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Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study

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CREAGEN—Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Department of Medical, Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Catania University, 95123 Catania, Italy
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Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
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Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
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Department of Public Health, Local Health Unit, 41121 Modena, Italy
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Neurology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
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ALS Centre Department of Neurology, ‘Maggiore della Carità’ University Hospital, 28100 Novara, Italy
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Neurological Rehabilitation Division, Policlinico San Marco di Zingonia, 24046 Zingonia (BG), Italy
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Neurology Unit, Department of Neuroscience, S. Agostino Estense Hospital, Azienda Ospedaliero Universitaria di Modena, 41126 Modena, Italy
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Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(3), 857; https://doi.org/10.3390/ijerph17030857
Received: 31 December 2019 / Revised: 28 January 2020 / Accepted: 28 January 2020 / Published: 30 January 2020
Background: Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease of the motor neurons. The etiology of ALS remains largely unknown, particularly with reference to the potential environmental determinants. Methods: We performed a population-based case-control study in four provinces from both Northern and Southern Italy in order to assess non-genetic ALS risk factors by collecting through tailored questionnaires information about clinical and lifestyle factors. We estimated ALS risk by calculating odds ratio (OR) with its 95% confidence interval (CI) using unconditional logistic regression models adjusted for sex, age and educational attainment. Results: We recruited 230 participants (95 cases and 135 controls). We found a possible positive association of ALS risk with trauma, particularly head trauma (OR = 2.61, 95% CI 1.19–5.72), electric shock (OR = 2.09, 95% CI 0.62–7.06), and some sports, although at a competitive level only. In addition, our results suggest an increased risk for subjects reporting use of private wells for drinking water (OR = 1.38, 95% CI 0.73–2.27) and for use of herbicides during gardening (OR = 1.95, 95% CI 0.88–2.27). Conversely, there was a suggestion of an inverse association with overall fish consumption (OR = 0.27, 95% CI 0.12–0.60), but with no dose-response relation. Consumption of some dietary supplements, namely those containing amino acids and, in the Southern Italy population, vitamins and minerals such as selenium, seemed associated with a statistically imprecise increased risk. Conclusions: Our results suggest a potential etiologic role a number of clinical and lifestyle factors with ALS risk. However, caution is needed due to some study limitations. These include the small sample size and the low number of exposed subjects, which affect statistical precision of risk estimates, the potential for exposure misclassification, and the uncertainties about mechanisms underpinning the possible association between these factors and disease risk. View Full-Text
Keywords: amyotrophic lateral sclerosis; case-control study; environmental factors; trauma; diet amyotrophic lateral sclerosis; case-control study; environmental factors; trauma; diet
MDPI and ACS Style

Filippini, T.; Fiore, M.; Tesauro, M.; Malagoli, C.; Consonni, M.; Violi, F.; Arcolin, E.; Iacuzio, L.; Oliveri Conti, G.; Cristaldi, A.; Zuccarello, P.; Zucchi, E.; Mazzini, L.; Pisano, F.; Gagliardi, I.; Patti, F.; Mandrioli, J.; Ferrante, M.; Vinceti, M. Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study. Int. J. Environ. Res. Public Health 2020, 17, 857. https://doi.org/10.3390/ijerph17030857

AMA Style

Filippini T, Fiore M, Tesauro M, Malagoli C, Consonni M, Violi F, Arcolin E, Iacuzio L, Oliveri Conti G, Cristaldi A, Zuccarello P, Zucchi E, Mazzini L, Pisano F, Gagliardi I, Patti F, Mandrioli J, Ferrante M, Vinceti M. Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study. International Journal of Environmental Research and Public Health. 2020; 17(3):857. https://doi.org/10.3390/ijerph17030857

Chicago/Turabian Style

Filippini, Tommaso, Maria Fiore, Marina Tesauro, Carlotta Malagoli, Michela Consonni, Federica Violi, Elisa Arcolin, Laura Iacuzio, Gea Oliveri Conti, Antonio Cristaldi, Pietro Zuccarello, Elisabetta Zucchi, Letizia Mazzini, Fabrizio Pisano, Ileana Gagliardi, Francesco Patti, Jessica Mandrioli, Margherita Ferrante, and Marco Vinceti. 2020. "Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study" International Journal of Environmental Research and Public Health 17, no. 3: 857. https://doi.org/10.3390/ijerph17030857

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