The Association between Dairy Consumption and the Risk of Developing Multiple Sclerosis: A Systematic Review and Meta-Analysis
-
Behnaz Sedighi
,
Simin Jafari
,
Shoboo Rahmati
,
Fatemeh Ajam
,
Seyedeh Tahereh Afrah
,
Simin Salehinejad
,
Mahdieh Mirzaie
,
Roya Amir Gooshki
,
Parya Jangipour Afshar
Abstract
Background: Multiple sclerosis (MS) is a chronic and disabling disease that commonly affects young adults. We aimed to provide a comprehensive review of the current literature on the association between dairy consumption, particularly cow milk, and the risk of developing MS.
Methods: This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. We searched PubMed, Web of Science, Cochrane Library, and Scopus for peer-reviewed papers published until 2024. Eligible studies included randomized controlled trials, quasi-experimental studies, and observational designs (case-control, cohort, cross-sectional). Studies were excluded if they did not report sufficient data to calculate effect sizes. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted, and heterogeneity was assessed using the I² statistic.
Results: Twenty studies met the inclusion criteria. The overall pooled odds ratio (OR) for the association between total dairy consumption and MS risk was 0.96 (95% CI: 0.93–0.99), indicating a weak but statistically significant inverse association. Subgroup analysis of cohort studies, however, showed no significant association (relative risk [RR] = 1.18, 95% CI: 0.95–1.47, P = 0.41). Furthermore, cow's milk consumption alone was not significantly associated with MS development (OR = 0.88, 95% CI: 0.46–1.69, P = 0.21).
Conclusion: Although pooled results suggest a slight protective effect of overall dairy consumption on MS risk, findings remain inconsistent and inconclusive, especially when considering specific dairy products and study design. Additional longitudinal studies with rigorous methodology are needed to clarify the potential role of dairy in MS pathogenesis.
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2. Sedighi B, Haghdoost A, Jangipour Afshar P, et al (2023). Multiple sclerosis and COVID-19: A retrospective study in Iran. PLoS One, 18 (3):e0283538.
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6. Riccio P, Rossano R (2015). Nutrition Facts in Multiple Sclerosis. ASN Neuro, 7 (1):1759091414568185.
7. Munger KL, Chitnis T, Frazier AL, et al (2011). Dietary intake of vitamin D during adolescence and risk of multiple sclerosis. J Neurol, 258 (3):479-485.
8. Sepčić J, Mesaroš E, Materljan E, Šepić-Grahovac D (1993). Nutritional factors and multiple sclerosis in Gorski Kotar, Croatia. Neuroepidemiology, 12 (4):234-240.
9. Simpson‐Yap S, Neate SL, Nag N, et al (2023). Longitudinal associations between quality of diet and disability over 7.5 years in an international sample of people with multiple sclerosis. Eur J Neurol, 30 (10):3200-3211.
10. Noormohammadi M, Ghorbani Z, Naser Moghadasi A, et al (2022). MIND diet adherence might be associated with a reduced odds of multiple sclerosis: results from a case–control study. Neurol Ther, 11 (1):397-412.
11. Dehghan M, Ghaedi-Heidari F (2018). Environmental risk factors for multiple sclerosis: A case-control study in Kerman, Iran. Iran J Nurs Midwifery Res, 23 (6):431-436.
12. Rezaeimanesh N, Moghadasi AN, Sahraian MA, Eskandarieh S (2021). Dietary risk factors of primary progressive multiple sclerosis: a population-based case-control study. Mult Scler Relat Disord, 56:103233.
13. Hadgkiss EJ, Jelinek GA, Weiland TJ, et al (2015). The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis. Nutr Neurosci, 18 (3):125-136.
14. Abbasi M, Nabavi SM, Fereshtehnejad SM, et al (2017). Multiple sclerosis and environmental risk factors: a case-control study in Iran. Neurol Sci, 38 (11):1941-1951.
15. Zhang Z, Wang M, Yuan S, Larsson SC, Liu X (2021). Genetically predicted milk intake and risk of neurodegenerative diseases. Nutrients, 13 (8):2893.
16. Papendorf H, Daly A, Black L (2023). Dairy consumption is not associated with disability progression in an Australian longitudinal cohort study of people with multiple sclerosis. Proc Nutr Soc, 82 (OCE2):E191.
17. Pakpoor J, Seminatore B, Graves JS, et al (2018). Dietary factors and pediatric multiple sclerosis: a case-control study. Mult Scler, 24 (8):1067-1076.
18. Ghazavi Y, Bahadoran Z, Nikfarjam M, et al (2019). Comparison of food intake in multiple sclerosis patients and healthy individuals: A hospital-based case-controlled study. Iran J Child Neurol, 13 (4):143-154.
19. Dieu DYR, Dunlop E, Daly A, et al (2022). Total dairy consumption is not associated with likelihood of a first clinical diagnosis of central nervous system demyelination. Front Neurol, 13:888559.
20. Abdollahpour I, Sormani MP, Nedjat S, et al (2021). The role of nutritional factors during adolescence in multiple sclerosis onset: a population-based incident case–control study. Nutr Neurosci, 24 (7):500-507.
21. Marck CH, Probst Y, Chen J, et al (2021). Dietary patterns and associations with health outcomes in Australian people with multiple sclerosis. Eur J Clin Nutr, 75 (10):1506-1514.
22. Simpson‐Yap S, Nag N, Probst Y, et al (2022). Higher‐quality diet and non‐consumption of meat are associated with less self‐determined disability progression in people with multiple sclerosis: A longitudinal cohort study. Eur J Neurol, 29 (1):225-236.
23. Kirkland H, Campbell J, Reece J, et al (2023). Higher diet quality is associated with short and long-term benefits on SF-6D health state utilities: a 5-year cohort study in an international sample of people with multiple sclerosis. Qual Life Res, 32 (7):1883-1896.
24. Bagheri M, Maghsoudi Z, Fayazi S, et al (2014). Several food items and multiple sclerosis: A case-control study in Ahvaz (Iran). Iran J Nurs Midwifery Res, 19 (6):659-665.
25. Shivappa N, Hebert JR, Behrooz M, Rashidkhani B (2016). Dietary inflammatory index and risk of multiple sclerosis in a case-control study from Iran. Neuroepidemiology, 47 (1):26-31.
26. Pekmezovic TD, Tepavcevic DBK, Mesaros ST, et al (2009). Food and dietary patterns and multiple sclerosis: a case-control study in Belgrade (Serbia). Italian Journal of Public Health, 6 (1):81-87.
27. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003). Measuring inconsistency in meta-analyses. BMJ, 327 (7414):557-560.
28. Egger M, Smith GD, Schneider M, Minder C (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315 (7109):629-634.
29. Sterne JA, Egger M (2001). Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol, 54 (10):1046-1055.
30. Mirzaei F, Michels KB, Munger K, et al (2011). Gestational vitamin D and the risk of multiple sclerosis in offspring. Ann Neurol, 70 (1):30-40.
31. Ascherio A, Munger KL, Simon KC (2010). Vitamin D and multiple sclerosis. Lancet Neurol, 9 (6):599-612.
32. Escribano BM, Muñoz-Jurado A, Luque E, et al (2022). Lactose and Casein Cause Changes on Biomarkers of Oxidative Damage and Dysbiosis in an Experimental Model of Multiple Sclerosis. CNS Neurol Disord Drug Targets, 21 (8):680-692.
33. Stefferl A, Schubart A, Storch M, et al (2000). Butyrophilin, a milk protein, modulates the encephalitogenic T cell response to myelin oligodendrocyte glycoprotein in experimental autoimmune encephalomyelitis. J Immunol, 165 (5):2859-65.
34. Winer S, Astsaturov I, Cheung RK, et al (2001). T cells of multiple sclerosis patients target a common environmental peptide that causes encephalitis in mice. J Immunol, 166 (7):4751-6.
35. Katz Sand I (2018). The Role of Diet in Multiple Sclerosis: Mechanistic Connections and Current Evidence. Curr Nutr Rep, 7 (3):150-160.
2. Sedighi B, Haghdoost A, Jangipour Afshar P, et al (2023). Multiple sclerosis and COVID-19: A retrospective study in Iran. PLoS One, 18 (3):e0283538.
3. Chunder R, Heider T, Kuerten S (2023). The prevalence of IgG antibodies against milk and milk antigens in patients with multiple sclerosis. Front Immunol, 14:1202006.
4. Rahmanzadeh R, Lu PJ, Barakovic M, et al C (2021). Myelin and axon pathology in multiple sclerosis assessed by myelin water and multi-shell diffusion imaging. Brain, 144 (6):1684-1696.
5. Attfield KE, Jensen LT, Kaufmann M, Friese MA, Fugger L (2022). The immunology of multiple sclerosis. Nat Rev Immunol, 22 (12):734-750.
6. Riccio P, Rossano R (2015). Nutrition Facts in Multiple Sclerosis. ASN Neuro, 7 (1):1759091414568185.
7. Munger KL, Chitnis T, Frazier AL, et al (2011). Dietary intake of vitamin D during adolescence and risk of multiple sclerosis. J Neurol, 258 (3):479-485.
8. Sepčić J, Mesaroš E, Materljan E, Šepić-Grahovac D (1993). Nutritional factors and multiple sclerosis in Gorski Kotar, Croatia. Neuroepidemiology, 12 (4):234-240.
9. Simpson‐Yap S, Neate SL, Nag N, et al (2023). Longitudinal associations between quality of diet and disability over 7.5 years in an international sample of people with multiple sclerosis. Eur J Neurol, 30 (10):3200-3211.
10. Noormohammadi M, Ghorbani Z, Naser Moghadasi A, et al (2022). MIND diet adherence might be associated with a reduced odds of multiple sclerosis: results from a case–control study. Neurol Ther, 11 (1):397-412.
11. Dehghan M, Ghaedi-Heidari F (2018). Environmental risk factors for multiple sclerosis: A case-control study in Kerman, Iran. Iran J Nurs Midwifery Res, 23 (6):431-436.
12. Rezaeimanesh N, Moghadasi AN, Sahraian MA, Eskandarieh S (2021). Dietary risk factors of primary progressive multiple sclerosis: a population-based case-control study. Mult Scler Relat Disord, 56:103233.
13. Hadgkiss EJ, Jelinek GA, Weiland TJ, et al (2015). The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis. Nutr Neurosci, 18 (3):125-136.
14. Abbasi M, Nabavi SM, Fereshtehnejad SM, et al (2017). Multiple sclerosis and environmental risk factors: a case-control study in Iran. Neurol Sci, 38 (11):1941-1951.
15. Zhang Z, Wang M, Yuan S, Larsson SC, Liu X (2021). Genetically predicted milk intake and risk of neurodegenerative diseases. Nutrients, 13 (8):2893.
16. Papendorf H, Daly A, Black L (2023). Dairy consumption is not associated with disability progression in an Australian longitudinal cohort study of people with multiple sclerosis. Proc Nutr Soc, 82 (OCE2):E191.
17. Pakpoor J, Seminatore B, Graves JS, et al (2018). Dietary factors and pediatric multiple sclerosis: a case-control study. Mult Scler, 24 (8):1067-1076.
18. Ghazavi Y, Bahadoran Z, Nikfarjam M, et al (2019). Comparison of food intake in multiple sclerosis patients and healthy individuals: A hospital-based case-controlled study. Iran J Child Neurol, 13 (4):143-154.
19. Dieu DYR, Dunlop E, Daly A, et al (2022). Total dairy consumption is not associated with likelihood of a first clinical diagnosis of central nervous system demyelination. Front Neurol, 13:888559.
20. Abdollahpour I, Sormani MP, Nedjat S, et al (2021). The role of nutritional factors during adolescence in multiple sclerosis onset: a population-based incident case–control study. Nutr Neurosci, 24 (7):500-507.
21. Marck CH, Probst Y, Chen J, et al (2021). Dietary patterns and associations with health outcomes in Australian people with multiple sclerosis. Eur J Clin Nutr, 75 (10):1506-1514.
22. Simpson‐Yap S, Nag N, Probst Y, et al (2022). Higher‐quality diet and non‐consumption of meat are associated with less self‐determined disability progression in people with multiple sclerosis: A longitudinal cohort study. Eur J Neurol, 29 (1):225-236.
23. Kirkland H, Campbell J, Reece J, et al (2023). Higher diet quality is associated with short and long-term benefits on SF-6D health state utilities: a 5-year cohort study in an international sample of people with multiple sclerosis. Qual Life Res, 32 (7):1883-1896.
24. Bagheri M, Maghsoudi Z, Fayazi S, et al (2014). Several food items and multiple sclerosis: A case-control study in Ahvaz (Iran). Iran J Nurs Midwifery Res, 19 (6):659-665.
25. Shivappa N, Hebert JR, Behrooz M, Rashidkhani B (2016). Dietary inflammatory index and risk of multiple sclerosis in a case-control study from Iran. Neuroepidemiology, 47 (1):26-31.
26. Pekmezovic TD, Tepavcevic DBK, Mesaros ST, et al (2009). Food and dietary patterns and multiple sclerosis: a case-control study in Belgrade (Serbia). Italian Journal of Public Health, 6 (1):81-87.
27. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003). Measuring inconsistency in meta-analyses. BMJ, 327 (7414):557-560.
28. Egger M, Smith GD, Schneider M, Minder C (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315 (7109):629-634.
29. Sterne JA, Egger M (2001). Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol, 54 (10):1046-1055.
30. Mirzaei F, Michels KB, Munger K, et al (2011). Gestational vitamin D and the risk of multiple sclerosis in offspring. Ann Neurol, 70 (1):30-40.
31. Ascherio A, Munger KL, Simon KC (2010). Vitamin D and multiple sclerosis. Lancet Neurol, 9 (6):599-612.
32. Escribano BM, Muñoz-Jurado A, Luque E, et al (2022). Lactose and Casein Cause Changes on Biomarkers of Oxidative Damage and Dysbiosis in an Experimental Model of Multiple Sclerosis. CNS Neurol Disord Drug Targets, 21 (8):680-692.
33. Stefferl A, Schubart A, Storch M, et al (2000). Butyrophilin, a milk protein, modulates the encephalitogenic T cell response to myelin oligodendrocyte glycoprotein in experimental autoimmune encephalomyelitis. J Immunol, 165 (5):2859-65.
34. Winer S, Astsaturov I, Cheung RK, et al (2001). T cells of multiple sclerosis patients target a common environmental peptide that causes encephalitis in mice. J Immunol, 166 (7):4751-6.
35. Katz Sand I (2018). The Role of Diet in Multiple Sclerosis: Mechanistic Connections and Current Evidence. Curr Nutr Rep, 7 (3):150-160.
| Files | ||
| Issue | Vol 54 No 11 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Dairy products Cow milk Multiple sclerosis Meta-analysis | ||
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How to Cite
1.
Sedighi B, Jafari S, Rahmati S, Ajam F, Afrah ST, Salehinejad S, Mirzaie M, Amir Gooshki R, Jangipour Afshar P. The Association between Dairy Consumption and the Risk of Developing Multiple Sclerosis: A Systematic Review and Meta-Analysis. Iran J Public Health. 2025;54(11):2408-2420.
