White matter lesion volumes on 3-T MRI in people with MS who had followed a diet- and lifestyle program for more than 10 years

Background Cerebral white matter lesions (WMLs) in people with multiple sclerosis (pwMS) are associated with the death of myelin-producing oligodendrocytes. MS treatment strategies aim to limit WML accumulation and disability progression. It is commonly accepted that nutrition is one of the possible environmental factors involved in the pathogenesis of MS, but its role as a complementary MS treatment is unclear and, to a large extent, ignored. Objective A pilot case control study over a 10 year period to ascertain whether a dietary- and lifestyle modification Program in pwMS reduces or prevents WML formation. Methods MRI was performed at baseline and after an interval period of at least 10 years or longer in 22 pwMS. WML volumes were determined using Sequence Adaptive Multimodal SEGmentation (SAMSEG) software, part of FreeSurfer 7.2. Other variables include age at MRI, disease duration, disability status and medication. Results PwMS (n=13) who had followed the Program for more than 10 years, had significantly smaller lesion volumes (mm[3][1]) compared to pwMS who did not adhere to the Program (n=9) (4950 ± 5303 vs 17934 ± 11139; p=0.002). WML volumes were significantly associated (p=0.02) with disability (EDSS) but not with age (p=0.350), disease duration (p=0.709), or Interferon-β treatment (p=0.70). Conclusion Dietary- and lifestyle changes may lower the risk of developing cerebral WMLs in pwMS and potentially slow down disease progression. Larger studies are required to confirm the effectiveness of such interventions in pwMS. ### Competing Interest Statement MJ Kotze is a nonexecutive director and shareholder of Gknowmix (Pty) Ltd, a spin-out company of the South African Medical Research Council. L Whati is a shareholder and SJ van Rensburg a scientific advisor at Gknowmix (Pty) Ltd. The remaining authors declared no conflict of interest. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. ### Funding Statement This study was funded by the National Health Laboratory Service Award Number 94139 and the South African BioDesign Initiative of the Department of Science and Innovation and the Technology Innovation Agency, South Africa (grant no. 401/01). MC Kemp was supported by Winetech, South Africa (grant no. N07/09/203). M Jaftha is funded by the Health and Welfare Sector Education and Training Authority (HW SETA) of South Africa (bursary code N716 02). The funding bodies had no role in the design of the study, collection, analysis and interpretation of data or in writing of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval was granted by the Faculty of Medicine and Health Sciences Research Ethics Committee of the SU (references NO7/09/203 and N09/08/224) and the Faculty of Health and Wellness Sciences Research Ethics Committee of CPUT (reference no: CPUT/HW-REC 2019/H27). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The anonymised data set used and analyzed during this study is available from the corresponding author upon reasonable request. [1]: #ref-3