Multiple Skleroz Hastalarında Tıbbi Beslenme Tedavisi ve Sinbiyotik Desteğinin Hastalık Göstergelerine ve Yaşam Kalitesine Etkilerinin Değerlendirilmesi

Abstract

This study was conducted as a randomized clinical trial to examine the effects of medical nutrition therapy applied to multiple sclerosis (MS) patients and synbiotic support given in addition to medical nutrition therapy on the nutritional status of individuals, quality of life and clinical course of the disease. The study was carried out with a total of 38 patients, 18 intervention and 20 control, who completed the 12-week intervention study among 92 volunteer female individuals with MS between the ages of 19-64 who applied to the Bakırköy Prof. Dr. Prof. Dr. Mazhar Osman Education and Research Hospital for Psychiatric and Neurological Disease MS policlinic and met the study criteria. It was conducted as a randomized clinical trial. For the first 6 weeks, all participants were given medical nutrition therapy training planned in accordance with the principles of the Mediterranean Diet. After the 6th week, the participants were divided into two groups according to the randomization table; during the following 6 weeks, in addition to medical nutrition therapy, placebo was given to the control group and synbiotic supplement was given to the study group twice a day, in the morning and in the evening, after meals. In the 1st, 6th and 12th weeks of the study, the participants' three-day food consumption records and Healthy Eating Index (HEI-2015) scores obtained from these records, 24-hour physical activity records, anthropometry and hand grip strength measurements, biochemical indicators, Beck Depression Inventory, Mediterranean Diet Adherence Scale, Multiple Sclerosis Quality of Life Scale-54, Expanded Disability Status Scale (EDSS) scores were evaluated. While the participants' dietary fiber, vitamin B6, potassium and iron intakes were below the requirement in the first week of the study, it was observed that the deficiency in fiber and vitamin B6 intakes was eliminated in both groups in the 6th and 12th weeks. After the medical nutrition therapy, dietary energy, carbohydrate, fat, saturated and monounsaturated fatty acid and cholesterol intakes and the percentages of energy obtained from fat and carbohydrates decreased in both groups in the 6th and 12th weeks compared to the 1st week while the percentage of energy provided by protein, fiber, soluble and insoluble fiber intakes increased (p≤0.05 for each). Following medical nutrition therapy, Mediterranean Diet Adherence Scale and HEI-2015 scores increased in both groups (p≤0.05 for each), but there was no statistical difference between the groups in the changes observed during the study (p>0.05). Among anthropometric measurements, body weight, body mass index, waist, hip and upper arm circumferences, triceps skinfold thickness and hand grip strength decreased in both groups during the study (p≤0.05 for each), and only the changes in triceps skinfold thickness and upper middle arm circumference were found to be statistically different between the groups (p≤0.05 for each). Among the biochemical indicators, serum fasting insulin (p=0.026) and serum LDL cholesterol (p=0.032) levels decreased in the study group, while serum albumin (p=0.001) and serum hematocrit (p=0.048) levels increased during the study. In the control group, serum triglyceride level (p=0.035) showed a statistically significant decrease during the study. Among the biochemical findings serum fasting insulin (p=0.026) and serum LDL cholesterol (p=0.032) levels decreased while serum albumin (p=0.001) and serum hematocrit (p=0.048) levels increased in the study group during the study. In the control group, only serum triglyceride level (p=0.035) showed a statistically significant decrease during the study. EDSS scores of the participants showed a significant decrease in both groups at the 6th and 12th weeks (p≤0.05), and the difference between the groups was found to be statistically significant (p=0.022). The composite mental health score showed a statistically significant increase between the 1st and 12th weeks in the study group (p=0.015) and during the study in the control group (p=0.002). While the composite physical health score increased in the 12th week in the study group compared to the 1st and 6th weeks (p = 0.001), it did not show a significant change in the control group (p=0.074). Beck Depression Inventory score decreased in the study group during the study (p=0.008) but did not show a statistically significant change in the control group (p=0.111). In conclusion, this study showed that medical nutrition therapy can improve the nutritional status, quality of life and disease symptoms of individuals with MS, and synbiotic support given in addition to medical nutrition therapy can have positive effects on some indicators of the disease. In addition, in order for prebiotics and probiotics to be included routinely in MS treatments, new studies with large samples and long follow-up periods are needed, primarily on probiotics whose activities are defined on a strain basis and on prebiotics that show the best synergistic effect.