Article
Family history, lifestyle and health factors in childhood and adolescence, and multiple sclerosis: Results from a large case-control study nested within the German National Cohort (NAKO)
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Authors
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Anja Holz
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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Nadia Obi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany; Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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NAKO collaborators
- NAKO e.V., Heidelberg, Germany
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Kerstin Hellwig
- Katholisches Klinikum Bochum, Neurology Clinic, Clinic of Ruhr-Universität Bochum, Bochum, Germany
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Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Heiko Becher
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| Published: | September 6, 2024 |
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Outline
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Introduction: Multiple Sclerosis (MS) is the predominant inflammatory neurodegenerative disease leading to disability in early adulthood. The worldwide MS prevalence has steadily increased in recent decades, while its aetiology is only partly known. Epidemiological studies have shown the influence of genetic risk factors on MS occurrence, however, MS aetiology cannot be explained solely by genetics. Rather, it has been hypothesized that exposure to environmental and lifestyle factors in genetically susceptible individuals ultimately leads to the onset of the disease. Smoking, an infection with the Epstein-Barr-Virus (EBV), overweight and obesity in childhood and adolescence, and vitamin D deficiency have been found to contribute to MS risk. Our aim was to identify other additional modifiable risk factors for MS.
Methods: Between November 2021 and March 2022, we performed a case-control study nested within the German National Cohort (NAKO Gesundheitsstudie, NAKO). Two controls matched to each case by sex, study center and year of birth were randomly selected from all eligible controls. We performed conditional logistic regression analysis to estimate associations between family history, prenatal, childhood, adolescence and adulthood factors and MS.
Results: Of the eligible and invited participants (746 cases; 1.495 controls), 576 cases (396 females, 180 males) and 895 controls (638 females, 257 males) participated. We found decreased odds ratios (OR) for MS with high physical activity (PA) during teenage years (OR 0.78 per level increase, 95% confidence interval (CI) 0.66-0.91). We observed increased ORs for MS with the number of common childhood viral infections (OR 1.13 per additional infection, 95% CI 1.03-1.25), the number of major stressful life events (OR 1.23 per additional event, 95% CI 1.04-1.46), and being the firstborn child to a mother ≥30 years at delivery (OR 2.11, 95% CI 1.08-4.13). Established risk factors for MS like smoking, an EBV infection, and overweight and obesity during childhood and adolescence were confirmed.
Conclusion: We identified new factors associated with MS, thus contributing to the knowledge of MS aetiology. Noteworthy, some of the identified risk factors also play a role in the development of other common diseases. Hence, preventive measures such as smoking cessation and the promotion of PA during adolescence, might also be useful in the context of MS prevention. Moreover, infectious diseases for which we observed an association with MS, might be preventable by childhood vaccinations.
The authors declare that they have no competing interests.
The authors declare that a positive ethics committee vote has been obtained.
