Susanne Hempel1, Glenn D Graham2, Ning Fu1, Elena Estrada3, Annie Y Chen3, Isomi Miake-Lye3, Jeremy N V Miles1, Roberta Shanman1, Paul G Shekelle4, Jessica M Beroes3, Mitchell T Wallin5. 1. Southern California Evidence-based Practice Center, RAND Corporation, Santa Monica, CA, USA. 2. Specialty Care Services, U.S. Department of Veterans Affairs, Washington, DC, USA/Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA. 3. Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, USA. 4. Southern California Evidence-based Practice Center, RAND Corporation, Santa Monica, CA USA/Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, USA. 5. Multiple Sclerosis Centers of Excellence-East, U.S. Department of Veterans Affairs, Washington, DC, USA/Department of Neurology, School of Medicine, Georgetown University, Washington, DC, USA.
Abstract
BACKGROUND: The presenting symptoms and rate of progression of multiple sclerosis (MS) are very heterogeneous. The diverse clinical manifestations and the clinical course of the disease may vary with modifiable risk factors. OBJECTIVE: To systematically review modifiable risk factors and exposures associated with MS progression. METHODS: We searched six databases till March 2015, reference-mined reviews, and consulted with experts (PROSPERO 2015:CRD42015016461). Two reviewers screened and extracted data. We used random meta-analysis models and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the quality of evidence. RESULTS: In total, 59 studies met inclusion criteria. Lower vitamin D levels were associated with higher Expanded Disability Status Scale (EDSS) scores ( r = -0.22; confidence interval (CI) = -0.32, -0.12; 11 studies; I2 = 66%), smokers had an increased risk of MS progression (hazard ratio (HR) = 1.55; CI = 1.10, 2.19; I2 = 72%; seven studies), and there was no association of MS progression with the use of epidural analgesics during childbirth delivery (three studies). There was insufficient evidence to draw conclusions for 11 risk factors due to conflicting results or use of different predictor and outcome measures. CONCLUSION: MS progression was consistently associated with low vitamin D levels, and smoking was associated with a more rapid decline in MS disability. Studies used a variety of methods, predictors, and outcomes making it difficult to draw conclusions. Future studies should focus on prospective assessments.
BACKGROUND: The presenting symptoms and rate of progression of multiple sclerosis (MS) are very heterogeneous. The diverse clinical manifestations and the clinical course of the disease may vary with modifiable risk factors. OBJECTIVE: To systematically review modifiable risk factors and exposures associated with MS progression. METHODS: We searched six databases till March 2015, reference-mined reviews, and consulted with experts (PROSPERO 2015:CRD42015016461). Two reviewers screened and extracted data. We used random meta-analysis models and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the quality of evidence. RESULTS: In total, 59 studies met inclusion criteria. Lower vitamin D levels were associated with higher Expanded Disability Status Scale (EDSS) scores ( r = -0.22; confidence interval (CI) = -0.32, -0.12; 11 studies; I2 = 66%), smokers had an increased risk of MS progression (hazard ratio (HR) = 1.55; CI = 1.10, 2.19; I2 = 72%; seven studies), and there was no association of MS progression with the use of epidural analgesics during childbirth delivery (three studies). There was insufficient evidence to draw conclusions for 11 risk factors due to conflicting results or use of different predictor and outcome measures. CONCLUSION: MS progression was consistently associated with low vitamin D levels, and smoking was associated with a more rapid decline in MS disability. Studies used a variety of methods, predictors, and outcomes making it difficult to draw conclusions. Future studies should focus on prospective assessments.
Authors: Sandra L Neate; Keryn L Taylor; George A Jelinek; Alysha M De Livera; Chelsea R Brown; Tracey J Weiland Journal: Front Psychol Date: 2018-01-31
Authors: Claudia H Marck; Alysha M De Livera; Chelsea R Brown; Sandra L Neate; Keryn L Taylor; Tracey J Weiland; Emily J Hadgkiss; George A Jelinek Journal: PLoS One Date: 2018-05-23 Impact factor: 3.240
Authors: Friederike Maretzke; Angela Bechthold; Sarah Egert; Jana B Ernst; Debora Melo van Lent; Stefan Pilz; Jörg Reichrath; Gabriele I Stangl; Peter Stehle; Dorothee Volkert; Michael Wagner; Julia Waizenegger; Armin Zittermann; Jakob Linseisen Journal: Nutrients Date: 2020-03-31 Impact factor: 5.717