Modified Mediterranean diet v. traditional Iranian diet: efficacy of dietary interventions on dietary inflammatory index score, fatigue severity and disability in multiple sclerosis patients

Background: Current evidence suggests that adherence to the Mediterranean diet (MeD) can reduce inflammation in chronic diseases; however, studies pertaining to relapsing-remitting multiple sclerosis (RRMS) are limited. Therefore, the aim of this study was to investigate the potential of the modi?ed MeD (mMeD) in improving Dietary Inflammatory Index (DII) scores, disability and fatigue severity, compared with traditional Iranian diet (TID), in RRMS patients. Results: Of the 180 patients enrolled, 147 participants were included in the ?nal analysis (n of mMeD = 68; n of TID = 79). Self-reported adherence was good (similar to 81 %). Dietary intakes of forty-five food parameters were assessed through the FFQ. The mMeD significantly reduced DII scores after 6 months (2 center dot 38 +/- 0 center dot 21 to -1 center dot 87 +/- 0 center dot 86, P < 0 center dot 001), but TID did not elicit any changes (2 center dot 21 +/- 0 center dot 44 to 2 center dot 14 +/- 1 center dot 01, P = 0 center dot 771). Additionally, Modified Fatigue Impact Scale (MFIS) total score decreased significantly (72 center dot 4 +/- 17 center dot 2 to 63 center dot 9 +/- 14 center dot 2, P < 0 center dot 001), whereas there was no considerable improvement for Expanded Disability Status Scale (EDSS) in the mMeD group. Methods: After initial screening (n 261), 180 RRMS patients were randomised to receive mMeD or TID (as control) for 6 months. DII score, EDSS and twenty-one-item MFIS were evaluated at baseline and trial cessation. Multivariate ANCOVA was conducted and adjusted for age, gender, body weight, BMI, education level, supplement use, family history and duration of MS. Conclusion: Adherence to mMeD, for 6 months, improved dietary inflammatory status and fatigue severity in RRMS patients; however, the TID did not positively impact dietary inflammation and MFIS score.