People with health problems lacking noon sun (severe Multiple Sclerosis, etc.) have even lower levels of vitamin D – March 2015

Vitamin D is associated with degree of disability in patients with fully ambulatory relapsing-remitting multiple sclerosis.

Eur J Neurol. 2015 Mar;22(3):564-9. doi: 10.1111/ene.12617. Epub 2014 Dec 20.
Thouvenot E1, Orsini M, Daures JP, Camu W.

BACKGROUND AND PURPOSE:
Vitamin D deficiency is a recognized risk factor for multiple sclerosis (MS) and is associated with increased disease activity. It has also been proposed that the lower the vitamin D levels are, the higher is the handicap.

METHODS:
To refine the links between vitamin D insufficiency and disability in MS patients, a retrospective cohort analysis was performed including 181 patients prospectively followed without previous vitamin D supplementation, and age, gender, age at MS onset, MS type, MS activity, Expanded Disability Status Scale (EDSS) were analysed in correlation with plasma vitamin D levels.

RESULTS:
Vitamin D levels were significantly higher in relapsing-remitting MS than in progressive forms of MS in multivariate analyses adjusted for age, ethnicity, gender, disease duration and season (P = 0.0487). Overall, there was a negative correlation between vitamin D level and EDSS score (P = 0.0001, r = -0.33). In relapsing-remitting MS, vitamin D levels were only correlated with disability scores for EDSS < 4 (P = 0.0012). Patients with >20 ng/ml of vitamin D were 2.78 times more likely to have an EDSS < 4 (P = 0.0011, 95% confidence interval 1.49-5.00).

CONCLUSION:
Data support previous work suggesting that vitamin D deficiency is associated with higher risk of disability in MS. Vitamin D levels also correlated with the degree of disability in fully ambulatory patients with relapsing-remitting MS. These additional results support the pertinence of randomized controlled trials analysing the interest of an early vitamin D supplementation in MS patients to influence evolution of disability.

PMID: 25530281

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Comment on the study at Faculty of 1000

This article aims to define the links between vitamin D insufficiency and disability in patients affected by multiple sclerosis (MS), by studying a cohort of 181 MS patients prospectively followed without previous vitamin D supplementation. Interestingly, vitamin D levels were correlated with clinical disability in the whole cohort of patients as well as in the subgroup of patients with relapsing-remitting MS. As very disabled patients are more inclined to remain indoors and therefore to have a lower exposure to sunlight, the authors intelligently separated them into two groups, the first with, and the second without, walking disability. A significant correlation between vitamin D and clinical disability was demonstrated in MS patients without walking disability and this correlation remained significant after adjustment for disease duration using the Multiple Sclerosis Severity Score (MSSS), a scale that integrates disease duration into the assessment of neurological disability. Based on these data, the authors conclude that vitamin D deficiency could be associated with more rapid acquisition of neurological disabilities in MS.

In our opinion, this manuscript can be relevant to the ongoing debate on the role of vitamin D as potential risk and prognostic factor for MS {1-5} and other neurological diseases, such as Parkinson's disease {6} and amyotrophic lateral sclerosis {7,8}.

References

1. Higher 25-hydroxyvitamin D is associated with lower relapse risk in multiple sclerosis.; Simpson S, Taylor B, Blizzard L, Ponsonby AL, Pittas F, Tremlett H, Dwyer T, Gies P, van der Mei I. Ann Neurol. 2010 Aug; 68(2):193-203; PMID: 20695012 DOI: 10.1002/ana.22043
2. Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis; Smolders J, Menheere P, Kessels A, Damoiseaux J, Hupperts R. Mult Scler. 2008 Nov; 14(9):1220-4; PMID: 18653736 DOI: 10.1177/1352458508094399
3. Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia; van der Mei IA, Ponsonby AL, Dwyer T, Blizzard L, Taylor BV, Kilpatrick T, Butzkueven H, McMichael AJ. J Neurol. 2007 May; 254(5):581-90; PMID: 17426912 DOI: 10.1007/s00415-006-0315-8
4. Association of serum 25(OH) vitamin D3 concentration with severity of multiple sclerosis; Harandi AA, Shahbeigi S, Pakdaman H, Fereshtehnejad SM, Nikravesh E, Jalilzadeh R. Iran J Neurol. 2012; 11(2):54-8; PMID: 24250862
5. Is serum vitamin D levels associated with disability in patients with newly diagnosed multiple sclerosis?; Hatamian H, Bidabadi E, Seyed Saadat SM, Saadat NS, Kazemnezhad E, Ramezani H, Bakhshayesh B. Iran J Neurol. 2013; 12(2):41-6; PMID: 24250900
6. Parkinson disease: Reduced level of dietary vitamin D is associated with PD; Fyfe I. Nat Rev Neurol. 2015 Feb; 11(2):68; PMID: 25582446 DOI: 10.1038/nrneurol.2014.265
7. Vitamin D deficiency and its supplementation in patients with amyotrophic lateral sclerosis; Karam C, Barrett MJ, Imperato T, MacGowan DJ, Scelsa S. J Clin Neurosci. 2013 Nov; 20(11):1550-3; PMID: 23815870 DOI: 10.1016/j.jocn.2013.01.011
8. Can vitamin D delay the progression of ALS?; Karam C, Scelsa SN. Med Hypotheses. 2011 May; 76(5):643-5; PMID: 21310542 DOI: 10.1016/j.mehy.2011.01.021

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