Association of lifestyle and metabolic factors with clinical performance in multiple sclerosis: A cross-sectional study

Objectives Optimizing brain health is increasingly recommended for patients with multiple sclerosis (MS). We investigated associations between modifiable lifestyle and metabolic factors with physical and cognitive performance in 101 MS patients. Methods In this prospective, cross-sectional, exploratory study, we assessed smoking, alcohol consumption, body mass index (BMI), lipid profiles (high-density lipoprotein, HDL; low-density lipoprotein, LDL; triglycerides), and vitamin levels (vitamin D, vitamin B12, and folic acid). Associations with upper limb function (Nine-Hole Peg Test, 9HPT), lower limb function (10-meter walking test; balance board), cognitive performance (Symbol Digit Modalities Test, SDMT), and employment (weekly working hours) were examined. Results Many patients showed potential for metabolic improvement, with abnormal levels observed in LDL (57%), triglycerides (27%), vitamin D (14%), vitamin B12 (7%), and folic acid (19%). Elevated BMI was found in 41% and 24% reported smoking. Pack-years were negatively associated with performance in the 10-meter walking test ( r = −0.59, 95% CI: −0.81 to −0.23, p = 0.003), and a higher BMI was linked to poorer balance ( r = 0.21, 95% CI: 0.01–0.4, p = 0.042), while higher HDL levels correlated with preserved upper limb function ( r = −0.21, 95% CI: −0.39 to −0.01, p = 0.04). No consistent correlations were observed regarding vitamins. Performance in the SDMT and the 10-meter walking test were associated with unemployment. Conclusions Many MS patients exhibit dyslipidemia and obesity, highlighting the need for targeted interventions to enhance neurological resilience. Our cross-sectional analysis indicates that smoking, low HDL, and higher BMI may have adverse clinical effects in MS.