The Prevalance of Malnutrition and Its Association With Disability in Patients With Relapsing-Remitting Multiple Sclerosis

Malnutrition status and risk of malnutrition will be assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) in patients with relapsing-remitting multiple sclerosis and healthy controls. MNA-SF is a screening tool with a total score ranging from 0 to 14. Lower scores indicate worse nutritional status. Scores from 12 to 14 indicate normal nutritional status, scores from 8 to 11 indicate risk of malnutrition, and scores from 0 to 7 indicate malnutrition.

The relationships between MNA-SF and anthropometric, body composition, depressive and anger-related variables will also be evaluated.

Disability severity will be assessed in patients with Multiple Sclerosis (MS) using the Expanded Disability Status Scale (EDSS), which ranges from 0 to 10 in 0.5-point increments. Higher scores indicate worse disability. A score of 0 indicates normal neurological status, and a score of 10 indicates death due to MS.

The relationships between disability severity and anthropometric, body composition, depressive, anger-related, and urinary incontinence-related variables will also be evaluated.

Height will be measured in meters in both patients with relapsing-remitting multiple sclerosis and healthy controls.

Body weight will be measured in kilograms in both patients with relapsing-remitting multiple sclerosis and healthy controls.

Body mass index (BMI) will be calculated in kilograms per square meter (kg/m²) using measured body weight and height in both patients with relapsing-remitting multiple sclerosis and healthy controls.

Waist circumference will be measured in centimeters in both patients with relapsing-remitting multiple sclerosis and healthy controls.

Hip circumference will be measured in centimeters in both patients with relapsing-remitting multiple sclerosis and healthy controls.

Waist-to-height ratio (WHtR) will be calculated using waist circumference and height measurements in both patients with relapsing-remitting multiple sclerosis and healthy controls. Higher values indicate greater central adiposity.

Waist-to-hip ratio (WHR) will be calculated using waist circumference and hip circumference measurements in both patients with relapsing-remitting multiple sclerosis and healthy controls.

Fat mass (FM) will be measured in kilograms using the TANITA® MC-180MA Bioelectric Impedance Analyser device in both patients with RRMS and healthy controls. Bioelectrical impedance analysis will be performed 2 hours after a meal, following 5 minutes of rest, with participants standing still on the device with bare hands and feet.

Fat mass percentage will be derived from fat mass relative to body weight and expressed as a percentage in both patients with RRMS and healthy controls. Measurements will be obtained using the TANITA® MC-180MA Bioelectric Impedance Analyser. Bioelectrical impedance analysis will be performed 2 hours after a meal, following 5 minutes of rest, with participants standing still on the device with bare hands and feet.

Fat-free mass (FFM) will be measured in kilograms using the TANITA® MC-180MA Bioelectric Impedance Analyser in both patients with RRMS and healthy controls. Bioelectrical impedance analysis will be performed 2 hours after a meal, following 5 minutes of rest, with participants standing still on the device with bare hands and feet.

Total body water (TBW) will be measured in kilograms using the TANITA® MC-180MA Bioelectric Impedance Analyser in both patients with RRMS and healthy controls. Bioelectrical impedance analysis will be performed 2 hours after a meal, following 5 minutes of rest, with participants standing still on the device with bare hands and feet.

Predicted muscle mass (PMM) will be measured in kilograms using the TANITA® MC-180MA Bioelectric Impedance Analyser in both patients with RRMS and healthy controls. Bioelectrical impedance analysis will be performed 2 hours after a meal, following 5 minutes of rest, with participants standing still on the device with bare hands and feet.

Depressive symptoms will be assessed using the Beck Depression Inventory (BDI), which ranges from 0 to 63. Higher scores indicate more severe depressive symptoms. Commonly used score ranges are 0-9 for minimal depression, 10-16 for mild depression, 17-29 for moderate depression, and 30-63 for severe depression.

Anger disposition will be assessed using the Trait Anger subscale of the State-Trait Anger Scale (STAS). Scores range from 10 to 40, with higher scores indicating greater trait anger.

Suppressed anger will be assessed using the Anger In subscale of the State-Trait Anger Scale (STAS). Scores range from 8 to 32, with higher scores indicating a greater tendency to suppress anger.

Outward expression of anger will be assessed using the Anger Out subscale of the State-Trait Anger Scale (STAS). Scores range from 8 to 32, with higher scores indicating a greater tendency to express anger outwardly.

Anger control will be assessed using the Anger Control subscale of the State-Trait Anger Scale (STAS). Scores range from 8 to 32, with higher scores indicating better anger control.

Urinary incontinence symptoms will be assessed using semi-structured symptom-based urinary incontinence screening questionnaires designed to identify stress, urge, and overflow incontinence patterns. The questionnaires include symptom-oriented items with response options such as yes, no, and "more than half of the time," and additional questions on urinary frequency, nocturia, leakage frequency, and leakage amount where applicable. Participants will be classified according to the predominant symptom pattern identified from the questionnaire responses as stress, urge, or overflow urinary incontinence.

The correlation between disability severity, as measured by EDSS, and nutritional status as measured by MNA-SF will be evaluated in patients with RRMS.