Waist Circumference and Body Mass Index as Predictors of Disability Progression in Multiple Sclerosis: A Systematic Review and Meta-Analysis

Abstract

Background: While obesity has been shown to elevate the risk of developing multiple sclerosis (MS), there is a lack of strong evidence regarding its role in the disability progression and status of MS patients. Methods: This systematic review and meta-analysis aimed to provide comparative estimates of WC and BMI in patients with MS (PwMS) and to investigate potential associations between the waist circumference (WC) and body mass index (BMI) and demographic and specific MS characteristics. Adhering to PRISMA guidelines, a detailed search of the MEDLINE PubMed, Cochrane Library, and Scopus databases was conducted. Results: A total of 16 studies were included. The pooled mean WC and BMI among PwMS was estimated to be 87.27 cm (95%CI [84.07; 90.47]) and 25.73 (95%CI [25.15; 26.31]), respectively. Meta-regression models established a significant bidirectional relationship between WC and the Expanded Disability Scale (EDSS) (p < 0.001) but not between BMI and EDSS (p = 0.45). Sensitivity analyses showed no association between WC and age (p = 0.48) and a tendency between WC and disease duration (p = 0.08). Conclusions: Although WC measurements classify PwMS as normal weight, BMI measurements classify them as overweight. Therefore, WC should complement BMI evaluations in clinical practice. Additionally, our findings highlight the significant association between abdominal fat, as indicated by WC, and disease progression. Considering the heightened risk of cardiovascular comorbidity and mortality among PwMS, we recommend integrating both WC and BMI as standard anthropometric measurements in routine clinical examinations and targeted prevention strategies for PwMS.

Keywords: body mass index (BMI); disability progression; multiple sclerosis; obesity; waist circumference (WC).

Figure 1

Prisma flowchart for the study selection.

Figure 2

Forest plot: pooled mean WC values [23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38].

Figure 3

Forest plot: pooled mean BMI values [23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38].

Figure 4

Forest plot: pooled mean WC values in the male subset [23,26,27,29,30,34,35,36,37,38].

Figure 5

Forest plot: pooled mean WC values in the female subset [23,26,27,29,30,34,35,36,37,38].

Figure 6

Forest plot: mean difference in WC between male and female PwMS [23,26,27,29,30,34,35,36,37,38].

Figure 7

Forest plot: pooled mean BMI values in the male subset [27,29,30,35,37].

Figure 8

Forest plot: pooled mean BMI values in the female subset [27,29,30,35,37].