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Int. J. Environ. Res. Public Health 2014, 11(6), 6417-6432; doi:10.3390/ijerph110606417

Environmental Factors and Multiple Sclerosis Severity: A Descriptive Study

1
Interdepartmental Research Center for Multiple Sclerosis (CRISM), C. Mondino National Neurological Institute, Pavia 27100, Italy
2
Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Forlanini, 2, Pavia 27100, Italy
*
Author to whom correspondence should be addressed.
Received: 15 April 2014 / Revised: 4 June 2014 / Accepted: 5 June 2014 / Published: 19 June 2014
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Abstract

Growing evidence suggests that environmental factors play a key role in the onset of multiple sclerosis (MS). This study was conducted to examine whether environmental factors may also be associated with the evolution of the disease. We collected data on smoking habits, sunlight exposure and diet (particularly consumption of vitamin D-rich foods) from a sample of 131 MS patients. We also measured their serum vitamin D concentration. The clinical impact of MS was quantified using the Multiple Sclerosis Severity Score (MSSS); MS was considered “severe” in patients with MSSS ≥ 6, and “mild” in patients with MSSS ≤ 1. The results showed a strong association between serum vitamin D concentration and both sunlight exposure (26.4 ± 11.9 ng/mL vs. 16.5 ± 12.1 ng/mL, p = 0.0004) and a fish-rich diet (23.5 ± 12.1 ng/mL vs. 16.1 ± 12.4 ng/mL, p = 0.005). Patients reporting frequent sunlight exposure had a lower MSSS (2.6 ± 2.4 h vs. 4.6 ± 2.6 h, p < 0.001). The mild MS patients reported much more frequent sunlight exposure (75% mild MS vs. 25% severe MS p = 0.004, Chi square test). A higher serum vitamin D concentration determined a lower risk of developing severe MS, adjusted for sunlight exposure (OR = 0.92 for one unit increase in vitamin D, 95% CI: 0.86–0.97, p = 0.005). A stronger inverse association emerged between frequent sunlight exposure and the risk of severe MS (OR = 0.26, 95% CI: 0.09–0.71, p = 0.009). Our data show that an appropriate diet and adequate expose to sunlight are associated with less aggressive MS. View Full-Text
Keywords: multiple sclerosis; environment; disease severity; vitamin D; sunlight exposure multiple sclerosis; environment; disease severity; vitamin D; sunlight exposure
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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MDPI and ACS Style

Mandia, D.; Ferraro, O.E.; Nosari, G.; Montomoli, C.; Zardini, E.; Bergamaschi, R. Environmental Factors and Multiple Sclerosis Severity: A Descriptive Study. Int. J. Environ. Res. Public Health 2014, 11, 6417-6432.

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Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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