A Pragmatic Trial of Dietary Programs in People With Multiple Sclerosis (MS)

Johns Hopkins University

Status: Completed

Conditions: Multiple Sclerosis

Treatments: Behavioral: Timing Restriction; Other: Frequent Patient Interaction; Device: LoseIt! Smartphone Application

Study type: Interventional

Funder types: Other

Identifiers

NCT02846558

IRB00105123

Details and patient eligibility

About

This is a pragmatic, single-blinded randomized trial of improving adherence to dietary interventions in patients with MS who are receiving monthly natalizumab infusions.

Full description

MS affects at least 400,000 people in the US alone, and its incidence has increased in the past 50 years, likely due to changing environmental risk factors. Recent research suggests that diet may be a critical factor in the development of MS. The "Western diet", high in sugar, fat, and salt, may influence MS risk and progression by directly affecting the immune system, altering gut bacteria, and changing metabolism.

Studying patients with MS who are overweight and obese may be relevant as obesity can cause chronic low-grade inflammation, potentially worsening MS symptoms. Diet modification represents an interesting potential therapy for MS, particularly calorie restriction and fasting, which have been associated with reduced markers of inflammation. In addition to these direct effects, weight optimization may lead to improvements in MS-related symptoms, like fatigue, and overall quality of life.

This is a single-blinded randomized trial of adherence to a dietary intervention in patients with MS who are receiving monthly natalizumab infusions. The study will evaluate how use of technology may help patients with MS adhere to a calorie restricted diet. It will also evaluate the effect of weight loss on fatigue and quality of life in patients with MS. A second part of the study will evaluate if shortening the period during the day in which people consume their typical food amounts leads to improvements in patient-reported outcomes.

Enrollment: 54 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Body Mass Index (BMI) ≥ 25 kg/m^2 for calorie restriction study
• BMI < 25 kg/m^2, or ≥ 25 kg/m^2 if participant was unwilling to enroll in calorie restriction study
• Smartphone with the ability to download and use the LoseIt! application (calorie restriction only)
• Smartphone with the ability to take and store photos (calorie timing only)

Exclusion criteria

• History of diabetes requiring medication
• Currently pregnant or breastfeeding
• History of an eating disorder
• Currently taking warfarin
• History of major surgery within past 3 months

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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54 participants in 4 patient groups, including a placebo group

Calorie Restriction - Frequent Patient Communication

Experimental group

Description:

MS patients receiving monthly natalizumab infusions will use the LoseIt! smartphone application to log daily food consumption. Data from the app will be collected at follow-up visits. Patients will receive initial training in using the app, and then receive weekly supportive messages encouraging them to adhere to the calorie restriction diet between 3- and 6-month followup visits. Results will be compared primarily to those collected from the Standard of Care arm.

Treatment:

Device: LoseIt! Smartphone Application

Other: Frequent Patient Interaction

Timing Restriction

Experimental group

Description:

MS patients receiving monthly natalizumab infusions who are ineligible for the calorie restriction portion of the study (the Frequent Patient Activation and Standard of Care arms) will be offered the option to enroll in the second part of the study, assessing differences in outcomes between daily 16-hour fasting periods and no dietary changes. Patients in the second part of the study randomized to this arm will consume their normal daily food intake, but restrict eating to an 8-hour period during the day. Results will be compared to patients who do not make any changes to their diet, the No Change arm.

Treatment:

Behavioral: Timing Restriction

Calorie Restriction - Communication Standard of Care

Placebo Comparator group

Description:

MS patients receiving monthly natalizumab infusions will use the LoseIt! smartphone application to log daily food consumption. Data from the app will be collected at follow-up visits. Besides initial training with the application and 3- and 6-month follow up exams, participants will not receive additional support or interaction from the study team.Results will be compared with those collected from the Frequent Patient Interaction arm.

Treatment:

Device: LoseIt! Smartphone Application

No Diet Change

No Intervention group

Description:

MS patients receiving natalizumab infusions who were ineligible for the calorie restriction portion of the study (e.g. body mass index \< 25 kg/m\^2) or did not wish to participate in calorie restriction, may elect to be part of the second portion of the study. If so, they may be randomized to this arm, in which no changes are made to amount or timing of daily food intake. Results will be compared with the experimental Timing arm