{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:10:39Z","timestamp":1784545839572,"version":"3.55.0"},"reference-count":43,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100018548","name":"Curtin University, Malaysia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018548","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020598","name":"Multiple Sclerosis Society of Western Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020598","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000924","name":"Multiple Sclerosis Research Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000924","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001797","name":"Curtin University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001797","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011873","name":"Multiple Sclerosis Scientific Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011873","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP2034008"],"award-info":[{"award-number":["APP2034008"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","msard-journal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Multiple Sclerosis and Related Disorders"],"published-print":{"date-parts":[[2026,5]]},"DOI":"10.1016\/j.msard.2026.107159","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T16:07:19Z","timestamp":1774368439000},"page":"107159","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"special_numbering":"C","title":["Higher ultra-processed food consumption is associated with higher likelihood of paediatric-onset multiple sclerosis"],"prefix":"10.1016","volume":"109","author":[{"given":"Priscila","family":"Machado","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajar","family":"Mazahery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucinda J","family":"Black","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Tremlett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Daly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngoc Minh","family":"Pham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gizachew A","family":"Tessema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Banwell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Bar-Or","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth Ann","family":"Marrie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles N","family":"Bernstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali I","family":"Mirza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Ann","family":"Yeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuelle","family":"Waubant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"O\u2019Mahony","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9139-015X","authenticated-orcid":false,"given":"Eleanor","family":"Dunlop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.msard.2026.107159_bib0001","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0029819","article-title":"Multiple sclerosis risk variant HLA-DRB1*1501 associates with high expression of DRB1 gene in different human populations","volume":"7","author":"Alcina","year":"2012","journal-title":"PLoS. One"},{"key":"10.1016\/j.msard.2026.107159_bib0002","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12883-018-1026-3","article-title":"Pediatric multiple sclerosis: a review","volume":"18","author":"Alroughani","year":"2018","journal-title":"BMC. Neurol."},{"issue":"12","key":"10.1016\/j.msard.2026.107159_bib0003","doi-asserted-by":"crossref","DOI":"10.1111\/obr.13126","article-title":"Ultra-processed foods and the nutrition transition: global, regional and national trends, food systems transformations and political economy drivers","volume":"21","author":"Baker","year":"2020","journal-title":"Obes. Rev."},{"issue":"2","key":"10.1016\/j.msard.2026.107159_bib0004","doi-asserted-by":"crossref","DOI":"10.1111\/mcn.13097","article-title":"First-food systems transformations and the ultra-processing of infant and young child diets: the determinants, dynamics and consequences of the global rise in commercial milk formula consumption","volume":"17","author":"Baker","year":"2020","journal-title":"Matern. Child Nutr."},{"key":"10.1016\/j.msard.2026.107159_bib0005","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/S1474-4422(11)70045-X","article-title":"Clinical, environmental, and genetic determinants of multiple sclerosis in children with acute demyelination: a prospective national cohort study","volume":"10","author":"Banwell","year":"2011","journal-title":"Lancet Neurol."},{"issue":"9","key":"10.1016\/j.msard.2026.107159_bib0006","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S1474-4422(07)70196-5","article-title":"Clinical features and viral serologies in children with multiple sclerosis: a multinational observational study","volume":"6","author":"Banwell","year":"2007","journal-title":"Lancet Neurol."},{"issue":"8","key":"10.1016\/j.msard.2026.107159_bib0007","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1093\/jn\/nxz089","article-title":"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","volume":"149","author":"Black","year":"2019","journal-title":"J. Nutr."},{"key":"10.1016\/j.msard.2026.107159_bib0008","doi-asserted-by":"crossref","first-page":"125","DOI":"10.3389\/fneur.2019.00125","article-title":"Higher non-processed red meat consumption is associated with a reduced risk of central nervous system demyelination","volume":"10","author":"Black","year":"2019","journal-title":"Front. Neurol."},{"issue":"11","key":"10.1016\/j.msard.2026.107159_bib0009","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1177\/1352458518793524","article-title":"A healthy dietary pattern associates with a lower risk of a first clinical diagnosis of central nervous system demyelination","volume":"25","author":"Black","year":"2019","journal-title":"Mult. Scler. J."},{"issue":"5","key":"10.1016\/j.msard.2026.107159_bib0010","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1038\/s41430-019-0476-z","article-title":"Higher fish consumption and lower risk of central nervous system demyelination","volume":"74","author":"Black","year":"2019","journal-title":"Eur. J. Clin. Nutr."},{"key":"10.1016\/j.msard.2026.107159_bib0011","article-title":"Ultraprocessed food consumption and obesity development in Canadian children","volume":"8","author":"Chen","year":"2025","journal-title":"JAMa Netw. Open."},{"issue":"18","key":"10.1016\/j.msard.2026.107159_bib0012","doi-asserted-by":"crossref","first-page":"3012","DOI":"10.3390\/nu17183012","article-title":"Ultra-processed food consumption and systemic inflammatory biomarkers: A scoping review","volume":"17","author":"Ciaffi","year":"2025","journal-title":"Nutrients."},{"key":"10.1016\/j.msard.2026.107159_bib0013","series-title":"Statistical Software Components","article-title":"PARAMED: Stata module to perform causal mediation analysis using parametric regression models","volume":"S457581","author":"Emsley","year":"2013"},{"issue":"7","key":"10.1016\/j.msard.2026.107159_bib0014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.29245\/2572.942X\/2016\/7.1064","article-title":"Obesity and multiple sclerosis susceptibility: A review","volume":"1","author":"Gianfrancesco","year":"2016","journal-title":"J. Neurol. Neuromedicine"},{"key":"10.1016\/j.msard.2026.107159_bib0015","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1086720","article-title":"Ultra-processed foods consumption is associated with multiple sclerosis severity","volume":"14","author":"Guglielmetti","year":"2023","journal-title":"Front. Neurol."},{"key":"10.1016\/j.msard.2026.107159_bib0016","series-title":"The Canadian Nutrient File","year":"2023"},{"issue":"2","key":"10.1016\/j.msard.2026.107159_bib0017","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1111\/j.1740-8709.2012.00446.x","article-title":"Relative validation of Block Kids food screener for dietary assessment in children and adolescents","volume":"11","author":"Hunsberger","year":"2015","journal-title":"Matern. Child Nutr."},{"key":"10.1016\/j.msard.2026.107159_bib0018","article-title":"Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses","volume":"384","author":"Lane","year":"2024","journal-title":"BMJ"},{"issue":"404","key":"10.1016\/j.msard.2026.107159_bib0019","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1080\/01621459.1988.10478722","article-title":"A test of missing completely at random for multivariate data with missing values","volume":"83","author":"Little","year":"1988","journal-title":"J. Am. Stat. Assoc."},{"issue":"5","key":"10.1016\/j.msard.2026.107159_bib0020","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1038\/s41430-023-01271-1","article-title":"Higher consumption of ultra-processed foods and increased likelihood of central nervous system demyelination in a case-control study of Australian adults","volume":"77","author":"Mannino","year":"2023","journal-title":"Eur. J. Clin. Nutr."},{"key":"10.1016\/j.msard.2026.107159_bib0021","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1038\/s41430-021-00864-y","article-title":"Dietary patterns and associations with health outcomes in Australian people with multiple sclerosis","volume":"75","author":"Marck","year":"2021","journal-title":"Eur. J. Clin. Nutr."},{"key":"10.1016\/j.msard.2026.107159_bib0022","doi-asserted-by":"crossref","DOI":"10.1016\/j.nut.2019.110609","article-title":"Effect of ultra-processed diet on gut microbiota and thus its role in neurodegenerative diseases","volume":"71","author":"Mart\u00ednez Leo","year":"2020","journal-title":"Nutrition"},{"key":"10.1016\/j.msard.2026.107159_bib0023","doi-asserted-by":"crossref","DOI":"10.1016\/j.nut.2019.110609","article-title":"Effect of ultra-processed diet on gut microbiota and thus its role in neurodegenerative diseases","volume":"71","author":"Mart\u00ednez Leo","year":"2020","journal-title":"Nutrition"},{"issue":"6","key":"10.1016\/j.msard.2026.107159_bib0024","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1038\/s43016-023-00779-w","article-title":"Best practices for applying the Nova food classification system","volume":"4","author":"Martinez-Steele","year":"2023","journal-title":"Nat. Food"},{"issue":"10","key":"10.1016\/j.msard.2026.107159_bib0025","doi-asserted-by":"crossref","DOI":"10.3390\/nu13103390","article-title":"Ultra-processed foods and nutritional dietary profile: A meta-analysis of nationally representative samples","volume":"13","author":"Martini","year":"2021","journal-title":"Nutrients."},{"key":"10.1016\/j.msard.2026.107159_bib0026","series-title":"Ultra-processed foods, diet quality, and health using the NOVA classification system","author":"Monteiro","year":"2019"},{"key":"10.1016\/j.msard.2026.107159_bib0027","series-title":"Ultra-processed foods, diet quality, and health using the NOVA classification system","author":"Monteiro","year":"2019"},{"issue":"5","key":"10.1016\/j.msard.2026.107159_bib0028","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1017\/S1368980018003762","article-title":"Ultra-processed foods: what they are and how to identify them","volume":"22","author":"Monteiro","year":"2019","journal-title":"Public Health Nutr."},{"issue":"1","key":"10.1016\/j.msard.2026.107159_bib0029","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1017\/S1368980017000234","article-title":"The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing","volume":"21","author":"Monteiro","year":"2018","journal-title":"Public Health Nutr."},{"issue":"10520","key":"10.1016\/j.msard.2026.107159_bib0030","doi-asserted-by":"crossref","first-page":"2667","DOI":"10.1016\/S0140-6736(25)01565-X","article-title":"Ultra-processed foods and human health: the main thesis and the evidence","volume":"406","author":"Monteiro","year":"2025","journal-title":"The Lancet"},{"key":"10.1016\/j.msard.2026.107159_bib0031","series-title":"Nutrition and MS. MS Canada, Toronto","year":"2023"},{"issue":"12","key":"10.1016\/j.msard.2026.107159_bib0032","doi-asserted-by":"crossref","DOI":"10.1111\/ijpo.12563","article-title":"Consumption of ultra-processed foods and its association with added sugar content in the diets of US children, NHANES 2009-2014","volume":"14","author":"Neri","year":"2019","journal-title":"Pediatr. Obes."},{"key":"10.1016\/j.msard.2026.107159_bib0033","doi-asserted-by":"crossref","DOI":"10.1111\/obr.13387","article-title":"Ultraprocessed food consumption and dietary nutrient profiles associated with obesity: A multicountry study of children and adolescents","volume":"23","author":"Neri","year":"2022","journal-title":"Obes. Rev."},{"issue":"8","key":"10.1016\/j.msard.2026.107159_bib0034","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1177\/1352458517713343","article-title":"Dietary factors and pediatric multiple sclerosis: A case-control study","volume":"24","author":"Pakpoor","year":"2018","journal-title":"Mult. Scler."},{"issue":"11","key":"10.1016\/j.msard.2026.107159_bib0035","first-page":"3","article-title":"Consumption of ultra-processed foods in Canada","volume":"31","author":"Polsky","year":"2020","journal-title":"Health Rep."},{"issue":"7","key":"10.1016\/j.msard.2026.107159_bib0036","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1212\/01.WNL.0000156155.19270.F8","article-title":"Multiple Sclerosis Severity Score: using disability and disease duration to rate disease severity","volume":"64","author":"Roxburgh","year":"2005","journal-title":"Neurology."},{"issue":"4","key":"10.1016\/j.msard.2026.107159_bib0037","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1177\/1536867X0900900403","article-title":"Bootstrap assessment of the stability of multivariable models","volume":"9","author":"Royston","year":"2009","journal-title":"Stata. J."},{"issue":"3","key":"10.1016\/j.msard.2026.107159_bib0038","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1111\/hex.13226","article-title":"Navigating dietary advice for multiple sclerosis","volume":"24","author":"Russell","year":"2021","journal-title":"Health Expect."},{"issue":"161","key":"10.1016\/j.msard.2026.107159_bib0039","first-page":"1","article-title":"Reported changes in dietary behavior following a first clinical diagnosis of central nervous system demyelination","volume":"9","author":"Russell","year":"2018","journal-title":"Front. Neurol."},{"issue":"12","key":"10.1016\/j.msard.2026.107159_bib0040","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1016\/S2468-1253(22)00169-8","article-title":"Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights","volume":"7","author":"Srour","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"issue":"2","key":"10.1016\/j.msard.2026.107159_bib0041","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria","volume":"17","author":"Thompson","year":"2018","journal-title":"Lancet Neurol."},{"issue":"12","key":"10.1016\/j.msard.2026.107159_bib0042","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1002\/acn3.51476","article-title":"The gut microbiota in pediatric multiple sclerosis and demyelinating syndromes","volume":"8","author":"Tremlett","year":"2021","journal-title":"Ann. Clin. Transl. Neurol."},{"issue":"6","key":"10.1016\/j.msard.2026.107159_bib0043","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1001\/jama.2021.10238","article-title":"Trends in consumption of ultraprocessed foods among US youths aged 2-19 years, 1999-2018","volume":"326","author":"Wang","year":"2021","journal-title":"JAMa"}],"container-title":["Multiple Sclerosis and Related Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2211034826001951?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2211034826001951?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T12:25:46Z","timestamp":1781526346000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2211034826001951"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":43,"alternative-id":["S2211034826001951"],"URL":"https:\/\/doi.org\/10.1016\/j.msard.2026.107159","relation":{},"ISSN":["2211-0348"],"issn-type":[{"value":"2211-0348","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Higher ultra-processed food consumption is associated with higher likelihood of paediatric-onset multiple sclerosis","name":"articletitle","label":"Article Title"},{"value":"Multiple Sclerosis and Related Disorders","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.msard.2026.107159","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Author(s). Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"107159"}}