November 29, 2024 | News | Living with MS MS Research

Lifestyle and MS: New research from ECTRIMS

Part 3

Obesity
Alcohol
Genetics
Epstein-Barr virus (EBV)

The impact of lifestyle and environmental factors on MS was a key topic at the annual congress of the European Committee for Treatment and Research in MS (ECTRIMS), the year’s largest meeting about MS. The following is a sampling of research about lifestyle (e.g. obesity, alcohol) and environmental factors (e.g. viral infection) that can influence the onset and severity of MS.

Obesity
It is now generally accepted that obesity during adolescence is associated with a higher risk of developing MS. A study in the UK found that people with higher body weight had more disabling symptoms at the time of their MS diagnosis (Craig and colleagues. ECTRIMS 2024;P1312). However, it should be noted that some of the disability symptoms they were assessing may have been due to obesity rather than MS. A separate analysis of 15 studies found that young women had a 2-fold higher risk of developing MS (Mohammadi and colleagues. ECTRIMS 2024;P1419).

Whether obesity makes MS worse is more controversial. The UK study found that disability worsening was unaffected by a person’s body weight. This was supported by a study in Turkey, which found that physical or mental worsening over a five-year period was not affected by body weight (Unal and colleagues. ECTRIMS 2024;P1182).

Many people now take weight-loss drugs such as Ozempic/Wegovy (semaglutide), and researchers at Massachusetts General Hospital looked at the safety of these products in 43 people with MS (Udawatta and colleagues. ECTRIMS 2024;P1302). The average age of people in the study was 54 years and most had relapsing-remitting MS. The average body-mass index (BMI) at the start was 39.8 (kg/m², e.g. a 5-foot 5 inch woman weighing 239 pounds). The most common side effect was gastrointestinal symptoms, reported by 11 (28%) people, which prompted three people to stop treatment. The average weight loss was 1.25 pounds (about half a kilo) per month. Younger people lost more weight (18 pounds after a year) compared to older people (10 pounds/year). In clinical trials of Ozempic/Wegovy – which emphasized the need to exercise during treatment – people lost more weight (about 24 pounds per year). So this suggests the benefits of weight-loss drugs may be modest in MS if physical disability limits how much exercise can be performed.

Alcohol
A Swedish study looked at how alcohol consumption affects disability worsening in MS over a 15-year period (Alfredsson and colleagues. ECTRIMS 2024;P068). The average age at the start of the study was 37 years. People who enjoyed low to moderate alcohol consumption had better physical functioning over the long term compared to non-drinkers. Moreover, heavy alcohol consumption did not affect the MS disease course.

Genetics
Researchers in the U.S. obtained MRIs for 180 close relatives of people with MS (children or siblings) to see if they showed early signs of disease (Alvarez and colleagues. ECTRIMS 2024;O003). A total of 27 MRI scans (15%) had abnormalities suggestive of MS (1 person was later diagnosed with MS). MS is not inherited, but the risk of MS is higher in close relatives (about 3%). This suggests that another four people in this group might go on to develop MS. A curious finding in this study was the number of people (almost 60%) with an abnormal (not MS-related) MRI scan – meaning if you look hard enough you will find something.

Epstein-Barr virus (EBV)
EBV is a normally innocuous virus that infects most people during their lifetime. Contracting the virus during adolescence – which can cause mononucleosis – is now recognized as an important risk factor for developing MS. A population study in Denmark found that people who were hospitalized with mononucleosis had a 3-fold higher risk of later developing MS (Kopp and colleagues. ECTRIMS 2024;P075). The MS risk was highest if a person was aged 11-19 years when they developed mononucleosis. Similar results were seen in an Ontario study (Rotstein and colleagues. ECTRIMS 2024;P078). Overall, 0.4% (4 people per 1000) with mononucleosis later developed MS. The average time from mononucleosis to the development of MS was 11.5 years. The MS risk was highest if mononucleosis occurred during adolescence or early adulthood.

How EBV contributes to the development of MS is not well understood. The latest studies have shown that people with MS have a higher EBV viral load (Thebault and colleagues. ECTRIMS 2024;O007, Kearns and colleagues. ECTRIMS 2024;P154). This suggests that EBV viral infection is less controlled in people with MS, perhaps due to genetic (or other) factors. It is interesting that the theory that MS is due to an inadequate anti-viral response has been discussed for over 40 years – the rationale for the first generation of MS drugs (the interferons).

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