Lipid profile, adiposity level predict clinical course after first demyelinating event
Among patients with central nervous system demyelination, higher adiposity and triglycerides are associated with relapse but not with conversion to multiple sclerosis (MS), a prospective cohort study has shown. Furthermore, higher levels of adiposity, non-high density lipoprotein (HDL) and total cholesterol (TC)/HDL ratio are related to a higher rate of disability progression.
The study followed 279 patients with a first clinical diagnosis of central nervous system demyelination for 5 years. Mean age at enrolment was 38.8 years, and majority were female (77 percent). Height, weight, waist and hip circumference were measured, and lipids and apolipoproteins were quantified from the serum samples.
Outcomes of interest were conversion to MS, time to relapse and annualised disability progression (as assessed using the Kurtzke Expanded Disability Status Scale). Analyses were performed using linear and Cox regression.
Results showed an increased risk of subsequent relapse among patients with higher body mass index (BMI; adjusted hazard ratio (aHR), 1.22 per 5-kg/m2 increase; 95 percent CI, 1.04 to 1.44), larger hip circumference (aHR, 1.32 per 10-cm increase; 1.12 to 1.56) and higher triglyceride levels (aHR, 1.20 per unit increase; 1.03 to 1.40). Adiposity and lipid-related measures showed no association with conversion to MS.
Moreover, higher BMI (β, 0.04 per 5-kg/m2 increase), hip circumference (β, 0.04 per 10-cm increase), waist circumference (β, 0.04 per 10-cm increase), TC/HDL ratio (β, 0.05) and non-HDL (β, 0.04) values were associated with increased annual rate of disability.
The findings highlight the value of improving the lipid profile and losing weight into the healthy range in reducing the accumulation of disability among patients with central nervous system demyelination, researchers said.
First demyelinating event represents the earliest clinical stage in the development of MS, which is an inflammatory, demyelinating and neurodegenerative disease of the central nervous system. A clearer understanding of the factors related to the risk of conversion from demyelination to MS could allow the identification of predictive biomarkers of conversion, disability progression, quality of life and potential intervention targets. [Neurohospitalist 2013;3:65–80; Neurology 2014;83:278–86; Ann Neurol 2011;69:292–302; J Neurol Neurosurg Psychiatry 2013;84:1186–91]