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Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register

Maggie Yu, Steve Simpson-Yap, Annalaura Lerede Orcid Logo, Richard Nicholas, Shelly Coe Orcid Logo, Thanasis G. Tektonidis Orcid Logo, Eduard Martinez Solsona, Rod Middleton Orcid Logo, Yasmine Probst Orcid Logo, Adam Hampshire, Elasma Milanzi, Guangqin Cui, Rebekah Allison Davenport Orcid Logo, Sandra Neate, Mia Pisano, Harry Kirkland, Jeanette Reece Orcid Logo

Nutrients, Volume: 17, Issue: 21, Start page: 3326

Swansea University Authors: Richard Nicholas, Rod Middleton Orcid Logo

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DOI (Published version): 10.3390/nu17213326

Abstract

Background: Multiple sclerosis (MS) is a chronic auto-immune neuroinflammatory disorder presenting as a range of systemic and neurological symptoms, including cognitive impairment. Emerging evidence suggests that diets targeting brain health—such as the Mediterranean (MED) and Mediterranean-DASH Int...

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Published in: Nutrients
ISSN: 2072-6643
Published: MDPI AG 2025
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2025-11-03T11:34:01.2053271</datestamp><bib-version>v2</bib-version><id>70817</id><entry>2025-11-03</entry><title>Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register</title><swanseaauthors><author><sid>b1b6e8c9f6c79bdd07143f24db58f792</sid><firstname>Richard</firstname><surname>Nicholas</surname><name>Richard Nicholas</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>005518f819ef1a2a13fdf438529bdfcd</sid><ORCID>0000-0002-2130-4420</ORCID><firstname>Rod</firstname><surname>Middleton</surname><name>Rod Middleton</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2025-11-03</date><deptcode>MEDS</deptcode><abstract>Background: Multiple sclerosis (MS) is a chronic auto-immune neuroinflammatory disorder presenting as a range of systemic and neurological symptoms, including cognitive impairment. Emerging evidence suggests that diets targeting brain health&#x2014;such as the Mediterranean (MED) and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets&#x2014;may improve cognitive function; however, studies examining their role in people living with MS are limited. Methods: We examined cross-sectional associations between diet and cognition data from 967 participants in the United Kingdom Multiple Sclerosis Register (UKMSR). Dietary pattern scores (alternate Mediterranean; aMED, and MIND) were derived from the 130-item EPIC-Norfolk food frequency questionnaire. Cognition was assessed using the MS-specific Cognitron-MS (C-MS) battery (13 tasks) and summarised as overall cognition (global G factor) and four domains (object memory, problem solving, information processing speed [IPS], and words memory). Cognitive outcomes were expressed as Deviation-from-Expected (DfE) scores standardised to demographic and device characteristics using external regression-based norms. Linear models were adjusted for total energy intake, MS phenotype, disease duration since diagnosis, and current disease-modifying therapy (DMT) use. Interactions tested moderation by MS phenotype (relapsing vs. progressive MS) and current DMT use (yes vs. no). Sensitivity analyses included within-domain multiple-comparison control, rank-based inverse-normal transformation, and winsorisation. Results: Greater alignment with aMED and MIND dietary patterns were associated with higher scores in specific cognitive domains but not in overall cognition. Higher aMED scores were associated most consistently with better IPS, while higher MIND scores were additionally associated with better words memory. In categorical models, participants with the middle or highest tertiles of aMED or MIND scores performed up to ~0.4 SD better on tasks of Verbal Analogies, Word Definitions, Simple Reaction Time, Words Memory Immediate, or Words Memory Delays compared with those in the lowest tertile. These findings were robust across sensitivity analyses. Stratified analyses showed differential cognitive performance and diet-cognition associations by MS phenotype and DMT use. Conclusions: Mediterranean and MIND dietary patterns showed modest cross-sectional associations with specific cognition domains, with differential cognitive performance in different subgroups according to MS phenotype and DMT use. Although causal inference is not possible, our findings indicate future MS-related dietary studies (longitudinal and/or randomised controlled trials) examining cognitive function domains across different MS subgroups are warranted.</abstract><type>Journal Article</type><journal>Nutrients</journal><volume>17</volume><journalNumber>21</journalNumber><paginationStart>3326</paginationStart><paginationEnd/><publisher>MDPI AG</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2072-6643</issnElectronic><keywords>multiple sclerosis; cognitive performance; cross-sectional study; mediterranean diet; MIND diet</keywords><publishedDay>22</publishedDay><publishedMonth>10</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-10-22</publishedDate><doi>10.3390/nu17213326</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This research was funded by the MULTIPLE SCLEROSIS AUSTRALIA project grant under grant number MSA #222089. A.L. conducted this work as part of the UK Research and Innovation Centre for Doctoral Training in Artificial Intelligence for Healthcare (http://ai4health.io, grant number EP/S023283/1), and as part of a postdoctoral position funded by the Institute of Psychiatry, Psychology &amp; Neuroscience at King&#x2019;s College London.</funders><projectreference/><lastEdited>2025-11-03T11:34:01.2053271</lastEdited><Created>2025-11-03T11:26:59.7827126</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Maggie</firstname><surname>Yu</surname><order>1</order></author><author><firstname>Steve</firstname><surname>Simpson-Yap</surname><order>2</order></author><author><firstname>Annalaura</firstname><surname>Lerede</surname><orcid>0000-0003-0903-8606</orcid><order>3</order></author><author><firstname>Richard</firstname><surname>Nicholas</surname><order>4</order></author><author><firstname>Shelly</firstname><surname>Coe</surname><orcid>0000-0003-0508-7507</orcid><order>5</order></author><author><firstname>Thanasis G.</firstname><surname>Tektonidis</surname><orcid>0000-0002-9655-1389</orcid><order>6</order></author><author><firstname>Eduard Martinez</firstname><surname>Solsona</surname><order>7</order></author><author><firstname>Rod</firstname><surname>Middleton</surname><orcid>0000-0002-2130-4420</orcid><order>8</order></author><author><firstname>Yasmine</firstname><surname>Probst</surname><orcid>0000-0002-1971-173X</orcid><order>9</order></author><author><firstname>Adam</firstname><surname>Hampshire</surname><order>10</order></author><author><firstname>Elasma</firstname><surname>Milanzi</surname><order>11</order></author><author><firstname>Guangqin</firstname><surname>Cui</surname><order>12</order></author><author><firstname>Rebekah Allison</firstname><surname>Davenport</surname><orcid>0000-0003-0426-2158</orcid><order>13</order></author><author><firstname>Sandra</firstname><surname>Neate</surname><order>14</order></author><author><firstname>Mia</firstname><surname>Pisano</surname><order>15</order></author><author><firstname>Harry</firstname><surname>Kirkland</surname><order>16</order></author><author><firstname>Jeanette</firstname><surname>Reece</surname><orcid>0000-0003-2897-0271</orcid><order>17</order></author></authors><documents><document><filename>70817__35539__56f904297ac044d3ba8394c74270d71e.pdf</filename><originalFilename>70817.VOR.pdf</originalFilename><uploaded>2025-11-03T11:31:41.5281288</uploaded><type>Output</type><contentLength>1004687</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2025 by the authors. 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spelling 2025-11-03T11:34:01.2053271 v2 70817 2025-11-03 Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register b1b6e8c9f6c79bdd07143f24db58f792 Richard Nicholas Richard Nicholas true false 005518f819ef1a2a13fdf438529bdfcd 0000-0002-2130-4420 Rod Middleton Rod Middleton true false 2025-11-03 MEDS Background: Multiple sclerosis (MS) is a chronic auto-immune neuroinflammatory disorder presenting as a range of systemic and neurological symptoms, including cognitive impairment. Emerging evidence suggests that diets targeting brain health—such as the Mediterranean (MED) and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets—may improve cognitive function; however, studies examining their role in people living with MS are limited. Methods: We examined cross-sectional associations between diet and cognition data from 967 participants in the United Kingdom Multiple Sclerosis Register (UKMSR). Dietary pattern scores (alternate Mediterranean; aMED, and MIND) were derived from the 130-item EPIC-Norfolk food frequency questionnaire. Cognition was assessed using the MS-specific Cognitron-MS (C-MS) battery (13 tasks) and summarised as overall cognition (global G factor) and four domains (object memory, problem solving, information processing speed [IPS], and words memory). Cognitive outcomes were expressed as Deviation-from-Expected (DfE) scores standardised to demographic and device characteristics using external regression-based norms. Linear models were adjusted for total energy intake, MS phenotype, disease duration since diagnosis, and current disease-modifying therapy (DMT) use. Interactions tested moderation by MS phenotype (relapsing vs. progressive MS) and current DMT use (yes vs. no). Sensitivity analyses included within-domain multiple-comparison control, rank-based inverse-normal transformation, and winsorisation. Results: Greater alignment with aMED and MIND dietary patterns were associated with higher scores in specific cognitive domains but not in overall cognition. Higher aMED scores were associated most consistently with better IPS, while higher MIND scores were additionally associated with better words memory. In categorical models, participants with the middle or highest tertiles of aMED or MIND scores performed up to ~0.4 SD better on tasks of Verbal Analogies, Word Definitions, Simple Reaction Time, Words Memory Immediate, or Words Memory Delays compared with those in the lowest tertile. These findings were robust across sensitivity analyses. Stratified analyses showed differential cognitive performance and diet-cognition associations by MS phenotype and DMT use. Conclusions: Mediterranean and MIND dietary patterns showed modest cross-sectional associations with specific cognition domains, with differential cognitive performance in different subgroups according to MS phenotype and DMT use. Although causal inference is not possible, our findings indicate future MS-related dietary studies (longitudinal and/or randomised controlled trials) examining cognitive function domains across different MS subgroups are warranted. Journal Article Nutrients 17 21 3326 MDPI AG 2072-6643 multiple sclerosis; cognitive performance; cross-sectional study; mediterranean diet; MIND diet 22 10 2025 2025-10-22 10.3390/nu17213326 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This research was funded by the MULTIPLE SCLEROSIS AUSTRALIA project grant under grant number MSA #222089. A.L. conducted this work as part of the UK Research and Innovation Centre for Doctoral Training in Artificial Intelligence for Healthcare (http://ai4health.io, grant number EP/S023283/1), and as part of a postdoctoral position funded by the Institute of Psychiatry, Psychology & Neuroscience at King’s College London. 2025-11-03T11:34:01.2053271 2025-11-03T11:26:59.7827126 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Maggie Yu 1 Steve Simpson-Yap 2 Annalaura Lerede 0000-0003-0903-8606 3 Richard Nicholas 4 Shelly Coe 0000-0003-0508-7507 5 Thanasis G. Tektonidis 0000-0002-9655-1389 6 Eduard Martinez Solsona 7 Rod Middleton 0000-0002-2130-4420 8 Yasmine Probst 0000-0002-1971-173X 9 Adam Hampshire 10 Elasma Milanzi 11 Guangqin Cui 12 Rebekah Allison Davenport 0000-0003-0426-2158 13 Sandra Neate 14 Mia Pisano 15 Harry Kirkland 16 Jeanette Reece 0000-0003-2897-0271 17 70817__35539__56f904297ac044d3ba8394c74270d71e.pdf 70817.VOR.pdf 2025-11-03T11:31:41.5281288 Output 1004687 application/pdf Version of Record true © 2025 by the authors. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. true eng https://creativecommons.org/licenses/by/4.0/
title Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register
spellingShingle Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register
Richard Nicholas
Rod Middleton
title_short Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register
title_full Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register
title_fullStr Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register
title_full_unstemmed Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register
title_sort Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register
author_id_str_mv b1b6e8c9f6c79bdd07143f24db58f792
005518f819ef1a2a13fdf438529bdfcd
author_id_fullname_str_mv b1b6e8c9f6c79bdd07143f24db58f792_***_Richard Nicholas
005518f819ef1a2a13fdf438529bdfcd_***_Rod Middleton
author Richard Nicholas
Rod Middleton
author2 Maggie Yu
Steve Simpson-Yap
Annalaura Lerede
Richard Nicholas
Shelly Coe
Thanasis G. Tektonidis
Eduard Martinez Solsona
Rod Middleton
Yasmine Probst
Adam Hampshire
Elasma Milanzi
Guangqin Cui
Rebekah Allison Davenport
Sandra Neate
Mia Pisano
Harry Kirkland
Jeanette Reece
format Journal article
container_title Nutrients
container_volume 17
container_issue 21
container_start_page 3326
publishDate 2025
institution Swansea University
issn 2072-6643
doi_str_mv 10.3390/nu17213326
publisher MDPI AG
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
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description Background: Multiple sclerosis (MS) is a chronic auto-immune neuroinflammatory disorder presenting as a range of systemic and neurological symptoms, including cognitive impairment. Emerging evidence suggests that diets targeting brain health—such as the Mediterranean (MED) and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets—may improve cognitive function; however, studies examining their role in people living with MS are limited. Methods: We examined cross-sectional associations between diet and cognition data from 967 participants in the United Kingdom Multiple Sclerosis Register (UKMSR). Dietary pattern scores (alternate Mediterranean; aMED, and MIND) were derived from the 130-item EPIC-Norfolk food frequency questionnaire. Cognition was assessed using the MS-specific Cognitron-MS (C-MS) battery (13 tasks) and summarised as overall cognition (global G factor) and four domains (object memory, problem solving, information processing speed [IPS], and words memory). Cognitive outcomes were expressed as Deviation-from-Expected (DfE) scores standardised to demographic and device characteristics using external regression-based norms. Linear models were adjusted for total energy intake, MS phenotype, disease duration since diagnosis, and current disease-modifying therapy (DMT) use. Interactions tested moderation by MS phenotype (relapsing vs. progressive MS) and current DMT use (yes vs. no). Sensitivity analyses included within-domain multiple-comparison control, rank-based inverse-normal transformation, and winsorisation. Results: Greater alignment with aMED and MIND dietary patterns were associated with higher scores in specific cognitive domains but not in overall cognition. Higher aMED scores were associated most consistently with better IPS, while higher MIND scores were additionally associated with better words memory. In categorical models, participants with the middle or highest tertiles of aMED or MIND scores performed up to ~0.4 SD better on tasks of Verbal Analogies, Word Definitions, Simple Reaction Time, Words Memory Immediate, or Words Memory Delays compared with those in the lowest tertile. These findings were robust across sensitivity analyses. Stratified analyses showed differential cognitive performance and diet-cognition associations by MS phenotype and DMT use. Conclusions: Mediterranean and MIND dietary patterns showed modest cross-sectional associations with specific cognition domains, with differential cognitive performance in different subgroups according to MS phenotype and DMT use. Although causal inference is not possible, our findings indicate future MS-related dietary studies (longitudinal and/or randomised controlled trials) examining cognitive function domains across different MS subgroups are warranted.
published_date 2025-10-22T12:45:47Z
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