{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:48:12Z","timestamp":1786981692165,"version":"build-2736575974"},"reference-count":75,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Direct-MS","award":["U54TR001356"],"award-info":[{"award-number":["U54TR001356"]}]},{"name":"CTSA","award":["U54TR001356"],"award-info":[{"award-number":["U54TR001356"]}]},{"name":"DJO Inc.","award":["U54TR001356"],"award-info":[{"award-number":["U54TR001356"]}]},{"name":"Pinnaclife Inc.","award":["U54TR001356"],"award-info":[{"award-number":["U54TR001356"]}]},{"name":"TZ Press LLC","award":["U54TR001356"],"award-info":[{"award-number":["U54TR001356"]}]},{"name":"Iowa City Veterans Administration Healthcare System","award":["U54TR001356"],"award-info":[{"award-number":["U54TR001356"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Cardiometabolic comorbidities are common in multiple sclerosis (MS), and lifestyle interventions are effective in managing these conditions in the general population, though evidence in the MS patient population is limited. Objective: To evaluate the effect of a multimodal lifestyle intervention on serum apolipoproteins (Apo), creatine kinase (CK), glucose, and insulin in people with progressive MS (PwPMS). Methods: This study included n = 19 PwPMS who participated in a 12-month multimodal lifestyle intervention (including a modified Paleolithic diet, exercise, neuromuscular electrical stimulation, supplements, and stress reduction). Lipid profile (ApoA1, B, and E), CK, glucose, and insulin were obtained at baseline and after 12 months under fasting conditions. Results: At 12 months, there was a marginally significant decrease in ApoB (mean change: \u22127.17 mg\/dL; 95% CI: \u221214.4, 0.12; p = 0.06), while no significant changes were observed for ApoA1 (mean change: \u22121.28 mg\/dL; 95% CI: 12.33, 9.76; p = 0.80), ApoE (mean change: +0.12 mg\/dL; 95% CI: \u22120.27, 0.52; p = 0.51), CK (mean change: +13.19 U\/L; 95% CI: \u221232.72, 59.11; p = 0.55), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) (mean change: \u22120.44; 95% CI: \u22121.11, 0.22; p = 0.17), and HOMA-\u03b2 (mean change: +45.62; 95% CI: \u221295.6, 186.9; p = 0.50). A positive association was observed between changes in HOMA-IR and fatigue changes at 12 months (\u03b2 = 0.81, p = 0.02), suggesting that an increase in HOMA-IR was linked to increased fatigue, which was no longer significant following the exclusion of outliers (\u03b2 = 0.71, p = 0.16). Conclusions: A multimodal lifestyle intervention did not negatively impact glycemic and lipid profiles. While improvements were observed in serum biomarkers, these changes were not statistically significant, highlighting the need for stronger evidence from larger, controlled studies to confirm the cardiometabolic health benefits in PwPMS.<\/jats:p>","DOI":"10.3390\/nu17071163","type":"journal-article","created":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T12:41:02Z","timestamp":1743079262000},"page":"1163","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of a Multimodal Lifestyle Intervention on Cardiometabolic Markers in People with Progressive Multiple Sclerosis: A Secondary Analysis of a Pilot Study"],"prefix":"10.3390","volume":"17","author":[{"given":"Arturo S.","family":"Martinez","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyanne J.","family":"Bastian","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0164-6498","authenticated-orcid":false,"given":"Farnoosh","family":"Shemirani","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8162-4768","authenticated-orcid":false,"given":"Tyler J.","family":"Titcomb","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA"},{"name":"Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babita","family":"Bisht","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9928-2922","authenticated-orcid":false,"given":"Warren G.","family":"Darling","sequence":"additional","affiliation":[{"name":"Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murali","family":"Ramanathan","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY 14214, USA"},{"name":"Department of Neurology, State University of New York, Buffalo, NY 14203, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mujeeb","family":"Shittu","sequence":"additional","affiliation":[{"name":"Department of Biotechnical and Clinical Laboratory Sciences, University at Buffalo, Getzville, NY 14214, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Hospital and Clinics, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda G.","family":"Snetselaar","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6059-7994","authenticated-orcid":false,"given":"Terry L.","family":"Wahls","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"ref_1","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_2","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1001\/jama.2020.26858","article-title":"Diagnosis and Treatment of Multiple Sclerosis: A Review","volume":"325","author":"McGinley","year":"2021","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/1477-7525-6-100","article-title":"Fatigue characteristics in multiple sclerosis: The North American Research Committee on Multiple Sclerosis (NARCOMS) survey","volume":"6","author":"Hadjimichael","year":"2008","journal-title":"Health Qual Life Outcomes"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1586\/ern.10.99","article-title":"Multiple sclerosis-associated fatigue","volume":"10","author":"Krupp","year":"2010","journal-title":"Expert Rev. Neurother."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1177\/1352458514564491","article-title":"A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: Overview","volume":"21","author":"Marrie","year":"2015","journal-title":"Mult. Scler. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1212\/WNL.0b013e3181d6b125","article-title":"Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis","volume":"74","author":"Marrie","year":"2010","journal-title":"Neurology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1212\/WNL.0000000000001187","article-title":"Comorbidity increases the risk of hospitalizations in multiple sclerosis","volume":"84","author":"Marrie","year":"2015","journal-title":"Neurology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1212\/WNL.0000000000004716","article-title":"Comorbidity increases the risk of relapse in multiple sclerosis: A prospective study","volume":"89","author":"Kowalec","year":"2017","journal-title":"Neurology"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Murali, N., Browne, R.W., Maxwell, K.F., Bodziak, M.L., Jakimovski, D., Hagemeier, J., Bergsland, N., Weinstock-Guttman, B., Zivadinov, R., and Ramanathan, M. (2020). Cholesterol and neurodegeneration: Longitudinal changes in serum cholesterol biomarkers are associated with new lesions and gray matter atrophy in multiple sclerosis over 5 years of follow-up. Eur. J. Neurol., 27.","DOI":"10.1111\/ene.14055"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Jakimovski, D., Gandhi, S., Paunkoski, I., Bergsland, N., Hagemeier, J., Ramasamy, D.P., Hojnacki, D., Kolb, C., Benedict, R.H.B., and Weinstock-Guttman, B. (2019). Hypertension and heart disease are associated with development of brain atrophy in multiple sclerosis: A 5-year longitudinal study. Eur. J. Neurol., 26.","DOI":"10.1111\/ene.13769"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/ene.14040","article-title":"Comorbidity in multiple sclerosis: Its temporal relationships with disease onset and dose effect on mortality","volume":"27","author":"Chou","year":"2020","journal-title":"Eur. J. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1212\/WNL.0000000000001718","article-title":"Effect of comorbidity on mortality in multiple sclerosis","volume":"85","author":"Marrie","year":"2015","journal-title":"Neurology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"175","DOI":"10.7224\/1537-2073.2021-052","article-title":"Desired Resources for Changing Diet Among Persons with Multiple Sclerosis: Qualitative Inquiry Informing Future Dietary Interventions","volume":"24","author":"Silveira","year":"2022","journal-title":"Int. J. MS Care"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Elkhalii-Wilhelm, S., Sippel, A., Riemann-Lorenz, K., Kofahl, C., Scheiderbauer, J., Arnade, S., Kleiter, I., Schmidt, S., and Heesen, C. (2022). Experiences of persons with Multiple Sclerosis with lifestyle adjustment-A qualitative interview study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0268988"},{"key":"ref_15","first-page":"221","article-title":"The perceptions of persons with multiple sclerosis (MS) on the impact of diet and supplements on MS symptoms","volume":"8","author":"Anderson","year":"2022","journal-title":"J. Altern. Complement Med."},{"key":"ref_16","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":"ref_17","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.msard.2018.02.019","article-title":"A survey of dietary characteristics in a large population of people with multiple sclerosis","volume":"22","author":"Fitzgerald","year":"2018","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Russell, R.D., Lucas, R.M., Brennan, V., Sherriff, J.L., Begley, A., Investigator, G.A., and Black, L.J. (2018). Reported Changes in Dietary Behavior Following a First Clinical Diagnosis of Central Nervous System Demyelination. Front. Neurol., 9.","DOI":"10.3389\/fneur.2018.00161"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3190","DOI":"10.1111\/ene.15940","article-title":"Engagement with three or more healthy lifestyle behaviours is associated with improved quality of life over 7.5 years in people with multiple sclerosis","volume":"30","author":"Fidao","year":"2023","journal-title":"Eur. J. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Giovannoni, G., Ford, H.L., Schmierer, K., Middleton, R., Stennett, A.M., Pomeroy, I., Fisniku, L., Scalfari, A., Bannon, C., and Stross, R. (2023). MS care: Integrating advanced therapies and holistic management. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1286122"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1007\/s10072-024-07811-2","article-title":"Lifestyle changes and patient-reported outcomes over five years in a sample of people with multiple sclerosis after a single multimodal intensive lifestyle education workshop","volume":"46","author":"Reece","year":"2024","journal-title":"Neurol. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1007\/s13311-017-0563-6","article-title":"Wellness and the Role of Comorbidities in Multiple Sclerosis","volume":"14","author":"Moss","year":"2017","journal-title":"Neurotherapeutics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1007\/s13668-024-00538-8","article-title":"Dietary Modification Combined with Nutrition Education and Counseling for Metabolic Comorbidities in Multiple Sclerosis: Implications for Clinical Practice and Research","volume":"13","author":"Allogmanny","year":"2024","journal-title":"Curr. Nutr. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Marrie, R.A., Fisk, J.D., Fitzgerald, K., Kowalec, K., Maxwell, C., Rotstein, D., Salter, A., and Tremlett, H. (2023). Etiology, effects and management of comorbidities in multiple sclerosis: Recent advances. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1197195"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1001\/jamaneurol.2024.2920","article-title":"Comorbidity and Disease Activity in Multiple Sclerosis","volume":"81","author":"Salter","year":"2024","journal-title":"JAMA Neurol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1177\/1352458514533162","article-title":"An adverse lipid profile is associated with disability and progression in disability, in people with MS","volume":"20","author":"Tettey","year":"2014","journal-title":"Mult. Scler. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/1742-2094-8-127","article-title":"Serum lipid profiles are associated with disability and MRI outcomes in multiple sclerosis","volume":"8","author":"Zivadinov","year":"2011","journal-title":"J. Neuroinflamm."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Nociti, V., and Romozzi, M. (2023). The Importance of Managing Modifiable Comorbidities in People with Multiple Sclerosis: A Narrative Review. J. Pers. Med., 13.","DOI":"10.3390\/jpm13111524"},{"key":"ref_29","first-page":"20552173211035399","article-title":"Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial","volume":"7","author":"Wahls","year":"2021","journal-title":"Mult. Scler. J. Exp. Transl. Clin."},{"key":"ref_30","first-page":"1","article-title":"Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: A pilot study","volume":"7","author":"Irish","year":"2017","journal-title":"Degener. Neurol. Neuromuscul. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1080\/07315724.2020.1734988","article-title":"A Modified MCT-Based Ketogenic Diet Increases Plasma \u03b2-Hydroxybutyrate but Has Less Effect on Fatigue and Quality of Life in People with Multiple Sclerosis Compared to a Modified Paleolithic Diet: A Waitlist-Controlled, Randomized Pilot Study","volume":"40","author":"Lee","year":"2021","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_32","first-page":"Cd004192","article-title":"Dietary interventions for multiple sclerosis-related outcomes","volume":"5","author":"Parks","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"101403","DOI":"10.1016\/j.msard.2019.101403","article-title":"Randomized-controlled trial of a modified Mediterranean dietary program for multiple sclerosis: A pilot study","volume":"36","author":"Benn","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1016\/j.apmr.2022.04.012","article-title":"Comparative Effectiveness of 4 Exercise Interventions Followed by 2 Years of Exercise Maintenance in Multiple Sclerosis: A Randomized Controlled Trial","volume":"103","author":"Baumann","year":"2022","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"105473","DOI":"10.1016\/j.msard.2024.105473","article-title":"The effect of exercise on mental health and health-related quality of life in individuals with multiple sclerosis: A Systematic review and meta-analysis","volume":"83","author":"Beratto","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"103016","DOI":"10.1016\/j.msard.2021.103016","article-title":"A mindfulness group intervention in newly diagnosed persons with multiple sclerosis: A pilot study","volume":"52","author":"Morrow","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1177\/1352458518786650","article-title":"Impact of mindfulness-based stress reduction for people with multiple sclerosis at 8 weeks and 12 months: A randomized clinical trial","volume":"25","author":"Senders","year":"2018","journal-title":"Mult. Scler. J."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Marck, C.H., De Livera, A.M., Brown, C.R., Neate, S.L., Taylor, K.L., Weiland, T.J., Hadgkiss, E.J., and Jelinek, G.A. (2018). Health outcomes and adherence to a healthy lifestyle after a multimodal intervention in people with multiple sclerosis: Three year follow-up. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0197759"},{"key":"ref_39","first-page":"19","article-title":"Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: A pilot study","volume":"5","author":"Bisht","year":"2015","journal-title":"Degener. Neurol. Neuromuscul. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Podbielska, M., O\u2019Keeffe, J., and Pokryszko-Dragan, A. (2021). New Insights into Multiple Sclerosis Mechanisms: Lipids on the Track to Control Inflammation and Neurodegeneration. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22147319"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Gafson, A.R., Thorne, T., McKechnie, C.I.J., Jimenez, B., Nicholas, R., and Matthews, P.M. (2018). Lipoprotein markers associated with disability from multiple sclerosis. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-35232-7"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1194\/jlr.M060970","article-title":"Protective associations of HDL with blood-brain barrier injury in multiple sclerosis patients","volume":"56","author":"Fellows","year":"2015","journal-title":"J. Lipid Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"102389","DOI":"10.1016\/j.msard.2020.102389","article-title":"Apolipoproteins AI and E are associated with neuroaxonal injury to gray matter in multiple sclerosis","volume":"45","author":"McComb","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1111\/j.1468-1331.2006.01360.x","article-title":"The association between apolipoprotein E and multiple sclerosis","volume":"13","author":"Pinholt","year":"2006","journal-title":"Eur. J. Neurol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1212\/WNL.56.3.312","article-title":"APOE genotype is a major predictor of long-term progression of disability in MS","volume":"56","author":"Chapman","year":"2001","journal-title":"Neurology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"186813","DOI":"10.1155\/2010\/186813","article-title":"The Immune-Modulatory Role of Apolipoprotein E with Emphasis on Multiple Sclerosis and Experimental Autoimmune Encephalomyelitis","volume":"2010","author":"Zhang","year":"2010","journal-title":"J. Immunol. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.jacl.2020.07.001","article-title":"Neuroprotective associations of apolipoproteins A-I and A-II with neurofilament levels in early multiple sclerosis","volume":"14","author":"McComb","year":"2020","journal-title":"J. Clin. Lipidol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1161\/CIRCULATIONAHA.120.051328","article-title":"Effects of a 2-Year Primary Care Lifestyle Intervention on Cardiometabolic Risk Factors","volume":"143","author":"Dorling","year":"2021","journal-title":"Circulation"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1093\/ajcn\/84.6.1317","article-title":"Effect of lifestyle intervention on metabolic coronary heart disease risk factors in obese older adults2","volume":"84","author":"Villareal","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1093\/nutrit\/nuad051","article-title":"Effects of therapeutic lifestyle change diets on blood lipids, lipoproteins, glycemic parameters, and blood pressure: A systematic review and meta-analysis of clinical trials","volume":"82","author":"Keshani","year":"2024","journal-title":"Nutr. Rev."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e26619","DOI":"10.5812\/jjcdc.26619","article-title":"The Effects of Aerobic Exercise on Lipid Profile and Body Composition in Women with Multiple Sclerosis","volume":"4","author":"Monazamnezhad","year":"2015","journal-title":"Jundishapur J. Chronic Dis. Care"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Fellows Maxwell, K., Wahls, T., Browne, R.W., Rubenstein, L., Bisht, B., Chenard, C.A., Snetselaar, L., Weinstock-Guttman, B., and Ramanathan, M. (2019). Lipid profile is associated with decreased fatigue in individuals with progressive multiple sclerosis following a diet-based intervention: Results from a pilot study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0218075"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Villa, A.T., Tu, B.H., Titcomb, T.J., Saxby, S.M., Shemirani, F., Eyck, P.T., Rubenstein, L.M., Snetselaar, L.G., and Wahls, T.L. (2023). Association between improved metabolic risk factors and perceived fatigue during dietary intervention trial in relapsing-remitting multiple sclerosis: A secondary analysis of the WAVES trial. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.1022728"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1007\/s11011-024-01347-2","article-title":"Association between insulin resistance and multiple sclerosis: A systematic review and meta-analysis","volume":"39","author":"Sepidarkish","year":"2024","journal-title":"Metab. Brain Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.jacl.2019.06.003","article-title":"High-density lipoprotein cholesterol is associated with multiple sclerosis fatigue: A fatigue-metabolism nexus?","volume":"13","author":"Browne","year":"2019","journal-title":"J. Clin. Lipidol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.msard.2018.08.014","article-title":"Metabolomic profile of insulin resistance in patients with multiple sclerosis is associated to the severity of the disease","volume":"25","author":"Lozano","year":"2018","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1007\/s11011-015-9665-1","article-title":"Hyperinsulinemia in newly diagnosed patients with multiple sclerosis","volume":"30","author":"Penesova","year":"2015","journal-title":"Metab. Brain Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e13288","DOI":"10.1111\/jne.13288","article-title":"Insulin resistance is associated with cognitive dysfunction in multiple sclerosis patients: A cross-sectional study","volume":"35","author":"Ayromlou","year":"2023","journal-title":"J. Neuroendocrinol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/j.apmr.2022.12.194","article-title":"Diet, Physical Activity, and Stress Among Wheelchair Users with Multiple Sclerosis: Examining Individual and Co-Occurring Behavioral Risk Factors","volume":"104","author":"Silveira","year":"2023","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_61","first-page":"e1","article-title":"Diet quality is associated with disability and symptom severity in multiple sclerosis","volume":"90","author":"Fitzgerald","year":"2017","journal-title":"Neurology"},{"key":"ref_62","unstructured":"AJMC (2019). Comorbidities Management and Lifestyle Modification in MS. Perspect. MS, 10\u201314."},{"key":"ref_63","first-page":"181","article-title":"Cardiovascular risk factors are associated with increased lesion burden and brain atrophy in multiple sclerosis","volume":"87","author":"Kappus","year":"2016","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.msard.2016.07.003","article-title":"Brain health: Time matters in multiple sclerosis","volume":"9","author":"Giovannoni","year":"2016","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Marck, C.H., Neate, S.L., Taylor, K.L., Weiland, T.J., and Jelinek, G.A. (2016). Prevalence of Comorbidities, Overweight and Obesity in an International Sample of People with Multiple Sclerosis and Associations with Modifiable Lifestyle Factors. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0148573"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"149","DOI":"10.2217\/nmt-2018-0046","article-title":"Lifestyle-based Modifiable Risk Factors in Multiple Sclerosis: Review of Experimental and Clinical Findings","volume":"9","author":"Jakimovski","year":"2019","journal-title":"Neurodegener. Dis. Manag."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1080\/07315724.2016.1255160","article-title":"A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis","volume":"36","author":"Lee","year":"2017","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1038\/ejcn.2009.4","article-title":"Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet","volume":"63","author":"Frassetto","year":"2009","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Navarrete-P\u00e9rez, A., G\u00f3mez-Melero, S., Escribano, B.M., Galvao-Carmona, A., Conde-Gavil\u00e1n, C., Pe\u00f1a-Toledo, M.\u00c1., Villarrubia, N., Villar, L.M., T\u00fanez, I., and Ag\u00fcera-Morales, E. (2024). MIND Diet Impact on Multiple Sclerosis Patients: Biochemical Changes after Nutritional Intervention. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms251810009"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"de la Rubia Ort\u00ed, J.E., Armero, J.L.P., Cuerda-Ballester, M., Sanchis-Sanchis, C.E., Navarro-Illana, E., Lajara-Romance, J.M., Benlloch, M., Ceron, J.J., Tvarijonaviciute, A., and Proa\u00f1o, B. (2023). Lipid Profile in Multiple Sclerosis: Functional Capacity and Therapeutic Potential of Its Regulation after Intervention with Epigallocatechin Gallate and Coconut Oil. Foods, 12.","DOI":"10.3390\/foods12203730"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"3293","DOI":"10.1080\/09638288.2022.2122601","article-title":"Replacing sitting with light-intensity physical activity throughout the day versus 1 bout of vigorous-intensity exercise: Similar cardiometabolic health effects in multiple sclerosis. A randomised cross-over study","volume":"45","author":"Nieste","year":"2023","journal-title":"Disabil. Rehabil."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e025858","DOI":"10.1161\/JAHA.122.025858","article-title":"Physiological Bases for the Superiority of Apolipoprotein B Over Low-Density Lipoprotein Cholesterol and Non\u2013High-Density Lipoprotein Cholesterol as a Marker of Cardiovascular Risk","volume":"11","author":"Glavinovic","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.msard.2015.10.005","article-title":"Cholesterol and markers of cholesterol turnover in multiple sclerosis: Relationship with disease outcomes","volume":"5","author":"Zhornitsky","year":"2016","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1136\/jnnp-2013-307106","article-title":"Apolipoproteins are associated with new MRI lesions and deep grey matter atrophy in clinically isolated syndromes","volume":"85","author":"Browne","year":"2014","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1159\/000116135","article-title":"Serum Creatine Kinase B Levels in Diseases of the Central Nervous System","volume":"27","author":"Vassilopoulos","year":"2008","journal-title":"Eur. Neurol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/7\/1163\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:03:15Z","timestamp":1760029395000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/7\/1163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":75,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["nu17071163"],"URL":"https:\/\/doi.org\/10.3390\/nu17071163","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,27]]}}}