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MS research update - Can levels of vitamin D at birth predict who will develop MS? - 7 July 2014

Summary

The cause of MS is not well understood, but previous research has shown that low vitamin D at birth may be associated with a higher risk of developing MS.

In Sweden blood samples have been taken from new born babies and stored since 1975. This study involved 459 people with MS in Sweden born after 1975. The researchers tested each participant's stored blood sample to measure the level of vitamin D in their blood just after they were born

The study found that there was no relationship between the level of vitamin D in the blood just after birth and the risk of developing MS later in life.

Background

The cause of MS is not well understood, but it seems that genetic and environmental factors come together, to trigger MS in an individual. One of the environmental factors that has been studied is vitamin D, as many observations and studies have shown that low vitamin D could be a risk factor for developing MS.

Vitamin D is made in the skin when it is exposed to sunlight but it can also be consumed in the diet, by eating oily fish or foods that have had it added, such as breakfast cereals. Unborn babies receive vitamin D from their mothers.

Previous research has shown that low vitamin D at birth may be associated with a higher risk of developing MS later in life. This study is the first to measure the level of vitamin D in the blood at birth and looked at who developed MS as an adult.

How this study was carried out

459 people with MS in Sweden took part in the study. Just over three quarters (76%) were women and the average age of MS onset was 25 years old. Each person was matched to two control participants, for age, gender and residential area. All participants were sent a questionnaire, which collected information on diet, social group, sunlight exposure, education, smoking, if the person had been breastfed as an infant and family background including any family history of MS.

Since 1975 blood samples have been taken from babies born in Sweden to test for diseases shortly after birth. These samples have been kept and stored since the initial test, forming what is known as the PKU register and this library now contains blood samples from almost all the babies born in Sweden since 1975.

All of the participants in this study had a blood sample stored in the PKU register. The researchers tested this sample to measure the level of vitamin D in the blood at birth.

What was found

The study found that the level of vitamin D in the blood just after birth was not associated with risk of developing MS later in life.

The researchers performed further analysis to adjust for other factors in early life (month of birth, being breastfed, latitude of birth) and adult life (sun exposure, vitamin D intake from the diet, fatty fish consumption and smoking) as well as family history of MS, ancestry and social group, and none of these significantly affected the result.

What does it mean?

This was the first study to directly examine the link between vitamin D levels at birth and risk of MS, and found that there was no relationship. The authors conclude that as the study participants were all born in Sweden and the majority of them were of Scandinavian origin the results may only apply to this population. They state that as they did not have genetic data in their study, they could not rule out that vitamin D may affect the risk of MS in people with a certain combination of genes. The authors suggest that further studies are needed to look at the role of genes alongside the environment and lifestyle factors they had studied.

Ueda P, Rafatnia F, Bäärnhielm M , et al.
Neonatal vitamin D status and risk of multiple sclerosis..
Ann Neurol. 2014 Jul 1 [Epub ahead of print]
abstract

More about about vitamin D

Vitamin D has several important roles in the body including keeping bones and teeth strong and healthy and regulating immune responses.

It can be obtained in several ways. It is manufactured by the skin when it is exposed to sunlight, it can be obtained in the diet or by taking supplements.

Vitamin D (vitamin D3) is created in the skin when exposed to ultraviolet B radiation in sunlight. In the UK, between May and September, about 20 to 30 minutes a day spent outdoors in short sleeves in direct sunshine in the middle of the day will meet vitamin D needs for most fair skinned people. It is important not to get red or burnt as this raises the risk of skin cancer.

Between October and April, the sunlight in the UK usually has too low a level of ultraviolet B (UVB) for vitamin D to be made. Vitamin D is found in some foods including oily fish, such as salmon and sardines, and cod liver oil. Lower amounts are found in eggs, fortified fat spreads and breakfast cereals and in powdered milk.

Vitamin D and MS

A lack of vitamin D may have a role in causing MS. It is known that multiple sclerosis is more common in countries further from the equator. As vitamin D is made in the skin, this has led to the hypothesis that low sunlight exposure and consequent low vitamin D production triggers the development of MS. Vitamin D may also play a role before birth as studies have shown more people with MS are born in May than in November. The mothers of these people would have been in the later stages of pregnancy during the darker months of the winter.

Vitamin D may also have a role in moderating relapses and disability in people who are already diagnosed with MS. There is some evidence that lower levels of vitamin D are associated with higher relapse rates and greater disability. Also, one study found that people with progressive forms of MS had lower levels than those with relapsing remitting MS.

Studies are underway to investigate both the role of vitamin D as a protective agent against the development of MS and as a treatment for people with the condition

Vitamin D dosage

Levels of vitamin D in people in the UK are generally low. The Department of Health reports that a quarter of the population have no more than a third of what is considered an adequate level.

For people with MS who have difficulty getting outdoors regularly or who find heat increases fatigue, supplements can also be useful. However, there is much debate as to what is an appropriate dose for people with MS.

The recommended daily intake in the UK (400IU or 10 micrograms, also written as µg) is based on reducing the risk of rickets and is widely considered to be too low. In August 2012, the European Food Safety Authority increased the Tolerable Upper Intake Levels (the levels that can be taken daily without causing harm) to 4000IU. Some authors feel this is also too low and some MS neurologists do recommend people with MS and their family members take more.

NICE has begun to consider the implementation of existing guidance on vitamin D, a review that will look at its role in general rather than specifically in MS. Publication of the guidance is expected towards the end of 2014. You can read more about vitamin D in the A to Z of MS.

Research by topic areas...

CCSVI

Siddiqui AH, Zivadinov R, Benedict RH, et al.
Prospective randomized trial of venous angioplasty in MS (PREMiSe).
Neurology. 2014 Jun 27. [Epub ahead of print]
abstract

Co-existing conditions

Carta MG, Moro MF, Lorefice L, et al.
Multiple sclerosis and bipolar disorders: the burden of comorbidity and its consequences on quality of life.
J Affect Disord. 2014 Jun 2;167C:192-197. [Epub ahead of print]
abstract

Disease modifying treatments

Capobianco M, di Sapio A, Malentacchi M, et al.
No impact of current therapeutic strategies on disease reactivation after natalizumab discontinuation: a comparative analysis of different approaches during the first year of natalizumab discontinuation.
Eur J Neurol. 2014 Jul 3. [Epub ahead of print]
abstract

Gold R, Giovannoni G, Phillips JT, et al.
Efficacy and safety of delayed-release dimethyl fumarate in patients newly diagnosed with relapsing-remitting multiple sclerosis (RRMS).
Mult Scler. 2014 Jul 2. [Epub ahead of print]
abstract
Read the full text of this paper

Clerico M, Schiavetti I, De Mercanti SF, et al.
Treatment of relapsing-remitting multiple sclerosis after 24 doses of natalizumab: evidence from an Italian spontaneous, prospective, and observational study (the TY-STOP study).
JAMA Neurol. 2014 Jun 30. [Epub ahead of print]
abstract

Falls

Kalron A, Frid L, Gurevich M.
Concern about falling is associated with step length in persons with multiple sclerosis.
Eur J Phys Rehabil Med. 2014 Jul 1. [Epub ahead of print]
abstract

Physical activity

Kerling A, Keweloh K, Tegtbur U, et al.
Physical capacity and quality of life in patients with multiple sclerosis.
NeuroRehabilitation. 2014 Jul 2. [Epub ahead of print]
abstract

Ploughman M, Shears J, BKin CH, et al.
Effectiveness of a novel community exercise transition program for people with moderate to severe neurological disabilities.
NeuroRehabilitation. 2014 Jul 2. [Epub ahead of print]
abstract

Plow M, Bethoux F, Mai K, et al.
A formative evaluation of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis.
Health Educ Res. 2014 Jul 2. [Epub ahead of print]
abstract

Psychological aspects

Samios C, Pakenham KI, O'Brien J.
A dyadic and longitudinal investigation of adjustment in couples coping with multiple sclerosis.
Ann Behav Med. 2014 Jul 4. [Epub ahead of print]
abstract

Goverover Y, Genova H, Hali G, et al.
Metacognitive knowledge and online awareness in persons with multiple sclerosis.
NeuroRehabilitation. 2014 Jul 2. [Epub ahead of print]
abstract

Rehabilitation

Octavia JR, Coninx K.
Adaptive personalized training games for individual and collaborative rehabilitation of people with multiple sclerosis.
Biomed Res Int. 2014;2014:345728.
abstract
Read the full text of this paper

Thaut MH, Peterson DA, McIntosh GC, et al.
Music mnemonics aid verbal memory and induce learning - related brain plasticity in multiple sclerosis.
Front Hum Neurosci. 2014;8:395.
abstract
Read the full text of this paper

Hammond ER, Recio AC, Sadowsky CL, et al.
Functional electrical stimulation as a component of activity-based restorative therapy may preserve function in persons with multiple sclerosis.
J Spinal Cord Med. 2014 Jun 29. [Epub ahead of print]
abstract

Services

Skinner S, Guimond C, Butler R, et al.
An assessment of genetic counseling services for individuals with multiple sclerosis.
J Genet Couns. 2014 Jul 5. [Epub ahead of print]
abstract

Methley AM, Chew-Graham C, Campbell S, et al.
Experiences of UK health-care services for people with multiple sclerosis: a systematic narrative review.
Health Expect. 2014 Jul 2. [Epub ahead of print]
abstract

Symptoms and symptom management

Streckis V, Skurvydas A, Mamkus G.
Effect of the time of day on central and peripheral fatigue during 2-min maximal voluntary contractions in persons with multiple sclerosis: gender differences.
J Electromyogr Kinesiol. 2014 Jun 17. [Epub ahead of print]
abstract

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