Prince Sebastian1, Nicolas Cherbuin1, Lisa F Barcellos1, Shelly Roalstad1, Charles Casper1, Janace Hart1, Gregory S Aaen1, Lauren Krupp1, Leslie Benson1, Mark Gorman1, Meghan Candee1, Tanuja Chitnis1, Manu Goyal1, Benjamin Greenberg1, Soe Mar1, Moses Rodriguez1, Jennifer Rubin1, Teri Schreiner1, Amy Waldman1, Bianca Weinstock-Guttman1, Jennifer Graves1, Emmanuelle Waubant2, Robyn Lucas1. 1. From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego. 2. From the Australian National University Medical School (P.S.), Centre for Research on Ageing, Health and Wellbeing (N.C.), and National Centre for Epidemiology and Population Health (R.L.), Australian National University, Canberra; Division of Epidemiology (L.F.B.), University of California Berkeley; Department of Pediatrics (S.R., C.C.), University of Utah School of Medicine, Salt Lake City; Pediatric Multiple Sclerosis Center (J.H.) and Department of Neurology (E.W.), University of California San Francisco; Pediatric Multiple Sclerosis Center (G.S.A.), Loma Linda University Children's Hospital, CA; MS Comprehensive Care Center (L.K.), New York University Langone, NY; Pediatric Multiple Sclerosis and Related Disorders Program (L.B., M. Gorman), Boston Children's Hospital, MA; Division of Pediatric Neurology (M.C.), University of Utah Primary Children's Hospital, Salt Lake City; Partners Pediatric Multiple Sclerosis Center (T.C.), Massachusetts General Hospital for Children, Boston; Department of Radiology (M. Goyal), Washington University St. Louis, MO; Department of Neurology (B.G.), University of Texas Southwestern, Dallas; Pediatric-Onset Demyelinating Diseases and Autoimmune Encephalitis Center (S.M.), St. Louis Children's Hospital, Washington University School of Medicine, MO; Mayo Clinic Pediatric Multiple Sclerosis Center (M.R.), Mayo Clinic, Rochester, MN; Department of Pediatric Neurology (J.R.), Northwestern Feinberg School of Medicine, Chicago, IL; Children's Hospital Colorado (T.S.), University of Colorado, Denver; Division of Neurology (A.W.), Children's Hospital of Philadelphia, PA; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, State University of New York Buffalo; and Department of Neurosciences (J.G.), University of California San Diego. emmanuelle.waubant@ucsf.edu.
Abstract
BACKGROUND AND OBJECTIVES: This study aims to determine the contributions of sun exposure and ultraviolet radiation (UVR) exposure to risk of pediatric-onset multiple sclerosis (MS). METHODS: Children with MS and controls recruited from multiple centers in the United States were matched on sex and age. Multivariable conditional logistic regression was used to investigate the association of time spent outdoors daily in summer, use of sun protection, and ambient summer UVR dose in the year before birth and the year before diagnosis with MS risk, with adjustment for sex, age, race, birth season, child's skin color, mother's education, tobacco smoke exposure, being overweight, and Epstein-Barr virus infection. RESULTS: Three hundred thirty-two children with MS (median disease duration 7.3 months) and 534 controls were included after matching on sex and age. In a fully adjusted model, compared to spending <30 minutes outdoors daily during the most recent summer, greater time spent outdoors was associated with a marked reduction in the odds of developing MS, with evidence of dose-response (30 minutes-1 hour: adjusted odds ratio [AOR] 0.48, 95% confidence interval [CI] 0.23-0.99, p = 0.05; 1-2 hours: AOR 0.19, 95% CI 0.09-0.40, p < 0.001). Higher summer ambient UVR dose was also protective for MS (AOR 0.76 per 1 kJ/m2, 95% CI 0.62-0.94, p = 0.01). DISCUSSION: If this is a causal association, spending more time in the sun during summer may be strongly protective against developing pediatric MS, as well as residing in a sunnier location.
BACKGROUND AND OBJECTIVES: This study aims to determine the contributions of sun exposure and ultraviolet radiation (UVR) exposure to risk of pediatric-onset multiple sclerosis (MS). METHODS: Children with MS and controls recruited from multiple centers in the United States were matched on sex and age. Multivariable conditional logistic regression was used to investigate the association of time spent outdoors daily in summer, use of sun protection, and ambient summer UVR dose in the year before birth and the year before diagnosis with MS risk, with adjustment for sex, age, race, birth season, child's skin color, mother's education, tobacco smoke exposure, being overweight, and Epstein-Barr virus infection. RESULTS: Three hundred thirty-two children with MS (median disease duration 7.3 months) and 534 controls were included after matching on sex and age. In a fully adjusted model, compared to spending <30 minutes outdoors daily during the most recent summer, greater time spent outdoors was associated with a marked reduction in the odds of developing MS, with evidence of dose-response (30 minutes-1 hour: adjusted odds ratio [AOR] 0.48, 95% confidence interval [CI] 0.23-0.99, p = 0.05; 1-2 hours: AOR 0.19, 95% CI 0.09-0.40, p < 0.001). Higher summer ambient UVR dose was also protective for MS (AOR 0.76 per 1 kJ/m2, 95% CI 0.62-0.94, p = 0.01). DISCUSSION: If this is a causal association, spending more time in the sun during summer may be strongly protective against developing pediatric MS, as well as residing in a sunnier location.
Authors: Lisa G Gallagher; Sindana Ilango; Annette Wundes; Gary A Stobbe; Katherine W Turk; Gary M Franklin; Martha S Linet; D Michal Freedman; Bruce H Alexander; Harvey Checkoway Journal: Mult Scler Date: 2018-06-22 Impact factor: 6.312
Authors: E Waubant; E M Mowry; L Krupp; T Chitnis; E A Yeh; N Kuntz; J Ness; D Chabas; J Strober; J McDonald; A Belman; M Milazzo; M Gorman; B Weinstock-Guttman; M Rodriguez; J R Oksenberg; J A James Journal: Neurology Date: 2011-06-07 Impact factor: 9.910
Authors: Brenda Banwell; Amit Bar-Or; Douglas L Arnold; Dessa Sadovnick; Sridar Narayanan; Melissa McGowan; Julia O'Mahony; Sandra Magalhaes; Heather Hanwell; Reinhold Vieth; Raymond Tellier; Thierry Vincent; Giulio Disanto; George Ebers; Katherine Wambera; Mary B Connolly; Jerome Yager; Jean K Mah; Fran Booth; Guillaume Sebire; David Callen; Brandon Meaney; Marie-Emmanuelle Dilenge; Anne Lortie; Daniela Pohl; Asif Doja; Sunita Venketaswaran; Simon Levin; E Athen Macdonald; David Meek; Ellen Wood; Noel Lowry; David Buckley; Conrad Yim; Mark Awuku; Pamela Cooper; François Grand'maison; J Burke Baird; Virender Bhan; Ruth Ann Marrie Journal: Lancet Neurol Date: 2011-03-31 Impact factor: 44.182
Authors: Ellen M Mowry; Emmanuelle Waubant; Charles E McCulloch; Darin T Okuda; Alan A Evangelista; Robin R Lincoln; Pierre-Antoine Gourraud; Don Brenneman; Mary C Owen; Pamela Qualley; Monica Bucci; Stephen L Hauser; Daniel Pelletier Journal: Ann Neurol Date: 2012-08 Impact factor: 10.422
Authors: Patrick J Waters; Lars Komorowski; Mark Woodhall; Sabine Lederer; Masoud Majed; Jim Fryer; John Mills; Eoin P Flanagan; Sarosh R Irani; Amy C Kunchok; Andrew McKeon; Sean J Pittock Journal: Neurology Date: 2019-02-06 Impact factor: 9.910