Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 454, 405 30, Gothenburg, Sweden.
Centre for Brain Repair and Rehabilitation, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Neurol. 2018 Mar;265(3):460-470. doi: 10.1007/s00415-017-8719-1. Epub 2017 Dec 28.
Recent research suggests that the incidence of amyotrophic lateral sclerosis (ALS) may be on the rise. Since ALS becomes predominant in later life, most studies on causal factors are conducted in middle-aged or older populations where potentially important influences from early life can usually not be adequately captured. We aimed to investigate predictors in young Swedish men for ALS in adulthood. Therefore, we performed a prospective cohort study of young men (aged 16-25, n = 1,819,817) who enlisted 1968-2005 and took part in comprehensive conscription examinations. Incident cases of ALS (n = 526) during up to 46 years of follow-up were identified in the National Hospital Register and Swedish Cause of Death Register. Those who developed ALS had lower BMI (body mass index) at conscription than their peers (p = 0.03). The risk of ALS during follow-up was calculated with Cox proportional hazards models. No associations were found with physical fitness, erythrocyte sedimentation rate, or non-psychotic mental disorders. Low overall muscle strength compared to high overall muscle strength [hazard ratio (HR) 1.36; 95% confidence interval (CI) 1.01-1.83] and low BMI (a one-unit increase HR 0.96; 95% CI 0.93-0.99) and lower erythrocyte volume fraction (a one-unit increase HR 0.96; 95% CI 0.92-0.998) were the statistically significant predictors for ALS in adjusted models. These findings provide novel epidemiologic evidence of a prospective association between low overall muscle strength and erythrocyte volume fraction in young men and ALS risk.
最近的研究表明，肌萎缩侧索硬化症（ALS）的发病率可能呈上升趋势。由于 ALS 在晚年更为常见，大多数关于因果因素的研究都是在中年或老年人群中进行的，而这些人群中早期生活的潜在重要影响通常无法充分捕捉到。我们旨在研究年轻的瑞典男性成年后发生 ALS 的预测因素。因此，我们对 1968 年至 2005 年入伍并参加全面征兵检查的年轻男性（年龄 16-25 岁，n=1,819,817）进行了一项前瞻性队列研究。在长达 46 年的随访期间，在国家医院登记处和瑞典死因登记处确定了 526 例 ALS （肌萎缩性侧索硬化症）病例。与同龄人相比，那些发展为 ALS 的人在入伍时的 BMI（体重指数）较低（p=0.03）。使用 Cox 比例风险模型计算了随访期间发生 ALS 的风险。与身体健康、红细胞沉降率或非精神病性精神障碍没有关联。与高总体肌肉力量相比，整体肌肉力量较低（HR 1.36；95%置信区间 1.01-1.83），BMI 较低（每增加一个单位 HR 0.96；95%置信区间 0.93-0.99）和红细胞体积分数较低（每增加一个单位 HR 0.96；95%置信区间 0.92-0.998）是调整后的模型中 ALS 的统计学显著预测因素。这些发现为年轻男性整体肌肉力量和红细胞体积分数与 ALS 风险之间的前瞻性关联提供了新的流行病学证据。
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