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RRMS often evolves into a progressive state with no symptomatic remission, termed secondary-progressive MS (SPMS) [7, 11]

The abnormalities of circadian rhythms are related to negative outcomes such as symptom aggravation and recurrence in psychiatric disorders [4, 5]
Table 3 describes the diet quality of participants, which ranged from poor to excellent, and 52% of participants reported a somewhat or very limited variety of foods consumed in the diet

doi: 10.1089/thy.2014.0028
