The effect of alcohol and red wine consumption on clinical and MRI outcomes in multiple sclerosis

https://doi.org/10.1016/j.msard.2017.06.011Get rights and content

Highlights

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    Moderate alcohol consumption was associated with lower EDSS score and MSSS.

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    Drinking > 3 glasses of red wine/week was associated with lower EDSS score and MSSS.

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    Subjects drinking 1–3 glasses of red wine/week had an increase in MRI lesion volume accumulation.

Abstract

Background

Alcohol and in particular red wine have both immunomodulatory and neuroprotective properties, and may exert an effect on the disease course of multiple sclerosis (MS).

Objective

To assess the association between alcohol and red wine consumption and MS course.

Methods

MS patients enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB) who completed a self-administered questionnaire about their past year drinking habits at a single time point were included in the study. Alcohol and red wine consumption were measured as servings/week. The primary outcome was the Expanded Disability Status Scale (EDSS) at the time of the questionnaire. Secondary clinical outcomes were the Multiple Sclerosis Severity Score (MSSS) and number of relapses in the year before the questionnaire. Secondary MRI outcomes included brain parenchymal fraction and T2 hyperintense lesion volume (T2LV). Appropriate regression models were used to test the association of alcohol and red wine intake on clinical and MRI outcomes. All analyses were controlled for sex, age, body mass index, disease phenotype (relapsing vs. progressive), the proportion of time on disease modifying therapy during the previous year, smoking exposure, and disease duration. In the models for the MRI outcomes, analyses were also adjusted for acquisition protocol.

Results

923 patients (74% females, mean age 47 ± 11 years, mean disease duration 14 ± 9 years) were included in the analysis. Compared to abstainers, patients drinking more than 4 drinks per week had a higher likelihood of a lower EDSS score (OR, 0.41; p = 0.0001) and lower MSSS (mean difference, − 1.753; p = 0.002) at the time of the questionnaire. Similarly, patients drinking more than 3 glasses of red wine per week had greater odds of a lower EDSS (OR, 0.49; p = 0.0005) and lower MSSS (mean difference, − 0.705; p = 0.0007) compared to nondrinkers. However, a faster increase in T2LV was observed in patients consuming 1–3 glasses of red wine per week compared to nondrinkers.

Conclusions

Higher total alcohol and red wine intake were associated with a lower cross-sectional level of neurologic disability in MS patients but increased T2LV accumulation. Further studies should explore a potential cause-effect neuroprotective relationship, as well as the underlying biological mechanisms.

Section snippets

Background

Several observational studies have linked moderate alcohol intake with a lower risk of developing autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, and autoimmune hypothyroidism (Carle et al., 2012, Liao et al., 2009, Wang et al., 2008). Additionally, recent epidemiological studies investigating the association between alcohol consumption and the risk of multiple sclerosis (MS) have shown conflicting results. For instance, data from two large population-based

Subjects

A subset of 923 patients enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB) study at the Partners MS Center, (Gauthier et al., 2006) who completed a self-administered questionnaire about their past year drinking habits, were included in this study. Table 1 provides the demographic and clinical characteristics of these subjects broken down based on alcohol consumption, and Supplementary Table 1 compares their demographic and

Results

923 patients were included in the main cross-sectional analysis. Demographic and clinical characteristics of subjects grouped by weekly alcohol consumption levels are provided in Table 1. Demographic and clinical characteristics of subjects who contributed to cross-sectional, longitudinal and MRI outcomes analyses are presented in Supplementary Table 2.

Discussion

This observational study provides further evidence of an inverse association between alcohol consumption and neurological disability scores in a cohort of patients with MS, after controlling for multiple potential confounders. Additionally, we found the same inverse association between red wine consumption and EDSS. However, we did not find an effect of alcohol or red wine consumption on longitudinal EDSS change. Our results are consistent with findings from other observational studies.

Conclusion

In conclusion, our findings add to the increasing amount of literature describing an inverse association between moderate alcohol intake and neurological disability in MS patients and additionally show similar effects with red wine consumption. Considering that our results are also consistent with published studies describing an alcohol-mediated inhibition of molecular pathways involved in the activation of the immune system, we propose that the effect of alcohol consumption should be

Conflict of interest

The authors declare no conflict of interest with the above listed funding sources.

Role of funding source

This work was supported by the National Multiple Sclerosis Society RG-4256A4/2 (TC). The CLIMB Study has received support from Merck Serono and the Nancy Davis Center Without Walls.

Acknowledgements

The authors wish to thank the following colleagues at the Brigham and Women's Hospital: Mariann Polgar- Turcsanyi, MS and Mark Anderson, MS for their role in managing the Partners MS Center research database, as well as Taylor Saraceno, BA for her research assistance.

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