A Scoping Review of Modifiable Risk Factors in Pediatric Onset Multiple Sclerosis: Building for the Future

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Abstract

Knowledge of the effect of modifiable lifestyle factors in the pediatric multiple sclerosis (MS) population is limited. We therefore conducted a scoping review, following the framework provided by Arksey and O’Malley. Four databases were searched for pediatric MS and modifiable lifestyle factors using index terms and keywords, from inception to May 2018. All quantitative and qualitative primary articles were included and limited to English and full text. Of the 7202 articles identified and screened, 25 full-text articles were relevant to our objective and were included. These articles focused on diet obesity, physical activity, and sleep. In cross-sectional analyses, these lifestyle factors were associated with increased risk of pediatric onset MS (POMS), and increased disease activity. Diet, particularly vitamin D and vegetable intake, was associated with reduced relapse rate. Obesity was linked to increased risk of POMS, and physical activity was associated with reduced relapse rate and sleep/rest fatigue. Thus, available studies of lifestyle related outcomes in pediatric MS suggest specific lifestyle related factors, including obesity, higher vitamin D levels, and higher physical activity may associate with lower disease burden in POMS. Studies reviewed are limited by their observational designs. Future studies with longitudinal and experimental designs may further clarify the role of modifiable lifestyle factors in this population.

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The influence of diet on the gut microbiota.

Karen Scott, Silvia Gratz, Paul Sheridan … (2013)

Diet is a major factor driving the composition and metabolism of the colonic microbiota. The amount, type and balance of the main dietary macronutrients (carbohydrates, proteins and fats) have a great impact on the large intestinal microbiota. The human colon contains a dense population of bacterial cells that outnumber host cells 10-fold. Bacteroidetes, Firmicutes and Actinobacteria are the three major phyla that inhabit the human large intestine and these bacteria possess a fascinating array of enzymes that can degrade complex dietary substrates. Certain colonic bacteria are able to metabolise a remarkable variety of substrates whilst other species carry out more specialised activities, including primary degradation of plant cell walls. Microbial metabolism of dietary carbohydrates results mainly in the formation of short chain fatty acids and gases. The major bacterial fermentation products are acetate, propionate and butyrate; and the production of these tends to lower the colonic pH. These weak acids influence the microbial composition and directly affect host health, with butyrate the preferred energy source for the colonocytes. Certain bacterial species in the colon survive by cross-feeding, using either the breakdown products of complex carbohydrate degradation or fermentation products such as lactic acid for growth. Microbial protein metabolism results in additional fermentation products, some of which are potentially harmful to host health. The current 'omic era promises rapid progress towards understanding how diet can be used to modulate the composition and metabolism of the gut microbiota, allowing researchers to provide informed advice, that should improve long-term health status. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Consensus definitions proposed for pediatric multiple sclerosis and related disorders.

Silvia Tenembaum, Brenda Banwell, … (2007)

The CNS inflammatory demyelinating disorders of childhood include both self-limited and lifelong conditions, which can be indistinguishable at the time of initial presentation. Clinical, biologic, and radiographic delineation of the various monophasic and chronic childhood demyelinating disorders requires an operational classification system to facilitate prospective research studies. The National Multiple Sclerosis Society (NMSS) organized an International Pediatric MS Study Group (Study Group) composed of adult and pediatric neurologists and experts in genetics, epidemiology, neuropsychology, nursing, and immunology. The group met several times to develop consensus definitions regarding the major CNS inflammatory demyelinating disorders of children and adolescents. Clinical definitions are proposed for pediatric multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), recurrent ADEM, multiphasic ADEM, neuromyelitis optica, and clinically isolated syndrome. These definitions are considered operational and need to be tested in future research and modified accordingly. CNS inflammatory demyelinating disorders presenting in children and adolescents can be defined and distinguished. However, prospective research is necessary to determine the validity and utility of the proposed diagnostic categories.

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Natural history of multiple sclerosis with childhood onset.

Sandra Vukusic, Jean Pelletier, Thibault Moreau … (2007)

The course and prognosis of childhood-onset multiple sclerosis have not been well described. We used data from 13 adult neurology departments affiliated with the European Database for Multiple Sclerosis (EDMUS) network to identify a cohort of 394 patients who had multiple sclerosis with an onset at 16 years of age or younger and a comparison group of 1775 patients who had multiple sclerosis with an onset after 16 years of age. We determined the initial clinical features, the dates of disease onset, and the occurrence of outcomes, including relapse, conversion to secondary progression, and irreversible disability as measured by scores of 4 (limited walking ability but ability to walk more than 500 m without aid or rest), 6 (ability to walk with unilateral support no more than 100 m without rest), and 7 (ability to walk no more than 10 m without rest while using a wall or furniture for support) on the Kurtzke Disability Status Scale (range, 0 to 10; higher scores indicate more severe disability). For patients with childhood-onset multiple sclerosis, the estimated median time from onset to secondary progression was 28 years, and the median age at conversion to secondary progression was 41 years. The median times from onset to disability scores of 4, 6, and 7 were 20.0, 28.9, and 37.0 years, respectively, and the corresponding median ages were 34.6, 42.2, and 50.5 years. In comparison with patients with adult-onset disease, those with childhood-onset disease were more likely to be female than male (female:male ratio, 2.8 vs. 1.8), were more likely to have an exacerbating-remitting initial course (98% vs. 84%), took approximately 10 years longer to reach secondary progression and irreversible disability, and reached these landmarks at an age approximately 10 years younger (P<0.001 for all comparisons). Patients with childhood-onset multiple sclerosis take longer to reach states of irreversible disability but do so at a younger age than patients with adult-onset multiple sclerosis.

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Author and article information

Journal

Journal ID (nlm-ta): Children (Basel)

Journal ID (iso-abbrev): Children (Basel)

Journal ID (publisher-id): children

Title: Children

Publisher: MDPI

ISSN (Electronic): 2227-9067

Publication date (Electronic): 26 October 2018

Publication date Collection: November 2018

Volume: 5

Issue: 11

Electronic Location Identifier: 146

Affiliations

[1 ]Department of Rehabilitation Sciences, School of Rehabilitation Therapy, Queen’s University, Louise D Acton Building, 31 George St, Kingston, ON K7L 3N6, Canada; julie.petrin@ 123456queensu.ca

[2 ]Faculty of Medicine, Dalhousie University, Sir Charles Tupper Building, 5850 College Street, Halifax, NS B3H 4R2, Canada; max.fiander@ 123456dal.ca

[3 ]Department of Neurosciences, Faculty of Medicine, Université Laval, Pavillon Ferdinand Vandry, 1050, Medecine Avenue, Quebec City, QC G1V 0A6, Canada; prenitha-mercy.ignatius-arokia-doss.1@ 123456ulaval.ca

[4 ]Hospital for Sick Children, Division of Neurology, SickKids Research Institute, Neurosciences and Mental Health, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 3H7, Canada

Author notes

[* ]Correspondence: ann.yeh@ 123456sickkids.ca ; Tel.: +1-416-813-7353

[†]

These authors contributed equally.

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Julie Pétrin https://orcid.org/0000-0003-4852-0286

E. Ann Yeh https://orcid.org/0000-0002-5393-7417

Article

Publisher ID: children-05-00146

DOI: 10.3390/children5110146

PMC ID: 6262383

PubMed ID: 30373215

SO-VID: 71be5e0a-8487-4593-88f0-52685d3c2651

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

A Scoping Review of Modifiable Risk Factors in Pediatric Onset Multiple Sclerosis: Building for the Future

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 43

The influence of diet on the gut microbiota.

Consensus definitions proposed for pediatric multiple sclerosis and related disorders.

Natural history of multiple sclerosis with childhood onset.

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