Wesnes Kristin, Myhr Kjell-Morten, Riise Trond, Kvistad Silje Stokke, Torkildsen Øivind, Wergeland Stig, Holmøy Trygve, Midgard Rune, Bru Alla, Edland Astrid, Eikeland Randi, Gosal Sonia, Harbo Hanne F, Kleveland Grethe, Sørenes Yvonne S, Øksendal Nina, Bjørnevik Kjetil
Department of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Neurology, St. Olav's University Hospital, Trondheim, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Mult Scler Relat Disord. 2021 May;50:102801. doi: 10.1016/j.msard.2021.102801. Epub 2021 Jan 28.
Low vitamin D levels, tobacco use and high body mass index (BMI) have been linked to adverse disease outcomes in multiple sclerosis (MS), but their influence on long-term disability progression remains unclear. Therefore, we explored whether these modifiable lifestyle factors were associated with 10-year clinical disability progression in patients with MS.
In this prospective study, a cohort of 88 patients with relapsing-remitting MS completed a randomized controlled study on ω-3 fatty acids between 2004 and 2008. During 24 months, serum 25-hydroxyvitamin D (25(OH)D), serum cotinine (nicotine metabolite), and BMI were repeatedly measured. In 2017, a follow-up study was conducted among 80 of the participants, including disability assessment by the Expanded Disability Status Scale (EDSS). Linear regression was used to explore associations between the lifestyle factors and the EDSS change over 10 years.
Higher seasonally adjusted 25(OH)D levels were associated with lower 10-year EDSS progression (change in EDSS per 1 SD increase in 25(OH)D in a model adjusted for sex, age and baseline EDSS: -0.45 point, 95% CI: -0.75 to -0.16, p=0.003). Further adjustments for potential confounders related to lifestyle and disease status gave similar results. The association was mainly driven by low 25(OH)D levels during spring, as well as seasonally adjusted levels below 80 nmol/L. No clear association was found for BMI and cotinine.
Lower 25(OH)D levels, but apparently not tobacco use or higher BMI, were significantly associated with worse long-term disability progression in MS.
维生素D水平低、吸烟和高体重指数（BMI）与多发性硬化症（MS）的不良疾病结局有关，但它们对长期残疾进展的影响仍不清楚。因此，我们探讨了这些可改变的生活方式因素是否与MS患者10年的临床残疾进展相关。
在这项前瞻性研究中，一组88例复发缓解型MS患者于2004年至2008年完成了一项关于ω-3脂肪酸的随机对照研究。在24个月期间，重复测量血清25-羟基维生素D（25(OH)D）、血清可替宁（尼古丁代谢物）和BMI。2017年，对80名参与者进行了随访研究，包括通过扩展残疾状态量表（EDSS）进行残疾评估。采用线性回归探讨生活方式因素与10年期间EDSS变化之间的关联。
经季节调整的较高25(OH)D水平与较低的10年EDSS进展相关（在调整了性别、年龄和基线EDSS的模型中，25(OH)D每增加1个标准差，EDSS变化为 -0.45分，95%CI：-0.75至-0.16，p = 0.003）。对与生活方式和疾病状态相关的潜在混杂因素进行进一步调整后，结果相似。这种关联主要由春季低25(OH)D水平以及经季节调整后低于80 nmol/L的水平驱动。未发现BMI和可替宁有明显关联。
较低的25(OH)D水平，但显然不是吸烟或较高的BMI，与MS患者更差的长期残疾进展显著相关。
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