Sodium intake and multiple sclerosis activity and progression in BENEFIT

Kathryn C Fitzgerald; Kassandra L Munger; Hans-Peter Hartung; Mark S Freedman; Xavier Montalbán; Gilles Edan; Eva-Maria Wicklein; Ernst-Wilhelm Radue; Ludwig Kappos; Christoph Pohl; Alberto Ascherio; BENEFIT Study Group; S Strasser-Fuchs; T Berger; K Vass; J Fredriksen; J Kesselring; A J Petkau; K V Toyka

doi:10.1002/ana.24965

Sodium intake and multiple sclerosis activity and progression in BENEFIT

Kathryn C Fitzgerald, Kassandra L Munger, Hans-Peter Hartung, Mark S Freedman, Xavier Montalbán, Gilles Edan, Eva-Maria Wicklein, Ernst-Wilhelm Radue, Ludwig Kappos, Christoph Pohl, Alberto Ascherio, BENEFIT Study Group, S Strasser-Fuchs, T Berger, K Vass, J Fredriksen, J Kesselring, A J Petkau, K V Toyka

Department of Clinical Medicine

41 Citations (Scopus)

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.

Original language	English
Journal	Annals of Neurology
Volume	82
Issue number	1
Pages (from-to)	20-29
ISSN	0364-5134
DOIs	https://doi.org/10.1002/ana.24965
Publication status	Published - 1 Jul 2017

Keywords

Adult
Brain/pathology
Demyelinating Diseases/diagnosis
Disability Evaluation
Disease Progression
Female
Humans
Interferon beta-1b/therapeutic use
Magnetic Resonance Imaging
Male
Multiple Sclerosis/diagnosis
Neuroimaging
Sodium, Dietary/adverse effects
Young Adult

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10.1002/ana.24965

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Fitzgerald, K. C., Munger, K. L., Hartung, H-P., Freedman, M. S., Montalbán, X., Edan, G., Wicklein, E-M., Radue, E-W., Kappos, L., Pohl, C., Ascherio, A., BENEFIT Study Group, Strasser-Fuchs, S., Berger, T., Vass, K., Fredriksen, J., Kesselring, J., Petkau, A. J., & Toyka, K. V. (2017). Sodium intake and multiple sclerosis activity and progression in BENEFIT. Annals of Neurology, 82(1), 20-29. https://doi.org/10.1002/ana.24965

Fitzgerald, KC, Munger, KL, Hartung, H-P, Freedman, MS, Montalbán, X, Edan, G, Wicklein, E-M, Radue, E-W, Kappos, L, Pohl, C, Ascherio, A, BENEFIT Study Group, Strasser-Fuchs, S, Berger, T, Vass, K, Fredriksen, J, Kesselring, J, Petkau, AJ & Toyka, KV 2017, 'Sodium intake and multiple sclerosis activity and progression in BENEFIT', Annals of Neurology, vol. 82, no. 1, pp. 20-29. https://doi.org/10.1002/ana.24965

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title = "Sodium intake and multiple sclerosis activity and progression in BENEFIT",

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.",

keywords = "Adult, Brain/pathology, Demyelinating Diseases/diagnosis, Disability Evaluation, Disease Progression, Female, Humans, Interferon beta-1b/therapeutic use, Magnetic Resonance Imaging, Male, Multiple Sclerosis/diagnosis, Neuroimaging, Sodium, Dietary/adverse effects, Young Adult",

author = "Fitzgerald, {Kathryn C} and Munger, {Kassandra L} and Hans-Peter Hartung and Freedman, {Mark S} and Xavier Montalb{\'a}n and Gilles Edan and Eva-Maria Wicklein and Ernst-Wilhelm Radue and Ludwig Kappos and Christoph Pohl and Alberto Ascherio and {BENEFIT Study Group} and S Strasser-Fuchs and T Berger and K Vass and J Fredriksen and J Kesselring and Petkau, {A J} and Toyka, {K V}",

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doi = "10.1002/ana.24965",

language = "English",

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TY - JOUR

T1 - Sodium intake and multiple sclerosis activity and progression in BENEFIT

AU - Fitzgerald, Kathryn C

AU - Munger, Kassandra L

AU - Hartung, Hans-Peter

AU - Freedman, Mark S

AU - Montalbán, Xavier

AU - Edan, Gilles

AU - Wicklein, Eva-Maria

AU - Radue, Ernst-Wilhelm

AU - Kappos, Ludwig

AU - Pohl, Christoph

AU - Ascherio, Alberto

AU - BENEFIT Study Group

AU - Strasser-Fuchs, S

AU - Berger, T

AU - Vass, K

AU - Fredriksen, J

AU - Kesselring, J

AU - Petkau, A J

AU - Toyka, K V

PY - 2017/7/1

Y1 - 2017/7/1

N2 - 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.

AB - 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.

KW - Adult

KW - Brain/pathology

KW - Demyelinating Diseases/diagnosis

KW - Disability Evaluation

KW - Disease Progression

KW - Female

KW - Humans

KW - Interferon beta-1b/therapeutic use

KW - Magnetic Resonance Imaging

KW - Male

KW - Multiple Sclerosis/diagnosis

KW - Neuroimaging

KW - Sodium, Dietary/adverse effects

KW - Young Adult

U2 - 10.1002/ana.24965

DO - 10.1002/ana.24965

M3 - Journal article

C2 - 28556498

SN - 0364-5134

VL - 82

SP - 20

EP - 29

JO - Annals of Neurology

JF - Annals of Neurology

IS - 1

ER -

Sodium intake and multiple sclerosis activity and progression in BENEFIT

Abstract

Keywords

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