Table 2 Studies for Meta-analyses investigating the effect of dietary interventions on MS-related outcomes. 2021

Mousavi-Shirazi-Fard 2020 [42]. Iran

3

100 RRMS

F (87%)

I:50, C:50

I:35,2 ± 6,61

C:36,26 ± 7,23

I:6,61 ± 2,88

C:5,74 ± 2,7

I:24,40 ± 2,96

C:24,10 ± 3,11

Yes. Activity factor: 1,2–1,3

Modified anti-inflammatory diet / control: (WHO) healthy diet

Restrictions.: sucrose, processed food, fast food, fried food, and animal fat. Substitutions: white rice /brown rice, white bread/whole wheat bread, high fat dairy/probiotics low fat products

15% / 55% / 30%

Katz Sand 2019 [79]

Iowa USA

6

36 MS (28RRMS, 3SPMS,1PPMS)

F (100%). I:18, C:18

I:44(37–51)

C:41(30–49)

I:5,4(2–10,7)

C:4,8 (2–11,2)

I:2(0–3)

C:2(0–5)

I:26(25–37)

C:25(23–30)

Modified Mediterranean dietary program (KS-mMdiet) / control: Western style diet that include at least meat or dairy

Restrictions: meat, dairy, white grains and processed food, salt intake to 2 g/day, and not eating for at least 12 h per night

-

Choi 2016 [63]. Germany

6

48 RRMS

F (79%)

FMD:18,

KD: 18,

C:12

FMD:44,4 ± 11,1

KD:41,3 ± 8,2

C:50,5 ± 10,4

FMD:11 ± 7,7

KD:6,3 ± 4,3

C:9,9 ± 9,2

FMD: 4 (2,4–4)

KD: 3(2,4–3,5)

C: 2,5 (1,5–4)

FMD:26 ± 4,8

KD:26,9 ± 5,3

C: 27,3 ± 6,9

Fasting-Mimicking-diet for 7 days, followed by a Mediterranean diet for 6 months (FMD)/ Low Glycemic Load Ketogenic Diet (KD) / control: Criteria of a regular diet in German population

KD < 50 g carbohydrates, > 160 g fat and < 100 g protein intake daily

Irish 2017 [80]. USA

3

17 RRMS

F (88%)

I:8, C:9

I:35.4 ± 5.7

C:37.1 ± 3.7

P = 0,26

Modified Paleolithic diet. Gluten Free / control: typical physician recommendation for MS

Restrictions: complete abstinence from products containing gluten, dairy, potatoes, and legumes

Rezapour‐Firouzi 2013 [43]

Iran

6

65 RRMS

F (65%) A:23, B:22, C:20

A:34,2 ± 7,5

B:35,9 ± 7,8

C:33,7 ± 7,8

A:6,26 ± 3,9

B: 7,55 ± 5,08

C:6,6 ± 4,0

A:2,76 ± 1,39

B:3,45 ± 1,41

C:3,25 ± 1,9

-

A: Co-supplemented hemp seed and evening primrose oils and advised hot nature diet. B: Supplement olive oil

C: Co-supplemented hemp seed and evening primrose oils

Restrictions: low intake of cholesterol, hydrogenated or trans fatty acids and saturated fats reducing sugar and refined starch, dairy products with honey or date and eliminating foods with Cold nature

Yadav 2016 [78]. USA

12

61 RRMS

F: (93,3%)

I:32, C:29

C:40.9 ± 8.48

I:40.8 ± 8.86

C:5.3 ± 3.86

I:5.33 ± 3.63

I:2.72 ± 1.05

C:2.22 ± 0.90

I:28,4 ± 6,76

C:29,3 ± 7,42

Very low fat plant based Diet / Control group: typical physician recommendation for MS

Restrictions: Meat, fish, eggs, dairy products, and vegetable oils such as corn and olive oil were prohibited

14% / 76% / 10%

Bohlouli 2021 [81]. Iran

6

147 RRMS

F: (83%)

I:68, C:79

I:38,6 ± 8,4

C:40,0 ± 9,6

I:8,1 ± 5,7

C:9,3 ± 6,9

I:1,7 ± 0,7

C:2,0 ± 0,9

I:26,1 ± 4,1

C:25,9 ± 4,5

Yes. To calculate the BEE

Modified Mediterranean diet:/ Traditional Iranian diet

Restrictions: low to moderate consumption of dairy products, meat and poultry. It is recommended whole grains and monounsaturated fatty acids

17% / 51% / 32%

Platero 2020 [82]

Spain

4

51 MS

I:27, C:24

(median)

I:45

C:50

(median)

I:9

C:13,5

I:3,37 ± 2,03

C:3,8 ± 2

I:25,92 ± 5,29

C:25,87 ± 6,10

Mediterranean-type food pattern*, with extra virgin coconut oil and supplemented with Epigallocatechin gallate (EGCG) / Control group: the same isocaloric diet and placebo

Restrictions: detriment of meat and meat products. It is recommended whole grain bread

20%/40%/40%