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Gouider R, Souissi A, Mrabet S, Gharbi A, Abida Y, Kacem I, Gargouri-Berrechid A. Environmental factors related to multiple sclerosis progression. J Neurol Sci 2024; 464:123161. [PMID: 39137699 DOI: 10.1016/j.jns.2024.123161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 07/29/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024]
Abstract
Multiple Sclerosis (MS) is a complex neurological disease which prevalence is increasing worldwide. The impact of environmental factors on MS susceptibility has already been defined and highlighted in many previous reports, particularly vitamin D or ultraviolet B light exposure, Epstein-Barr virus (EBV) infection, obesity, and smoking. There is increasing evidence that environmental and lifestyle factors are not only important in triggering MS but are also implicated in MS progression. Low sun exposure and vitamin D deficiency exhibit a strong relationship with disease progression in both animal and human studies. The gestational period seems also to impact long-term disease progression as January's babies had a higher risk of requiring walking assistance than those born in other months. The implication of EBV in neurodegeneration and MS progression was also suggested even though its specific targets and mechanisms are still unclear. Cigarette smoking is correlated with faster clinical progression. The association of obesity and smoking seems to be associated with a faster progression and an increased rate of brain atrophy. Although the effect of air pollution on MS pathogenesis remains not fully understood, exposure to polluted air can stimulate several mechanisms that might contribute to MS severity. People with MS with active disease have an altered microbiota compared to patients in the remission phase. Cardiovascular comorbidities, epilepsy, and depression are also associated with a more severe disability accrual. Knowledge about MS modifiable risk factors of progression need to be incorporated into everyday clinical practice in order to ameliorate disease outcomes.
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Affiliation(s)
- Riadh Gouider
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine of Tunis, 1007, Tunisia.
| | - Amira Souissi
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine of Tunis, 1007, Tunisia
| | - Saloua Mrabet
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine of Tunis, 1007, Tunisia
| | - Alya Gharbi
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine of Tunis, 1007, Tunisia
| | - Youssef Abida
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine of Tunis, 1007, Tunisia
| | - Imen Kacem
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine of Tunis, 1007, Tunisia
| | - Amina Gargouri-Berrechid
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine of Tunis, 1007, Tunisia
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Hosseini-Moghaddam S, Marrie RA, Wolfson C, Carruthers R, Freedman MS, Morrow S, Lee L, Nisenbaum R, Konig A, Magalhaes S, Rotstein DL. A Canadian case control study investigating demographic and environmental factors associated with MOGAD. Mult Scler Relat Disord 2023; 79:105023. [PMID: 37804766 DOI: 10.1016/j.msard.2023.105023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/05/2023] [Accepted: 09/23/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Little is known about demographic and environmental factors associated with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). OBJECTIVE To investigate factors associated with MOGAD using a case-control design and validated questionnaire from the Environmental Risk Factors in Multiple Sclerosis Study (EnvIMS). METHODS We enrolled patients with positive MOG antibody serology and diagnosis of MOGAD at six Canadian centres. MOGAD participants completed the EnvIMS questionnaire, and were compared to unaffected controls from the Canadian arm of EnvIMS. We calculated crude and adjusted odds ratios (OR) using logistic regression models and Firth's procedure for rare events. RESULTS We enrolled 39 MOGAD participants with mean (SD) age 45.0 (14.4) years, 28 (71.8 %) women, 25 (64.1 %) White, 26 (66.7 %) residents of Ontario, and mean BMI 28.6 (7.1). They were compared to 956 controls. Using multivariable logistic regression, larger body size at age 10 years (OR: 3.57, 95 % CI:1.23 - 10.33) and non-White ethnicity (OR:3.81, 95 % CI:1.93-7.54) were associated with higher odds of MOGAD. Among Ontario residents, current BMI ≥30 was associated with higher odds of MOGAD (OR:2.79, 95 % CI:1.03-7.53). CONCLUSION Our findings are hypothesis-generating due to the sample size, but suggest that obesity and ethnicity should be explored as potential risk factors for MOGAD in other settings.
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Affiliation(s)
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christina Wolfson
- Departments of Epidemiology and Biostatistics and Occupational Health and Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Carruthers
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mark S Freedman
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sarah Morrow
- Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Liesly Lee
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, 3rd floor, Toronto, Ontario M5S 3H2, Canada
| | - Rosane Nisenbaum
- Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, 3rd floor, Toronto, Ontario M5S 3H2, Canada; Applied Health Research Centre, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, A Site of Unity Health Toronto, Toronto, ON, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andrea Konig
- St. Michael's Hospital, Toronto, 30 Bond St., Toronto, Ontario M5B 1W8, Canada
| | - Sandra Magalhaes
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Dalia L Rotstein
- St. Michael's Hospital, Toronto, 30 Bond St., Toronto, Ontario M5B 1W8, Canada; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, 3rd floor, Toronto, Ontario M5S 3H2, Canada.
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Rotstein DL, Wolfson C, Carruthers R, Freedman MS, Morrow SA, Lee L, Burton JM, Nisenbaum R, Konig A, Magalhaes S, Marrie RA. A national case-control study investigating demographic and environmental factors associated with NMOSD. Mult Scler 2023; 29:521-529. [PMID: 36803237 PMCID: PMC10152218 DOI: 10.1177/13524585231151953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Risk factors for aquaporin-4 (AQP4+) antibody neuromyelitis optica spectrum disorder (NMOSD) are not well-established. OBJECTIVE To investigate demographic and environmental factors associated with NMOSD using a validated questionnaire and case-control design. METHODS We enrolled patients with AQP4 + NMOSD through six Canadian Multiple Sclerosis Clinics. Participants completed the validated Environmental Risk Factors in Multiple Sclerosis Study (EnvIMS) questionnaire. Their responses were compared to those of 956 unaffected controls from the Canadian arm of EnvIMS. We calculated odds ratios (ORs) for the association between each variable and NMOSD using logistic regression and Firth's procedure for rare events. RESULTS In 122 participants (87.7% female) with NMOSD, odds of NMOSD in East Asian and Black participants were ⩾8 times that observed in White participants. Birthplace outside Canada was associated with an increased risk of NMOSD (OR = 5.5, 95% confidence interval (CI) = 3.6-8.3) as were concomitant autoimmune diseases (OR = 2.7, 95% CI = 1.4-5.0). No association was observed with reproductive history or age at menarche. CONCLUSION In this case-control study, risk of NMOSD in East Asian and Black versus White individuals was greater than that observed in many previous studies. Despite the preponderance of affected women, we did not observe any association with hormonal factors such as reproductive history or age at menarche.
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Affiliation(s)
- Dalia L Rotstein
- DL Rotstein MS Clinic, St. Michael’s
Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada.
| | - Christina Wolfson
- Departments of Epidemiology, Biostatistics and
Occupational Health and Medicine, Faculty of Medicine and Health Sciences,
McGill University, Montreal, QC, Canada/Research Institute of the McGill
University Health Centre, Montreal, QC, Canada
| | - Robert Carruthers
- Division of Neurology, Faculty of Medicine,
University of British Columbia, Vancouver, BC, Canada
| | - Mark S Freedman
- Department of Medicine, University of Ottawa,
Ottawa, ON, Canada/Ottawa Hospital Research Institute, Ottawa, ON,
Canada
| | - Sarah A Morrow
- Western University, London, ON, Canada/London
Health Sciences Centre, London, ON, Canada
| | - Liesly Lee
- Department of Medicine, University of Toronto,
Toronto, ON, Canada/Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, ON, Canada
| | - Jodie M Burton
- Departments of Clinical Neurosciences and
Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Rosane Nisenbaum
- St. Michael’s Hospital, Toronto, ON,
Canada/Applied Health Research Centre and MAP Centre for Urban Health
Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity
Health Toronto, Toronto, ON, Canada/Division of Biostatistics, Dalla Lana
School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Sandra Magalhaes
- Department of Sociology, University of New
Brunswick, Fredericton, NB, Canada
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health
Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences,
University of Manitoba, Winnipeg, MB, Canada
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Pilotto S, Gencarelli J, Bova S, Gerosa L, Baroncini D, Olivotto S, Alfei E, Zaffaroni M, Suppiej A, Cocco E, Trojano M, Amato MP, D'Alfonso S, Martinelli-Boneschi F, Waubant E, Ghezzi A, Bergamaschi R, Pugliatti M. Etiological research in pediatric multiple sclerosis: A tool to assess environmental exposures (PEDiatric Italian Genetic and enviRonment ExposurE Questionnaire). Mult Scler J Exp Transl Clin 2021; 7:20552173211059048. [PMID: 34868629 PMCID: PMC8640303 DOI: 10.1177/20552173211059048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background The etiology of pediatric-onset multiple sclerosis is unknown although putative genetic and environmental factors appear to be involved. Among children multiple sclerosis onset occurs closer to the susceptibility window thank in adults and the exposure to etiological environmental factors is more informative. An Italian multicentre case-control study (the PEDiatric Italian Genetic and enviRonment ExposurE, PEDIGREE study) was designed to investigate environmental exposures in pediatric-onset multiple sclerosis and their interaction with genetics. Objectives To collect evidence on exposures to environmental risk factors in pediatric-onset multiple sclerosis, a questionnaire was developed for the Italian population (PEDIGREE Questionnaire) and is presented. Methods PEDIGREE Questionnaire develops from an existing tool used in case-control studies on pediatric-onset multiple sclerosis in US Americans, and was translated, adapted and tested for the contents perceived relevance, acceptability, feasibility and reliability in a population of Italian pediatric subjects and their parents recruited from clinics and general population. Results PEDIGREE Questionnaire contents were overall deemed relevant by the study population, acceptable for 100% participants and feasible for at least 98%. PEDIGREE Questionnaire degree of reliability ranged 56% to 72%. Conclusion PEDIGREE Questionnaire proves to be an efficient tool to assess environmental exposures in the Italian pediatric population. We encourage the dissemination of population-specific questionnaires and shared methodology to optimize efforts in MS etiological research.
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Affiliation(s)
- Silvy Pilotto
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Jessica Gencarelli
- Department of Medical Sciences - Pediatric Section, University of Ferrara, Ferrara, Italy
| | - Stefania Bova
- Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Leonardo Gerosa
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | | | - Enrico Alfei
- Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate, Italy
| | - Agnese Suppiej
- Department of Medical Sciences - Pediatric Section, University of Ferrara, Ferrara, Italy
| | - Eleonora Cocco
- Department Medical Science and Public Health, University of Cagliari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | | | | | | | - Emmanuelle Waubant
- Department of Neurology, UC San Francisco, San Francisco, California, USA
| | - Angelo Ghezzi
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate, Italy
| | | | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy
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Sipilä JOT. Nordic clues for uncovering the aetiology of Multiple Sclerosis. Mult Scler Relat Disord 2021; 50:102804. [PMID: 33561666 DOI: 10.1016/j.msard.2021.102804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/19/2022]
Abstract
Our understanding of the etiology of multiple sclerosis (MS) is inadequate to effectively combat the increasing incidence and prevalence of the disease. Environmental factors are of crucial importance but more information about them is needed. Recent results of incidence trends over several decades in Denmark, Norway and Finland provide suggestions for further studies on the subject. Since incidence trends show marked differences by region and sex taking these factors into account when investigating birth cohort exposures could provide important new insights. Exposures during the first 15 years of life should be prioritized. International and multidisciplinary co-operation is needed.
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Affiliation(s)
- Jussi O T Sipilä
- Department of Neurology, Siun sote, North Karelia Central Hospital, Joensuu, Finland; Clinical Neurosciences, University of Turku, Turku, Finland.
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Oliveira M, Padrão A, Ramalho A, Lobo M, Teodoro AC, Gonçalves H, Freitas A. Geospatial Analysis of Environmental Atmospheric Risk Factors in Neurodegenerative Diseases: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228414. [PMID: 33202965 PMCID: PMC7697835 DOI: 10.3390/ijerph17228414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
Despite the vast evidence on the environmental influence in neurodegenerative diseases, those considering a geospatial approach are scarce. We conducted a systematic review to identify studies concerning environmental atmospheric risk factors for neurodegenerative diseases that have used geospatial analysis/tools. PubMed, Web of Science, and Scopus were searched for all scientific studies that included a neurodegenerative disease, an environmental atmospheric factor, and a geographical analysis. Of the 34 included papers, approximately 60% were related to multiple sclerosis (MS), hence being the most studied neurodegenerative disease in the context of this study. Sun exposure (n = 13) followed by the most common exhaustion gases (n = 10 for nitrogen dioxide (NO2) and n = 5 for carbon monoxide (CO)) were the most studied atmospheric factors. Only one study used a geospatial interpolation model, although 13 studies used remote sensing data to compute atmospheric factors. In 20% of papers, we found an inverse correlation between sun exposure and multiple sclerosis. No consensus was reached in the analysis of nitrogen dioxide and Parkinson’s disease, but it was related to dementia and amyotrophic lateral sclerosis. This systematic review (number CRD42020196188 in PROSPERO’s database) provides an insight into the available evidence regarding the geospatial influence of environmental factors on neurodegenerative diseases.
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Affiliation(s)
- Mariana Oliveira
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal; (A.R.); (M.L.); (H.G.); (A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
- Correspondence:
| | - André Padrão
- Faculty of Arts and Humanities, University of Porto, Via Panorâmica, s/n, 4150-564 Porto, Portugal;
| | - André Ramalho
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal; (A.R.); (M.L.); (H.G.); (A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Mariana Lobo
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal; (A.R.); (M.L.); (H.G.); (A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Ana Cláudia Teodoro
- Department of Geosciences, Environment and Land Planning, Faculty of Sciences, University of Porto, Rua do Campo Alegre 687, 4169-007 Porto, Portugal;
- Earth Sciences Institute (ICT), Pole of the FCUP, University of Porto, 4169-007 Porto, Portugal
| | - Hernâni Gonçalves
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal; (A.R.); (M.L.); (H.G.); (A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - Alberto Freitas
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal; (A.R.); (M.L.); (H.G.); (A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, s/n, 4200-450 Porto, Portugal
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7
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Magalhaes S, Pugliatti M, Riise T, Myhr KM, Ciampi A, Bjornevik K, Wolfson C. Shedding light on the link between early life sun exposure and risk of multiple sclerosis: results from the EnvIMS Study. Int J Epidemiol 2020; 48:1073-1082. [PMID: 30561654 DOI: 10.1093/ije/dyy269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Lower levels of sun exposure in childhood have been suggested to be associated with increased risk of multiple sclerosis (MS). In this paper we extend previous work, using two novel analytical strategies. METHODS Data collected in the Environmental risk factors In MS (EnvIMS) study, a case-control study with MS cases and population-based controls from Canada, Italy and Norway, were used. Participants reported on sun exposure behaviours for 5-year age intervals from birth; we focused on the first three age intervals (≤15 years). We compared two life course epidemiology conceptual models, the critical period and the accumulation model. We also used latent class analysis to estimate MS risk for different latent sun exposure behaviour groups. RESULTS The analyses included 2251 cases and 4028 controls. The accumulation model was found to be the best model, which demonstrated a nearly 50% increased risk of MS comparing lowest reported summer sun exposure with highest [risk ratio (RR) = 1.47 (1.24, 1.74)]. The latent sun exposure behaviour group, characterized by low sun exposure during summer and winter and high sun protection use, had the highest risk of MS; a 76% increased risk as compared with the group with high sun exposure and low sun protection use [RR = 1.76 (1.27, 2.46)]. CONCLUSIONS Our analyses provide novel insights into the link between sun exposure and MS. We demonstrate that more time indoors during childhood and early adolescence is linked with MS risk, and that sun protection behaviours in those who spend most time indoors may play a key role in increasing risk.
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Affiliation(s)
- Sandra Magalhaes
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Sociology, University of New Brunswick, Fredericton, NB, Canada
| | - Maura Pugliatti
- Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Biomedical and Surgical Sciences, Unit of Clinical Neurology, University of Ferrara, Ferrara, Italy
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway
| | - Kjell-Morten Myhr
- National Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Antonio Ciampi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Kjetil Bjornevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christina Wolfson
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
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8
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Organic solvent exposure as a risk factor for multiple sclerosis: An updated review. Rev Neurol (Paris) 2019; 175:625-630. [DOI: 10.1016/j.neurol.2019.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/20/2022]
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9
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Jakimovski D, Weinstock-Guttman B, Gandhi S, Guan Y, Hagemeier J, Ramasamy DP, Fuchs TA, Browne RW, Bergsland N, Dwyer MG, Ramanathan M, Zivadinov R. Dietary and lifestyle factors in multiple sclerosis progression: results from a 5-year longitudinal MRI study. J Neurol 2019; 266:866-875. [PMID: 30758665 DOI: 10.1007/s00415-019-09208-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Evidence regarding the role, if any, of dietary and lifestyle factors in the pathogenesis of multiple sclerosis (MS) is poorly understood. OBJECTIVE To assess the effect of lifestyle-based risk factors linked to cardiovascular disease (CVD) on clinical and MRI-derived MS outcomes. METHODS The study enrolled 175 MS or clinically isolated syndrome (CIS) patients and 42 age- and sex-matched healthy controls (HCs) who were longitudinally followed for 5.5 years. The 20-year CVD risk was calculated by Healthy Heart Score (HHS) prediction model which includes age, smoking, body mass index, dietary intake, exercise, and alcohol consumption. Baseline and follow-up MRI scans were obtained and cross-sectional and longitudinal changes of T2-lesion volume (LV), whole brain volume (WBV), white matter volume (WMV), gray matter volume (GMV), and lateral ventricular volume (LVV) were calculated. RESULTS After correcting for disease duration, the baseline HHS values of the MS group were associated with baseline GMV (rs = - 0.20, p = 0.01), and longitudinal LVV change (rs = 0.19, p = 0.01). The association with LVV remained significant after adjusting for baseline LVV volumes (rs = 0.2, p = 0.008) in MS patients. The diet component of the HHS was associated with the 5-year T2-LV accrual (rs = - 0.191, p = 0.04) in MS. In the HC group, the HHS was associated with LVV (rs = 0.58, p < 0.001), GMV (rs = - 0.57, p < 0.001), WBV (rs = - 0.55, p = 0.001), T2-LV (rs = 0.41, p = 0.027), and WMV (rs = - 0.38, p = 0.042). Additionally, the HC HHS was associated with the 5-year change in LVV (rs = 0.54, p = 0.001) and in WBV (rs = - 0.45, p = 0.011). CONCLUSION Lifestyle risk factors contribute to accelerated central brain atrophy in MS patients, whereas unhealthier diet is associated with MS lesion accrual. Despite the lower overall effect when compared to HCs, lifestyle-based modifications may still provide a beneficial effect on reducing brain atrophy in MS patients.
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Affiliation(s)
- Dejan Jakimovski
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Multiple Sclerosis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Sirin Gandhi
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Yi Guan
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Jesper Hagemeier
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Deepa P Ramasamy
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Tom A Fuchs
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Richard W Browne
- Department of Biotechnical and Clinical Laboratory Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
| | - Michael G Dwyer
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 142013, USA.
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
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10
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Halawani AT, Zeidan ZA, Kareem AM, Alharthi AA, Almalki HA. Sociodemographic, environmental and lifestyle risk factors for multiple sclerosis development in the Western region of Saudi Arabia. A matched case control study. Saudi Med J 2018; 39:808-814. [PMID: 30106419 PMCID: PMC6194980 DOI: 10.15537/smj.2018.8.22864] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: To examine the association of exposure to sociodemographic, environmental, and lifestyle risk factors during adolescence with the development of multiple sclerosis (MS). Methods: We conducted a case-control study between October 2017 and January 2018 at King Fahd General Hospital (KFH) in Madinah, Saudi Arabia. Data were collected by direct physician-subject interviews. We utilized a questionnaire modified from the environmental risk factors in multiple sclerosis questionnaire (EnvIMS-Q). Chi-square tests were used to examine associations of selected risk factors with the development of MS, a p-value of <0.05 was considered significant. Results: A total of 80 cases and 160 controls were enrolled into the study. Smoking during adolescence significantly increased the risk of MS, with an adjusted odds ratio (AOR) of 4.165, and a 95% confidence interval (CI) of 1.449-11.974. Large body size, assessed using a figure rating scale, also increased the risk of MS (AOR=8.970, 95% CI=1.032-77.983), as well as a history of measles infection (AOR=3.758, 95% CI=1.455-9.706). Furthermore, exposure to sunlight during the weekend for more than 4 hours/day decreased the risk of MS (AOR=0.063, 95% CI=0.006-0.654), so did the consumption of fish for more than once per week (AOR=0.206, 95% CI=0.055-0.773). Conclusion: The risk of developing MS is significantly increased by exposure during adolescence to smoking, a history of measles infection, and large body size (obesity).
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Affiliation(s)
- Abdulrahman T Halawani
- Saudi Board of Preventive Medicine, Ministry of Health, Madinah, Kingdom of Saudi Arabia. E-mail.
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11
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Abbasi M, Nabavi SM, Fereshtehnejad SM, Jou NZ, Ansari I, Shayegannejad V, Mohammadianinejad SE, Farhoudi M, Noorian A, Razazian N, Abedini M, Faraji F. Multiple sclerosis and environmental risk factors: a case-control study in Iran. Neurol Sci 2017; 38:1941-1951. [PMID: 28799006 DOI: 10.1007/s10072-017-3080-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 07/21/2017] [Indexed: 01/25/2023]
Abstract
Studies have shown an increase in the incidence of MS in Iran. The aim of our study was to evaluate the relationship between environmental exposure and MS in Iran. This case-control study was conducted on 660 MS patients and 421 controls. Many environmental factors are compared between the two groups. Our findings demonstrated that prematurity ([OR = 4.99 (95% CI 1.34-18.68), P = 0.017]), history of measles and mumps ([OR = 1.60 (95% CI 1.05-2.45), P = 0.029; OR = 1.85 (95% CI 1.22-2.78), P = 0.003, respectively]), breast feeding [OR = 2.90 (95% CI 1.49-5.65), P = 0.002], head trauma in childhood ([OR = 8.21 (95% CI 1.56-43.06), P = 0.013]), vaccination in adulthood ([OR = 4.57 (95% CI 1.14-18.41), P = 0.032, respectively]), migraine ([OR = 3.50 (95% CI 1.61-7.59), P = 0.002]), family history of MS, IBD, migraine, and collagen vascular diseases ([OR = 2.73 (95% CI 1.56-4.78), P < 0.001], [OR = 3.14 (95% CI 1.460-6.78), P = 0.004; OR = 3.18 (95% CI 1.83-5.53), P < 0.001; OR = 1.81 (95% CI 1.03-3.20), P = 0.040, respectively]), stressful events ([OR = 32.57 (95% CI 17.21-61.64), P < 0.001]), and microwave exposure ([OR = 3.55 (95% CI 2.24-5.63), P ≤0.001]) were more in the MS group. Sun exposure ([OR = 0.09 (95% CI 0.02-0.38), P = 0.001]), dairy and calcium consumption ([OR = 0.44 (95% CI 0.27-0.71), P = 0.001]), diabetes mellitus ([OR = 0.11 (95% CI 0.01-00.99), P = 0.049], and complete vaccination during childhood appeared to decreased MS risk. Our results investigated many risk factors and protective factors in Iran.
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Affiliation(s)
- Maryam Abbasi
- Immunoregulation Research Center, Shahed University, Tehran, Iran.,Medical Students Research Committee, Shahed University, Tehran, Iran
| | - Seyed Massood Nabavi
- Neurology group, Department of Regenerative Biomedicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran. .,MS research unit, Mostafa Khomeini Hospital, School of Medicine, Shahed University, Tehran, Iran.
| | - Seyed Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Nikan Zerafat Jou
- Medical Students Research Committee, Shahed University, Tehran, Iran
| | - Iman Ansari
- Medical Students Research Committee, Shahed University, Tehran, Iran
| | | | | | - Mahdi Farhoudi
- Neurology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Noorian
- Neurology Department, Azad Medical University of Mashhad, Mashhad, Iran
| | - Nazanin Razazian
- Neurology Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahmoud Abedini
- Neurology Department, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fardin Faraji
- Neurology Department, Arak University of Medical Sciences, Arak, Iran
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12
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Wesnes K, Myhr KM, Riise T, Cortese M, Pugliatti M, Boström I, Landtblom AM, Wolfson C, Bjørnevik K. Physical activity is associated with a decreased multiple sclerosis risk: The EnvIMS study. Mult Scler 2017; 24:150-157. [DOI: 10.1177/1352458517694088] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The lifestyle factors smoking and obesity have been associated with the risk of multiple sclerosis (MS). Physical activity (PA) may also be of importance. Objective: To examine the association between PA and MS risk in Italy, Norway, and Sweden and to evaluate the possible influence by established risk factors. Methods: In this case–control study, 1904 cases and 3694 controls were asked to report their average weekly amounts of light and vigorous PA during adolescence on a scale ranging from none to more than 3 hours activity. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and adjusted for potential confounders. Results: Vigorous PA was inversely associated with MS risk in the pooled analysis ( p-trend < 0.001) with an age- and sex-adjusted OR of 0.74 (95% CI: 0.63–0.87) when comparing the highest and lowest levels. Adjusting for outdoor activity, infectious mononucleosis, body size, and smoking yielded similar results. The association was present in all countries and was not affected by exclusion of patients with early disease onset. Light PA was not associated with the risk of MS. Conclusion: Our findings suggest that vigorous PA can modify the risk of developing MS independent of established risk factors.
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Affiliation(s)
- Kristin Wesnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Marianna Cortese
- Department of Clinical Medicine, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Maura Pugliatti
- Department of Biomedical and Specialty Surgical Sciences, Section of Clinical Neurology, University of Ferrara, Ferrara, Italy/Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Inger Boström
- Division of Neurology, Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden
| | - Anne-Marie Landtblom
- Division of Neurology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden/Department of Neuroscience/Neurology, Uppsala University, Uppsala, Sweden
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada/The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
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13
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Bjørnevik K, Riise T, Bostrom I, Casetta I, Cortese M, Granieri E, Holmøy T, Kampman MT, Landtblom AM, Magalhaes S, Pugliatti M, Wolfson C, Myhr KM. Negative interaction between smoking and EBV in the risk of multiple sclerosis: The EnvIMS study. Mult Scler 2016; 23:1018-1024. [DOI: 10.1177/1352458516671028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Results from previous studies on a possible interaction between smoking and Epstein–Barr virus (EBV) in the risk of multiple sclerosis (MS) are conflicting. Objectives: To examine the interaction between smoking and infectious mononucleosis (IM) in the risk of MS. Methods: Within the case–control study on Environmental Factors In Multiple Sclerosis (EnvIMS), 1904 MS patients and 3694 population-based frequency-matched healthy controls from Norway, Italy, and Sweden reported on prior exposure to smoking and history of IM. We examined the interaction between the two exposures on the additive and multiplicative scale. Results: Smoking and IM were each found to be associated with an increased MS risk in all three countries, and there was a negative multiplicative interaction between the two exposures in each country separately as well as in the pooled analysis ( p = 0.001). Among those who reported IM, there was no increased risk associated with smoking (odds ratio (OR): 0.95, 95% confidence interval (CI): 0.66–1.37). The direction of the estimated interactions on the additive scale was consistent with a negative interaction in all three countries (relative excess risk due to interaction (RERI): −0.98, 95% CI: −2.05–0.15, p = 0.09). Conclusion: Our findings indicate competing antagonism, where the two exposures compete to affect the outcome.
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Affiliation(s)
- Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Inger Bostrom
- Division of Neurology, Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden
| | - Ilaria Casetta
- Department of Biomedical and Specialist Surgical Sciences, Section of Clinical Neurology, University of Ferrara, Ferrara, Italy
| | - Marianna Cortese
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Enrico Granieri
- Department of Biomedical and Specialist Surgical Sciences, Section of Clinical Neurology, University of Ferrara, Ferrara, Italy
| | - Trygve Holmøy
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway/Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Margitta T Kampman
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Anne-Marie Landtblom
- Division of Neurology, Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden/Department of Neuroscience/Neurology, Uppsala University, Uppsala, Sweden
| | - Sandra Magalhaes
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Maura Pugliatti
- Department of Biomedical and Specialty Surgical Sciences, Section of Clinical Neurology, University of Ferrara, Ferrara, Italy/Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada/Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Kjell-Morten Myhr
- The Kristian Gerhard Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway/The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
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