Online Interventions Can Improve Dietary Behaviors in People With MS

People with multiple sclerosis were interested in nutrition education and improved their dietary behaviors after completing an online nutrition program, according to a study published online ahead of print in Multiple Sclerosis and Related Disorders.¹

The Australian study focused on nutritional education because nutrition is potentially linked with multiple sclerosis disease activity and progression, according to past research.² In the new study, researchers aimed to determine the feasibility of an online nutrition program for patients with multiple sclerosis using a single-arm pre- and post design.¹

The study suggests the codesigned EWWMS program filled a need for reliable and evidence-based nutrition information for patients with MS. | Image credit: Studio Romantic - stock.adobe.com

“Diet quality is important for people with multiple sclerosis (MS), but conflicting online information causes them confusion,” the authors wrote. “People with MS want evidence-based MS-specific information to help them make healthy dietary changes, and we co-designed an asynchronous, online nutrition education program (Eating Well With MS [EWWMS]) with the MS community.”

The study assessed 4 feasibility outcomes: demand, which was determined by recruitment; practicality, assessed by completion; acceptability, measured by the Intrinsic Motivation Inventory: interest/enjoyment and value/usefulness subscales; and limited efficacy testing, which included the Diet Habits Questionnaire (DHQ), Critical Nutrition Literacy Tool (CNLT), and Food Literacy Behaviour Checklist (FLBC).

A total of 70 participants enrolled in the study and completed baseline assessments, and 44 completed more than half of the modules in the program and the postintervention survey. At baseline, 26% of patients reported currently making dietary changes, and 10% were following a specific diet. Of the patients who completed more than half the modules and the postintervention survey, 98% were female, 52% held a bachelor’s degree or higher, and 66% were currently employed.

A total of 59 participants (84%) completed at least 1 of 5 core modules in the program, 44 participants (63%) finished more than half of the program, and 38 participants (54%) finished all 5 EWWMS program modules within 9 weeks.

Regarding acceptability, the median (IQR) rating was 5.0 (1.7) for interest/enjoyment and the median value/usefulness rating was 5.9 (2.1) out of 7, with 7 indicating “very true.”

“Our study completion rates highlight the practicality of the intervention,” the authors explained. “Additionally, the median interest/enjoyment and value/usefulness scores indicate that EWWMS was well-received, reinforcing the acceptability as an intervention for people with MS. The EWWMS program was codesigned with MS community input and best practice educational features, including positive tone and credible presenters, the success of which has also been shown in other acceptable online MS programs.”

In terms of limited efficacy testing, total DHQ and DHQ subscores except food preparation were significantly better after the intervention vs at baseline, with a mean (SD) increase of 6.7 (6.4) among the 44 participants who finished more than half or all of the modules. CNLT and FLBC scores were also statistically significantly higher following the intervention vs at baseline.

Health-related outcomes did not differ before and after the EWWMS intervention, but the researchers noted that participants with higher reported fatigue and depression symptoms appeared more vulnerable to lower diet quality.

“Epidemiological evidence suggests that a healthy diet can alleviate some MS symptoms, improve quality of life, and reduce relapse rate,” the authors wrote. “The positive changes in dietary behaviors demonstrated in this feasibility study suggest that interventions like EWWMS could contribute to improved well-being and disease management among people with MS.”

The study was limited in its reliance on self-reported measures to assess diet and psychosocial factors, the varying rates of module completion and participant retention, and the lack of comparator arm. However, the findings suggest that the codesigned EWWMS program filled a need for reliable and evidence-based nutrition information for patients with MS.

“The potential for further tailoring of the content and delivery, investigating factors influencing engagement and strategies to enhance adherence to the program, and a larger-scale effectiveness study to validate the long-term impact of the program are warranted,” the authors concluded. “Our findings support nutritionists and dietitians to use co-design methods when developing resources to improve dietary behaviors.”

References

1. Russell RD, Begley A, Daly A, et al. Feasibility of a co-designed online nutrition education program for people with multiple sclerosis. Mult Scler Relat Disord. Published online August 12, 2024. doi:10.1016/j.msard.2024.105816

2. Stoiloudis P, Kesidou E, Bakirtzis C, et al. The role of diet and interventions on multiple sclerosis: a review. Nutrients. 2022;14(6):1150. doi:10.3390/nu14061150