{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:13:38Z","timestamp":1791940418194,"version":"4.3.4"},"reference-count":42,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Multiple sclerosis (MS) is a chronic, immune-mediated neurological disorder characterized by inflammation, demyelination, and progressive neurodegeneration. While genetic susceptibility contributes to disease risk, a growing body of evidence highlights the crucial role of modifiable lifestyle factors in influencing MS onset, disease activity, progression, and overall quality of life. In this narrative review, we explored the relevant literature from commonly used datasets (PubMed, Scopus, Google Scholar), using search terms such as \u201cLifestyle and Multiple Sclerosis\u201d, \u201cDiet and Multiple Sclerosis\u201d, \u201cSleep and Multiple Sclerosis\u201d, \u201cAlcohol consumption and Multiple Sclerosis\u201d, and \u201cPhysical Activity and Multiple Sclerosis\u201d. Obesity, particularly during adolescence, has emerged as a significant risk factor for MS, acting through immunometabolic mechanisms such as chronic low-grade inflammation, insulin resistance, and dysregulated adipokine signaling. Sleep disturbances are increasingly recognized as contributors to neuroinflammation and cognitive dysfunction, potentially mediated by impaired glymphatic clearance. Smoking is consistently associated with accelerated disability progression, while alcohol consumption shows dose-dependent effects, with excessive intake negatively impacting sleep and glymphatic function. Overall, lifestyle factors converge on shared biological pathways involving immune regulation, metabolic health, vascular integrity, and glymphatic function. Integrating evidence-based lifestyle counseling with disease-modifying therapies may represent a complementary strategy to optimize long-term outcomes in people with MS, while highlighting key areas for future translational and clinical research.<\/jats:p>","DOI":"10.3390\/brainsci16020224","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T17:51:32Z","timestamp":1771005092000},"page":"224","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Role of Lifestyle Factors in Multiple Sclerosis: An Integrative Perspective"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6388-8180","authenticated-orcid":false,"given":"Roberta","family":"Lanzillo","sequence":"first","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80138 Naples, Italy"},{"name":"MS Center, Federico II University Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marinella","family":"Clerico","sequence":"additional","affiliation":[{"name":"Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy"},{"name":"San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5226-8373","authenticated-orcid":false,"given":"Saverio","family":"Stranges","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Biostatistics, Western University, London, ON N6G 2M1, Canada"},{"name":"Department of Family Medicine, Western University, London, ON N6G 2M1, Canada"},{"name":"Department of Medicine, Western University, London, ON N6G 2M1, Canada"},{"name":"Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1038\/nri3871","article-title":"Immunopathology and pathogenesis of multiple sclerosis","volume":"15","author":"Dendrou","year":"2015","journal-title":"Nat. Rev. Immunol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition","volume":"26","author":"Walton","year":"2020","journal-title":"Mult. Scler. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1759091414568185","DOI":"10.1177\/1759091414568185","article-title":"Nutrition facts in multiple sclerosis","volume":"7","author":"Riccio","year":"2015","journal-title":"ASN Neuro"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1212\/WNL.0000000000004768","article-title":"Diet quality is associated with disability and symptom severity in multiple sclerosis","volume":"90","author":"Fitzgerald","year":"2018","journal-title":"Neurology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"463","DOI":"10.3945\/an.116.014191","article-title":"Influence of diet in multiple sclerosis: A systematic review","volume":"8","author":"Bagur","year":"2017","journal-title":"Adv. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1001\/jamaneurol.2013.5993","article-title":"Vitamin D as an early predictor of multiple sclerosis activity and progression","volume":"71","author":"Ascherio","year":"2014","journal-title":"JAMA Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1212\/WNL.0b013e3182343274","article-title":"A randomized trial of high-dose vitamin D2 in relapsing-remitting multiple sclerosis","volume":"77","author":"Stein","year":"2011","journal-title":"Neurology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1906","DOI":"10.1212\/WNL.0000000000008445","article-title":"Randomized trial of daily high-dose vitamin D3 in patients with RRMS receiving subcutaneous interferon beta-1a","volume":"93","author":"Hupperts","year":"2019","journal-title":"Neurology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1093\/brain\/awad409","article-title":"Vitamin D did not reduce multiple sclerosis disease activity after a clinically isolated syndrome","volume":"147","author":"Butzkueven","year":"2024","journal-title":"Brain"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1001\/jama.2025.1604","article-title":"High-Dose Vitamin D in Clinically Isolated Syndrome Typical of Multiple Sclerosis: The D-Lay MS Randomized Clinical Trial","volume":"333","author":"Thouvenot","year":"2025","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.plefa.2005.05.024","article-title":"Low-fat dietary intervention with omega-3 fatty acid supplementation in multiple sclerosis patients","volume":"73","author":"Baier","year":"2005","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1001\/archneurol.2012.283","article-title":"\u03c9-3 fatty acid treatment in multiple sclerosis (OFAMS Study): A randomized, double-blind, placebo-controlled trial","volume":"69","author":"Torkildsen","year":"2012","journal-title":"Arch. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mokry, L.E., Ross, S., Timpson, N.J., Sawcer, S., Davey Smith, G., and Richards, J.B. (2016). Obesity and Multiple Sclerosis: A Mendelian Randomization Study. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1002053"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mandato, C., Colucci, A., Lanzillo, R., Staiano, A., Scarpato, E., Schiavo, L., Operto, F.F., Serra, M.R., Di Monaco, C., and Napoli, J.S. (2023). Multiple Sclerosis-Related Dietary and Nutritional Issues: An Updated Scoping Review with a Focus on Pediatrics. Children, 10.","DOI":"10.3390\/children10061022"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"103274","DOI":"10.1016\/j.msard.2021.103274","article-title":"ProspeCtive study to evaluate efficacy, safety and tOlerability of dietary supplemeNT of Curcumin (BCM95) in subjects with Active relapsing MultIple Sclerosis treated with subcutaNeous Interferon beta 1a 44 mcg TIW (CONTAIN): A randomized, controlled trial","volume":"56","author":"Petracca","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1177\/1352458517694088","article-title":"Physical activity is associated with a decreased multiple sclerosis risk: The EnvIMS study","volume":"24","author":"Wesnes","year":"2018","journal-title":"Mult. Scler. J."},{"key":"ref_17","first-page":"e1507","article-title":"Supervised high-intensity aerobic exercise improves aerobic capacity, motor function, and fatigue in multiple sclerosis: A randomized controlled trial","volume":"96","author":"Birk","year":"2021","journal-title":"Neurology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2922","DOI":"10.1007\/s00415-021-10935-6","article-title":"Fitness, physical activity, and exercise in multiple sclerosis: A systematic review on current evidence for interactions with disease activity and progression","volume":"269","author":"Proschinger","year":"2022","journal-title":"J. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1177\/1352458520915629","article-title":"Exercise and lifestyle physical activity recommendations for people with multiple sclerosis throughout the disease course","volume":"26","author":"Kalb","year":"2020","journal-title":"Mult. Scler. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2583","DOI":"10.1007\/s11064-015-1581-6","article-title":"The glymphatic system: A beginner\u2019s guide","volume":"40","author":"Jessen","year":"2015","journal-title":"Neurochem. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1126\/science.1241224","article-title":"Sleep drives metabolite clearance from the adult brain","volume":"342","author":"Xie","year":"2013","journal-title":"Science"},{"key":"ref_22","first-page":"111","article-title":"The glymphatic system and cerebrospinal fluid circulation: AQP4 and glymphatic dysfunction","volume":"41","author":"Munk","year":"2018","journal-title":"Trends Neurosci."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Buongiorno, M., Tur, C., Giraldo, D.M., Cullell, N., Krupinski, J., Lanzillo, R., and S\u00e1nchez-Benavides, G. (2025). Sleep and risk of multiple sclerosis: Bridging the gap between inflammation and neurodegeneration via glymphatic failure. Brain Sci., 15.","DOI":"10.3390\/brainsci15070766"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s11910-018-0809-7","article-title":"Sleep disturbance and cognitive dysfunction in multiple sclerosis: A systematic review","volume":"18","author":"Hughes","year":"2018","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"133","DOI":"10.31083\/j.jin2307133","article-title":"Sleep and Multiple Sclerosis: An Intriguing and Promising Relationship","volume":"23","author":"Cordone","year":"2024","journal-title":"J. Integr. Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2785","DOI":"10.1093\/brain\/awab454","article-title":"Glymphatic system impairment in multiple sclerosis: Relation with brain damage and disability","volume":"145","author":"Carotenuto","year":"2022","journal-title":"Brain"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4483","DOI":"10.1073\/pnas.1721694115","article-title":"\u03b2-Amyloid accumulation in the human brain after one night of sleep deprivation","volume":"115","author":"Wang","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.sleep.2023.07.002","article-title":"The relationship between sleep health and multimorbidity in community dwelling populations: Systematic review and global perspectives","volume":"109","author":"Nistor","year":"2023","journal-title":"Sleep Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1212\/WNL.0b013e3181b2a706","article-title":"Smoking is associated with increased lesion volume and decreased brain volume in multiple sclerosis","volume":"73","author":"Zivadinov","year":"2009","journal-title":"Neurology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"10960","DOI":"10.1038\/s41598-020-67883-w","article-title":"Smoking and Epstein-Barr virus infection in multiple sclerosis development","volume":"10","author":"Huang","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1001\/jamaneurol.2015.1788","article-title":"Effect of Smoking Cessation on Multiple Sclerosis Prognosis","volume":"72","author":"Ramanujam","year":"2015","journal-title":"JAMA Neurol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1038\/s41598-018-20424-y","article-title":"Beneficial effects of low-dose alcohol on glymphatic function and detrimental effects of high-dose alcohol","volume":"8","author":"Lundgaard","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"107936","DOI":"10.5498\/wjp.v15.i10.107936","article-title":"Glymphatic system dysfunction in alcohol use disorder: Current understanding and future directions","volume":"15","author":"Lin","year":"2025","journal-title":"World J. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"5382","DOI":"10.1007\/s00415-022-11193-w","article-title":"Early use of high-efficacy disease-modifying therapies makes the difference in people with multiple sclerosis: An expert opinion","volume":"269","author":"Filippi","year":"2022","journal-title":"J. Neurol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.dhjo.2018.05.003","article-title":"Quality of life and psychological well-being in the early stages of multiple sclerosis (MS): Importance of adopting a biopsychosocial model","volume":"11","author":"Strober","year":"2018","journal-title":"Disabil. Health J."},{"key":"ref_36","first-page":"102093","article-title":"Socioeconomic deprivation increases the risk of disability in multiple sclerosis patients","volume":"42","author":"Calocer","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e2334675","DOI":"10.1001\/jamanetworkopen.2023.34675","article-title":"Premorbid sociodemographic status and multiple sclerosis outcomes in a universal health care context","volume":"6","author":"He","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.msard.2018.12.043","article-title":"Inequalities in access to health and social care among adults with multiple sclerosis: A scoping review of the literature","volume":"28","author":"Roddam","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1001\/jamaneurol.2021.3416","article-title":"Health disparities, inequities, and social determinants of health in multiple sclerosis and related disorders in the US: A review","volume":"78","author":"Amezcua","year":"2024","journal-title":"JAMA Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.3109\/09638288.2014.993435","article-title":"Demographic, socioeconomic and clinical correlates of self-management in multiple sclerosis","volume":"37","author":"Wilski","year":"2015","journal-title":"Disabil. Rehabil."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"102967","DOI":"10.1016\/j.msard.2021.102967","article-title":"Socioeconomic status and access to multiple sclerosis treatment in Mexico","volume":"52","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3664","DOI":"10.1093\/brain\/awab342","article-title":"Socioeconomic disparity is associated with faster retinal neurodegeneration in multiple sclerosis","volume":"144","author":"Vasileiou","year":"2021","journal-title":"Brain"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/2\/224\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T05:27:32Z","timestamp":1771133252000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/2\/224"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":42,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["brainsci16020224"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16020224","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]}}}