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Saul A, Taylor BV, Blizzard L, Simpson-Yap S, Oddy WH, Shivappa N, Hebert JR, Black LJ, Ponsonby AL, Broadley SA, Lechner-Scott J, van der Mei I. A pro-inflammatory diet is associated with long-term depression and anxiety levels but not fatigue in people with multiple sclerosis. Mult Scler Relat Disord 2024; 84:105468. [PMID: 38359692 DOI: 10.1016/j.msard.2024.105468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/24/2023] [Accepted: 01/21/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Multiple sclerosis is characterised by acute and chronic inflammation in the CNS. Diet may influence inflammation, and therefore MS outcomes. OBJECTIVE To determine whether the Dietary Inflammatory Index (DII®)) is associated with depression, anxiety, and fatigue in a prospective cohort of people with MS. METHODS People with a first clinical diagnosis of demyelination were followed over 10 years (n=223). DII and energy-adjusted DII (E-DIITM) scores were calculated from the dietary intake in the preceding 12 months measured by food frequency questionnaire. Depression and anxiety were assessed by the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively), and fatigue by the Fatigue Severity Scale. RESULTS A higher E-DII score was associated with higher levels of depression and anxiety five years later (e.g., highest vs lowest E-DII quartile, HADS-D score: β=2.23, 95%CI=0.98,3.48, p<0.001; HADS-A score: β=1.90, 95%CI=0.59,3.21, p<0.001). A cumulative E-DII score was associated with depression (p<0.01) and anxiety (p=0.05) at the 10-year review. No associations were seen for fatigue. CONCLUSION Our findings suggest that, in people with MS, a more pro-inflammatory diet may long-term adverse impact on depression and anxiety, but not fatigue.
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Affiliation(s)
- A Saul
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - B V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - S Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - W H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - N Shivappa
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Department of Nutrition, Connecting Health Innovations LLC, Columbia, South Carolina, USA; Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - J R Hebert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Department of Nutrition, Connecting Health Innovations LLC, Columbia, South Carolina, USA; Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - L J Black
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - A L Ponsonby
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, VIC, Australia; The Florey Institute of Neuroscience & Mental Health, Parkville, VIC, Australia
| | - S A Broadley
- School of Medicine, Griffith University, Gold Coast, Australia
| | - J Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia; Faculty of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - I van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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Mousley JJ, Simpson-Yap S, Yu M, Fletcher D, Dunne B. Australian and New Zealand surgeons' attitudes to our role in climate change mitigation. ANZ J Surg 2023; 93:2559-2561. [PMID: 37470407 DOI: 10.1111/ans.18607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Johanna J Mousley
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Steven Simpson-Yap
- Neuroepidemiology Unit, Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- CORe, School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maggie Yu
- Neuroepidemiology Unit, Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Fletcher
- Department of Surgery, University of Western Australia, Perth, Western Australia, Australia
- Environmental Sustainability in Surgical Practice Working Party, Royal Australasian College of Surgeons Melbourne, Melbourne, Victoria, Australia
| | - Ben Dunne
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Western Australia, Perth, Western Australia, Australia
- Department of Surgery, Peter McCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Saul A, Taylor BV, Blizzard L, Simpson-Yap S, Oddy WH, Probst YC, Black LJ, Ponsonby AL, Broadley SA, Lechner-Scott J, van der Mei I. Higher dietary quality is prospectively associated with lower MRI FLAIR lesion volume, but not with hazard of relapse, change in disability or black hole volume in people with Multiple Sclerosis. Mult Scler Relat Disord 2023; 78:104925. [PMID: 37542923 DOI: 10.1016/j.msard.2023.104925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND The influence of diet quality on multiple sclerosis (MS) progression or inflammatory activity is not well understood. METHODS Study participants with MS from the AusLong cohort, were followed annually (10 years, n = 223 post-onset). At baseline, 5 and 10-year reviews, indices of dietary quality - the Australian Recommended Food Score (ARFS) and Diet Quality Tracker (DQT) - were calculated from self-reported dietary intake data of the preceding 12 months (Food Frequency Questionnaire, Dietary Questionnaire for Epidemiological Studies v2). Associations were examined between measures of dietary quality with measures of MS progression and inflammatory activity hazard of relapse, annualised disability progression (Expanded Disability Status Scale, EDSS) and Magnetic Resonance Imaging (MRI) outcomes. MRI outcomes included fluid-attenuated inversion recovery (FLAIR, T2 MRI) lesion volume and black hole volume (T1 MRI) in the juxtacortical, periventricular, and infratentorial regions of the brain, as well as total calculated from the sum of the three regions. RESULTS A higher diet quality (at least with the ARFS) was associated with lower FLAIR lesion volume in the periventricular region only (highest vs lowest quartile: β=-1.89,95%CI=-3.64, -0.13, p = 0.04, periventricular FLAIR region median (IQR) for 5-year review: 4.41 (6.06) and 10-year review: 4.68 (7.27)). Associations with black hole lesion volume, hazard of relapse, and annualised EDSS progression, lacked in significance and/or dose-dependency. CONCLUSION We found evidence that diet quality may have a role in modulating one aspect of MS inflammatory activity (periventricular MRI FLAIR lesion volume), but not other MRI and clinical outcome measures.
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Affiliation(s)
- A Saul
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - B V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - S Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - W H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Y C Probst
- Illawarra Health and Medical Research Institute, Wollongong, Australia; School of Medicine, University of Wollongong, Wollongong, Australia
| | - L J Black
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - A L Ponsonby
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, VIC, Australia; The Florey Institute of Neuroscience & Mental Health, Parkville, VIC, Australia
| | - S A Broadley
- School of Medicine, Griffith University, Gold Coast, Australia
| | - J Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia; Faculty of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - I van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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Saul A, Taylor BV, Blizzard L, Simpson-Yap S, Probst YC, Black LJ, Ponsonby AL, Broadley SA, Lechner Scott J, van der Mei I. Long-term dietary acid load is associated with depression in multiple sclerosis, but less evidence was found with fatigue and anxiety. Mult Scler Relat Disord 2023; 69:104415. [PMID: 36434910 DOI: 10.1016/j.msard.2022.104415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 10/17/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diet-dependent acid-base load has been associated with worsening in mental health, but to date no study has examined this in people with multiple sclerosis (PwMS). We examined the association between potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores and depression, anxiety, and fatigue in PwMS. METHODS Participants with a first clinical diagnosis of CNS demyelination were followed prospectively as part of the AusLong Study (aged 18-59 years at cohort entry). At baseline, 5- and 10-year reviews, PRAL and NEAP scores were calculated using dietary intake in the preceding 12 months calculated from a food frequency questionnaire. At 5- and 10-year reviews, the Hospital Anxiety and Depression Scale was used to assess depression and anxiety, and the Fatigue Severity Scale assessed fatigue. RESULTS Higher PRAL and NEAP scores were associated with increased subsequent absolute value and change in HADS depression scores over five years' follow-up (e.g., highest vs lowest PRAL quartile, 5-year change in HADS-D score: β=+3.01, 95%CI= 1.54, 4.48, p<0.001). The level of depression at the 10-year review was determined by both the baseline dietary acid scores and baseline-5-year changes in dietary acid scores (e.g., PRAL change from baseline to 5-year review, 10-year review HADS-D score: β=+0.09, 95%CI= 0.03, 0.15, p<0.001, NEAP change from baseline to 5-year review, 10-year review HADS-D score: β=+0.07, 95%CI= 0.01, 0.14, p=0.03). Some associations were observed with anxiety and fatigue but were much weaker and less consistent. CONCLUSION Our findings indicate that a higher dietary acid load potentially has a long-term influence on the level of depression in PwMS. The evidence is less convincing for anxiety and fatigue.
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Affiliation(s)
- A Saul
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - B V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - S Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - Y C Probst
- Illawarra Health and Medical Research Institute, Wollongong, Australia; School of Medicine, University of Wollongong, Wollongong, Australia
| | - L J Black
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - A L Ponsonby
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, VIC, Australia; The Florey Institute of Neuroscience & Mental Health, Parkville, VIC, Australia
| | - S A Broadley
- School of Medicine, Griffith University, Gold Coast, Australia
| | - J Lechner Scott
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia; Faculty of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New South Wales, Australia
| | - I van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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French JA, Gow P, Simpson-Yap S, Collins K, Ng J, Angus PW, van der Mei IAF. Alcohol intake is associated with a decreased risk of developing primary biliary cholangitis. World J Hepatol 2022; 14:1747-1756. [PMID: 36185715 PMCID: PMC9521450 DOI: 10.4254/wjh.v14.i9.1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/13/2022] [Accepted: 08/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary biliary cholangitis (PBC) is a chronic progressive liver disease of unknown aetiology characterised by immune-mediated destruction of small and medium-sized intrahepatic bile ducts. There are few well-established risk factors and epidemiological studies are needed to further evaluate the pathogenesis of the disease.
AIM To evaluate the relationship between alcohol intake, smoking and marijuana use with PBC development.
METHODS We conducted a prevalent case control study of 200 cases and 200 age (within a five year age band) and sex-matched controls, identified from the Victorian PBC prevalence study. We assessed lifetime alcohol intake and smoking behaviour (both tobacco and marijuana) prior to PBC onset and used conditional logistic regression for analyses.
RESULTS Alcohol intake consistently showed a dose-dependent inverse association with case status, and this was most substantial for 21-30 years and 31-40 years (Ptrend < 0.001). Smoking was associated with PBC, with a stronger association with a longer duration of smoking [e.g., adjusted OR 2.27 (95%CI: 1.12- 4.62) for those who had smoked for 20-35 years]. There was no association between marijuana use and PBC.
CONCLUSION Alcohol appears to have an inverse relationship with PBC. Smoking has been confirmed as an environmental risk factor for PBC. There was no association between marijuana use and PBC.
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Affiliation(s)
| | - Paul Gow
- Department of Gastroenterology, Austin Hospital, Heidelberg 3084, Australia
| | - Steven Simpson-Yap
- Melbourne School of Population and Global Health, University of Melbourne, Carlton 3053, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Kate Collins
- Department of Gastroenterology, Austin Hospital, Heidelberg 3084, Australia
| | - Justin Ng
- Department of Gastroenterology, Austin Hospital, Heidelberg 3084, Australia
| | - Peter W Angus
- Department of Gastroenterology, Austin Hospital, Heidelberg 3084, Australia
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Saul A, Taylor BV, Blizzard L, Simpson-Yap S, Oddy WH, Probst YC, Black LJ, Ponsonby AL, Broadley SA, Lechner-Scott J, van der Mei I. Associations between diet quality and depression, anxiety, and fatigue in multiple sclerosis. Mult Scler Relat Disord 2022; 63:103910. [DOI: 10.1016/j.msard.2022.103910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
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Bevens W, Reece J, Jelinek PL, Weiland TJ, Nag N, Simpson-Yap S, Gray K, Jelinek GA, Neate SL. The feasibility of an online educational lifestyle program for people with multiple sclerosis: A qualitative analysis of participant semi-structured interviews. Digit Health 2022; 8:20552076221123713. [PMID: 36081754 PMCID: PMC9445470 DOI: 10.1177/20552076221123713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the feasibility of a randomised controlled trial of a multiple sclerosis online course (MSOC) via qualitative analysis of participant semi-structured interviews. Methods The MSOC was developed in two arms: intervention arm which contained evidence-based lifestyle modification recommendations, and standard-care arm which delivered information from MS websites reflecting standard advice. Participants were recruited via online advertisements, completed a baseline questionnaire, and randomised. Seven modules were delivered over six weeks. Course completers were invited to participate in semi-structured interviews. Within a qualitative paradigm, interviews were analysed using reflexive thematic analysis. Results Fourteen of the 17 course completers were interviewed: 86% (12/14) female; mean age 50 years; residing in Australia, New Zealand, and the USA, predominantly had relapsing-remitting MS, mean time from diagnosis 9.5 years, and patient-determined disease steps disability assessment distributed evenly across all three categories. Four themes were identified: 1) “Hearing our stories” (hope for the future, feeling represented, exploring the journey of others with MS, learning from diversity, and wanting to connect with others); 2) “Taking the plunge” (not wanting to be first, feelings of nervousness or reluctance and feeling confronted); 3) “The accessibility and safety of being online” (ease of access, going at your own pace, making it work and not letting others down); and 4) “unpacking the course” (ease of navigation, visuals, understandability, and length and timing). Conclusion Participants felt represented, found the course accessible and content was easy to understand. These experiences provide important insights and considerations for this digital health intervention.
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Affiliation(s)
- William Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - J Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - PL Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - TJ Weiland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - N Nag
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - S Simpson-Yap
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - K Gray
- Faculty of Medicine, Dentistry and Health Sciences, Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - GA Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - SL Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Bevens W, Gray K, Neate SL, Nag N, Weiland TJ, Jelinek GA, Simpson-Yap S. Characteristics of mHealth app use in an international sample of people with multiple sclerosis. Mult Scler Relat Disord 2021; 54:103092. [PMID: 34246024 DOI: 10.1016/j.msard.2021.103092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/25/2021] [Accepted: 06/13/2021] [Indexed: 11/25/2022]
Abstract
The management of multiple sclerosis (MS) has progressed significantly with the emergence of mHealth technologies. Uptake of mHealth apps amongst people with MS, and clinical and demographic characteristics of mHealth adopters is unknown outside North America. Participants of the HOLISM study were queried about their mHealth apps use. We summarize mHealth app usage, and clinical and demographic characteristics of mHealth app adopters using descriptive statistics. Overall, 3.1% of respondents reported using an mHealth app, most of whom were located in Australasia and North America. This study provides insight regarding mHealth app usage within a large international cohort of people with MS.
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Affiliation(s)
- W Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - K Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Australia
| | - S L Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - N Nag
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - T J Weiland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - G A Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - S Simpson-Yap
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmania, Australia
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