Impacto en el estado de inflamación de pacientes con esclerosis múltiple, tras tratamiento con epigalocatequina galato y aceite de coco. Posible disminución del riesgo cardíaco

Résumé

Theoretical framework: Multiple Sclerosis (MS) is a chronic neurodegenerative, inflammatory, demyelinating, and autoimmune disease. Among its pathogenic mechanisms, high oxidative stress and energy alterations at the mitochondrial level stand out, which in turn imply elevated levels of inflammation; and symptomatically anthropometric changes, characterized by a decrease in muscle mass accompanied by an increase in fat mass, which leads to progressive functional disability. These changes often promote the presence of obesity, mainly abdominal, which is closely related to inflammation, which in turn implies the risk of cardiac alterations, present in many patients. The administration of polyphenol epigallocatechin gallate (EGCG); and the increase in ketone bodies blood levels (specially βHB) after hepatic metabolism of foods rich in medium-chain fatty acids (MCFA), among which coconut oil stands out, show anti-inflammatory effects and benefits on anthropometric and biochemical variables, which reduce cardiovascular risk. Objectives: the main objective is to assess the impact of EGCG and coconut oil intervention in inflammation levels related to cardiac activity in MS patients; and as secondary objectives, to determine the possible anthropometric improvement, changes in the lipid profile and the impact on cardiac risk after the intervention. Material and methods: a pilot, prospective, analytic, quantitative, and experimental study was carried out by means of a clinical trial. The initial population sample of the study was 72 patients diagnosed with MS, of which 57 underwent an anthropometric study; and finally, 51 received the treatment or placebo for 4 months, for which they were randomly assigned to a control group and an intervention group. The latter took the daily dose of 800 mg of EGCG and 60 ml of coconut oil, whereas the control group received a placebo; all patients in the study followed an individually adapted isocaloric diet of Mediterranean nature. Before and after the intervention were measured: anthropometric variables, allowing to detect the presence of abdominal obesity and cardiac risk; different markers in blood such as: β-hydroxybutyrate (βHB) levels, lipoproteins (such as total cholesterol (CT), high-density lipoproteins (HDL), low- density lipoproteins (LDL), Apolipoprotein A-1 (APOA-1) and triglycerides (TG)), haptoglobin (Hp), C-reactive protein (CRP), paraoxonase 1 (PON1), butyrylcholinesterase (BuChE), albumin, cortisol and interleukin 6 (IL-6); and the Expanded Disability Status Scale (EDSS) which determines functional capacity. Results: at the anthropometric level, 87.7% of MS patients present abdominal obesity, who also present significantly higher a body mass index (BMI), body fat percentage, waist hip ratio (WHR) and waist height ratio (WHtR) than patients without abdominal obesity. In addition, IL-6 is significantly higher in patients with abdominal obesity (while there are no differences in the mean values of PON1 activity) and shows a significant and positive correlation with waist circumference and WHtR. After treatment, a significant decrease in fat percentage, WHR and fat weight; and an increase in muscle mass was only observed in the intervention group. And as for biomarkers, just in the intervention group significantly increased in blood: βHB, BuChE, PON1 activity and albumin; and IL-6 and triglycerides decreased significantly (as did EDSS, which represents an improvement in functional capacity). Whereas in control group only IL-6 decreased. Cortisol did not show changes in either group. Furthermore, BuChE only correlated significantly and positively in the intervention group with fat mass percentages, blood TG levels and PON1 activity. Also, and despite the fact that muscle improvements only occur in the intervention group, and that Hp shows a significant and positive correlation with IL-6 levels and negative correlation with pre-intervention muscle percentage, Hp levels in blood did not change in this group. As far as lipoproteins in blood are concerned, CT significantly increased in both groups, HDL increased only in control group, and TG, which showed a different trend between both groups (with increase in control group and decrease in intervention group), after the analysis as independent samples showed significant differences with lower levels in the intervention group. Moreover, just in the intervention group, TG significantly and positively correlated with EDSS values, and in turn, these EDSS values significantly and positively correlated with CPR values in blood, which seems to indicate the relation of elevated TG and inflammation levels with functional capacity. Finally, and possibly as a consequence of these anthropometric and molecular changes, an improvement in cardiac risk could be observed only in the intervention group, with a decrease in the number of high-risk patients and an increase in those at moderate or low risk. Conclusions: MS patients show abdominal obesity associated with increased inflammation. The intervention with EGCG and coconut oil in MS patients seems to decrease the inflammatory state characteristic of the disease, which could explain the decrease in cardiac risk. This could be due to an anthropometric improvement, with increased muscle mass and decreased fat mass. In this changes, BuChE seems to play a role in the increase of lipolytic activity, while albumin and Hp could play roles in: decrease in abdominal fat, and muscular regeneration associated with improvements in inflammation levels, respectively.