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Intervention Review

Dietary interventions for multiple sclerosis

  1. Mariangela Farinotti1,*,
  2. Silvana Simi2,
  3. Carlo Di Pietrantonj3,
  4. Nicola McDowell4,
  5. Lorenzo Brait5,
  6. Daniela Lupo6,
  7. Graziella Filippini1

Editorial Group: Cochrane Multiple Sclerosis Group

Published Online: 24 JAN 2007

Assessed as up-to-date: 2 AUG 2006

DOI: 10.1002/14651858.CD004192.pub2

How to Cite

Farinotti M, Simi S, Di Pietrantonj C, McDowell N, Brait L, Lupo D, Filippini G. Dietary interventions for multiple sclerosis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004192. DOI: 10.1002/14651858.CD004192.pub2.

Author Information

  1. 1

    Fondazione I.R.C.C.S. - Istituto Neurologico C.Besta, Neuroepidemiology Unit, Milano, Italy

  2. 2

    Italian National Research Council (CNR), Institute of Clinical Physiology, Pisa, Italy

  3. 3

    Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Alessandria, Piemonte, Italy

  4. 4

    UK Cochrane Centre, Oxford, Oxfordshire, UK

  5. 5

    Centro Diagnostico Italiano, Cyberknife, Milano, Italy

  6. 6

    Politecnico di Milano, Dipartimento di Matematica, Milano, Italy

*Mariangela Farinotti, Neuroepidemiology Unit, Fondazione I.R.C.C.S. - Istituto Neurologico C.Besta, via Celoria 11, Milano, 20133, Italy. farinotti@istituto-besta.it.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2007

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This is not the most recent version of the article. View current version (12 DEC 2012)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Clinical and experimental data suggest that certain dietary regimens, particularly those including polyunsaturated fatty acids (PUFAs) and vitamins might improve outcomes in people with multiple sclerosis (MS). Diets and dietary supplements are much used by people with MS in the belief that they might improve disease outcomes.

Objectives

To answer MS consumers' questions regarding the efficacy and safety of dietary regimens for MS.

Search methods

We searched the Cochrane MS Group trial register (February 2006), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Library, Issue 1, 2006, MEDLINE (PubMed) (1966 to March 2006), EMBASE (1974 to March 2006) and the bibliographies of papers found.

Selection criteria

All randomised controlled trials comparing a specific dietary intervention, diet plan or dietary supplementation, with no dietary modification or placebo, were eligible.

Data collection and analysis

Two reviewers independently selected articles, assessed trial quality and extracted data.

Main results

Trial quality was poor, particularly as regards descriptions of randomisation, blinding and adverse event reporting. Some studies had large numbers of drop-outs; dropouts were never included in the analyses. PUFAs did not have a significant effect on disease progression, measured as worsening of Disability Status Scale. Omega-6 fatty acids (11-23 g/day linoleic acid) had no benefit in 75 relapsing remitting (RR) MS patients (progression at two years: relative risk (RR)=0.78, 95% CI [0.45 to 1.36]) or in 69 chronic progressive (CP) MS patients (RR=1.67, 95% CI [0.75 to 3.72]. Linoleic acid (2.9-3.4 g/day) had no benefit in CPMS (progression at two years: RR=0.78, 95% CI [0.43 to 1.42]). Slight decreases in relapse rate and relapse severity were associated with omega-6 fatty acids in some small studies, however these findings are limited by the limited validity of the endpoints.
Omega-3 fatty acids had no benefit on progression at 12 months in 14 RRMS patients or at 24 months in 292 RRMS patients (RR=0.15, 95% CI [0.01 to 3.11], p= 0.22 at 12 months, and 0.82 95% CI [0.65 to 1.03], p=0.08, at 24 months).
The low frequency of reported adverse events suggests no major toxicity associated with PUFA administration.
No studies on vitamin supplementation and allergen-free diets were analysed as none met the eligibility criteria.

Authors' conclusions

PUFAs seem to have no major effect on the main clinical outcome in MS (disease progression), and does not substantially affect the risk of clinical relapses over 2 years. However, the data available are insufficient to assess any potential benefit or harm from PUFA supplementation. Evidence bearing on the possible benefits and risks of vitamin supplementation and antioxidant supplements in MS is lacking. More research is required to assess the effectiveness of diets interventions in MS.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Dietary interventions as complementary therapies for MS

Because available conventional treatments are only partially effective and may produce side effects, most patients with MS use therapies proposed by complementary and alternative medicine - usually diets and dietary supplements. In fact, an Internet search using the terms "multiple sclerosis" and "diet" produces over 6 million references, indicating that these treatments are widely used and believed in by the MS consumer community. The most common dietary interventions are supplementation with polyunsaturated fatty acids, allergen (gluten and milk)-free diets, vitamins, and micronutrients and antioxidants such as selenium, Gingko biloba extracts, coenzyme Q10.
The authors of this review tried to assess whether changes in dietary habits could favourably influence the prognosis of people with MS.
Although a massive amount of data has been published in this area, only 6 studies on polyunsaturated fatty acids (PUFA), studying a total of 699 patients, met the minimal inclusion criteria in terms of methodological quality, for inclusion in this review. No studies on vitamins and antioxidant supplements were found that met our criteria. No papers on any other proposed dietary intervention for MS were found after extensive searching of the scientific databases.
The data available are insufficient to assess any potential benefit or harm that might result from PUFA supplementation. This is unfortunate since 50-75% of people with MS make use of such diets and dietary supplementations.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

針對多發性硬化症之飲食療法

臨床及實驗資料顯示某些飲食, 特別是那些含有未飽和脂肪酸及維他命, 可以改善多發性硬化症病患的預後,飲食及補充劑用在越來越多的多發性硬化病人身上,我們相信它可能改善疾病預後。

目標

我們回顧了考科藍資料庫裏頭有關於多發性硬化飲食配方的隨機試驗,希望能解答評估這些飲食調控的效果及安全性。

搜尋策略

我們搜尋了考科藍資料庫多發性硬化群組試驗登錄(2006年2月)、考科藍對照試驗登錄中心(CENTRAL)、考科藍資料庫2006年議題1、MEDLINE(PubMed)(1966年至2006年3月)、EMBASE(1974年至2006年3月)以及相關的論文書目。

選擇標準

我們搜尋所有隨機對照試驗比較特定飲食配方、飲食計畫或補充劑使用,並且不能更動內容或使用安慰劑

資料收集與分析

2位審查者獨立篩選文章,評估試驗品質並摘錄資訊,發現試驗品質不佳,尤其是關於隨機化、盲目化以及報告不良反應方面,有些研究的對象退出比例相當高,至於退出研究的對象則不涵括在分析裡面。

主要結論

若以失能狀態的惡化來評估,PUFA並無對病程有顯著的影響。Ω6脂肪酸(11 – 23 g/day亞油酸)使用在75位RRMS病人身上無益處(在2年時惡化的RR = 0.78, 95% CI [0.45 to 1.36]),或使用在69位CPMS病人身上亦然RR = 1.67, 95% CI [0.75 to 3.72]。亞油酸(2.9 – 3.4 g/day)對於CPMS無益處(在2年時惡化的RR = 0.78, 95% CI [0.43 to 1.42])。 在某些研究顯示Ω6脂肪酸能稍微降低復發機率及復發的嚴重程度,不過效度有限。Ω3脂肪酸的使用療效評估方面,則是在12個月時評估14位RRMS病人及在24個月時評估292位RRMS病人,都沒有益處(12個月時RR = 0.15, 95% CI [0.01 to 3.11], p = 0.22, 24個月時RR = 0.82, 95% CI [0.65 to 1.03], p = 0.08,)。PUFA的嚴重副作用不多,沒有關於補充維他命的研究,研究不含致敏物的飲食則不符合選擇標準。

作者結論

以疾病惡化程度來評估,PUFA對多發性硬化的預後並無顯著的影響,也不會影響到2年內復發的機會,不過可擷取的資料還不足以評估PUFA的潛在益處或壞處。給多發性硬化病人補充維他命的可能益處或風險以及補充抗氧化劑都是缺乏證據的,需要更多研究來評估飲食療法在多發性硬化症的效果。

翻譯人

本摘要由新光醫院吳亞縈翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

由於目前已知傳統的多發性硬化症治療只有部分效果,大部分病人選擇附加的或替代的療法,常是飲食和食物補充品,事實上在網路用“多發性硬化”及“飲食”作搜尋會得到超過6百萬篇參考資料,表示這樣的治療被廣泛使用並且得到多發性硬化病人的認同,最常被使用的飲食療法為補充多元不飽和脂肪酸、不含致敏物(麥麩及牛奶)的飲食、微量營養素以及抗氧化物例如硒、銀杏萃取、輔脢Q10。這篇作者希望能評估何種飲食的改變能對多發性硬化預後有較佳的影響,雖然這方面有許多相關文獻,但是符合選擇標準的只有6篇,是研究多元不飽和脂肪酸療法,一共699位病人;並沒有關於維他命及抗氧化物補充的研究能符合收錄標準,也沒有找到其他多發性硬化建議的飲食療法的相關文獻。以目前有限的資料無法提供多元不飽和脂肪酸對多發性硬化的影響是好或壞,可惜約50 – 75%的多發性硬化病人都有使用飲食療法。