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Latitude, sun exposure and vitamin D supplementation: associations with quality of life and disease outcomes in a large international cohort of people with multiple sclerosis.
BMC Neurol 2015; 15:132BN

Abstract

BACKGROUND

A growing evidence base implicates vitamin D, sun exposure and latitude in the aetiology of multiple sclerosis (MS), however there are less data on the associations of these variables with disease outcomes.

METHODS

We undertook a cross-sectional survey of over 2000 people with MS recruited through internet platforms, seeking self-reported data on geographical location, intentional sun exposure for health, and supplementation with vitamin D, among other lifestyle variables. We also requested data on health-related quality of life (MSQOL-54), self-reported doctor-diagnosed relapse rate, and disability (Patient Determined Disease Steps). Bivariate and multivariate analyses were used for comparisons, including multiple linear regression modeling.

RESULTS

Of 2301 participants, 82.3 % were female, median age was 45 years (IQR 38-53 years), with a median time since diagnosis of 6 years (IQR 3-12 years), the majority (61.6 %) having relapsing-remitting MS. Nearly two-thirds (64.6 %) lived in the Northern hemisphere, mostly in developed countries. Most (66.8 %) reported deliberate sun exposure to raise their vitamin D level, and the vast majority (81.8 %) took vitamin D supplements, mostly 2000-5000 IU a day on average. Unadjusted regression modeling incorporating deliberate sun exposure, latitude and vitamin D supplementation showed strong associations of sun exposure with HRQOL which disappeared when controlling for gender, age, disability, physical activity, and fish consumption. In contrast, associations between vitamin D supplementation and HRQOL were maintained adjusting for these variables, with a dose-response effect. Only latitude had significant adjusted associations with disability, with an increase of latitude by one degree (further from the equator) predicting increased odds of moderate disability (OR 1.02 (95 % CI 1.01-1.04)) or high disability (OR 1.03 (95 % CI 1.01-1.05)) compared to no/mild disability. Similarly, latitude was related to relapse rate, with increase in latitude of 1 degree associated with increased odds of having more relapses over the previous year (1.01 (1.00-1.02)).

CONCLUSIONS

We detected significant associations between latitude, deliberate sun exposure and vitamin D supplementation and health outcomes of this large group of people with MS. Vitamin D is likely to have a key role in these associations and its role in the health outcomes of people with MS urgently requires further study.

Authors+Show Affiliations

Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia. g.jelinek@unimelb.edu.au.Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia. Claudia.Marck@unimelb.edu.au.Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia. Tracey.weiland@svha.org.au. Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, VIC, Australia. Tracey.weiland@svha.org.au.Emergency Department, Box Hill Hospital, Box Hill, VIC, Australia. Naresh.pereira@gmail.com.Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, VIC, Australia. Daniavan8@gmail.com.Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia. Emily.hadgkiss@unimelb.edu.au.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26243188

Citation

Jelinek, George A., et al. "Latitude, Sun Exposure and Vitamin D Supplementation: Associations With Quality of Life and Disease Outcomes in a Large International Cohort of People With Multiple Sclerosis." BMC Neurology, vol. 15, 2015, p. 132.
Jelinek GA, Marck CH, Weiland TJ, et al. Latitude, sun exposure and vitamin D supplementation: associations with quality of life and disease outcomes in a large international cohort of people with multiple sclerosis. BMC Neurol. 2015;15:132.
Jelinek, G. A., Marck, C. H., Weiland, T. J., Pereira, N., van der Meer, D. M., & Hadgkiss, E. J. (2015). Latitude, sun exposure and vitamin D supplementation: associations with quality of life and disease outcomes in a large international cohort of people with multiple sclerosis. BMC Neurology, 15, p. 132. doi:10.1186/s12883-015-0394-1.
Jelinek GA, et al. Latitude, Sun Exposure and Vitamin D Supplementation: Associations With Quality of Life and Disease Outcomes in a Large International Cohort of People With Multiple Sclerosis. BMC Neurol. 2015 Aug 5;15:132. PubMed PMID: 26243188.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Latitude, sun exposure and vitamin D supplementation: associations with quality of life and disease outcomes in a large international cohort of people with multiple sclerosis. AU - Jelinek,George A, AU - Marck,Claudia H, AU - Weiland,Tracey J, AU - Pereira,Naresh, AU - van der Meer,Dania M, AU - Hadgkiss,Emily J, Y1 - 2015/08/05/ PY - 2015/02/04/received PY - 2015/07/28/accepted PY - 2015/8/6/entrez PY - 2015/8/6/pubmed PY - 2016/4/15/medline SP - 132 EP - 132 JF - BMC neurology JO - BMC Neurol VL - 15 N2 - BACKGROUND: A growing evidence base implicates vitamin D, sun exposure and latitude in the aetiology of multiple sclerosis (MS), however there are less data on the associations of these variables with disease outcomes. METHODS: We undertook a cross-sectional survey of over 2000 people with MS recruited through internet platforms, seeking self-reported data on geographical location, intentional sun exposure for health, and supplementation with vitamin D, among other lifestyle variables. We also requested data on health-related quality of life (MSQOL-54), self-reported doctor-diagnosed relapse rate, and disability (Patient Determined Disease Steps). Bivariate and multivariate analyses were used for comparisons, including multiple linear regression modeling. RESULTS: Of 2301 participants, 82.3 % were female, median age was 45 years (IQR 38-53 years), with a median time since diagnosis of 6 years (IQR 3-12 years), the majority (61.6 %) having relapsing-remitting MS. Nearly two-thirds (64.6 %) lived in the Northern hemisphere, mostly in developed countries. Most (66.8 %) reported deliberate sun exposure to raise their vitamin D level, and the vast majority (81.8 %) took vitamin D supplements, mostly 2000-5000 IU a day on average. Unadjusted regression modeling incorporating deliberate sun exposure, latitude and vitamin D supplementation showed strong associations of sun exposure with HRQOL which disappeared when controlling for gender, age, disability, physical activity, and fish consumption. In contrast, associations between vitamin D supplementation and HRQOL were maintained adjusting for these variables, with a dose-response effect. Only latitude had significant adjusted associations with disability, with an increase of latitude by one degree (further from the equator) predicting increased odds of moderate disability (OR 1.02 (95 % CI 1.01-1.04)) or high disability (OR 1.03 (95 % CI 1.01-1.05)) compared to no/mild disability. Similarly, latitude was related to relapse rate, with increase in latitude of 1 degree associated with increased odds of having more relapses over the previous year (1.01 (1.00-1.02)). CONCLUSIONS: We detected significant associations between latitude, deliberate sun exposure and vitamin D supplementation and health outcomes of this large group of people with MS. Vitamin D is likely to have a key role in these associations and its role in the health outcomes of people with MS urgently requires further study. SN - 1471-2377 UR - https://www.unboundmedicine.com/medline/citation/26243188/Latitude_sun_exposure_and_vitamin_D_supplementation:_associations_with_quality_of_life_and_disease_outcomes_in_a_large_international_cohort_of_people_with_multiple_sclerosis_ L2 - https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-015-0394-1 DB - PRIME DP - Unbound Medicine ER -