Highlights
- •Active and passive smoking are risk factors for Japanese MS, exacerbating disability.
- •Longer sunlight exposure in early childhood is a protective factor for Japanese MS.
- •Earlier age of menarche is a risk factor for MS in Japanese females.
- •Intake of rice is lower in MS patients than in healthy controls in Japanese.
Abstract
Background
The prevalence of multiple sclerosis (MS) has been increasing worldwide in recent
years, especially among females. The same increasing trends are even observed in East
Asian countries, where the prevalence of MS is relatively low compared with Northern
European ancestries. Whether the environmental risk factors for MS are shared between
Asian and North European ancestries, and the types of environmental factors that contribute
to the low and recent increase in MS prevalence in Asian countries remain unknown.
This study provides the first comprehensive survey of environmental risks for MS in
East Asia.
Methods
Patients with MS were recruited from the Department of Neurology at Kyushu University
Hospital, Japan between 01 April 2017 and 31 March 2018. Healthy controls (HCs) were
recruited by public notification. All participants were residents of Kyushu Island
and were required to complete medical history and lifestyle questionnaires. Dietary
data were collected using a Food Frequency Questionnaire comprising intake of approximately
140 food and beverage items in the past 1 year. One hundred and three patients with
MS and 124 healthy controls (HCs) completed the questionnaires. Age at onset and disability
score measured by the Kurtzke Expanded Disability Status Scale (EDSS) were obtained
from medical records.
Results
Frequency of obesity (body mass index ≥25 kg/m2) at present time was higher in MS patients than in HCs (19.4% vs. 7.4%, p = 0.009), while body mass index at age 18–20 years did not differ between the two
groups. Frequency of current or ex-smokers was higher in MS patients than in HCs (50.5%
vs. 22.8%, p < 0.0001) and disability measured by the EDSS was more severe in MS patients with
active smoking history than in patients without such history (p = 0.006 after adjusting for sex). Passive smoking after age 16 years was also a risk
factor for MS (odds ratio: 1.31, 95% confidence interval: 1.05–1.63, p = 0.015). Longer sunlight exposure in early childhood was a protective factor for
MS (odds ratio: 0.65 during summer and 0.71 during winter at age 6–10 years; 0.71
during summer and 0.72 during winter at age 11–15 years). MS patients had earlier
age of menarche than HCs (mean: 12.4 years vs. 12.9 years, p = 0.031). Intake of grains was lower in MS patients than in HCs, with intake of rice
in particular being significantly lower in MS patients than in HCs (mean: 235.2 g/day
vs. 280.6 g/day, p = 0.006). Previously reported foods associated with MS in Northern European ancestries
were not replicated in Japanese people.
Conclusion
Smoking and earlier age of menarche are positively associated and sunlight exposure
in early childhood is negatively associated with MS in Japanese people as shown in
Caucasians. Intake of steamed short-grain white rice, a staple food in Japan, is newly
found to be negatively associated with MS in Japanese people. Although the causality
is unclear because the participants were prevalent cases, these environmental factors
may be involved in the rising prevalence of MS in Japanese females.
Keywords
Abbreviations:
BMI (body mass index), CI (confidence interval), CNS (central nervous system), EBV (Epstein–Barr virus), EDSS (Kurtzke Expanded Disability Status Scale), HCs (healthy controls), IM (infectious mononucleosis, MS, multiple sclerosis), MSSS (Multiple Sclerosis Severity Score), OR (odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 25, 2019
Accepted:
November 24,
2019
Received in revised form:
September 11,
2019
Received:
May 20,
2019
Identification
Copyright
© 2019 Published by Elsevier B.V.
