Fish Consumption Tied to Disability Progression in Multiple Sclerosis

Higher fish consumption was tied to less disability progression among people with multiple sclerosis (MS), a case-control study in Sweden showed.

Compared with low consumption, higher total consumption of lean and oily fish at MS diagnosis was associated with a reduced risk of confirmed disability worsening (HR 0.66, 95% CI 0.51-0.86), reported Anna Hedström, MD, PhD, of the Karolinska Institute in Stockholm, Sweden, and colleagues.

It was also tied to less progression to two Expanded Disability Status Scale (EDSS) milestones: EDSS 3 (HR 0.55, 95% CI 0.39-0.79) and EDSS 4 (HR 0.57, 95% CI 0.33-0.96). Scores on the EDSS can range from 0 to 10, with higher scores indicating worse disability.

The associations remained consistent after further adjustment for several lifestyle factors, the researchers wrote in the Journal of Neurology, Neurosurgery, and Psychiatry. Protective effects were more pronounced among patients who maintained consistent fish consumption over time, they added.

“MS is a chronic, progressive disease, and while disease-modifying therapies are essential, lifestyle factors such as diet may also play a role in disease progression,” Hedström noted.

“Our study suggests that higher fish consumption is associated with a lower risk of disability progression in MS, adding to the growing body of evidence that dietary choices could influence long-term outcomes,” she told MedPage Today. “Understanding modifiable lifestyle factors is crucial because they offer accessible and complementary strategies alongside medical treatments to help patients manage their disease more effectively.”

Fish contains several bioactive compounds that may contribute to neuroprotection and inflammation control, including omega-3 fatty acids and taurine.

“Taurine is an amino acid abundant in fish that has been linked to antioxidant and immunomodulatory effects,” Hedström noted. “Interestingly, both lean and oily fish were linked to favorable outcomes in our study, suggesting that nutrients beyond omega-3s — such as taurine — could also be contributing to these benefits.”

The study builds on previous research that suggests a healthy diet could improve quality of life and may reduce disability progression in people with MS, noted Emma Gray, PhD, research director of the MS Society in London, who wasn’t involved with the study.

“However, we’d like to see further research to confirm the findings, and understand what is going on in the body to produce these benefits,” Gray was quoted as saying on the U.K. Science Media Centre site. “Additional factors like the impact of other dietary choices and socioeconomic status could also be taken into account.”

Hedström and colleagues followed 2,719 people with incident MS cases with data on fish intake and EDSS outcomes from the Swedish population-based case-control Epidemiological Investigation of MS (EIMS) study.

EIMS participants were diagnosed with MS according to McDonald criteria; they were recruited between 2005 and 2015 and followed for up to 15 years post-diagnosis through the Swedish MS registry. Confirmed disability worsening was defined as an increase in the EDSS score of at least 1 point from baseline, sustained between two further check-ups at least 6 months apart.

The mean age at diagnosis was 38 years, and 72% were women. Most participants had relapsing MS, and the mean baseline EDSS score was 1.8.

Participants were asked specifically about their average consumption of lean and oily fish. Oily fish species were defined as species with a fat content greater than 3%, such as herring, mackerel, tuna, salmon, and trout. Lean fish had a fat content under 3%, such as cod, pollock, haddock, whiting, and pike perch.

Responses were recorded on a 4-point scale of never or seldom, 1-3 times/month, weekly, or daily consumption of fish. There was no significant difference in baseline EDSS scores by fish consumption habits.

A digital follow-up questionnaire in 2021 assessed changes in fish intake among 1,719 participants over time. Of these, 24% had altered their fish consumption frequency. Favorable outcomes were more pronounced when the analysis was limited to MS patients who maintained consistent fish consumption over the follow-up period.

The study was observational, and unknown factors may have influenced outcomes, the researchers acknowledged.

“While our findings are promising, this is an observational study, so we cannot establish causation — only associations,” Hedström pointed out. “That said, our findings suggest that encouraging MS patients to include fish as part of a balanced, anti-inflammatory diet may be a simple and practical strategy to support long-term health.”

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