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October 10, 2017; 89 (15) Article

25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort

Kassandra L. Munger, Kira Hongell, Julia Åivo, Merja Soilu-Hänninen, Heljä-Marja Surcel, Alberto Ascherio
First published September 13, 2017, DOI: https://doi.org/10.1212/WNL.0000000000004489
Kassandra L. Munger
From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland.
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Kira Hongell
From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland.
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Julia Åivo
From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland.
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Merja Soilu-Hänninen
From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland.
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Heljä-Marja Surcel
From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland.
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Alberto Ascherio
From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland.
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Citation
25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort
Kassandra L. Munger, Kira Hongell, Julia Åivo, Merja Soilu-Hänninen, Heljä-Marja Surcel, Alberto Ascherio
Neurology Oct 2017, 89 (15) 1578-1583; DOI: 10.1212/WNL.0000000000004489

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Abstract

Objective: To determine whether and to what extent vitamin D deficiency is associated with multiple sclerosis (MS) risk.

Methods: We conducted a prospective nested case-control study among women in the Finnish Maternity Cohort (FMC). The FMC had 1.8 million stored serum samples taken during the pregnancies of over 800,000 women at the time of this study. Through linkages with hospital and prescription registries, we identified 1,092 women with MS diagnosed between 1983 and 2009 with at least 1 serum sample collected prior to date of MS diagnosis; ≥2 serum samples were available for 511 cases. Cases were matched to up to 3 controls (n = 2,123) on date of birth (±2 years) and area of residence. 25-Hydroxyvitamin D (25[OH]D) levels were measured using a chemiluminescence assay. We used conditional logistic regression adjusted for year of sample collection, gravidity, and parity to estimate relative risks (RRs) and 95% confidence intervals (CIs).

Results: A 50 nmol/L increase in 25(OH)D was associated with a 39% reduced risk of MS (RR 0.61, 95% CI 0.44–0.85), p = 0.003. Women with 25(OH)D levels <30 nmol/L had a 43% higher MS risk (RR 1.43, 95% CI 1.02–1.99, p = 0.04) as compared to women with levels ≥50 nmol/L. In women with ≥2 samples, MS risk was 2-fold higher in women with 25(OH)D <30 nmol/L as compared to women with 25(OH)D ≥50 nmol/L (RR 2.02, 95% CI 1.18–3.45, p = 0.01).

Conclusions: These results directly support vitamin D deficiency as a risk factor for MS and strengthen the rationale for broad public health interventions to improve vitamin D levels.

GLOSSARY

25(OH)D=
25-hydroxyvitamin D;
CI=
confidence interval;
FMC=
Finnish Maternity Cohort;
HILMO=
Finnish Hospital Discharge Register;
ICD=
International Classification of Diseases;
MS=
multiple sclerosis;
RR=
relative risk;
UV=
ultraviolet

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 1538

  • Received March 13, 2017.
  • Accepted in final form July 5, 2017.
  • © 2017 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • Author response to Dr. Braillon
    • Kassandra L. Munger, Research Scientist, Harvard TH Chan School of Public Healthkgorham@hsph.harvard.edu
    • Alberto Ascherio, Merja Soilu-Hanninen, Helja-Marja Surcel, Julia Aivo
    Submitted October 20, 2017
  • Multiple sclerosis and vitamin D: Searching for robust evidence
    • Alain Braillon, Senior Consultant, University Hospital. 80000 Amiens. Francebraillon.alain@gmail.com
    Submitted October 16, 2017
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