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Sun Exposure, Vitamin D Intake and Progression to Disability among Veterans with Progressive Multiple Sclerosis

McDowell T.-Y.a, b · Amr S.b · Culpepper W.J.a, d · Langenberg P.b · Royal W.a, c · Bever C.a, c · Bradham D.D.a, e
aMS Center of Excellence–East, Baltimore VAMC, Departments of bEpidemiology and Public Health and cNeurology, University of Maryland, Baltimore School of Medicine, and dDepartment of Pharmaceutical Health Services Research, University of Maryland, Baltimore School of Pharmacy, Baltimore, Md., and eDepartment of Preventive Medicine and Public Health, University of Kansas, School of Medicine–Wichita, Wichita, Kans., USA Neuroepidemiology 2011;37:52–57 (DOI:10.1159/000329258)


Background: Early life events have been suggested to influence multiple sclerosis (MS) susceptibility, and to potentially modulate its clinical course. We assessed vitamin D-related exposures from childhood to disease onset and their associations with MS progression. Methods: Among veterans in the Multiple Sclerosis Surveillance Registry, 219 reported having the progressive form and met the inclusion criteria. Participants reported their past sun exposure, vitamin D-related intake and age at disability milestones using the Patient-Determined Disease Steps (PDDS). The Cox proportional hazards model was used to examine the association between vitamin D-related exposures and time (years) to disability. Results: Low average sun exposure in the fall/winter before disease onset was associated with an increased risk of progressing to a PDDS score of 8 (hazard ratio, HR: 2.13, 95% confidence interval, CI: 1.20–3.78), whereas use of cod liver oil during childhood and adolescence was associated with a reduced risk (HR: 0.44, 95% CI: 0.20–0.96). Conclusions: These results suggest that exposure to vitamin D before MS onset might slow disease-related neurodegeneration and thus delay progression to disability among patients with the progressive subtype.


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