Severe Vitamin D Deficiency and Smoking Spike the Risk of MS Disability

Several presentations focusing on vitamin D’s role in multiple sclerosis (MS) were presented at the 32^nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS 2016) in London, England. One of the late breaking studies looked at how 25OH vitamin D (25OHVitD) and smoking influences disability in this population.

The goal was to identify a possible connection between vitamin D and cotinine (the alkaloid found in tobacco) levels in the risk of MS and progression in disability.

“Clinical and imaging data were prospectively acquired from an ongoing CIS cohort started in 1995,” explained the researchers from Barcelona, Spain. “25OHVitD and cotinine levels were analyzed in serum samples collected during the first year after CIS and stored in standard conditions.”

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The team recorded 25OHVitD levels and cotinine levels in 503 patients with MS and accrual disability — Expanded Disability Status Scale (EDSS) of 3.0. The findings were adjusted for sex, age, CIS topography, oligoclonal bands, baseline number of lesions, and disease modifying treatment initiation.

The average 25OHVitD level was 17.6 ng/mg. Out of all the participants, 72% had low levels — which was considered 20 ng/ml and lower. Severe 25OHVitD deficiency, which was considered anything less than 8.0 ng/ml, increased the risk for disability with a hazard ratio of 2.3.

From the 464 patients who provided cotinine levels, 43% were in the active smoker range — which was considered more than 14 ng/ml. The median value in the entire cohort was 0.54 ng/ml. The active smokers had a 2.5 higher hazard ratio for disability progression. This finding continued even when adjusted for possible confounders.

When looking at both of these factors, however, there was a less consistent conversion to MS.

“Severe vitamin D deficiency 25OHVitD and active smoking at the time of the CIS have a robust independent effect on disability accumulation in CIS patients,” the team concluded.

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