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Sodium intake and multiple sclerosis activity and progression in BENEFIT
Author(s) -
Fitzgerald Kathryn C.,
Munger Kassandra L.,
Hartung HansPeter,
Freedman Mark S.,
Montalbán Xavier,
Edan Gilles,
Wicklein EvaMaria,
Radue ErnstWilhelm,
Kappos Ludwig,
Pohl Christoph,
Ascherio Alberto
Publication year - 2017
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.24965
Subject(s) - expanded disability status scale , interquartile range , medicine , multiple sclerosis , hazard ratio , confidence interval , urine , sodium , magnetic resonance imaging , proportional hazards model , gastroenterology , randomized controlled trial , immunology , chemistry , radiology , organic chemistry
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