Multiple sclerosis and the independent roles of vitamin D and sun exposure
AminZarghami, Researcher, Department of Neurology, Babol University of Medical Sciences, Babol, Iran; Chancellor for Heal[email protected]
Submitted January 04, 2017
In the article by Nielsen et al., the authors supported justification of routine vitamin-D supplementation during pregnancy. [1] The region type and ethnic-related parameters of the study population was well underlined in the editorial. [2] The distribution of multiple sclerosis (MS) might vary in different populations with different geographic characteristics, socio-demographic characteristics, and genetic predisposition. [3] Both the current study and similar previous similar studies were conducted among Scandinavian populations with genetic homogeneity. [1,4] Conversely, the geographic placement of these neighboring countries and the resulting lower sun exposures could be a pivotal environmental predisposing factor. Whereas the probable independent roles of sun exposure and vitamin-D status in the pathophysiology of CNS demyelination of MS were considered. [5]
Nielsen et al. suggested supplementation of vitamin D, [1] but if the combination of sun exposure/vitamin D are independent factors, why undergo costly vitamin-D supplementation when a sun-exposure regiment is freely available. Future randomized clinical trials are necessary for comparing the efficacy and cost-benefit of these two regiments. Deciding whether vitamin-D supplementation during pregnancy should be conducted or not seems premature at this stage. Therefore, clinical decisions, such as vitamin-D supplementation during pregnancy, should be made by weighing cost vs benefit.
1. Nielsen NM, Munger KL, Koch-Henriksen N, et al. Neonatal vitamin D status and risk of multiple sclerosis: A population-based case-control study. Neurology 2017;88:44-51.
2. Marrie RA, Daumer M. A gestational dose of vitamin D per day keeps the MS doctor away. Neurology 2017;88:13-14.
3. Hojjati SM, Zarghami A, Hojjati SA, Baes M. Optic neuritis, the most common initial presenting manifestation of multiple sclerosis in northern Iran. Caspian J Intern Med 2015;6:151-155.
4. Munger KL, Aivo J, Hongell K, et al. Vitamin D Status During Pregnancy and Risk of Multiple Sclerosis in Offspring of Women in the Finnish Maternity Cohort. JAMA Neurol 2016;73:515-519.
5. Lucas RM, Ponsonby AL, Dear K, et al. Sun exposure and vitamin D are independent risk factors for CNS demyelination. Neurology 2011;76:540-548.
For disclosures, please contact the editorial office at [email protected].
In the article by Nielsen et al., the authors supported justification of routine vitamin-D supplementation during pregnancy. [1] The region type and ethnic-related parameters of the study population was well underlined in the editorial. [2] The distribution of multiple sclerosis (MS) might vary in different populations with different geographic characteristics, socio-demographic characteristics, and genetic predisposition. [3] Both the current study and similar previous similar studies were conducted among Scandinavian populations with genetic homogeneity. [1,4] Conversely, the geographic placement of these neighboring countries and the resulting lower sun exposures could be a pivotal environmental predisposing factor. Whereas the probable independent roles of sun exposure and vitamin-D status in the pathophysiology of CNS demyelination of MS were considered. [5]
Nielsen et al. suggested supplementation of vitamin D, [1] but if the combination of sun exposure/vitamin D are independent factors, why undergo costly vitamin-D supplementation when a sun-exposure regiment is freely available. Future randomized clinical trials are necessary for comparing the efficacy and cost-benefit of these two regiments. Deciding whether vitamin-D supplementation during pregnancy should be conducted or not seems premature at this stage. Therefore, clinical decisions, such as vitamin-D supplementation during pregnancy, should be made by weighing cost vs benefit.
1. Nielsen NM, Munger KL, Koch-Henriksen N, et al. Neonatal vitamin D status and risk of multiple sclerosis: A population-based case-control study. Neurology 2017;88:44-51.
2. Marrie RA, Daumer M. A gestational dose of vitamin D per day keeps the MS doctor away. Neurology 2017;88:13-14.
3. Hojjati SM, Zarghami A, Hojjati SA, Baes M. Optic neuritis, the most common initial presenting manifestation of multiple sclerosis in northern Iran. Caspian J Intern Med 2015;6:151-155.
4. Munger KL, Aivo J, Hongell K, et al. Vitamin D Status During Pregnancy and Risk of Multiple Sclerosis in Offspring of Women in the Finnish Maternity Cohort. JAMA Neurol 2016;73:515-519.
5. Lucas RM, Ponsonby AL, Dear K, et al. Sun exposure and vitamin D are independent risk factors for CNS demyelination. Neurology 2011;76:540-548.
For disclosures, please contact the editorial office at [email protected].