Pediatric multiple sclerosis: current perspectives on health behaviors

Figures & data

Table 1 Papers investigating diet/nutrition/obesity

Reference number	Author, year	Purpose	Results
^Citation26	McDonald et al, 2016	Determine if salt intake is associated with POMS risk	No association between salt intake and POMS risk
^Citation27	Pakpoor et al, 2017	Determine association between dietary factors and POMS	POMS vs controls: POMS are less likely to have insufficient iron No difference in fat, protein, carbohydrates, sugars, fruits, or vegetables
^Citation28	Chitnis et al, 2016	Evaluate contribution of BMI and puberty for risk and age of onset of POMS	POMS had earlier puberty and higher BMI
^Citation29	Langer-Gould et al, 2013	Determine whether obesity is a risk factor for development of POMS or CIS	↑ BMI = ↑ risk for demyelination
^Citation30	Nourbakhsh et al, 2016	Determine if salt intake is associated with time to relapse in POMS	No association between salt intake and relapse rate
^Citation31	Gianfrancesco et al, 2017	Determine association between vitamin D, BMI, and POMS using genetic risk scores	Vitamin D associated with increased odds of POMS Significant association between BMI genetic risk score and POMS
^Citation32	Brenton et al, 2014	Evaluate prevalence and factors associated with vitamin D insufficiency and deficiency in childhood vs adult-onset demyelinating disease	No difference in vitamin D deficiency between childhood and adult-onset demyelinating disease
^Citation33	Mowry et al, 2010	Determine if vitamin D status is associated with relapses in POMS	Vitamin D levels associated with relapse rates
^Citation34	Kyrsko et al, 2016	Determine whether BMI at dx of POMS predicts disease activity, including ARR and MRI lesions	>50% POMS were overweight or obese at time of dx No association between BMI at POMS dx and disease activity
^Citation35	Azary et al, 2018	Evaluate effect of diet on relapse rate in POMS	↑ fat intake = ↑ hazard to relapse
^Citation36	Graves et al, 2016	Determine association between established risk factors for POMS and relapse rate	HLA-DRB1*15 modified association between vitamin D and relapse rate in POMS

Abbreviations: ARR, annualized relapse rate; BMI, body mass index; CIS, clinically isolated syndrome; dx, diagnosis; POMS, pediatric-onset multiple sclerosis.

Table 2 Papers investigating physical activity

Reference number	Author, year	Purpose	Results
^Citation19	Yeh, 2012	Provide overview of diagnosis and management of POMS	Exercise may reduce fatigue
^Citation37	Grover et al, 2015	Examine PA, fatigue, depression, relapse rate, and MRI metrics in children with POMS and mono-ADS	↓ PA = ↑ fatigue (and vice versa) ↑ PA = ↓ sleep/rest fatigue symptoms POMS had less PA than mono-ADS ↑ strenuous PA = ↓ T2 lesion volumes, sleep/rest fatigue symptoms, and annualized relapse rate
^Citation38	Grover et al, 2016	Evaluate PA with objective and self-report measures with children with POMS, healthy controls, and mono-ADS Assessed correlates of PA, including demographic and clinical characteristics, and theory related determinants	Light and total PA associated with sleep/rest and fatigue Exercise goal setting and self-efficacy linked to PA POMS had less min/day vigorous PA than mono-ADS and controls POMS had less total PA than mono-ADS
^Citation39	Sawicki et al, 2015	Assess relationship between self-efficacy, functional disability, and PA in POMS	Self-efficacy and functional disability correlate with self-report and objective measures of PA
^Citation40	Grover et al, 2015	Investigate and compare PA levels in youth with POMS, healthy controls, and mono-ADS	POMS report ↓ PA self-efficacy and ↑ perceived functional disability than peers POMS had less vigorous PA than peers
^Citation41	Yeh et al, 2015	Describe a research agenda on PA and its consequences and promotion in POMS	Effects of PA and PA maintenance track across lifespan, particularly when developed early in life
^Citation42	Rocca et al, 2015	Editorial review on PA to control MS from childhood	Physical activity may influence disease outcome
^Citation43	Kinnett-Hopkins et al, 2016	Validate the GLTEQ in POMS patients by using accelerometer in combination with a nomological net	↑ Vigorous PA = ↓ depressive and fatigue symptoms POMS had less strenuous and total PA than mono-ADS

Abbreviations: GLTEQ, Godin leisure-time exercise questionnaire; mono-ADS, monophasic acquired demyelinating syndrome; PA, physical activity; POMS, pediatric-onset multiple sclerosis.

Table 3 Papers investigating sleep

Reference number	Author, year	Purpose	Results
^Citation37	Grover et al, 2015	Examine PA, fatigue, depression, relapse rate, and MRI metrics in children with POMS and mono-ADS	Moderate PA associated with fewer sleep/rest fatigue symptoms
^Citation38	Grover et al, 2016	Evaluate PA with objective and self-report measures with children with POMS, healthy controls, and mono-ADS Assessed correlates of PA, including demographic and clinical characteristics, and theory related determinants	Moderate PA associated with fewer sleep/rest fatigue symptoms
^Citation45	Zafar et al, 2012	Determine whether children with POMS have more sleep disturbances, fatigue, and daytime sleepiness vs healthy controls	POMS more successful in following consistent bedtime routines POMS had comparable fatigue with matched controls

Abbreviations: mono-ADS, monophasic acquired demyelinating syndrome; PA, physical activity; POMS, pediatric-onset multiple sclerosis.

Figure 1 Flow diagram of paper selection.

McDonaldJGravesJWaldmanAA case-control study of dietary salt intake in pediatric-onset multiple sclerosisMult Scler Relat Disord20166879227063630

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PakpoorJSeminatoreBGravesJSUS Network of Pediatric Multiple Sclerosis CentersDietary factors and pediatric multiple sclerosis: a case-control studyMult Scler2017 1352458517713343

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ChitnisTGravesJWeinstock-GuttmanBDistinct effects of obesity and puberty on risk and age at onset of pediatric MSAnn Clin Transl Neurol201631289790728097202

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Langer-GouldABraraSMBeaberBEKoebnickCChildhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndromeNeurology201380654855223365063

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NourbakhshBGravesJCasperTCNetwork of Pediatric Multiple Sclerosis CentersDietary salt intake and time to relapse in paediatric multiple sclerosisJ Neurol Neurosurg Psychiatry201687121350135327343226

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GianfrancescoMAStridhPRheadBNetwork of Pediatric Multiple Sclerosis CentersEvidence for a causal relationship between low vitamin D, high BMI, and pediatric-onset MSNeurology201788171623162928356466

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BrentonJNKoenigSGoldmanMDVitamin D status and age of onset of demyelinating diseaseMult Scler Relat Disord20143668468825891547

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MowryEMKruppLBMilazzoMVitamin D status is associated with relapse rate in pediatric-onset multiple sclerosisAnn Neurol201067561862420437559

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KryskoKYehEAHanwellHCohenARotsteinDObesity and disease activity in pediatric-onset multiple sclerosis (P1376)Neurology20168616 Suppl376

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AzarySSchreinerTGravesJContribution of dietary intake to relapse rate in early paediatric multiple sclerosisJ Neurol Neurosurg Psychiatry2018891283328993476

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GravesJSBarcellosLFShaoXU.S. Network of Pediatric MS CentersGenetic predictors of relapse rate in pediatric MSMult Scler J2016221215281535

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YehEAManagement of children with multiple sclerosisPaediatr Drugs201214316517722497553

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GroverSAAubert-BrocheBFetcoDLower physical activity is associated with higher disease burden in pediatric multiple sclerosisNeurology201585191663166926268901

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GroverSASawickiCPKinnett-HopkinsDPhysical activity and its correlates in youth with multiple sclerosisJ Pediatr201617919720327717498

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SawickiCGroverSKinnett-HopkinsDSelf-efficacy and functional disability as barriers to physical activity participation in pediatric multiple sclerosis (P4.023)Neurology20158414 Suppl P4. 023

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GroverSAKinnett-HopkinsDSawickiCPLow levels of participation in vigorous physical activity in youth with multiple sclerosis and the associations with fatigue and depressionMultiple Sclerosis Journal201521379380

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YehEAKinnett-HopkinsDGroverSAMotlRWPhysical activity and pediatric multiple sclerosis: developing a research agendaMult Scler201521131618162526447061

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RoccaMAFilippiMDeivaKPromoting physical activity to control multiple sclerosis from childhoodNeurology201585191644164526268902

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Kinnett-HopkinsDGroverSAYehEAMotlRWPhysical activity in pediatric onset multiple sclerosis: Validating a questionnaire for clinical practice and researchMult Scler Relat Disord201610262927919494

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ZafarABNessJDowdySAvisKBashirKExamining sleep, fatigue, and daytime sleepiness in pediatric multiple sclerosis patientsMult Scler201218448148821965417

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