Vitamin D: a link between childhood obesity and paediatric multiple sclerosis
JuliaPakpoor, Medical student, Department of Physiology, Anatomy and Genetics and Medical Research Council Functional Genomics Unitjulia.pakpoor@medschool.ox.ac.uk
Julia Pakpoor, Oxford, UK; Jina Pakpoor, Cambridge, UK
Submitted February 12, 2013
We read with great interest the study demonstrating a strong association between pediatric MS/CIS risk and weight. [1] This association can partially be explained by consideration of vitamin D status. Vitamin D deficiency is widely recognized as an environmental risk factor of MS, and more recently, obese adolescents have been highlighted as at particular risk of vitamin D deficiency. [2] Vitamin D is a fat soluble vitamin with a reduced bioavailability in obese individuals due to its sequestration in body fat. [3] An American study of 68 multi-ethnic obese adolescents found low vitamin D status in 100% of females and 91% of males [4], greater than in adolescents in general. [5] We postulate that the association between weight and risk of MS/CIS may be a consequence of greater vitamin D deficiency in obese individuals, which confers increased MS/CIS risk. Less likely, there may be a shared underlying risk factor in vitamin D deficiency. Elucidating the mechanism underlying the reported association and particularly the role of (preventable) vitamin D deficiency may become an increasingly important public health issue in light of the emerging childhood obesity epidemic which, as the authors note, may predict a rising incidence of pediatric MS/CIS.
1. Langer-Gould A, Brara SM, Beaber BE, Koebnick C. Childhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndrome.
Neurology 2013 Jan 30. [Epub ahead of print].
2. Smotkin-Tangorra M, Purushothaman R, Gupta A, Nejati G, Anhalt H, Ten S. Prevalence of vitamin D insufficiency in obese children and adolescents. J Pediatr Endocrinol 2007;20:817-823.
3. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000;72:690-693.
4. Harel Z, Flanagan P, Forcier M, Harel D. Low Vitamin D Status Among Obese Adolescents: Prevalence and Response to Treatment. J Adolesc Health. 2011;48:448-452.
5. Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001-2004. Pediatrics 2009;124:e362-370.
For disclosures, please contact the editorial office at journal@neurology.org.
We read with great interest the study demonstrating a strong association between pediatric MS/CIS risk and weight. [1] This association can partially be explained by consideration of vitamin D status. Vitamin D deficiency is widely recognized as an environmental risk factor of MS, and more recently, obese adolescents have been highlighted as at particular risk of vitamin D deficiency. [2] Vitamin D is a fat soluble vitamin with a reduced bioavailability in obese individuals due to its sequestration in body fat. [3] An American study of 68 multi-ethnic obese adolescents found low vitamin D status in 100% of females and 91% of males [4], greater than in adolescents in general. [5] We postulate that the association between weight and risk of MS/CIS may be a consequence of greater vitamin D deficiency in obese individuals, which confers increased MS/CIS risk. Less likely, there may be a shared underlying risk factor in vitamin D deficiency. Elucidating the mechanism underlying the reported association and particularly the role of (preventable) vitamin D deficiency may become an increasingly important public health issue in light of the emerging childhood obesity epidemic which, as the authors note, may predict a rising incidence of pediatric MS/CIS.
1. Langer-Gould A, Brara SM, Beaber BE, Koebnick C. Childhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndrome. Neurology 2013 Jan 30. [Epub ahead of print].
2. Smotkin-Tangorra M, Purushothaman R, Gupta A, Nejati G, Anhalt H, Ten S. Prevalence of vitamin D insufficiency in obese children and adolescents. J Pediatr Endocrinol 2007;20:817-823.
3. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000;72:690-693.
4. Harel Z, Flanagan P, Forcier M, Harel D. Low Vitamin D Status Among Obese Adolescents: Prevalence and Response to Treatment. J Adolesc Health. 2011;48:448-452.
5. Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001-2004. Pediatrics 2009;124:e362-370.
For disclosures, please contact the editorial office at journal@neurology.org.