Obesity Associated With Greater Relapse Activity, Impaired Function in MS

The investigators examined the association between obesity and the age of first symptom(s), number of impaired functional domains, and early relapse activity in patients with MS.
The following article is part of conference coverage from the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers in Nashville, Tennesssee. 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 CMSC 2018.

Obesity is associated with increases in the number of impaired functional domains (NIFDs) and early relapse activity (ERA) during the early clinical stages of multiple sclerosis (MS), according to a study presented at the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 30-June 2 in Nashville, Tennessee.

“In recent years the relationship between obesity and risk of MS has become clear, however, the influence on the manifestation of MS is not known,” the study investigators reported. “Given temporality, we hypothesize obesity negatively affects the early clinical expression of MS.”

The study included 1524 participants with MS from the Accelerated Cure Project, a nonprofit research program. A subset of patients had genotypic data available for analysis (n=1054). The investigators examined the association between obesity and the age of first MS symptom(s), the number of NIFDs, and ERA (ie, number of relapses in the first 2 years following onset).

The investigators included other variables within the analysis, including gender, birth year, race, type of MS (eg, relapsing-remitting MS [RRMS] or primary progressive MS [PPMS] at onset), smoking status within 5 years of MS onset, diagnosis of obesity by onset, history of infectious mononucleosis, education level as a determinant of socioeconomic status (SES), comorbidity burden, and presence of the HLA-DRB1*15:01 haplotype.

Patients with the HLA-DRB1*15:01 haplotype experienced an earlier age of MS onset. In addition, patients who smoked and had a lower education level (lower SES) also experienced an earlier age of MS symptom onset. Participants with PPMS were more often older at MS onset compared with patients with RRMS. Obese participants were approximately 8% older at MS onset compared with non-obese patients (P =3×10-4).

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Patients with RRMS, lower SES, and older age of MS symptom onset also had increased NIFDs at MS onset. Further, there was a 15% increase in NIFDs among obese patients (P =.04) and an 8% increase in NIFDs among smokers (P =.07). Additionally, obese patients demonstrated a 30% increase in ERA compared with non-obese patients (P <.01). An association was demonstrated between increased ERA and younger age of MS onset and lower SES, and there was a trend toward increased ERA in smokers (P =.06).

“There were multiple significant associations; of note, obesity was associated with older AOO and increases in NIFDs and ERA,” added the researchers. “These results warrant further investigation into the impact of this proinflammatory phenotype in MS.”

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Briggs FBS, Yu J, Jiangyang J, Utigard E, Gunzler DD, Ontaneda D. Obesity at onset impacts the early clinical presentation of multiple sclerosis. Presented at: 32nd Annual Meeting of the Consortium of Multiple Sclerosis Centers. May 30-June 2, 2018; Nashville, TN. Abstract DA07.