Mediterranean diet and associations with the gut microbiota and pediatric-onset multiple sclerosis using trivariate analysis

Ali I Mirza; Feng Zhu; Natalie Knox; Lucinda J Black; Alison Daly; Christine Bonner; Gary Van Domselaar; Charles N Bernstein; Ruth Ann Marrie; Janace Hart; E Ann Yeh; Amit Bar-Or; Julia O'Mahony; Yinshan Zhao; William Hsiao; Brenda Banwell; Emmanuelle Waubant; Helen Tremlett

doi:10.1038/s43856-024-00565-0

Mediterranean diet and associations with the gut microbiota and pediatric-onset multiple sclerosis using trivariate analysis

Commun Med (Lond). 2024 Jul 19;4(1):148. doi: 10.1038/s43856-024-00565-0.

Authors

Ali I Mirza^{1

2}, Feng Zhu¹, Natalie Knox^{3

4}, Lucinda J Black^{5

6

7}, Alison Daly⁵, Christine Bonner³, Gary Van Domselaar^{3

4}, Charles N Bernstein^{8

9}, Ruth Ann Marrie^{8

10}, Janace Hart¹¹, E Ann Yeh¹², Amit Bar-Or¹³, Julia O'Mahony¹², Yinshan Zhao¹, William Hsiao², Brenda Banwell¹⁴, Emmanuelle Waubant¹¹, Helen Tremlett¹⁵

Affiliations

¹ Department of Medicine (Neurology), The University of British Columbia, Vancouver, BC, Canada.
² Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
³ National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.
⁴ Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.
⁵ Curtin School of Population Health, Curtin University, Perth, WA, Australia.
⁶ Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia.
⁷ Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
⁸ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁹ Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.
¹⁰ Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹¹ Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
¹² Department of Pediatrics (Neurology), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
¹³ Centre for Neuroinflammation and Experimental Therapeutics and Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹⁴ Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Division of Child Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁵ Department of Medicine (Neurology), The University of British Columbia, Vancouver, BC, Canada. [email protected].

Abstract

Background: The interplay between diet and the gut microbiota in multiple sclerosis (MS) is poorly understood. We aimed to assess the interrelationship between diet, the gut microbiota, and MS.

Methods: We conducted a case-control study including 95 participants (44 pediatric-onset MS cases, 51 unaffected controls) enrolled from the Canadian Pediatric Demyelinating Disease Network study. All had completed a food frequency questionnaire ≤21-years of age, and 59 also provided a stool sample.

Results: Here we show that a 1-point increase in a Mediterranean diet score is associated with 37% reduced MS odds (95%CI: 10%-53%). Higher fiber and iron intakes are also associated with reduced MS odds. Diet, not MS, explains inter-individual gut microbiota variation. Several gut microbes abundances are associated with both the Mediterranean diet score and having MS, and these microbes are potential mediators of the protective associations of a healthier diet.

Conclusions: Our findings suggest that the potential interaction between diet and the gut microbiota is relevant in MS.

Plain language summary

Multiple sclerosis (MS) is a disease where the immune system attacks the protective covering of nerve cells in the brain. There may be a relationship between diet and bacteria within the gut and MS, however this is not well understood. We investigated how diet and gut bacteria are linked to MS in young people. We examined the diet and types of bacteria in stool samples from those with and without MS. We found that a diet richer in fiber and Mediterranean foods were less common in those with MS. This dietary pattern was linked to certain differences in the gut bacteria. These findings raise the possibility, but cannot prove, that what we eat may help prevent MS by influencing our gut bacteria. This research opens the door to further studies on how diet can impact MS through our gut bacteria.