Galus Weronika, Winder Mateusz, Owczarek Aleksander J, Walawska-Hrycek Anna, Rzepka Michalina, Kaczmarczyk Aleksandra, Siuda Joanna, Krzystanek Ewa
Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
Nutrients. 2025 Jul 9;17(14):2271. doi: 10.3390/nu17142271.
Vitamin D is currently well regarded for its pleiotropic effects on the immune system, stimulating an anti-inflammatory response and enhancing immune tolerance. Vitamin D deficiency is an established risk factor for multiple sclerosis (MS). Additionally, lower vitamin D serum levels are associated with worse disease outcomes. However, current randomized clinical trials provide conflicting evidence about the beneficial role of vitamin D on disease progression. Most studies have evaluated the effect of vitamin D supplementation on clinical and radiological activity, yet very few have examined the impact on brain atrophy. A 4-year observational, non-interventional study design was applied to evaluate the association between vitamin D supplementation and disease progression. Altogether, 132 relapsing-remitting multiple sclerosis patients were enrolled in the study (97 subjects in the group with vitamin D supplementation and 35 subjects in the group without supplementation). The analyzed groups were similar in terms of age, body mass index, sun exposure, comorbidities, nicotinism, duration of the disease, and current treatment. The number of relapses, Expanded Disability Status Scale assessments, and the number of new/enlarged T2-weighted lesions and gadolinium-enhancing lesions in magnetic resonance imagining analyses, as well as 25-hydroxyvitamin D serum levels, were assessed every 12 months of a 4-year follow-up, whereas brain atrophy was assessed at the baseline and after 36 months using two-dimensional measurements. After 36 months, a significant increase in atrophy was observed in both groups; however, patients without vitamin D supplementation had a significantly higher increase in intercaudate distance, third ventricle width, and bicaudate ratio after 36 months of observation ( < 0.05). Vitamin D supplementation among the studied group did not affect other disease activity outcomes. Our study revealed an observed association between vitamin D supplementation and reduced brain atrophy in patients with MS. Randomized controlled trials are required to establish the impact of vitamin D supplementation on brain atrophy progression.
维生素D目前因其对免疫系统的多效性作用而备受关注，它能刺激抗炎反应并增强免疫耐受性。维生素D缺乏是多发性硬化症（MS）的既定风险因素。此外，较低的血清维生素D水平与更差的疾病预后相关。然而，目前的随机临床试验关于维生素D对疾病进展的有益作用提供了相互矛盾的证据。大多数研究评估了补充维生素D对临床和影像学活动的影响，但很少有研究考察其对脑萎缩的影响。一项为期4年的观察性、非干预性研究设计被用于评估补充维生素D与疾病进展之间的关联。总共132例复发缓解型多发性硬化症患者被纳入研究（补充维生素D组97例，未补充组35例）。分析的两组在年龄、体重指数、阳光暴露、合并症、吸烟情况、疾病持续时间和当前治疗方面相似。在4年随访期间，每12个月评估复发次数、扩展残疾状态量表评估结果、磁共振成像分析中新增/扩大的T2加权病灶和钆增强病灶数量，以及血清25-羟基维生素D水平，而脑萎缩在基线和36个月后使用二维测量进行评估。36个月后，两组均观察到萎缩显著增加；然而，未补充维生素D的患者在观察36个月后尾状核间距离、第三脑室宽度和双尾状核比率的增加显著更高（<0.05）。研究组中补充维生素D对其他疾病活动结果没有影响。我们的研究揭示了补充维生素D与MS患者脑萎缩减少之间的观察到的关联。需要进行随机对照试验来确定补充维生素D对脑萎缩进展的影响。
