Navigation
Efficacy of diet on fatigue and Quality of Life in Multiple Sclerosis: a systematic review and network meta-analysis of randomized trials
The influence of dietary choices on managing multiple sclerosis (MS) has been increasingly recognized, yet existing evidence lacks the robustness to warrant specific dietary recommendations. This study systematically reviews the efficacy of diverse dietary approaches for addressing MS-related fatigue and quality of life (QoL) using a network meta-analysis (NMA).
Conducted via electronic database searches in May 2021, the research included randomized trials of dietary interventions in adult participants diagnosed with MS according to the McDonald criteria. Key inclusion criteria included assessment of patient-reported outcomes for fatigue and/or QoL, with a minimum intervention duration of 4 weeks. The study’s protocol is registered with PROSPERO (CRD42021262648).
The primary analysis included 12 trials evaluating 8 distinct dietary interventions: low-fat, Mediterranean, ketogenic, anti-inflammatory, Paleolithic, fasting, calorie restriction, and a control (usual diet). These trials collectively involved 608 participants. Results indicated that the Paleolithic diet achieved significant reductions in fatigue (standardized mean difference), along with the low-fat and Mediterranean diets, all outperforming the control group. Furthermore, regarding physical QoL, the Paleolithic and Mediterranean diets showed greater improvements than the control. In terms of mental QoL, the Paleolithic and Mediterranean diets also showed greater efficacy than the control.
However, despite these promising results, the credibility of the evidence, as evaluated using the NutriGRADE system, remains low due to pervasive risk of bias across most trials, limited participant numbers, and the limited number of studies included in the NMA. Thus, while certain dietary strategies may have potential benefits in reducing fatigue and enhancing both physical and mental QoL for MS patients, these findings underscore the need for more rigorous, controlled trials to substantiate these benefits. [NPID: Multiple Sclerosis, dietary pattern, paleolithic diet, mediterranean diet, ketogenic]
Year: 2026
