Inflammation, Disability Made Worse by Obesity in Patients With Relapsing-Remitting Multiple Sclerosis

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Obesity could exacerbate inflammation and worsen clinical disability in patients with relapsing-remitting multiple sclerosis.

Obesity may exacerbate inflammation and clinical disability in patients with relapsing-remitting multiple sclerosis (RRMS), according to a study in Multiple Sclerosis Journal.

"It is important to precisely define the relationship between obesity, blood lipids and multiple sclerosis. Body weight and dyslipidemias are implicated in various chronic inflammatory conditions, but they are also factors that strictly depend on lifestyle,” said Diego Centonze, MD, PhD, professor of neurology at Tor Vergata University and head of the neurology unit at Neuromed, in a statement. “Specific strategies, such as diet or increased physical activity, may therefore pave the way to the possibility of improving the condition of patients with multiple sclerosis, contrasting the increase of disability over time.”

Researchers conducted a cross-sectional study of 140 patients with RRMS to examine whether adipocyte mass, in terms of body mass index (BMI), and levels of serum lipids affected cerebrospinal fluid inflammation and disease severity.


Participants were clinically assessed, had their BMI calculated, underwent magnetic resonance imaging, and had their blood and cerebrospinal fluid collected before they were treated. Cerebrospinal fluids were analyzed to measure levels of cytokines, adipocytokines, and inflammatory factors, including interleukin-6 and -13, granulocyte macrophage colony-stimulating factor, leptin, ghrelin, osteoprotegerin, osteopontin, plasminogen activator inhibitor-1, resistin, and Annexin A1. Serum levels of triglycerides, total cholesterol, and high-density lipoprotein cholesterol were also measured.

A positive correlation was found between BMI and Expanded Disability Status Scale (EDSS) score. Patients who were obese had higher EDSS scores at the time of diagnosis, indicating heightened clinical disability and worse disease severity.

Researchers found that patients who were obese had higher levels of proinflammatory molecules interleukin-6 and leptin as well as lower concentrations of the anti-inflammatory cytokine interleukin-13. They also discovered that triglyceride levels and total to high-density lipoprotein (T/HDL) cholesterol ratios were positively correlated with interleukin-6 concentrations, as obese patients with high triglycerides and elevated T/HDL ratios were also found to have greater levels of interleukin-6.

"This study confirms that obesity is associated with greater symptomatic severity of relapsing-remitting multiple sclerosis. In particular, the analysis of cerebrospinal fluid has highlighted the role of leptin produced by fat cells. Previous studies have shown that leptin is directly involved in the complex relationship between metabolism and inflammation,” said Mario Stampanoni Bassi, MD, neurologist at Neuromed and the study’s lead author, in a statement. “Our results therefore suggest that excessive body weight, or altered lipid profile, are associated to increased central inflammation causing a worse clinical expression of the disease.”


Bassi MS, Iezzi E, Buttari F, et al. Obesity worsens central inflammation and disability in multiple sclerosis. Mult Scler J. Published online June 4, 2019. doi: 10.1177/1352458519853473.