Mediterranean Diet Score, Disability, and Brain Atrophy in Multiple Sclerosis

Close up of a healthy home-cooked meal on a plate which includes a grilled salmon fillet topped with arugula pesto accompanied by a green salad with avocado, romaine lettuce, cucumber, tomatoes, carrots and red cabbage.
In a study presented at the 2022 AAN Annual Meeting, researchers investigated the relationships between Mediterranean diet score and disability in multiple sclerosis.

The following article is part of conference coverage from the 2022 American Academy of Neurology (AAN) Annual Meeting. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from the 2022 AAN Annual Meeting.


A significant relationship between Mediterranean diet score and multiple sclerosis (MS)-related disability was established in study findings presented at the 2022 American Academy of Neurology (AAN) Annual Meeting, held from April 2 to April 7 in Seattle, Washington, and virtually from April 24-26, 2022.

Mediterranean diet score is associated with structural brain metrics and clinical outcomes in cognitive aging, suggesting potential neuroprotection, the researchers wrote. The team noted that they had previously observed a relationship between a similar score (MIND, Mediterranean-DASH Intervention for Neurodegenerative Delay) and thalamic volume in early MS.

“The MS community has a high interest in whether diet can act as a disease-modifier,” the researchers explained. Their current study sought to evaluate relationships between Mediterranean diet score and disability in MS.

The study of a representative clinical cohort included 500 patients with MS (70% women; aged 43.8±11.6 years) who completed the Mediterranean Diet Adherence Screener (MEDAS) and the Multiple Sclerosis Functional Composite (MSFC) evaluation of cognition, upper extremity coordination, and gait speed. The researchers measured third ventricle width (TVW) on axial T1 images from clinical MRIs as a validated estimate of cerebral atrophy. Multiple regressions investigated the independent contribution of MEDAS to MSFC and TVW controlling for age, sex, race, ethnicity, socioeconomic status, BMI, physical exercise, sleep disturbance, and a cardiovascular risk (CVR) index (hypertension, diabetes, hyperlipidemia, cardiac conditions, smoking).

Assessments conducted by the researchers found that higher MEDAS independently predicted better MSFC (rp=0.200, P <.001) and lower TVW (less atrophy; rp=-0.122, P =.007). MEDAS was a “much better predictor” of both MDFC and TVW than were BMI, exercise, sleep disturbance, or CVR, they wrote. The link between MEDAS and MSFC was strongest in progressive disease. The relationship between higher MEDAS and better MSFC was partially mediated through lower TVW (rpΔ: 0.200 to 0.167, Ps < .001), “consistent with the notion that MEDAS preserves functional outcomes by supporting brain maintenance,” they wrote.

A “significant association” exists between Mediterranean diet score and MS-related disability, the researchers concluded, after controlling for important potential confounders. They believe that, “The strength of the relationship in progressive disease and partial mediation by third ventricle width suggests the possibility of a neuroprotective mechanism.” As such, they suggested that longitudinal studies and interventional clinical trials are needed.


Katz Sand I, Fitzgerald K, Sorets T, Levy S, Sumowski J. Mediterranean Diet Score is Associated with Disability and Brain Atrophy in Multiple Sclerosis. Presented at: the 2022 AAN Annual Meeting; April 2-7, 2022; Seattle, Washington; April 24-26, 2022; Virtual Meeting. Abstract S14.002.