIVE To describe the characteristics of MetS in a cohort of MS patients and evaluate its relationship with the MS phenotype. METHODS A monocentric cohort study was conducted on MS patients, collecting demographic, clinical, radiological, and therapeutic data, as well as metabolic data including waist circumference, blood pressure, serum triglycerides, high-density lipoprotein cholesterol, and fasting blood glucose. RESULTS Among the 84 patients included in the study, 27% were diagnosed with MetS. MetS was found to be associated with secondary progressive MS (SPMS). Patients with SPMS had a higher prevalence of MetS compared to those with relapsing-remitting MS (RRMS), even after adjusting for disease duration. While MetS was associated with Expanded Disability Status Scale (EDSS) progression in the 3-year period according to univariate analysis, it did not show a significant association with disease activity. CONCLUSION This study provides evidence supporting the connection between MetS and the progression of disability in MS, independent of disease relapse activity.
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Affiliation(s)
- H Gauthier
- Service de neurologie, hôpital Henri-Mondor, centre hospitalier universitaire Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; CRC SEP Grand-Paris-Est, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - M Zedet
- Service de neurologie, hôpital Henri-Mondor, centre hospitalier universitaire Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; CRC SEP Grand-Paris-Est, hôpital Henri-Mondor, AP-HP, Créteil, France; EA4391, université Paris-Est, Créteil, France
| | - A Wahab
- Service de neurologie, hôpital Henri-Mondor, centre hospitalier universitaire Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; CRC SEP Grand-Paris-Est, hôpital Henri-Mondor, AP-HP, Créteil, France; EA4391, université Paris-Est, Créteil, France
| | - S Baldé
- CRC SEP Grand-Paris-Est, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - B Bapst
- EA4391, université Paris-Est, Créteil, France; Service de neuroradiologie, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - C Lafont
- IMRB, Inserm, université Paris-Est-Créteil, 94010 Créteil, France; Service de santé publique, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - A Créange
- Service de neurologie, hôpital Henri-Mondor, centre hospitalier universitaire Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; CRC SEP Grand-Paris-Est, hôpital Henri-Mondor, AP-HP, Créteil, France; EA4391, université Paris-Est, Créteil, France.
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Doskas T, Dardiotis E, Vavougios GD, Ntoskas KT, Sionidou P, Vadikolias K. Stroke risk in multiple sclerosis: a critical appraisal of the literature. Int J Neurosci 2023; 133:1132-1152. [PMID: 35369835 DOI: 10.1080/00207454.2022.2056459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Observational studies suggest that the occurrence of stroke on multiple sclerosis (MS) patients is higher compared to the general population. MS is a heterogeneous disease that involves an interplay of genetic, environmental and immune factors. The occurrence of stroke is subject to a wide range of both modifiable and non-modifiable, short- and long-term risk factors. Both MS and stroke share common risk factors. The immune mechanisms that underlie stroke are similar to neurodegenerative diseases and are attributed to neuroinflammation. The inflammation in autoimmune diseases may, therefore, predispose to an increased risk for stroke or potentiate the effect of conventional stroke risk factors. There are, however, additional determinants that contribute to a higher risk and incidence of stroke in MS. Due to the challenges that are associated with their differential diagnosis, the objective is to present an overview of the factors that may contribute to increased susceptibility or occurrence of stroke in MSpatients by performing a review of the available to date literature. As both MS and stroke can individually detrimentally affect the quality of life of afflicted patients, the identification of factors that contribute to an increased risk for stroke in MS is crucial for the prompt implementation of preventative therapeutic measures to limit the additive burden that stroke imposes.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Giannopapas V, Palaiodimou L, Kitsos D, Papagiannopoulou G, Stavrogianni K, Chasiotis A, Kosmidou M, Tzartos JS, Paraskevas GP, Bakalidou D, Tsivgoulis G, Giannopoulos S. The Prevalence of Diabetes Mellitus Type II (DMII) in the Multiple Sclerosis Population: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4948. [PMID: 37568348 PMCID: PMC10420178 DOI: 10.3390/jcm12154948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Introduction: The interactions between Diabetes Mellitus type II (DMII) and Multiple Sclerosis (MS) lead to higher levels of fatigue, higher risk of physical disability, faster cognitive decline, and in general a lower quality of life and a higher frequency of depression compared to the general population. All of the above accelerate the disability progression of patients with MS, reduce the patients' functional capacity, and further increase their psychological and economic burden. Methods: This systematic review and meta-analysis aims to calculate the prevalence of DMII in the MS population. Following PRISMA guidelines, a thorough search of the Medline Pubmed, Cochrane Library, and Scopus databases was performed, focusing on the frequency of DMII in the MS population. Results: A total of 19 studies were included in the synthesis. The results of the main meta-analysis of random effects using R studio 3.3.0 for Windows and the Meta r package showed that the prevalence of DMII in the MS population is 5% (95% CI [0.03, 0.07], 19 studies, I2 = 95%, pQ < 0.001). Additional subgroup analysis based on region showed a difference of 4.4% (I2 = 95.2%, pQ < 0.001), psubgroupdifference = 0.003) between European and non-European participants, while demographic- and MS-specific characteristic (EDSS, Disease Duration) did not seem to affect the prevalence of DMII in the MS population (p = 0.30, p = 0.539, p = 0.19, p = 0.838). No publication bias was discovered (Egger's p test value: 0.896). Conclusions: Even though the prevalence of DMII in the MS population is lower than 10% (the reported prevalence of DMII in the general population) the interactions between the two conditions create significant challenges for MS patients, their caregivers, and physicians. DΜΙΙ should be systematically recorded in the case of MS patients to clearly delineate any potential relationship between the two conditions. Additionally, more structured studies investigating the interactions of MS and DMΙΙ as well as the direction of the causation between those two conditions are necessary in order to gain a deeper insight into the nature of the interaction between MS and DMII.
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Affiliation(s)
- Vasileios Giannopapas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
- Physical Therapy Department, University of West Attica, 12210 Athens, Greece;
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (Lanecasm), 12243 Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - Dimitrios Kitsos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - Georgia Papagiannopoulou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - Konstantina Stavrogianni
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
- Department of Physiology, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Athanasios Chasiotis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
- Physical Therapy Department, University of West Attica, 12210 Athens, Greece;
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (Lanecasm), 12243 Athens, Greece
| | - Maria Kosmidou
- Department of Internal Medicine, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece;
| | - John S. Tzartos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - George P. Paraskevas
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - Daphne Bakalidou
- Physical Therapy Department, University of West Attica, 12210 Athens, Greece;
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (Lanecasm), 12243 Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
| | - Sotirios Giannopoulos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National & Kapodistrian University of Athens, 15784 Athens, Greece; (V.G.); (L.P.); (G.P.); (K.S.); (A.C.); (J.S.T.); (G.P.P.); (G.T.)
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Silva AS, Guimarães J, Sousa C, Mendonça L, Soares-Dos-Reis R, Mendonça T, Abreu P, Sequeira L, Sá MJ. Metabolic syndrome parameters and multiple sclerosis disease outcomes: A Portuguese cross-sectional study. Mult Scler Relat Disord 2023; 69:104370. [PMID: 36401965 DOI: 10.1016/j.msard.2022.104370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/31/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Metabolic syndrome and multiple sclerosis [MS] share the presence of chronic inflammation in their pathogenic mechanisms. This study aimed to estimate the prevalence of metabolic syndrome parameters in MS and their association with disease disability, cognitive function, and Neurofilament Light chain [NfL] levels. METHODS Clinical, analytical, and magnetic resonance imaging data were obtained through medical records. Disease disability was measured by the Expanded Disability Status Scale [EDSS], the MS Severity Scale [MSSS] along with cognitive impairment by the Brief International Cognitive Assessment for MS [BICAMS] and Word List Generation test [WLG]. Metabolic syndrome parameters were evaluated by fasting blood glucose, triglycerides, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol, total cholesterol, blood pressure, and waist circumference [WC]. We also analysed serum leptin and ghrelin and cerebrospinal fluid NfL. RESULTS Our sample included 51 people with MS, 34 (66.7%) females, mean age of 38.20±12.12 years and median disease duration of 3 years (P25=2.0, P75=5.0). Multivariate linear regression analysis confirmed that WC correlates with EDSS (β=0.04, p=.001) and MSSS (β=0.07, p=.002) as well as Brief Visuospatial Memory Test-Revised (β=-0.29, p=.008), WLG (β=-0.20, p=.039). NfL is also negatively associated with HDL-C (β=-4.51, p=.038). CONCLUSIONS Waist circumference is associated with disability and deficits in cognitive tests. A decrease in HDL-C is associated with an increase in NfL. This suggests metabolic syndrome might be an important factor in MS disease course.
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Affiliation(s)
- Ana Sofia Silva
- Faculty of Medicine of the University of Porto, Al. Prof. Hernâni Monteiro, Porto 4200-319, Portugal.
| | - Joana Guimarães
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Portugal; Center for Drug Discovery and Innovative Medicines (MedInUP), University of Porto, Portugal
| | - Cláudia Sousa
- Neuropsychological Unit, Department of Psychology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Liliana Mendonça
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ricardo Soares-Dos-Reis
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Portugal; i3S, University of Porto, Portugal
| | - Teresa Mendonça
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Pedro Abreu
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Portugal
| | - Lucinda Sequeira
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Maria José Sá
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
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Neurogenic Bladder:. Urol Clin North Am 2022; 49:519-532. [DOI: 10.1016/j.ucl.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Farzinmehr S, Hosseini S, Kamali H, Moghadasi AN, Poursadeghfard M, Sharifi MH. Association of self-reported adherence to the Mediterranean diet with anthropometric indices, comorbidities, and degree of disability in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 66:104060. [PMID: 35908448 DOI: 10.1016/j.msard.2022.104060] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/28/2022] [Accepted: 07/15/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND One of the important challenges in the treatment of patients with multiple sclerosis (MS) is determining the effective factors in the treatment of MS, including dietary adherence. The aim of this study was to investigate the relationship between adherence to the Mediterranean diet with anthropometric indices and the expanded disability status scale (EDSS) scores in patients with MS. MATERIAL AND METHODS The present multicenter and cross-sectional study was conducted on patients with clinically definite MS (according to the 2017 revised McDonald criteria) who were referred to the MS clinics at medical centers affiliated to Shiraz and Tehran Universities of Medical Sciences during 2019. Disease phenotype, EDSS, waist circumference (WC), body mass index (BMI), and comorbidities were assessed. Adherence to the Mediterranean diet was measured with a 14-item modified Mediterranean Diet Adherence Questionnaire. In this questionnaire, a score of 0-5 indicates low adherence, a score of 6-9 shows moderate adherence, and a score of 10 and above demonstrates high adherence (healthy eating pattern). RESULTS This study was performed on 478 patients with a mean age of 37.99 ± 9.60 years, out of which 352 patients (73.6%) were female. The percentage of low, medium, and high adherence to the Mediterranean diet in patients with MS was 26.4%, 64%, and 9.6%, respectively. The difference in the level of education between the groups based on adherence to the Mediterranean diet was statistically significant. Low adherence to the Mediterranean diet in underweight, normal, and overweight patients was, respectively, 1.31, 1.32, and 2.29 times higher than in obese patients. This increased risk was only significant in overweight patients (P = 0.019). The results revealed that the score of adherence to the Mediterranean diet had no significant relationship with mild (2.86 ± 2.18), moderate (2.76 ± 2.16), and severe (2.70 ± 2.02) levels of disability. CONCLUSION The level of adherence to the Mediterranean diet in Iranian patients with MS was moderate. This level was associated with BMI, such that low adherence to the Mediterranean diet was higher in overweight patients than obese patients.
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Affiliation(s)
- Somaye Farzinmehr
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Hosseini
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hoda Kamali
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Poursadeghfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Hossein Sharifi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Gruber N, Haham LM, Raanani H, Cohen Y, Gabis L, Berkenstadt M, Ries-Levavi L, Elizur S, Pinhas-Hamiel O. Female fragile X premutation carriers are at increased risk for metabolic syndrome from early adulthood. Nutr Metab Cardiovasc Dis 2022; 32:1010-1018. [PMID: 35086765 DOI: 10.1016/j.numecd.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/20/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Women with primary ovarian insufficiency exhibit an unfavorable cardiovascular risk profile. A common cause for primary ovarian insufficiency is fragile X premutation (FXPC), and data on the cardiovascular risk factors in women with FXPC are scarce. We aimed to assess the prevalences of abnormal metabolic components among FXPC. METHODS AND RESULTS Clinical, anthropometric and laboratory data were collected from 71 women with FXPC and compared to 78 women referred for counseling in an in-vitro fertilization clinic (control group). The mean ± SD ages of the FXPC and control groups were 33.5 ± 5.6 and 36.2 ± 5.3 years, respectively (p = 0.003). In a logistic regression analysis, the FXPC group had increased risks for hyperglycemia, hypertriglyceridemia, central obesity and low high-density lipoprotein cholesterol, of 21.8-fold (95% CI 2.7-175, p = 0.004), 6.9-fold (95% CI 2.5-18.7, p < 0.0001), 3.1-fold (95% CI 1.4-6.9, p = 0.005) and 2.4-fold (95% CI 1.1-5.2, p = 0.03), compared to the control group. The FXPC group had 2.7-fold higher prevalence of two abnormal metabolic components; 19% met the full criteria of MetS, compared to 3% of the control group. Neither CGG repeats nor ovarian reserve markers were associated with metabolic risk. CONCLUSIONS Carriers of fragile X premutation are at increased metabolic risk from early adulthood; waist circumference, glucose and lipid levels are particularly elevated. We recommend metabolic screening for all women with FMR1 premutation, to enable early interventions for prevention of long-term cardiovascular comorbidities.
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Affiliation(s)
- Noah Gruber
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | | | - Hila Raanani
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; IVF Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Yoram Cohen
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; IVF Unit, Sheba Medical Center, Ramat Gan, Israel
| | - LidiaV Gabis
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Child Development Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Michal Berkenstadt
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Ramat Gan, Israel
| | - Liat Ries-Levavi
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Ramat Gan, Israel
| | - Shai Elizur
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; IVF Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Xu Y, Bao L, Liu C. The Relationship Between Blood Lipid and Attention-Deficit/Hyperactivity Disorder (ADHD) in an Obese Population of Chinese Children: An Obesity-Stratified Cross-Sectional Study. Int J Gen Med 2021; 14:10503-10509. [PMID: 35002306 PMCID: PMC8722542 DOI: 10.2147/ijgm.s333247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although obesity has been related to attention-deficit/hyperactivity disorder (ADHD), few studies have examined the relationship between blood lipid levels and ADHD in children. We aimed to evaluate whether increased blood lipid levels are associated with the prevalence of ADHD in children. METHODS A total of 1179 children were studied in the cross-sectional analysis. Multivariate logistic regression and linear regression analyses were performed to evaluate the association of blood lipid levels with the prevalence of ADHD in children. RESULTS In 1179 children, the average age was 10.4 years, and the percentage of boys was 50.3%. 97 (8.2%) of the children were diagnosed with ADHD. The logistic regression analysis demonstrated that elevated levels of total cholesterol (OR=2.001, 95% CI 1.247-3.541, P-trend=0.024), triglycerides (OR=1.776, 95% CI 1.448-2.187, P-trend=0.003) and LDL (low density lipoprotein; OR=2.016, 95% CI 1.335-3.966, P-trend<0.001) and reduced levels of HDL (high density lipoprotein; OR=0.577, 95% CI 0.298-0.948, P-trend=0.023) were associated with the prevalence of ADHD after adjustments were made for age, sex, body mass index (BMI), residence type, maternal smoking during pregnancy, breastfeeding and breastfeeding length, maternal and paternal educational levels, and marital status of parents in Model 3. The stratified analysis using "obese" as a covariate showed that elevated levels of total cholesterol, triglycerides and LDL and reduced levels of HDL were independently associated with an increased risk of ADHD in obese children. CONCLUSION Increased blood lipid levels were associated with ADHD in obese children.
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Affiliation(s)
- Yan Xu
- Huai ‘an Maternal and Child Health Hospital, Huai’an City, 223000, Jiangsu Province, People’s Republic of China
| | - Lijuan Bao
- Huai ‘an Maternal and Child Health Hospital, Huai’an City, 223000, Jiangsu Province, People’s Republic of China
| | - Chengquan Liu
- Huai ‘an Maternal and Child Health Hospital, Huai’an City, 223000, Jiangsu Province, People’s Republic of China
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Rube J, Bross M, Bernitsas C, Hackett M, Bao F, Bernitsas E. Effect of Obesity on Retinal Integrity in African Americans and Caucasian Americans With Relapsing Multiple Sclerosis. Front Neurol 2021; 12:743592. [PMID: 34899566 PMCID: PMC8651698 DOI: 10.3389/fneur.2021.743592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: To study the effect of obesity on retinal structures in African Americans (AAs) and Caucasian Americans (CAs) with relapsing-remitting multiple sclerosis (RRMS). Methodology: About 136 patients with RRMS without history of optic neuritis were divided into two groups, based on body mass index (BMI): 67 obese (40 AA, 27 CA, mean BMI ± SD: 36.7 ± 5.8), and 69 non-obese (23 AA, 46 CA, mean BMI ± SD: 24.0 ± 3.1). The peripapillary retinal nerve fiber layer (pRNFL) thickness was quantified by optical coherence tomography (OCT) and was segmented into quadrant thickness: superior (S), inferior (I), temporal (T), and nasal (N). Papillomacular bundle (PMB) thickness, retinal nerve fiber layer (RNFL), ganglion cell + inner plexiform layer (GCIPL), inner nuclear (INL), outer plexiform (OPL), outer nuclear (ONL), and total macular (TMV) volumes were obtained. Results: Obesity was associated with lower T thickness (58.54 ± 15.2 vs. 61.9 12.4, p = 0.044), higher INL (0.98 ± 0.07 vs. 0.96 ± 0.06, p = 0.034), and lower RNFL (0.77 ± 0.14 vs. 0.82 ± 0.12, p = 0.009) volumes. Obese AA had significantly thinner T (58.54 ± 15.19 vs. 61.91 ± 12.39, p = 0.033), N (68.94 ± 2.7 vs. 77.94 ± 3.3, p = 0.044), and TMV (8.15 ± 0.07 vs. 8.52 ± 0.09, p = 0.003), RNFL (0.74 ± 0.02 vs. 0.82 ± 0.02, p = 0.013), OPL (0.76 ± 0.01 vs. 0.79 ± 0.1, p = 0.050), ONL (1.68 ± 0.031 vs. 1.79 ± 0.038, p = 0.026), and GCIPL (1.78 ± 0.04 vs. 1.9 ± 0.05, p = 0.038) compared to obese CA. Among patients with non-obesity, the ONL was significantly lower in AA (1.78 ± 0.04 vs. 1.9 ± 0.05, p < 0.001). Conclusions: Obesity is associated with retinal structure abnormalities in patients with RRMS. Its impact might be more prominent in AA than CA. Large longitudinal studies are needed to validate our findings.
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Affiliation(s)
- Jacob Rube
- Wayne State University School of Medicine and University Health Center, Detroit, MI, United States
| | - Madeline Bross
- Wayne State University School of Medicine and University Health Center, Detroit, MI, United States
| | | | - Melody Hackett
- PPD Regional, Clinical Operations, Detroit, MI, United States
| | - Fen Bao
- Wayne State University Imaging Laboratory and Sastry Foundation Imaging Initiative, Detroit, MI, United States
| | - Evanthia Bernitsas
- Wayne State University School of Medicine and University Health Center, Detroit, MI, United States.,Wayne State University Imaging Laboratory and Sastry Foundation Imaging Initiative, Detroit, MI, United States
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10
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Hauer L, Perneczky J, Sellner J. A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications. J Neurol 2021; 268:4066-4077. [PMID: 32719975 PMCID: PMC8505322 DOI: 10.1007/s00415-020-10107-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system which is associated with numerous comorbidities. These include cardiovascular disease, psychiatric and neurologic disturbances, restless leg syndrome, migraine, cancer, autoimmune diseases, and metabolic disorders. Comorbid disease is an important consideration for clinicians treating patients with MS; early presentation of comorbidities can obscure or delay MS diagnosis, as well as significantly impacting the disease course. Improved understanding of comorbidities and their emergence in MS populations is important for improving the quality of life and optimizing treatment for patients. Therefore, we evaluated published studies reporting epidemiologic data on comorbidities and their associated impact on disease progression in patients with MS (PwMS). The prevalence of neurologic, cardiovascular, metabolic, and autoimmune comorbidities was elevated in PwMS in general, and furthermore, this adversely affected a broad range of outcomes. Compared with PwMS, cancer rates in people without MS or the general population were lower, which should prompt further studies into the mechanisms of both diseases. Studies were under-represented in many regions owing to the latitudinal gradient of MS and possible underfunding of studies.
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Affiliation(s)
- Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Julian Perneczky
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstrase 67, 2130, Mistelbach, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstrase 67, 2130, Mistelbach, Austria.
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
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11
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Obesity and Multiple Sclerosis-A Multifaceted Association. J Clin Med 2021; 10:jcm10122689. [PMID: 34207197 PMCID: PMC8234028 DOI: 10.3390/jcm10122689] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/30/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Given the common elements in the pathophysiological theories that try to explain the appearance and evolution of obesity and multiple sclerosis, the association between the two pathologies has become an increasingly researched topic in recent years. On the one hand, there is the chronic demyelinating inflammation caused by the autoimmune cascade of multiple sclerosis, while on the other hand, according to the latest research, it has been shown that obesity shares an inflammatory component with most chronic diseases. METHODS The authors performed independent research of the available literature in the most important electronic databases (PubMed, Google Scholar, Embase, and Science Direct) in February 2021. After applying the exclusion criteria, the reviewers focused on the most relevant articles published during the last 10 years with respect to epidemiology and pathophysiology. RESULTS The data presented are a step forward in trying to elucidate the intricate relationship between obesity and MS, especially the causal relationship between childhood and adolescent obesity and MS, focusing on the epidemiological associations observed in the most relevant observational studies conducted in recent years. In the second part, the authors comment on the latest findings related to the pathophysiological mechanisms that may explain the correlations between obesity and multiple sclerosis, focusing also on the role of adipokines. CONCLUSIONS Based on available epidemiological data, obesity in early life appears to be strongly associated with a higher risk of MS development, independent of other risk factors. Although much research has been done on the pathophysiology of obesity, MS, their possible common mechanism, and the role of adipokines, further studies are needed in order to explain what remains unknown. No relevant data were found regarding the association between obesity, disability (high EDSS score), and mortality risk in MS patients. Thus, we consider that this topic should be elucidated in future research.
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12
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Signoriello E, Mallardo M, Nigro E, Polito R, Casertano S, Di Pietro A, Coletta M, Monaco ML, Rossi F, Lus G, Daniele A. Adiponectin in Cerebrospinal Fluid from Patients Affected by Multiple Sclerosis Is Correlated with the Progression and Severity of Disease. Mol Neurobiol 2021; 58:2663-2670. [PMID: 33486671 PMCID: PMC8128828 DOI: 10.1007/s12035-021-02287-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
Adiponectin exerts relevant actions in immunity and is modulated in several disorders, such as multiple sclerosis (MS). In this study, we characterized adiponectin expression and profiles in cerebrospinal fluid (CSF) from MS patients to investigate its potential relationship with the severity and progression of the disease. Total adiponectin in CSF was measured by ELISA in 66 unrelated CSF MS patients and compared with 24 age- and sex-matched controls. Adiponectin oligomer profiles were analysed by Western blotting and FPLC chromatography. Total CSF adiponectin was significantly increased in MS patients compared with controls (9.91 ng/mL vs 6.02 ng/mL) (p < 0.001). Interestingly, CSF adiponectin positively correlated with CSF IgG, and CSF/serum albumin directly correlated with CSF/serum adiponectin. Our data demonstrated that CSF adiponectin predicts a worse prognosis: patients with the progressive form of MS had higher levels compared with the relapsing remitting form; patients with higher EDSS at baseline and a higher MS severity score at 4.5-year follow-up had significantly elevated adiponectin levels with respect to patients with a less severe phenotype. Finally, the adiponectin oligomerization profile was altered in CSF from MS patients, with a significant increase in HMW and MMW. The correlation of CSF adiponectin with the severity and prognosis of MS disease confirmed the role of this adipokine in the inflammatory/immune processes of MS and suggested its use as a complementary tool to assess the severity, progression and prognosis of the disease. Further studies on larger MS cohorts are needed to clarify the contribution of adiponectin to the etiopathogenesis of MS.
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Affiliation(s)
- Elisabetta Signoriello
- Centro di Sclerosi Multipla, II Clinica Neurologica, Università della Campania "Luigi Vanvitelli", Via S. Pansini 5, 80131, Naples, Italy
| | - Marta Mallardo
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania, "Luigi Vanvitelli", Via G. Vivaldi 42, 81100, Caserta, Italy
- CEINGE-Biotecnologie Avanzate Scarl, Via G. Salvatore 486, 80145, Naples, Italy
| | - Ersilia Nigro
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania, "Luigi Vanvitelli", Via G. Vivaldi 42, 81100, Caserta, Italy
- CEINGE-Biotecnologie Avanzate Scarl, Via G. Salvatore 486, 80145, Naples, Italy
| | - Rita Polito
- CEINGE-Biotecnologie Avanzate Scarl, Via G. Salvatore 486, 80145, Naples, Italy
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli "Federico II", via Pansini 5, 80145, Naples, Italy
| | - Sara Casertano
- Centro di Sclerosi Multipla, II Clinica Neurologica, Università della Campania "Luigi Vanvitelli", Via S. Pansini 5, 80131, Naples, Italy
| | - Andrea Di Pietro
- Centro di Sclerosi Multipla, II Clinica Neurologica, Università della Campania "Luigi Vanvitelli", Via S. Pansini 5, 80131, Naples, Italy
| | - Marcella Coletta
- Centro di Sclerosi Multipla, II Clinica Neurologica, Università della Campania "Luigi Vanvitelli", Via S. Pansini 5, 80131, Naples, Italy
| | | | - Fabiana Rossi
- Centro di Sclerosi Multipla, II Clinica Neurologica, Università della Campania "Luigi Vanvitelli", Via S. Pansini 5, 80131, Naples, Italy
| | - Giacomo Lus
- Centro di Sclerosi Multipla, II Clinica Neurologica, Università della Campania "Luigi Vanvitelli", Via S. Pansini 5, 80131, Naples, Italy
| | - Aurora Daniele
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania, "Luigi Vanvitelli", Via G. Vivaldi 42, 81100, Caserta, Italy.
- CEINGE-Biotecnologie Avanzate Scarl, Via G. Salvatore 486, 80145, Naples, Italy.
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13
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Livne-Margolin M, Tokatly Latzer I, Pinhas-Hamiel O, Harari G, Achiron A. Bodyweight Measures and Lifestyle Habits in Individuals with Multiple Sclerosis and Moderate to Severe Disability. J Clin Med 2021; 10:2083. [PMID: 34066209 PMCID: PMC8151674 DOI: 10.3390/jcm10102083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/08/2021] [Accepted: 05/08/2021] [Indexed: 02/05/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic disease marked by progressive disability and decreased mobility over time. We studied whether individuals with MS of higher disability levels will be more overweight/obese as a result of their immobility and/or recurrent steroid treatments. In a prospective study, 130 individuals with MS and significant disability were classified according to the Expanded Disability Status Scale (EDSS) score as belonging to four groups: EDSS 3.0-4.0 (n = 31, 24%), EDSS 4.5-5.5 (n = 24, 18%), EDSS = 6.0 (n = 44, 34%) and EDSS ≥ 6.5 (n = 31, 24%). Medical history, body mass index (BMI), waist circumference and the level of engagement in physical activity were obtained. The mean ± standard error age was 55.8 ± 0.5 years, disease duration 18.2 ± 1.0 years and EDSS score 5.5 ± 0.1. Disease duration, the number of steroid courses per disease duration, weight, BMI and physical activity did not differ according to the four disability groups. The mean waist circumference increased significantly with increased severity of EDSS, p = 0.03. Increased disability in individuals with MS was not correlated with disease duration, lifestyle habits or overweight/obesity. However, increased disability was associated with central obesity.
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Affiliation(s)
- Moran Livne-Margolin
- Sackler School of Medicine, Tel-Aviv University, Ramat Aviv 69978, Israel; (M.L.-M.); (O.P.-H.); (A.A.)
- Gastroenterology Department, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Itay Tokatly Latzer
- Sackler School of Medicine, Tel-Aviv University, Ramat Aviv 69978, Israel; (M.L.-M.); (O.P.-H.); (A.A.)
- Pediatric Neurology Institute, Dana-Dwek Children’s Hospital, Tel Aviv Medical Center, Tel Aviv 60198, Israel
| | - Orit Pinhas-Hamiel
- Sackler School of Medicine, Tel-Aviv University, Ramat Aviv 69978, Israel; (M.L.-M.); (O.P.-H.); (A.A.)
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Gil Harari
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel;
| | - Anat Achiron
- Sackler School of Medicine, Tel-Aviv University, Ramat Aviv 69978, Israel; (M.L.-M.); (O.P.-H.); (A.A.)
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
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14
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Zanghì A, D'Amico E, Lo Fermo S, Patti F. Exploring polypharmacy phenomenon in newly diagnosed relapsing-remitting multiple sclerosis: a cohort ambispective single-centre study. Ther Adv Chronic Dis 2021; 12:2040622320983121. [PMID: 33717425 PMCID: PMC7923988 DOI: 10.1177/2040622320983121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/02/2020] [Indexed: 01/29/2023] Open
Abstract
Aims: We aimed to examine the frequency of polypharmacy in a large cohort of patients at the time of diagnosis of relapsing–remitting multiple sclerosis (RRMS) and to explore its effects on discontinuation of first disease-modifying treatment (DMT) using survival analysis. Methods: This was a cohort ambispective single-centre study. We enrolled RRMS patients starting their first DMT between 1st January 2013 and 31st December 2015. According to the number of medicines prescribed (except DMTs), we divided the patients into three groups: no-poly RRMS, minor-poly RRMS (from one to three medications), and major-poly RRMS (more than three medications). Results: A total of 392 RRMS patients were enrolled (mean age 41.1). The minor-poly RRMS group included 61 patients (15.6%) and the major-poly RRMS group included 112 (28.6%). Individuals in these groups were older and had higher median body mass index (BMI) than patients in the no-poly RRMS group (p < 0.05). Upon multinomial regression analysis, older age at onset was associated with minor and major polypharmacy (OR 1.050, CI 1.010–1.093, p = 0.015 and OR 1.063, CI 1.026–1.101, p = 0.001, respectively) and higher BMI was associated with major polypharmacy (OR 1.186, CI 1.18–1.29, p = 0.001). The rates of discontinuation of first DMT were similar among the three groups (50.7% for no-Poly RRMS, 50.8% for minor-Poly RRMS, and 53.3% for major-Poly RRMS, p = 0.264). At log-Rank test, there were no differences among the three groups (p = 0.834). Conclusion: Polypharmacy was more common in older RRMS patients with high BMI.
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Affiliation(s)
- Aurora Zanghì
- Department "G.F. Ingrassia"; University of Catania, Catania, Italy
| | - Emanuele D'Amico
- Department "G.F. Ingrassia", Policlinico G. Rodolico, V. Santa Sofia 78, Catania, 95123, Italy
| | | | - Francesco Patti
- Department "G.F. Ingrassia"; University of Catania, Catania, Italy
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15
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Hernández-Ledesma AL, Rodríguez-Méndez AJ, Gallardo-Vidal LS, García-Gasca T, Alatorre-Cruz JM, García-Solís P, López Reyes J, Solís-Saínz JC. Lipid profile: causal relationship on cognitive performance in multiple sclerosis? Mol Biol Rep 2020; 47:9667-9676. [PMID: 33259011 DOI: 10.1007/s11033-020-06011-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022]
Abstract
Although cognitive impairment (CI) is classically associated with aging, it has been proposed that neurological pathologies may increase the risk to suffer CI. Despite the evidence of an elevated prevalence of CI in patients with multiple sclerosis (MS), it is not considered among standard clinical evaluations, due the lack of specialists and time required. The aim of this study was to evaluate if lipid profile is associated with cognitive performance in persons with MS. Twenty patients with MS were evaluated. Montreal Cognitive Assessment (MoCA) was employed to determine cognitive performance. CI was observed in 85% of patients, with memory recall and language as the most affected domains. Despite biomarkers were mostly found within reference values, several correlations were observed. MoCA total score was correlated with cholesterol (r = - 0.468, p = 0.037) and LDL (r = - 0.453, p = 0.045). Visuospatial domain was correlated with LDL (r = - 0.493, p = 0.027). Attention domain correlated with triglycerides (r = - 0.455, p = 0.044) and cholesterol (r = - 0.549, p = 0.012). When the person reaches borderline levels of triglycerides, LDL and cholesterol a decrease in cognitive performance can be observed. The mechanism underlying this association has not been established still, it has been proposed that it could be linked with neuroinflammation, alterations in synapses and in the metabolism of amyloid-β protein. This study settles the potential importance that lipid profile could have on cognitive performance in MS. Further studies are needed to establish optimal levels and implication of lipid profile in the diagnosis and monitoring of cognitive performance in Mexican people with MS.
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Affiliation(s)
- Ana Laura Hernández-Ledesma
- Laboratorio de Neuroinmunoendocrinología, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel #200. Prados de la Capilla. CP 76170, Santiago de Querétaro, México
| | - Adriana Jheny Rodríguez-Méndez
- Laboratorio de Neuroinmunoendocrinología, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel #200. Prados de la Capilla. CP 76170, Santiago de Querétaro, México.
| | | | - Teresa García-Gasca
- Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Santiago de Querétaro, México
| | | | - Pablo García-Solís
- Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro, México
| | - Julián López Reyes
- Facultad de Medicina, Clínica del Sistema Nervioso, Universidad Autónoma de Querétaro, Santiago de Querétaro, México
| | - Juan Carlos Solís-Saínz
- Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro, México
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16
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Le CT, Khuat LT, Caryotakis SE, Wang M, Dunai C, Nguyen AV, Vick LV, Stoffel KM, Blazar BR, Monjazeb AM, Murphy WJ, Soulika AM. PD-1 Blockade Reverses Obesity-Mediated T Cell Priming Impairment. Front Immunol 2020; 11:590568. [PMID: 33193426 PMCID: PMC7658608 DOI: 10.3389/fimmu.2020.590568] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/22/2020] [Indexed: 01/22/2023] Open
Abstract
Despite obesity reaching pandemic proportions, its impact on antigen-specific T cell responses is still unclear. We have recently demonstrated that obesity results in increased expression of PD-1 on T cells, and checkpoint blockade targeting PD-1/PD-L1 surprisingly resulted in greater clinical efficacy in cancer therapy. Adverse events associated with this therapy center around autoimmune reactions. In this study, we examined the impact of obesity on T cell priming and on autoimmune pathogenesis using the mouse model experimental autoimmune encephalomyelitis (EAE), which is mediated by autoreactive myelin-specific T cells generated after immunization. We observed that diet-induced obese (DIO) mice had a markedly delayed EAE onset and developed milder clinical symptoms compared to mice on control diet (CD). This delay was associated with impaired generation of myelin-specific T cell numbers and concurrently correlated with increased PD-L1 upregulation on antigen-presenting cells in secondary lymphoid organs. PD-1 blockade during the priming stage of EAE restored disease onset and severity and increased numbers of pathogenic CD4+ T cells in the central nervous system (CNS) of DIO mice to similar levels to those of CD mice. Administration of anti-PD-1 after onset of clinical symptoms did not increase EAE pathogenesis demonstrating that initial priming is the critical juncture affected by obesity. These findings demonstrate that obesity impairs antigen-specific T cell priming, but this can be reversed with PD-1 blockade. Our results further suggest that PD-1 blockade may increase the risk of autoimmune toxicities, particularly in obesity.
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Affiliation(s)
- Catherine T Le
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Lam T Khuat
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Sofia E Caryotakis
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Marilyn Wang
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States.,Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Cordelia Dunai
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Alan V Nguyen
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States.,Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Logan V Vick
- Department of Radiation-Oncology, School of Medicine, Comprehensive Cancer Center, University of California, Davis, Sacramento, CA, United States
| | - Kevin M Stoffel
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Bruce R Blazar
- Masonic Cancer Center, and Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Arta M Monjazeb
- Department of Radiation-Oncology, School of Medicine, Comprehensive Cancer Center, University of California, Davis, Sacramento, CA, United States
| | - William J Murphy
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States.,Department of Internal Medicine, Division of Hematology and Oncology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Athena M Soulika
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States.,Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children Northern California, Sacramento, CA, United States
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17
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Fahmi RM, El Ebeary MES, Abd Alrasheed EM, Elkhatib THM. Metabolic syndrome components and disease disability in egyptian multiple sclerosis patients. Mult Scler Relat Disord 2020; 44:102336. [PMID: 32645641 DOI: 10.1016/j.msard.2020.102336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/09/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is limited and inconsistent data on metabolic syndrome (MetS) in multiple sclerosis (MS) patients. The aim of this study was to estimate the frequency of MetS and its components in MS patients and to evaluate their association with disease disability in Egyptian MS patients. METHODS A cross-section study was carried out on 60 patients (19 males and 41 females) with relapsing remitting MS. All patients were subjected to full general and neurological examination, laboratory and radiological investigations. Assessment of disease disability was performed using Expanded Disability Status Scale (EDSS) and MetS was diagnosed according to National Cholesterol Education Program Adult Treatment Panel Ш (NCEP-ATP III). RESULTS The frequency of MetS in MS patients was 36.7%. Our findings show that 53.3% of MS patients had abdominal obesity, 21.7% had hypertension, 38.3% had diabetes mellitus, 43.3% had elevated triglycerides level and 56.7% had dyslipidemia. Linear regression analysis revealed that body mass index (BMI), dyslipidemia, current medication and disease duration were significantly associated with disease disability. CONCLUSION High frequency of MetS and its component was observed in MS patients. Disease duration and current medication as well as some MetS component such as BMI, dyslipidemia, were significantly associated with disability in MS patients.
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Affiliation(s)
- Rasha M Fahmi
- Neurology Department, Faculty of Medicine, Zagazig University; Sharkia, Egypt.
| | | | | | - Takwa H M Elkhatib
- Neurology Department, Faculty of Medicine, Zagazig University; Sharkia, Egypt
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18
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Uzdil Z, Kaya S, Sökülmez Kaya P, Terzi M, Dünder E. The Effectiveness of New Adiposity Indices on Plasma Lipid Profile in Patients with Multiple Sclerosis: A Cross-Sectional Study with A Body Shape Index, Body Roundness Index, and Visceral Adiposity Index. Mult Scler Relat Disord 2020; 43:102214. [PMID: 32470861 DOI: 10.1016/j.msard.2020.102214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aimed to determine the effectiveness of three different indices used to identify the effect of visceral adiposity on lipid profile markers in patients with multiple sclerosis. METHODS The study consisted of a total of 152 patients with relapsing-remitting multiple sclerosis who were aged 18 years and older. High-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), total cholesterol (TC), and triglyceride (TG) were accessed from the patient system. Patients' height, body weight, waist circumference, and hip circumference measurements were also obtained. The effects of three different adiposity indices, including A Body Shape Index (ABSI), the Body Roundness Index (BRI), and the Visceral Adiposity Index (VAI), on plasma lipid profile in multiple sclerosis patients were evaluated. The data were analyzed using the R software and SPSS 21 statistical software package. RESULTS HDL-c was impacted by ABSI and VAI in males and only VAI in females (p < 0.05). An increase of 0.01 units of ABSI in males led to an increase of 5.88 mg/dL in plasma HDL-c level. In male patients with multiple sclerosis, LDL-c was positively affected by BRI and VAI changes (p < 0.05). One unit increase in BRI in males increased LDL-c level by 5.56 mg/dL, whereas 1 unit increase in VAI increased LDL-c level by 3.52 mg/dL (p < 0.05). CONCLUSION This study indicated that these three different indices employed to evaluate adiposity were associated with plasma lipid profile. The effect of VAI on plasma lipids is higher than that of the other indices. In patients with multiple sclerosis, the use of these practical and non-invasive indices will be useful in assessing plasma lipid profile.
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Affiliation(s)
- Zeynep Uzdil
- Ondokuz Mayıs University, Faculty of Health Sciences, Department of Nutrition and Dietetics.
| | - Seda Kaya
- Ankara University, Faculty of Health Sciences, Department of Nutrition and Dietetics
| | - Pınar Sökülmez Kaya
- Ondokuz Mayıs University, Faculty of Health Sciences, Department of Nutrition and Dietetics
| | - Murat Terzi
- Ondokuz Mayıs University, Faculty of Medicine, Department of Neurology
| | - Emre Dünder
- Ondokuz Mayıs University, Faculty of Science, Department of Statistics
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19
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Impact of insulin resistance and metabolic syndrome on disability in patients with multiple sclerosis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-0155-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Abstract
Background
Currently, little is known regarding the association of metabolic comorbidities and disability among multiple sclerosis (MS) patients.
Objectives
To evaluate insulin resistance (IR) and metabolic syndrome (MetS) in multiple sclerosis patients and their effect on disease progression and disability.
Subjects and methods
This case-control study was conducted on 50 MS patients and 25 healthy individuals. They were subjected to clinical evaluation and laboratory assessment for metabolic syndrome and insulin resistance. The homeostasis model assessment (HOMA) was used as a measurement of insulin sensitivity. Disability was evaluated by the Extended Disability Status Scale (EDSS).
Results
As compared to control group, MS patients had a significantly higher prevalence of metabolic syndrome (22% vs 8%, p = 0.04) and insulin resistance (46% vs 0%, p < 0.001). Patients group had significantly higher systolic blood pressure (p = 0.005), waist circumference (p < 0.001), fasting blood sugar (p < 0.001), insulin level (p = 0.001), low-density lipoproteins (p = 0.01), triglycerides (p = 0.02), HOMA-IR (p < 0.001), and significantly lower high-density lipoproteins (p = 0.01). No differences in neurological disability was reported between patients who have MetS (p = 0.7) or IR (p = 0.3) and those who do not.
Conclusion
Insulin resistance and metabolic syndrome are more prevalent among MS patients; however, their association with disability and disease progression is questionable.
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Flauzino T, Simão ANC, de Carvalho Jennings Pereira WL, Alfieri DF, Oliveira SR, Kallaur AP, Lozovoy MAB, Kaimen-Maciel DR, Maes M, Reiche EMV. Disability in multiple sclerosis is associated with age and inflammatory, metabolic and oxidative/nitrosative stress biomarkers: results of multivariate and machine learning procedures. Metab Brain Dis 2019; 34:1401-1413. [PMID: 31302813 DOI: 10.1007/s11011-019-00456-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 07/03/2019] [Indexed: 12/17/2022]
Abstract
The aim of this study was to evaluate the immune-inflammatory, metabolic, and nitro-oxidative stress (IM&NO) biomarkers as predictors of disability in multiple sclerosis (MS) patients. A total of 122 patients with MS were included; their disability was evaluated using the Expanded Disability Status Scale (EDSS) and IM&NO biomarkers were evaluated in peripheral blood samples. Patients with EDSS ≥3 were older and showed higher homocysteine, uric acid, advanced oxidized protein products (AOPP) and low-density lipoprotein (LDL)-cholesterol and higher rate of metabolic syndrome (MetS), while high-density lipoprotein (HDL)-cholesterol was lower than in patients with EDSS <3; 84.6% of all patients were correctly classified in these EDSS subgroups. We found that 36.3% of the variance in EDSS score was explained by age, Th17/T regulatory (Treg) and LDL/HDL ratios and homocysteine (all positively related) and body mass index (BMI) (inversely related). After adjusting for MS treatment modalities, the effects of the LDL/HDL and zTh17/Treg ratios, homocysteine and age on disability remained, whilst BMI was no longer significant. Moreover, carbonyl proteins were associated with increased disability. In conclusion, the results showed that an inflammatory Th17 profile coupled with age and increased carbonyl proteins were the most important variables associated with high disability followed at a distance by homocysteine, MetS and LDL/HDL ratio. These data underscore that IM&NO pathways play a key role in increased disability in MS patient and may be possible new targets for the treatment of these patients. Moreover, a panel of these laboratory biomarkers may be used to predict the disability in MS.
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Affiliation(s)
- Tamires Flauzino
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Andrea Name Colado Simão
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University Hospital, State University of Londrina, Av. Robert Koch 60, Londrina, Paraná, CEP 86038-350, Brazil
| | | | - Daniela Frizon Alfieri
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Sayonara Rangel Oliveira
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University Hospital, State University of Londrina, Av. Robert Koch 60, Londrina, Paraná, CEP 86038-350, Brazil
| | - Ana Paula Kallaur
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Marcell Alysson Batisti Lozovoy
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University Hospital, State University of Londrina, Av. Robert Koch 60, Londrina, Paraná, CEP 86038-350, Brazil
| | | | - Michael Maes
- Impact Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Chulalongkorn, Bangkok, Thailand
| | - Edna Maria Vissoci Reiche
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University Hospital, State University of Londrina, Av. Robert Koch 60, Londrina, Paraná, CEP 86038-350, Brazil.
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21
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Noori H, Gheini MR, Rezaeimanesh N, Saeedi R, Rezaei Aliabadi H, Sahraian MA, Naser Moghadasi A. The correlation between dyslipidemia and cognitive impairment in multiple sclerosis patients. Mult Scler Relat Disord 2019; 36:101415. [PMID: 31586799 DOI: 10.1016/j.msard.2019.101415] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/24/2019] [Accepted: 09/25/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND A large number of multiple sclerosis [MS] patients suffer from cognitive dysfunction affecting their routine life in family and society. Investigating modifiable factors for cognition decline and controlling them, could improve the quality of life in MS patients. Therefore, the present study was aimed to evaluate the association between lipid profile components and cognition in MS patients. METHODS A cross-sectional study was conducted on 50 Relapsing-Remitting MS (RRMS) patients referred to Sina hospital, Tehran, Iran. The definite diagnosis of MS was done based on the revised McDonald criteria. Data on demographic and clinical data of patients were obtained. 5 cc blood samples were taken from all subjects after 10-hour night fasting, and lipid profile components including LDL, HDL, triglyceride, and total cholesterol were evaluated. The Persian version of the Minimal Assessment of Cognitive Functions in MS [MACFIMS] battery was administered to assess the cognitive function. Spearman and Pearson correlation tests were applied to investigate the correlation between lipid profile components and MACFIMS subtests or clinical features of MS patients. RESULTS The mean age of subjects was equal to 32.26 years old, and 85% of them were women. There was no significant correlation between MACFIMS subtests results with disease duration, patient's disability according to Expanded Disability Status Scale (EDSS), annual attack rate, and disease-modifying drug onset year (P value >0.05). A significant inverse correlation was found between greater serum total cholesterol and lower scores of Symbol Digit Modalities subtest [SDMT] (P value 0.02; r: -0.31), the Delis-Kaplan Executive Function System [DKEFS] sorting (P value 0.01; r: -0.34) and DKEFS-descriptive (P value 0.04; r: -0.28) subtests. This significant inverse correlation was also found in terms of the correlation between higher serum LDL and impairment in the case of DKEFS-sorting score (P value 0.05; r: -0.27), and DKEFS-descriptive score (P value 0.05; r: -0.27). No significant correlation was found in case of serum HDL or triglyceride and MACFIMS subtests (P value >0.05). DISCUSSION Our findings proposed a possible correlation between the increased serum LDL cholesterol, serum total cholesterol and cognitive dysfunction among MS patients.
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Affiliation(s)
- Hossein Noori
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Gheini
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Rezaeimanesh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roghayyeh Saeedi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Rezaei Aliabadi
- Department of Epidemiology and biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
PURPOSE OF REVIEW To present current data on the coexistence of attention deficit hyperactivity disorder (ADHD) and the metabolic syndrome and type 2 diabetes mellitus in adults and children and to discuss possible mechanisms. RECENT FINDINGS Emerging data suggest that risk factors for obesity and insulin resistance such as diabetes during pregnancy and intrauterine growth failure may also have a role in the development of ADHD. Furthermore, ADHD and obesity share lifestyle factors, such as abnormal eating patterns, binge eating, and a sedentary lifestyle. ADHD is a risk factor for components of the metabolic syndrome, particularly obesity and type 2 diabetes mellitus, and also hypertension, both in adults and youth. Associations of ADHD with obesity, diabetes, and hypertension have been ascertained, and various mechanisms have been proposed. Research is needed to decipher the shared genetic, pharmacological, and lifestyle risk factors. Individuals with ADHD should be treated as a high-risk group for cardiometabolic complications.
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Affiliation(s)
- Zohar Landau
- Pediatric Division, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Maccabi Juvenile Diabetes Center, Raanana, Israel
| | - Orit Pinhas-Hamiel
- Maccabi Juvenile Diabetes Center, Raanana, Israel.
- Pediatric Endocrine and Diabetes Unit, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Miget G, Hentzen C, Turmel N, Chesnel C, Charlanes A, Le Breton F, Amarenco G. [Impact of body mass index on lower urinary tract disorders in multiple sclerosis]. Prog Urol 2019; 29:366-370. [PMID: 31133495 DOI: 10.1016/j.purol.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS), and principally overactive bladder, are common in multiple sclerosis (MS). However, their origin is not necessarily unique. Obesity is widely recognized as a risk factor for stress urinary incontinence (SUI) and overactive bladder (OAB) in the general population. We wanted to evaluate the influence of body mass index (BMI) on LUTS in the MS population. MATERIALS AND METHODS We conducted an uncontrolled monocentric retrospective study in 260 subjects classified into 4 BMI groups: underweight, normal weight, overweight, obese people. Comparisons by Mann-Whitney test were made between different BMI groups, in the overall population and then by gender. LUTS (SUI, OAB, BOO (bladder outlet obstruction) were assessed using USP questionnaire. RESULTS In women, the mean OAB score was higher for obese women, 10.27 (SD=4.5) than for normal weight women, 7.96 (SD=4.58), P=0.024. The SUI score was lower for normal weight, 1.69 (SD=2.38) than for overweight, 3.19 (SD=2.91), P=0.002 and obese subjects, 3.80 (SD=3.23), P=0.0005. As in the overall population, the BOO score was higher in subjects with normal weight, 4.09 (SD=3.33) than in subjects with overweight, 1.91 (SD=2.03), P=0.0003 and in obese subjects, 2.33 (SD=2.37), P=0.013. The same comparisons in men were not significant. CONCLUSION In this series, increased BMI was associated with higher OAB and SUI USP questionnaire scores, in women presenting with MS. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- G Miget
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France.
| | - C Hentzen
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - N Turmel
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - C Chesnel
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - A Charlanes
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - F Le Breton
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
| | - G Amarenco
- GRC 001, GREEN groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne université, AP-HP, 75020 Paris, France
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Jakimovski D, Topolski M, Genovese AV, Weinstock-Guttman B, Zivadinov R. Vascular aspects of multiple sclerosis: emphasis on perfusion and cardiovascular comorbidities. Expert Rev Neurother 2019; 19:445-458. [PMID: 31003583 DOI: 10.1080/14737175.2019.1610394] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. Over the last two decades, more favorable MS long-term outcomes have contributed toward increase in prevalence of the aged MS population. Emergence of age-associated pathology, such as cardiovascular diseases, may interact with the MS pathophysiology and further contribute to disease progression. Areas covered: This review summarizes the cardiovascular involvement in MS pathology, its disease activity, and progression. The cardiovascular health, the presence of various cardiovascular diseases, and their effect on MS cognitive performance are further explored. In similar fashion, the emerging evidence of a higher incidence of extracranial arterial pathology and its association with brain MS pathology are discussed. Finally, the authors outline the methodologies behind specific perfusion magnetic resonance imaging (MRI) and ultrasound Doppler techniques, which allow measurement of disease-specific and age-specific vascular changes in the aging population and MS patients. Expert opinion: Cardiovascular pathology significantly contributes to worse clinical and MRI-derived disease outcomes in MS. Global and regional cerebral hypoperfusion may be associated with poorer physical and cognitive performance. Prevention, improved detection, and treatment of the cardiovascular-based pathology may improve the overall long-term health of MS patients.
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Affiliation(s)
- Dejan Jakimovski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Matthew Topolski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Antonia Valentina Genovese
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,c Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences , University of Pavia , Pavia , Italy
| | - Bianca Weinstock-Guttman
- b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Robert Zivadinov
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA.,d Center for Biomedical Imaging at Clinical Translational Science Institute , University at Buffalo, State University of New York , Buffalo , NY , USA
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25
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Van Dyken P, Lacoste B. Impact of Metabolic Syndrome on Neuroinflammation and the Blood-Brain Barrier. Front Neurosci 2018; 12:930. [PMID: 30618559 PMCID: PMC6297847 DOI: 10.3389/fnins.2018.00930] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022] Open
Abstract
Metabolic syndrome, which includes diabetes and obesity, is one of the most widespread medical conditions. It induces systemic inflammation, causing far reaching effects on the body that are still being uncovered. Neuropathologies triggered by metabolic syndrome often result from increased permeability of the blood-brain-barrier (BBB). The BBB, a system designed to restrict entry of toxins, immune cells, and pathogens to the brain, is vital for proper neuronal function. Local and systemic inflammation induced by obesity or type 2 diabetes mellitus can cause BBB breakdown, decreased removal of waste, and increased infiltration of immune cells. This leads to disruption of glial and neuronal cells, causing hormonal dysregulation, increased immune sensitivity, or cognitive impairment depending on the affected brain region. Inflammatory effects of metabolic syndrome have been linked to neurodegenerative diseases. In this review, we discuss the effects of obesity and diabetes-induced inflammation on the BBB, the roles played by leptin and insulin resistance, as well as BBB changes occurring at the molecular level. We explore signaling pathways including VEGF, HIFs, PKC, Rho/ROCK, eNOS, and miRNAs. Finally, we discuss the broader implications of neural inflammation, including its connection to Alzheimer's disease, multiple sclerosis, and the gut microbiome.
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Affiliation(s)
- Peter Van Dyken
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Baptiste Lacoste
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
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26
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Study of the metabolomics characteristics of patients with metabolic syndrome based on liquid chromatography quadrupole time-of-flight mass spectrometry. ANNALES D'ENDOCRINOLOGIE 2017; 79:37-44. [PMID: 29246383 DOI: 10.1016/j.ando.2017.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/14/2017] [Accepted: 05/27/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) is a disease with complex pathophysiology and pathogenesis involving multiple systems of the human body. This study aimed to identify serum metabolites that are relevant to MS. MATERIAL AND METHODS This study involved 40 patients with MS and 28 healthy adults, and the following data were statistically analyzed: basic clinical data, blood lipids, fasting blood glucose, blood pressure, waist circumference, and visceral fat coefficient. Serum samples from both groups were collected and analyzed by liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF/MS); multivariate and univariate statistical methods were used to identify potential MS biomarkers and MS-related metabolic pathways. In addition, leucine and valine levels in serum from MS patients and normal subjects were measured using enzyme-linked immunosorbent assays (ELISAs). RESULTS In this study, 23 potential biomarkers were identified in the plasma of MS patients. These biomarkers were mainly related to metabolism; the tricarboxylic acid cycle; galactose metabolism; arachidonic acid metabolism; valine, leucine, and isoleucine degradation; and valine, leucine, and isoleucine biosynthesis. ELISAs were utilized to verify serum leucine and valine levels, and the results supported the experimental metabolomics results. CONCLUSIONS In total, 23 MS-related metabolites were identified in the serum; these differential metabolites were mainly associated with lipid metabolism, amino acid metabolism, glucose metabolism, purine metabolism, and other related metabolic pathways. This study shows that LC/MS-based metabolomics methods can be used to investigate the pathological changes in MS patients and identify biomarkers for the early diagnosis of MS.
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27
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Abstract
Multiple sclerosis (MS) is a demyelinating and neurodegenerative disorder of the central nervous system, for which disease modifying therapies (DMTs) are the mainstay treatment approach to reduce inflammatory disease activity and slow worsening disability. In addition to conventional pharmacologic therapy, there is growing interest in the use of lifestyle strategies to support wellness and mitigate disease-related complications in MS. This interest stems from a growing appreciation of the role of certain comorbidities and lifestyle factors on disease activity, disability, mortality, and overall quality of life. While the current literature is not conclusive, there is evidence to suggest a potential role for vitamin D supplementation, tobacco smoking cessation, routine exercise, a plant-based, anti-inflammatory diet, and maintenance of emotional well-being as adjunct therapies to DMTs. In addition to DMTs, lifestyle strategies should be emphasized as part of a management plan focused on overall health and well-being.
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Affiliation(s)
- Brandon P Moss
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Mary R Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Carrie M Hersh
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA
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28
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Hypothalamic Dysfunction and Multiple Sclerosis: Implications for Fatigue and Weight Dysregulation. Curr Neurol Neurosci Rep 2017; 16:98. [PMID: 27662896 DOI: 10.1007/s11910-016-0700-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Signs and symptoms of multiple sclerosis are usually attributed to demyelinating lesions in the spinal cord or cerebral cortex. The hypothalamus is a region that is often overlooked yet controls many important homeostatic functions, including those that are perturbed in multiple sclerosis. In this review we discuss how hypothalamic dysfunction may contribute to signs and symptoms in people with multiple sclerosis. While dysfunction of the hypothalamic-pituitary-adrenal axis is common in multiple sclerosis, the effects and mechanisms of this dysfunction are not well understood. We discuss three hypothalamic mechanisms of fatigue in multiple sclerosis: (1) general hypothalamic-pituitary-adrenal axis hyperactivity, (2) disordered orexin neurotransmission, (3) abnormal cortisol secretion. We then review potential mechanisms of weight dysregulation caused by hypothalamic dysfunction. Lastly, we propose future studies and therapeutics to better understand and treat hypothalamic dysfunction in multiple sclerosis. Hypothalamic dysfunction appears to be common in multiple sclerosis, yet current studies are underpowered and contradictory. Future studies should contain larger sample sizes and standardize hormone and neuropeptide measurements.
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Sicras-Mainar A, Ruíz-Beato E, Navarro-Artieda R, Maurino J. Comorbidity and metabolic syndrome in patients with multiple sclerosis from Asturias and Catalonia, Spain. BMC Neurol 2017; 17:134. [PMID: 28716070 PMCID: PMC5512748 DOI: 10.1186/s12883-017-0914-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/09/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The impact of comorbidity on multiple sclerosis (MS) is a new area of interest. Limited data on the risk factors of metabolic syndrome (MetS) is currently available. The aim of this study was to estimate the presence of comorbid conditions and MetS in a sample of adult patients with MS. METHODS A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Catalonia and Asturias, Spain. The number of chronic diseases (diagnoses), the Charlson Comorbidity Index and the individual Case-mix Index were used to assess general comorbidity variables. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III. Patients were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0-3.5 and 4-10. RESULTS A total of 222 patients were studied (mean age = 45.5 (SD 12.5) years, 64.4% were female and 62.2% presented a diagnosis of relapsing-remitting MS). Mean EDSS score was 3.2 (SD 2.0). Depression (32.4%), dyslipidaemia (31.1%), hypertension (23.0%) and obesity (22.5%) were the most common comorbidities. Overall MetS prevalence was 31.1% (95% CI: 25.0-37.2%). Patients with an EDSS ≥ 4.0 showed a significantly higher number of comorbidities (OR=2.2; 95% CI: 1.7-3.0; p<0.001). CONCLUSION MS patients had a high prevalence of MetS. Screening for comorbidity should be part of standard MS care. Further studies are necessary to confirm this association and the underlying mechanisms of MS and its comorbidities.
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Affiliation(s)
- Antoni Sicras-Mainar
- Fundación Rediss (Red de Investigación en servicios Sanitarios), Barcelona, Spain
| | - Elena Ruíz-Beato
- Health Economics and Outcomes Research Unit, Roche Farma S.A., Madrid, Spain
| | - Ruth Navarro-Artieda
- Department of Medical Information, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Mills EA, Mirza A, Mao-Draayer Y. Emerging Approaches for Validating and Managing Multiple Sclerosis Relapse. Front Neurol 2017; 8:116. [PMID: 28424654 PMCID: PMC5372802 DOI: 10.3389/fneur.2017.00116] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/14/2017] [Indexed: 12/17/2022] Open
Abstract
The autoimmune disease multiple sclerosis (MS) is characterized by relapses in the majority of patients. A definitive clinical diagnosis of relapse in MS can be complicated by the presence of an infection or comorbid disorder. In this mini-review, we describe efforts to develop enhanced imaging techniques and biomarker detection as future tools for relapse validation. There is emerging evidence of roles for meningeal inflammation, sex hormones, comorbid metabolic or mood disorders, and a dysregulated immune profile in the manifestation and severity of relapse. Specific subsets of immune cells likely drive the pathophysiology of relapse, and identification of a patient's unique immunological signature of relapse may help guide future diagnosis and treatment. Finally, these studies highlight the diversity in terms of relapse presentation, immunological signature, and response in patients with MS, indicating that going forward the best approach to assessment and treatment of relapse will be multifactorial and highly personalized.
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Affiliation(s)
- Elizabeth A Mills
- Molecular and Behavioral Neuroscience Institute, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ali Mirza
- Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yang Mao-Draayer
- Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
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31
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Esposito S, Bonavita S, Sparaco M, Gallo A, Tedeschi G. The role of diet in multiple sclerosis: A review. Nutr Neurosci 2017; 21:377-390. [PMID: 28338444 DOI: 10.1080/1028415x.2017.1303016] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Multiple sclerosis (MS) is a multifactorial, inflammatory, and neurodegenerative disease of the central nervous system, where environmental factors interact with genetic susceptibility. The role of diet on MS has not been comprehensively elucidated; therefore, through an extensive search of relevant literature, this review reports the most significant evidence regarding nutrition as a possible co-factor influencing the inflammatory cascade by acting on both its molecular pathways and gut microbiota. Since nutritional status and dietary habits in MS patients have not been extensively reported, the lack of a scientific-based consensus on dietary recommendation in MS could encourage many patients to experiment alternative dietetic regimens, increasing the risk of malnutrition. This work investigates the health implications of an unbalanced diet in MS, and collects recent findings on nutrients of great interest among MS patients and physicians. The aim of this review is to elucidate the role of an accurate nutritional counseling in MS to move toward a multidisciplinary management of the disease and to encourage future studies demonstrating the role of a healthy diet on the onset and course of MS.
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Affiliation(s)
- Sabrina Esposito
- a I Clinic of Neurology, Second University of Naples , 80138 , Italy.,b Department of Neuroscience, Psychology, Drug Research and Child Health , University of Florence , Italy
| | - Simona Bonavita
- a I Clinic of Neurology, Second University of Naples , 80138 , Italy.,c MRI Research Center SUN-FISM, Second University of Naples , Italy.,d Institute for Diagnosis and Care "Hermitage Capodimonte" , Naples , Italy
| | - Maddalena Sparaco
- a I Clinic of Neurology, Second University of Naples , 80138 , Italy
| | - Antonio Gallo
- a I Clinic of Neurology, Second University of Naples , 80138 , Italy.,c MRI Research Center SUN-FISM, Second University of Naples , Italy.,d Institute for Diagnosis and Care "Hermitage Capodimonte" , Naples , Italy
| | - Gioacchino Tedeschi
- a I Clinic of Neurology, Second University of Naples , 80138 , Italy.,c MRI Research Center SUN-FISM, Second University of Naples , Italy.,d Institute for Diagnosis and Care "Hermitage Capodimonte" , Naples , Italy
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32
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Su P, Ding H, Zhang W, Duan G, Yang Y, Long J, Du L, Xie C, Jin C, Hu C, Sun Z, Duan Z, Gong L, Tian W. Joint Association of Obesity and Hypertension with Disability in the Elderly-- A Community-Based Study of Residents in Shanghai, China. J Nutr Health Aging 2017; 21:362-369. [PMID: 28346562 DOI: 10.1007/s12603-016-0777-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability. METHODS Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor's diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody. RESULTS A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21). CONCLUSIONS Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn't significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.
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Affiliation(s)
- P Su
- Wenhua Tian, PhD, Department of Health Services Management, the Second Military Medical University, No.800 Xiangyin Rd, Shanghai, 200433, China; Tel: +86-21-8187-1428; Fax: +86-21-8187-1428; Email address:
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Simonsen CS, Celius EG, Brunborg C, Tallaksen C, Eriksen EF, Holmøy T, Moen SM. Bone mineral density in patients with multiple sclerosis, hereditary ataxia or hereditary spastic paraplegia after at least 10 years of disease - a case control study. BMC Neurol 2016; 16:252. [PMID: 27919248 PMCID: PMC5139093 DOI: 10.1186/s12883-016-0771-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 11/23/2016] [Indexed: 12/12/2022] Open
Abstract
Background Although disability is considered the main cause of low bone mineral density (BMD) in multiple sclerosis (MS), other factors related to the disease process or treatment could also be involved. The aim of this study was to assess whether patients with MS are more likely to develop low BMD (osteopenia or osteoporosis) than patients with the non-inflammatory neurological diseases Hereditary Spastic Paraplegia (HSP) and Hereditary Ataxia (HA). Methods We performed a case control study comparing BMD (spine, hip and total body) and biochemical measures of bone metabolism in 91 MS patients and 77 patients with HSP or HA, matched for age, gender and disability. Both patient groups had lived with the disease for at least 10 years. Results In total 74.7% of the patients with MS and 75.3% of the patients with HSP or HA had osteopenia (−2.5 < T- score < −1.0) or osteoporosis (T- score ≤ −2.5) in one or more sites. Osteoporosis was more common in patients with MS than with HSP/HA (44.0 vs 20.8%, p =0.001). This difference was not significant after correction for confounders (p = 0.07), nor were any of the biochemical markers. Conclusion Most patients with disabling neurological diseases like MS and HSP/HA develop osteopenia or osteoporosis. MS patients had osteoporosis more frequently than HA/HSP patients, though the difference was not significant after adjusting for confounders. Osteoporosis and bone health should be considered in all patients with both inflammatory and degenerative chronic neurological diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0771-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilia Smith Simonsen
- Department of Neurology, Drammen Hospital, Vestre Viken HF, Dronnigsgate 28, 3004, Drammen, Norway. .,Department of Neurology, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Chantal Tallaksen
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Erik Fink Eriksen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trygve Holmøy
- Department of Neurology, Akershus University Hospitals, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Affiliation(s)
- A H V Schapira
- Clinical Neurosciences, UCL Institute of Neurology, London, UK
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Palavra F, Almeida L, Ambrósio AF, Reis F. Obesity and brain inflammation: a focus on multiple sclerosis. Obes Rev 2016; 17:211-24. [PMID: 26783119 DOI: 10.1111/obr.12363] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 10/25/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023]
Abstract
The increase in prevalence of obesity in industrialized societies is an indisputable fact. However, the apparent passive role played by adipocytes, in pathophysiological terms, has been gradually substituted by a metabolically active performance, relevant to many biochemical mechanisms that may contribute to a chronic low-grade inflammatory status, which increasingly imposes itself as a key feature of obesity. This chronic inflammatory status will have to be integrated into the complex equation of many diseases in which inflammation plays a crucial role. Multiple sclerosis (MS) is a chronic inflammatory condition typically confined to the central nervous system, and many work has been produced to find possible points of contact between the biology of this immune-mediated disease and obesity. So far, clinical data are not conclusive, but many biochemical features have been recently disclosed. Brain inflammation has been implicated in some of the mechanisms that lead to obesity, which has also been recognized as an important player in inducing some degree of immune dysfunction. In this review, we collected evidence that allows establishing bridges between obesity and MS. After considering epidemiological controversies, we will focus on possible shared mechanisms, as well as on the potential contributions that disease-modifying drugs may have on this apparent relationship of mutual interference.
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Affiliation(s)
- F Palavra
- Laboratory of Pharmacology & Experimental Therapeutics, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Neuroscience and Cell Biology-Institute for Biomedical Imaging and Life Sciences (CNC.IBILI) Research Consortium, University of Coimbra, Coimbra, Portugal
| | - L Almeida
- Laboratory of Pharmacology & Experimental Therapeutics, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A F Ambrósio
- Laboratory of Pharmacology & Experimental Therapeutics, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Neuroscience and Cell Biology-Institute for Biomedical Imaging and Life Sciences (CNC.IBILI) Research Consortium, University of Coimbra, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - F Reis
- Laboratory of Pharmacology & Experimental Therapeutics, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Neuroscience and Cell Biology-Institute for Biomedical Imaging and Life Sciences (CNC.IBILI) Research Consortium, University of Coimbra, Coimbra, Portugal
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Marck CH, Neate SL, Taylor KL, Weiland TJ, Jelinek GA. Prevalence of Comorbidities, Overweight and Obesity in an International Sample of People with Multiple Sclerosis and Associations with Modifiable Lifestyle Factors. PLoS One 2016; 11:e0148573. [PMID: 26849357 PMCID: PMC4743906 DOI: 10.1371/journal.pone.0148573] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/19/2016] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic neurological disorder, often affecting young people. Comorbid disorders such as depression, anxiety and hypertension are common and can affect disease course, treatment, and quality of life (QOL) of people with MS (PwMS). The associations between comorbidities, body mass index (BMI) and health outcomes are not well studied in MS, although research shows most PwMS are overweight. Most data on the prevalence of comorbidities and obesity in PwMS comes from North American populations. This study describes the prevalence of comorbidities, overweight and obesity and associations with modifiable factors in an international sample of PwMS recruited online through social media, MS societies and websites. The online survey consisted of validated and researcher-devised instruments to assess self-reported health outcomes and lifestyle behaviors. Of the 2399 respondents, 22.5% were overweight, 19.4% were obese and 67.2% reported at least one comorbidity, with back pain (36.2%), depression (31.7%), anxiety (29.1%) and arthritis (13.7%) most prevalent and most limiting in daily activities. Obesity and most comorbid disorders were significantly more prevalent in North America. Obese participants were more likely to have comorbidities, especially diabetes (OR 4.8) and high blood pressure (OR 4.5) but also depression (OR 2.2). Being overweight, obese, or a former, or current smoker was associated with an increase in the number of comorbidities; while healthy diet, physical activity (borderline significant) and moderate alcohol consumption were associated with decreased number of comorbidities. Increasing number of comorbidities was related to worse QOL, increased odds of disability and prior relapse. Obese PwMS had higher odds of disability and lower QOL. The associations between BMI, comorbidities and health outcomes are likely to be bi-directional and associated with lifestyle behaviors. Preventing and treating comorbid disorders and obesity in PwMS is warranted, and advice regarding healthy and risky lifestyle may assist in improving health outcomes.
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Affiliation(s)
- Claudia Helena Marck
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sandra Leanne Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Keryn Louise Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Tracey Joy Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - George Alexander Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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