Lifestyle Factors and Multiple Sclerosis: A Case-Control Study in Belgrade

Pekmezović, Tatjana; Drulović, Jelena; Milenkovic, Marija; Jarebinski, M; Stojsavljević, Nebojša; Mesaroš, Šarlota; Kisić, Darija; Kostic, Jelena

doi:10.1159/000096853

Cited by 84 publications

(74 citation statements)

References 43 publications

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“…However, case numbers have been small and some of the studies were subject to methodological limitations. 2,3 A prospective study found no association between alcohol intake and risk of MS. However, the risk of other autoimmune diseases such as autoimmune hypothyroidism, 5 systemic lupus erythematosus, 6 and rheumatoid arthritis 7,8 has been found to be lower in alcohol drinkers as compared with nondrinkers.…”

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confidence: 99%

Alcohol as a Modifiable Lifestyle Factor Affecting Multiple Sclerosis Risk

et al. 2014

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IMPORTANCE Alcohol consumption may be a modifiable lifestyle factor that affects the risk of developing multiple sclerosis (MS). Results of previous studies have been inconsistent.OBJECTIVE To investigate the possible association of alcohol consumption with the risk of developing MS and to relate the influence of alcohol to the effect of smoking. DESIGN, SETTING, AND PARTICIPANTS This report is based on 2 case-control studies: Epidemiological Investigation of Multiple Sclerosis (EIMS) included 745 cases and 1761 controls recruited from April 2005 to June 2011, and Genes and Environment in Multiple Sclerosis (GEMS) recruited 5874 cases and 5246 controls between November 2009 and November 2011. All cases fulfilled the McDonald criteria. Both EIMS and GEMS are population-based studies of the Swedish population aged 16 to 70 years. In EIMS, incident cases of MS were recruited via 40 study centers, including all university hospitals in Sweden.In GEMS, prevalent cases were identified from the Swedish national MS registry. In both studies, controls were randomly selected from the national population register, matched by age, sex, and residential area at the time of disease onset. MAIN OUTCOME AND MEASURE Multiple sclerosis status.RESULTS There was a dose-dependent inverse association between alcohol consumption and risk of developing MS that was statistically significant in both sexes. In EIMS, women who reported high alcohol consumption had an odds ratio (OR) of 0.6 (95% CI, 0.4-1.0) of developing MS compared with nondrinking women, whereas men with high alcohol consumption had an OR of 0.5 (95% CI, 0.2-1.0) compared with nondrinking men. The OR for the comparison in GEMS was 0.7 (95% CI, 0.6-0.9) for women and 0.7 (95% CI, 0.2-0.9) for men. In both studies, the detrimental effect of smoking was more pronounced among nondrinkers.CONCLUSIONS AND RELEVANCE Alcohol consumption exhibits a dose-dependent inverse association with MS. Furthermore, alcohol consumption is associated with attenuation of the effect of smoking. Our findings may have relevance for clinical practice because they give no support for advising patients with MS to completely refrain from alcohol.

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confidence: 99%

Alcohol as a Modifiable Lifestyle Factor Affecting Multiple Sclerosis Risk

et al. 2014

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“…From reading titles and abstracts, 312 papers did not fulfil the specified criteria and, therefore, 30 papers were initially selected for full consideration. In the end, eleven research articles published between 2004 and 2016 were included in this review [8][9][10][11][12][13][14][15][16][17][18]. Papers discussing the role of lifestyle habits in relation to MS were typically very recent publications.…”

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confidence: 99%

Is Alcohol Harmful for Patients with Multiple Sclerosis?

Fragoso¹,

Cardoso²

2017

J Mult Scler

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Objective: Alcohol consumption has been linked with increased risk and worse outcomes in multiple sclerosis (MS). However, the results are not uniform and conflicting data on the matter have been published. This systematic review addresses the association of alcohol with increased risk and worse outcomes in MS.Method: Systematic review of the literature, searching for the terms "Alcohol" AND "Multiple Sclerosis" OR "MS" in the Medline, PubMed, Lilacs, SciELO and Google Scholar databases. References from selected articles were used to identify studies that might not previously have been recognized as pertinent to this review. The period established for searching for articles started in 1983, after publication of Poser's criteria for diagnosing MS and finished on July 31, 2016. Results:The initial search identified 1399 potential papers from the search terms selected. After exclusion of duplications and articles that did not fulfil the criteria of the review, 30 papers were selected for full-text discussion. Eleven research articles published between 2004 and 2016 were included in this review. Alcohol consumption was considered to be a risk factor for development of MS by some authors but not by others. Some studies even reported that drinking small amounts of alcohol had a protective effect against developing MS. Alcohol seemed to have a negative effect on disability progression in MS. Data from different countries and cultures may have played a role in the results from the studies. Conclusion:It has been suggested that alcohol use might be related both to bad and to good outcomes in MS. There are no recommendations on doses that might be acceptable.

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“…With a healthier lifestyle, better nutrient intake and regular exercise, the patient is likely to be less resistant to stopping smoking and drinking. It is perhaps time to consider more than just supplementation of vitamin D for patients with MS 60,61 . In fact, single supplementation of vitamin D (often at high doses or even megadoses) may alter the delicate immunological homeostasis that occurs between vitamin D and vitamin A 33 .…”

Section: Discussionmentioning

confidence: 99%

Modifiable environmental factors in multiple sclerosis

Fragoso

2014

Arq. Neuro-Psiquiatr.

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Potential environmental modifiable factors involved in multiple sclerosis (MS) include low adherence to treatment, smoking, obesity, low levels of liposoluble vitamins A and D, high consumption of salt, and a sedentary lifestyle. Chronic tobacco use, obesity, sedentarism and insufficient levels of these vitamins all contribute to maintenance of a proinflammatory state. It is unlikely that there will be noticeable improvement in the inflammatory condition of MS if stopping smoking, reducing weight, exercising, increasing vitamin levels are done in an isolated and erratic manner. Modification of each and every one of these environmental risk factors is likely to be an important approach in the management of MS. The present review presents the arguments for an association between these hazardous modifiable factors and the chronic inflammatory state observed in MS.Keywords: multiple sclerosis, smoking, obesity, vitamin D, vitamin A, exercise. RESUMOPotenciais fatores ambientais modificáveis envolvidos na esclerose múltipla (EM) incluem baixa adesão ao tratamento, tabagismo, obesidade, baixos níveis das vitaminas lipossolúveis A e D, e um estilo de vida sedentário. O uso crônico de tabaco, obesidade, sedentarismo e níveis insuficientes destas vitaminas podem todos contribuir para a manutenção de um estado pró-inflamatório. É pouco provável que haja melhora notável na condição inflamatória da EM se a cessação do tabagismo, a redução de peso, exercícios e maiores níveis de vitaminas forem obtidos isoladamente e de maneira errática. A modificação de cada um destes fatores de risco ambientais poderá ser importante parte do manejo eficaz da EM. A presente revisão apresenta argumentos para uma associação entre os fatores modificáveis nocivos e o estado inflamatório crônico observado na EM. It is possible that, with a specific approach to modifiable factors, the use of more aggressive treatment may not be necessary and the patient might thrive on immunomodulatory drugs that have less severe side effects. However, when the patient presents an aggressive form of MS and/or does not respond to immunomodulatory drugs 3 , the immediate reaction is to progress to immunosuppression 4 . Perhaps it is time to consider the modifiable factors in MS when treating a patient. It goes without saying that adequate adherence to treatment needs to have been confirmed before the patient is given second-line therapy with potentially more serious, and even fatal, side effects. Through quitting smoking, losing weight, exercising and maintaining proper serum levels of vitamins A and D, the patient may respond better to all pharmacological treatments. It is, after all, the environmental factors that perpetuate the inflammatory state in MS and, for unknown reasons, these factors are frequently ignored. A summary of the potentially modifiable factors in presented in Table. Departamento de Neurologia, Faculdade de Medicina, Universidade Metropolitana de Santos, Santos SP, Brazil. . The relative risk of developing MS among smokers is almost twi...

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Lifestyle Factors and Multiple Sclerosis: A Case-Control Study in Belgrade

Cited by 84 publications

References 43 publications

Alcohol as a Modifiable Lifestyle Factor Affecting Multiple Sclerosis Risk

Alcohol as a Modifiable Lifestyle Factor Affecting Multiple Sclerosis Risk

Is Alcohol Harmful for Patients with Multiple Sclerosis?

Modifiable environmental factors in multiple sclerosis

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