Highlights
- •Key finding 1: We identified drug abuse as a relatively strong risk factor in MS with a clear dose-response association.
- •Key finding 2: In a middle-eastern setting, higher sun exposure during adolescence was clearly associated with a reduced risk of MS.
- •Key finding 3: Physical activity during adolescence was not associated with MS.
Abstract
Objective
Although low sun exposure, low vitamin D, and smoking are established risk factor
of multiple sclerosis (MS), there is less evidence on the role of the other lifestyle
factors. We examined the association of sun exposure, physical activity, drug abuse,
and alcohol intake with MS.
Materials and methods
This was population-based incident case-control study in Iran with 547 incident cases
and 1057 general population controls (7/8/2013–17/2/2015). Logistic regression was
used to analyse the data.
Results
Higher sun exposure during adolescence was associated with a reduced risk of MS, both
in summer (test for trend p < 0.001) and winter (P < 0.001), while physical activity
was not associated with MS (test for trend p = 0.712). Lifetime drug abuse (OR for
ever use 2.93 (1.83–4.70)), with a dose-response association (test for trend p < 0.001),
and alcohol intake (OR for ever use 1.49 (1.05–2.12)) was significantly associated
with an increased risk of MS.
Conclusion
In a middle-eastern setting, we found that sun exposure during adolescence, drug abuse,
and alcohol use were all associated with MS. Increasing sun exposure and reducing
drug abuse and the use of alcohol through educational programs is likely to reduce
the rate of MS.
Abbreviations:
IMSS (Iranian Multiple Sclerosis Society), RDD (Random digit dialing)Keywords
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References
- Waterpipe smoking associated with multiple sclerosis: a population-based incident case-control study.Mult. Scler. J. 2017; 23: 1328-1335
- Relationship of subjective and objective social status with psychological and physiological functioning: preliminary data in healthy, White women.Health Psychol. 2000; 19: 586
- Compendium of physical activities: an update of activity codes and MET intensities.Med. Sci. Sports Exerc. 2000; 32: S498-S504
- Environmental risk factors for multiple sclerosis. Part II: noninfectious factors.Ann. Neurol. 2007; 61: 504-513
- The initiation and prevention of multiple sclerosis.Nat. Rev. Neurol. 2012; 8: 602-612
- International physical activity questionnaire: 12-country reliability and validity.Med Sci. Sports Exerc. 2003; 195 (3508-1381)
- Drug abuse as a risk factor of multiple sclerosis: case-control analysis and a study of heterogeneity.Neuroepidemiology. 1993; 12: 6-14
- Atlas of Multiple Sclerosis 2013: a growing global problem with widespread inequity.Neurology. 2014; 83: 1022-1024
- The genetics of multiple sclerosis.Clin. Chem. Lab. Med. 2000; 38: 133-135
- Timing of use of cod liver oil, a vitamin D source, and multiple sclerosis risk: The EnvIMS study.Mult. Scler. J. 2015; 21: 1856-1864
- Prevalence of vitamin D deficiency among Iranian adolescents.J. Pediatr. Endocrinol. Metab. 2014; 27: 595-602
- A 20-year incidence trend (1989–2008) and point prevalence (March 20, 2009) of multiple sclerosis in Tehran, Iran: a population-based study.Neuroepidemiology. 2011; 36: 141-147
- Sharp increase in the incidence and prevalence of multiple sclerosis in Isfahan, Iran.Mult. Scler. J. 2011; 17: 1022-1027
- A case-control study of the association between socio-demographic, lifestyle and medical history factors and multiple sclerosis.Can. J. Public Health. 2001; 92: 281
- Smoking and multiple sclerosis: an updated meta-analysis.PloS One. 2011; 6: e16149
- Risk associated behavior in premorbid multiple sclerosis: a case-control study.Mult. Scler. Relat. Disord. 2014; 3: 40-47
- Alcohol as a modifiable lifestyle factor affecting multiple sclerosis risk.JAMA Neurol. 2014; 71: 300-305
- Multiple sclerosis in Tehran, Iran: a joinpoint trend analysis.Mult. Scler. J. 2014; 20 (512-512)
- A procedure for objective respondent selection within the household.J. Am. Stat. Assoc. 1949; 44: 380-387
- Epidemiologic contributions to multiple sclerosis An overview.Neurology. 1980; 30: 61-79
- Sun exposure and vitamin D are independent risk factors for CNS demyelination.Neurology. 2011; 76: 540-548
- Caffeine and alcohol intakes have no association with risk of multiple sclerosis.Mult. Scler. J. 2013; 19: 53-58
- Body size and risk of MS in two cohorts of US women.Neurology. 2009; 73: 1543-1550
- Population-based case-control study of amyotrophic lateral sclerosis in western Washington State. I. Cigarette smoking and alcohol consumption.Am. J. Epidemiol. 2000; 151: 156-163
- High prevalence of vitamin D deficiency in school-age children in Tehran, 2008: a red alert.Public Health Nutr. 2012; 15: 324-330
- Lifestyle factors and multiple sclerosis: a case-control study in Belgrade.Neuroepidemiology. 2006; 27: 212-216
- Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.Ann. Neurol. 2011; 69: 292-302
- The physical anthropometry, lifestyle habits and blood pressure of people presenting with a first clinical demyelinating event compared to controls: The Ausimmune study.Mult. Scler. J. 2013; 19: 1717-1725
- A questionnaire for multinational case-control studies of environmental risk factors in multiple sclerosis (EnvIM-Q).Acta Neurol. Scand. 2012; 126: 43-50
- Modern epidemiology.Lippincott Williams & Wilkins, 2008
- Evidence based physical activity for school-age youth.J. Pediatr. 2005; 146: 732-737
University of Minnesota, 1992. Nutrient Coordinating Center. Nutrientdatasystem, release 2. 4. Minneapolis, MN.
- Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study.Bmj. 2003; 327: 316
- Selection of controls in case-control studies: II. Types of controls.Am. J. Epidemiol. 1992; 135: 1029-1041
- Physical activity is associated with a decreased multiple sclerosis risk: the EnvIMS study.Mult. Scler. J. 2017; (1352458517694088)
Article info
Publication history
Published online: March 31, 2018
Accepted:
March 28,
2018
Received in revised form:
January 27,
2018
Received:
November 17,
2017
Identification
Copyright
© 2018 Published by Elsevier B.V.
