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Ann Neurol. 2017 Jul;82(1):20-29. doi: 10.1002/ana.24965.

Sodium intake and multiple sclerosis activity and progression in BENEFIT.

Author information

1
Department of Neurology and Neuroimmunology, Johns Hopkins School of Medicine, Baltimore, MA.
2
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.
3
Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
4
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
5
Vall d'Hebron University Hospital, Barcelona, Spain.
6
Pontchaillou University Hospital Center, Rennes, France.
7
Bayer AG, Berlin, Germany.
8
Medical Image Analysis Center, University Hospital Basel, Basel, Switzerland.
9
Neurological Clinic and Polyclinic, Departments of Medicine, Clinical Research, and Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland.
10
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.

Abstract

OBJECTIVE:

To assess whether a high-salt diet, as measured by urinary sodium concentration, is associated with faster conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) and MS activity and disability.

METHODS:

BENEFIT was a randomized clinical trial comparing early versus delayed interferon beta-1b treatment in 465 patients with a CIS. Each patient provided a median of 14 (interquartile range = 13-16) spot urine samples throughout the 5-year follow-up. We estimated 24-hour urine sodium excretion level at each time point using the Tanaka equations, and assessed whether sodium levels estimated from the cumulative average of the repeated measures were associated with clinical (conversion to MS, Expanded Disability Status Scale [EDSS]) and magnetic resonance imaging (MRI) outcomes.

RESULTS:

Average 24-hour urine sodium levels were not associated with conversion to clinically definite MS over the 5-year follow-up (hazard ratio [HR] = 0.91, 95% confidence interval [CI] = 0.67-1.24 per 1g increase in estimated daily sodium intake), nor were they associated with clinical or MRI outcomes (new active lesions after 6 months: HR = 1.05, 95% CI = 0.97-1.13; relative change in T2 lesion volume: -0.11, 95% CI = -0.25 to 0.04; change in EDSS: -0.01, 95% CI = -0.09 to 0.08; relapse rate: HR = 0.78, 95% CI = 0.56-1.07). Results were similar in categorical analyses using quintiles.

INTERPRETATION:

Our results, based on multiple assessments of urine sodium excretion over 5 years and standardized clinical and MRI follow-up, suggest that salt intake does not influence MS disease course or activity. Ann Neurol 2017;82:20-29.

PMID:
28556498
PMCID:
PMC5555227
DOI:
10.1002/ana.24965
[Indexed for MEDLINE]
Free PMC Article

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