Chang Gina, Sebastian Prince, Virupakshaiah Akash, Schoeps Vinicius A, Cherbuin Nicolas, Casper T Charles, Gorman Mark P, Benson Leslie A, Chitnis Tanuja, Rensel Mary, Abrams Aaron W, Lotze Tim, Mar Soe S, Schreiner Teri L, Wheeler Yolanda S, Rose John W, Graves Jennifer, Krupp Lauren B, Waldman Amy T, Lucas Robyn, Waubant Emmanuelle
Division of Child Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Liverpool Hospital, Sydney, Australia.
Neurol Neuroimmunol Neuroinflamm. 2025 Mar;12(2):e200375. doi: 10.1212/NXI.0000000000200375. Epub 2025 Feb 12.
Low sun and ultraviolet radiation (UVR) exposures have been associated with increased risk of developing pediatric-onset multiple sclerosis (MS); however, their effect on disease course has not been well characterized. We primarily investigated whether there was an association between time spent in the sun in early childhood and risk of relapse in pediatric MS. We secondarily investigated the effect of sun exposure during more recent periods on risk of relapse.
We conducted a multicenter cohort study of participants with pediatric-onset MS recruited from 18 pediatric MS clinics across the United States between November 1, 2011, and July 1, 2017. Relapses were identified prospectively after study enrollment; relapses preceding study enrollment were entered retrospectively. Time spent in the sun at various periods of life was measured using a detailed environmental questionnaire, and ambient UVR exposure was determined using zip codes. Multivariable Cox regression models were used to assess the association between time spent in the sun and UVR dose at specific periods of life and the risk of relapse. Models were adjusted for demographic, clinical, and sun exposure-related characteristics.
In our cohort of 334 children with MS, 206 (62%) experienced at least one relapse from disease onset to the end of the follow-up period. After adjustment, ≥30 minutes of daily sun exposure during the first summer of life was associated with a lower risk of relapse compared with <30 minutes (adjusted hazard ratio [aHR] 0.67, CI 0.48-0.92, = 0.01). Greater time spent in the sun during the second trimester of pregnancy was also associated with reduced risk of relapse (aHR 0.68, CI 0.48-0.97, = 0.04). UVR dose and time spent in the sun later in life were not significantly associated with relapse risk.
In this large cohort study of children with MS, greater early childhood and prenatal sun exposure time was associated with lower risk of relapse. Further investigation of sun exposure at other periods is needed to better characterize its impact on disease course and guide potential future interventions.
日照时间短和紫外线辐射（UVR）暴露量低与儿童期多发性硬化症（MS）发病风险增加有关；然而，它们对疾病病程的影响尚未得到充分描述。我们主要研究幼儿期日照时长与儿童MS复发风险之间是否存在关联。其次，我们研究了近期日照暴露对复发风险的影响。
我们对2011年11月1日至2017年7月1日期间从美国18家儿科MS诊所招募的儿童期MS患者进行了一项多中心队列研究。研究入组后前瞻性确定复发情况；入组前的复发情况进行回顾性录入。使用详细的环境问卷测量不同生命阶段的日照时长，并使用邮政编码确定环境UVR暴露量。多变量Cox回归模型用于评估特定生命阶段的日照时长和UVR剂量与复发风险之间的关联。模型针对人口统计学、临床和日照暴露相关特征进行了调整。
在我们的334名MS儿童队列中，206名（62%）从疾病发作到随访期结束经历了至少一次复发。调整后，生命中第一个夏季每天日照≥30分钟与<30分钟相比，复发风险较低（调整后风险比[aHR]0.67，可信区间[CI]0.48 - 0.92，P = 0.01）。孕期第二个 trimester 日照时间较长也与复发风险降低相关（aHR 0.68，CI 0.48 - 0.97，P = 0.04）。生命后期的UVR剂量和日照时长与复发风险无显著关联。
在这项针对MS儿童的大型队列研究中，幼儿期和产前日照时间较长与复发风险较低相关。需要进一步研究其他时期的日照暴露情况，以更好地描述其对疾病病程的影响并指导未来潜在的干预措施。
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