A Higher Mediterranean Diet Score, Including Unprocessed Red Meat, Is Associated with Reduced Risk of Central Nervous System Demyelination in a Case-Control Study of Australian Adults

• Published in: The Journal of nutrition 2019-08, Vol.149 (8), p.1385-1392
• Main Authors: Black, Lucinda J, Baker, Kimberley, Ponsonby, Anne-Louise, van der Mei, Ingrid, Lucas, Robyn M, Pereira, Gavin, Chapman, Caron, Coulthard, Alan, Dear, Keith, Dwyer, Terry, Kilpatrick, Trevor, Lucas, Robyn, McMichael (dec), Tony, Pender, Michael P, Taylor, Bruce, Valery, Patricia, van der Mei, Ingrid, Williams, David
• Format: Article
• Language: English
• Subjects: 25-Hydroxyvitamin D; Adult; Ausimmune Study; Australia; Case-Control Studies; Categories; Central nervous system; Central Nervous System Diseases - prevention & control; Demyelinating Diseases - prevention & control; Demyelination; Diet; Diet, Mediterranean; Dietary intake; Energy intake; Environmental risk; Female; Health risk assessment; Humans; Infectious mononucleosis; Male; Meat; Mediterranean diet; Middle Aged; Mononucleosis; Multiple sclerosis; nutrition and disease; nutritional epidemiology; Red Meat; Risk analysis; Risk factors; Risk management; Risk reduction; Smoking; Statistical analysis
• ISSN: 0022-3166; 1541-6100
• DOI: 10.1093/jn/nxz089

The evidence associating diet and risk of multiple sclerosis (MS) is inconclusive. The aim of this study was to investigate associations between a Mediterranean diet and risk of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. We used data from the 2003–2006 Ausimmune Study, an Australian multicenter, case-control study examining environmental risk factors for FCD, with participants matched on age, sex, and study region (282 cases, 558 controls; 18–59 y old; 78% female). The alternate Mediterranean diet score (aMED) was calculated based on data from a food-frequency questionnaire. We created a modified version of the aMED (aMED-Red) where ∼1 daily serving (65 g) of unprocessed red meat received 1 point. All other components remained the same as aMED. Conditional logistic regression (254 cases, 451 controls) was used to test associations between aMED and aMED-Red scores and categories and risk of FCD, adjusting for history of infectious mononucleosis, serum 25-hydroxyvitamin D concentrations, smoking, education, total energy intake, and dietary underreporting. There was no statistically significant association between aMED and risk of FCD [per 1-SD increase in aMED score: adjusted odds ratio (aOR): 0.89; 95% CI: 0.75, 1.06; P = 0.181]. There was evidence of a nonlinear relation between aMED-Red and risk of FCD when a quadratic term was used (P = 0.016). Compared with the lowest category of aMED-Red, higher categories were significantly associated with reduced risk of FCD, corresponding to a 37% (aOR: 0.63; 95% CI: 0.41, 0.98; P = 0.039), 52% (aOR: 0.48; 95% CI: 0.28, 0.83; P = 0.009), and 42% (aOR: 0.58; 95% CI: 0.35, 0.96; P = 0.034) reduced risk of FCD in categories 2, 3, and 4, respectively. A Mediterranean diet, including unprocessed red meat, was associated with reduced risk of FCD in this Australian adult population. The addition of unprocessed red meat to a Mediterranean diet may be beneficial for those at high risk of MS.