Obesity May Up Risk for Severe Disease, Poorer Outcomes in Multiple Sclerosis

Obesity is associated with higher baseline and subsequent levels of disability among patients with multiple sclerosis.

Among patients with newly diagnosed multiple sclerosis (MS), obesity was assoicated with greater disease severity at baseline and poorer outcomes, according to findings from a nationwide longitudinal cohort study published in the Journal of Neurology, Neurosurgery & Psychiatry.

Higher body mass index (BMI) during childhood and adolescence has been assoicated with elevated risk for MS. Despite the apparent link between MS and obesity, it remains unclear whether obesity at diagnosis or during disease progression affects outcomes.

At 22 centers affiliated with the German Competence Network Multiple Sclerosis (KKNMS), patients (N=1066) with newly diagnosed MS were recruited for the German National MS (NationMS) cohort. Outcomes up to 6 years were evaluated on the basis of obesity at baseline. Obesity was defined as BMI ³30 kg/m2.

The patient population comprised 70.5% women; median age, 31 (interquartile range [IQR], 26-40) years; median BMI, 24.17 (IQR, 21.55-27.46) kg/m2, median Expanded Disability Status Scale (EDSS) score of 1.5 (IQR, 1-2) points; serum neurofilament light chain (sNfL) levels of 11.49 (IQR, 7.5-21) pg/mL; and 70.8% were not receiving disease modifying therapy (DMT) at baseline.

A total of 159 patients were classified as obese and compared with the patients without obesity, they had higher EDSS scores (P =.001), were older (P =.012), and had lower sNfL levels (P =.029).

These data suggest that dedicated management of obesity should be explored for its potential merit in improving long-term clinical outcomes of patients diagnosed with MS.

Patients with obesity had a higher EDSS scores at baseline, but the patients who were obese continued to have worse EDSS scores than individuals without obesity at the 2- (P <.001), 4- (P <.001), and 6- (P <.001) year follow-ups.

The median time to reach EDSS 3 was shorter for patients with obesity than patients without obesity (median, 0.99 vs 1.46 years), respectively, and obesity associated with risk for reaching EDSS 3 by year 6 after, adjusting for covariates (adjusted hazard ratio [aHR], 1.87; 95% CI, 1.3-2.6; P <.001).

Among the cohort of patients who completed the 6-year follow-up (n=511), more of the patients with obesity reached EDSS 3 compared with patients without obesity (37% vs 17.7%; aHR, 2.13; 95% CI, 1.39-3.27; P <.001), respectively.

After patients were additionally stratified by BMI, no association with poorer outcomes was observed among patients who were classified as overweight (BMI 25-29.9 kg/m2). Although patients with obesity had higher rates of comorbidities, such as type 2 diabetes and arterial hypertension, these comorbidities themselves were not significantly related with poorer outcomes.

The major limitation of this study was the high proportion of patients lost during follow-up.

These data indicated that patients who are diagnosed with MS with obesity likely have a poorer prognosis than those without obesity. “These data suggest that dedicated management of obesity should be explored for its potential merit in improving long-term clinical outcomes of patients diagnosed with MS,” the researchers concluded.


Lutfullin I, Eveslage M, Bittner S, et al. Association of obesity with disease outcome in multiple sclerosis. J Neurol Neurosurg Psychiatry. Published online November 1, 2022. doi:10.1136/jnnp-2022-329685