Patients with neuromyelitis optica spectrum disorder (NMOSD) are at higher risk of malnutrition than healthy controls, according to a Chinese study published in Multiple Sclerosis and Related Disorders.

Almost 85% of patients with NMOSD in the study were either at risk of malnutrition (74.3%) or had definite malnutrition (11.4%) based on Mini Nutritional Assessment (MNA) scores. The mean scores for the patients with NMOSD were also significantly lower than healthy controls (20.4 ± 3.3 vs 23.3 ± 2.5; P =0.002). An MNA score between 17 and 23.5 suggests a risk of malnutrition and scores below 17 indicate definite malnutrition.

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Among the 4 components of the MNA, global evaluation and subjective assessment were significantly lower in the NMOSD group (P <0.001 for both), while anthropometric assessment and dietetic evaluation were not significantly different than healthy controls.

MNA total score was also found to be positively correlated with several aspects of patients’ quality of life scores measured through the 36-item short-form (SF-36) health survey, including bodily pain, physical functioning, general health, social functioning, vitality, emotional roles (all P <0.001), and mental health (P =0.003). The global evaluation component was also found to be significantly correlated with several aspects of the SF-36.

“Malnutrition among [patients with NMOSD] is caused by a combination of various physiological and psychological factors. A multifaceted and personalized intervention is required to improve the prognosis of NMOSD,” the authors wrote.

Several disease factors were also found to be negatively correlated to total MNA scores including number of NMOSD attacks, anxiety, duration of disease, sleep quality, depression, and fatigue (all P <0.03).

In MNA component analysis, depression was also correlated anthropometric assessment, global evaluation, and dietetic evaluation while anxiety was correlated with global evaluation and dietetic evaluation. Sleep quality was correlated with global evaluation and disease duration was correlated with dietetic evaluation.

Female patients in the study also tended to have lower MNA scores than males (P =0.02). Significantly lower scores in the MNA components of dietetic evaluation and subjective assessment were also observed in female patients (P <0.0001 and P <0.002, respectively).

Multivariable linear regression found that only sleep quality score, measured through Pittsburgh Sleep Quality Inde, was independently correlated with total MNA score although several factors were correlated with individual components of the MNA score.

During the study, a total of 70 patients with NMOSD and 66 healthy controls were recruited from the Sichuan Provincial People’s Hospital. No significant difference was observed in the sex or body mass index of the patient and healthy control groups and 87.1% of the patients with NMOSD were aquaporin-4 seropositive.


Huang R, Huang X, Wang Y, et al. The nutritional risk in patients with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord. Published online July 17, 2023. doi:10.1016/j.msard.2023.104900