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Background: Receiving a multiple sclerosis (MS) diagnosis is a significant stressor. Therefore, highly individualised counselling is needed, especially in early MS. Modifiable risk factors (e.g. smoking and obesity) are gaining relevance in MS. Despite evidence for worse MS-related health outcomes, prevalence of adverse health behaviours, such as smoking and physical inactivity, is high across all MS stages. However, knowledge regarding health behaviours as well as their association with MS-related health outcomes among newly diagnosed PwMS in Germany is scarce. Currently, the efficacy of an interactive digital lifestyle management application intended to be used as an add-on to standard care among newly diagnosed PwMS in Germany is evaluated in an ongoing multicentre randomised controlled trial (RCT) ('POWER@MS1')., Objectives: To describe baseline disease characteristics and health behaviours of the POWER@MS1 cohort and investigate associations between MS characteristics, quality of life (QOL), health behaviours and intention to optimise health behaviour habits., Methods: This study included 234 persons with early MS from 20 study centres located across Germany who participate in the POWER@MS1 RCT. Participants were recruited by treating neurologists from different regions and health-care settings in Germany. Baseline data was obtained using paper-based questionnaires and a web-based healthy diet screener between July 2019 and end of March 2022 and analysed descriptively., Results: In this early MS cohort (mean disease duration 4 months), a screening tool showed severe symptoms of anxiety in 15 % of the participants. Better means for stress management appeared to be particularly relevant for the whole cohort. Moreover, 19 % were current smokers, 15 % were obese and 36 % were insufficiently physically active. On average, participants only moderately adhered to dietary guidelines for recommended intake of key food groups (e.g. vegetables, fruits and fatty marine fish). Higher EDSS scores were associated with approximately 20 % higher T2-lesion burden (rate ratio RR=1.2, p<0.001) and 13 % higher relapse rate (RR=1.13,p=0.02) per EDSS disability level. Moreover, a higher T2-lesion burden was associated with current smoking (RR=0.76, p=0.033), resulting in approximately 24 % less T2-lesions at disease onset among non-smokers. In addition, smoking was associated with unhealthier dietary habits according to lower diet scores (linear regression coefficient β=-1.27, p<0.001). Higher EDSS scores (β=0.19,p<0.001) and higher BMI (β=0.013,p=0.03) were associated with higher HAQUAMS (lower QOL). Further, lower diet scores (β=-0.044,p=0.039) were associated with lower QOL. Moreover, higher HAQUAMS (lower QOL) indicated a higher intention to optimise stress management (β=0.98,p<0.001), physical activity (β=0.74,p=0.046) and sleep behaviour (β=1.82,p<0.001). Further, higher intention to optimise stress management was accounted for by higher EDSS scores (β=0.39,p=0.004) and a higher number of T2-lesions (β=0.029,p=0.015) in this newly diagnosed MS cohort., Conclusion: Results indicate a clear need for modifications of health behaviours among newly diagnosed PwMS participating in POWER@MS1. Individualised psychological and health behaviour counselling appears to be an important factor in treatment, also for similar early MS cohorts and particularly in those who demonstrate a more severe disease in clinical and MRI metrics., Competing Interests: Declaration of Competing Interest CH has received research grants, speaker honoraria and travel grants from Biogen, Celgene, Genzyme, Merck and Roche; all outside of this work. HT has no personal pecuniary interests to disclose, other than being the Secretary General of the German MS Society, federal association, which receives funding from a range of public and corporate sponsors, recently including Bundesgesundheitsministerium (BMG), The German Innovation Fund (G-BA), The German MS Trust, Biogen, Bristol Myers Squibb, Merck Serono, Novartis, Roche, Sanofi, Viatris (former Mylan); none resulted in a conflict of interest. TF reports personnel fees from Bayer, BiosenseWebster, Boehringer Ingelheim, CSL Behring, Daiichi Sankyo, Enanta, Fresenius Kabi, Galapagos, Immunic, Janssen, LivaNova, Novartis, Relaxera, Roche, and Vifor; all outside this work. DB has received speaker honoraria and travel grants from Bayer, Novartis, Roche, Genzyme; all outside this work. AB has received consulting and/or speaker fees from Alexion, Biogen, Celgene, Horizon, Novartis, Roche and Sandoz/Hexal and his institution has received compensation for clinical trials from Alexion, Biogen, Merck, Novartis, Roche, and Sanofi Genzyme; all outside this work. KG has received compensation as investigator, advisor and speaker as well as travel fees from Abbvie, Almirall, Aristo, Bayer, Biogen, BMS, Celgene, Genzyme, Ipsen, Janssen, Merck, Novartis and Roche; all outside this work. SM has received financial support for consulting activities from Roche; all outside this work. PO received research support as well as speaking fees and travel fees from Alexion, Bayer Health Care, Biogen, Janssen, Merck Serono, Novartis, Pfizer, Roche, Sanofi Genzyme, TEVA; all outside this work. HR has received speaker honoraria from Roche, MerckSerono, and Novartis and participated in advisory boards for Novartis, Teva, and Hexal; all outside this work. SSch has received research grants, speaker honoraria and travel compensations from BayerVital, Biogen, Genzyme, Merck, Novartis, Roche, Teva; all outside this work. AS received speaker honoraria from Bayer and Biogen, and participated in AdBoards for Merck Serono; all outside this work. KHS has received speaker honoraria or travel grants from Biogen, Bristol Myers Squibb, Merck and Roche; all outside this work. CW has received institutional honoraria and/or grant support from Novartis, Sanofi-Genzyme, Alexion, Janssen, Merck, Biogen, and Roche; all outside this work. All other authors have nothing to declare., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)