Skip to main content
Log in

Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background

Adequate 25(OH)D levels are required to prevent adverse effects on bone health. Population-based data on factors associated with 25(OH)D levels of people with MS have been lacking. Objectives To examine the prevalence and determinants of vitamin D insufficiency in a population-based sample of MS cases and controls, and to compare 25(OH)D status between MS cases and controls, taking into account case disability.

Methods

We conducted a population based case-control study in Tasmania, Australia (latitude 41-3°S) on 136 prevalent cases with MS confirmed by magnetic resonance imaging and 272 community controls, matched on sex and year of birth. Measurements included serum 25(OH)D, sun exposure, skin type, dietary vitamin D intake and disability including EDSS.

Results

A high prevalence of vitamin D insufficiency was found in MS cases and controls. Among MS cases, increasing disability was strongly associated with lower levels of 25(OH)D and with reduced sun exposure. Cases with higher disability (EDSS > 3) were more likely to have vitamin D insufficiency than controls (OR = 3.07 (1.37, 6.90) for 25(OH)D >40 nmol/l), but cases with low disability were not (OR = 0.87 (0.41, 1.86)).

Conclusion

The strong associations between disability, sun exposure and vitamin D status indicate that reduced exposure to the sun, related to higher disability, may contribute to the high prevalence of vitamin D insufficiency found in this population-based MS case sample. Active detection of vitamin D insufficiency among people with MS and intervention to restore vitamin D status to adequate levels should be considered as part of the clinical management of MS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bergamaschi R, Romani A, Versino M, Poli R, Cosi V (1997) Clinical aspects of fatigue in multiple sclerosis. Funct Neurol 12:247-51

    CAS  PubMed  Google Scholar 

  2. Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Begerow B, Lew RA, Conzelmann M (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18:343-51

    Article  CAS  PubMed  Google Scholar 

  3. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, Wong JB (2004) Effect of Vitamin D on falls: a meta-analysis. JAMA 291:1999-006

    Article  CAS  PubMed  Google Scholar 

  4. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B (2005) Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 293:2257-264

    Article  CAS  PubMed  Google Scholar 

  5. Boiko A (1997) Data collection guidelines for questionnaires to be used in case-control studies of multiple sclerosis. Neurology 49:S75-0

    CAS  PubMed  Google Scholar 

  6. Bouillon R, Okamura WH, Norman AW (1995) Structure-Function Relationships in the Vitamin D Endocrine System. Endocrine Rev 16:200-57

    CAS  Google Scholar 

  7. Cantorna MT, Hayes CE, DeLuca HF (1996) 1,25-Dihydroxyvitamin D3 reversibly blocks the progression of relapsing encephalomyelitis, a model of multiple sclerosis. Proc Natl Acad Sci U S A 93:7861-864

    Article  CAS  PubMed  Google Scholar 

  8. Cohen JA (1968) nominal scale agreement with provision for scaled disagreement or partial credit. Am Psychol Assoc 70:213-19

    CAS  Google Scholar 

  9. Cosman F, Nieves J, Komar L, Ferrer G, Herbert J, Formica C, Shen V, Lindsay R (1998) Fracture history and bone loss in patients with MS. Neurology 51:1161-165

    CAS  PubMed  Google Scholar 

  10. Dwyer T, Blizzard L, Gies PH, Ashbolt R, Roy C (1996) Assessment of habitual sun exposure in adolescents via questionnaire-a comparison with objective measurement using polysulphone badges. Melanoma Res 6:231-39

    Article  CAS  PubMed  Google Scholar 

  11. Dwyer T, Muller HK, Blizzard L, Ashbolt R, Phillips G (1998) The use of spectrophotometry to estimate melanin density in Caucasians. Cancer Epidemiol Biomarkers Prev 7:203-06

    CAS  PubMed  Google Scholar 

  12. Dwyer T, Prota G, Blizzard L, Ashbolt R, Vincensi MR (2000) Melanin density and melanin type predict melanocytic naevi in 19-0 year olds of northern European ancestry. Melanoma Res 10:387-94

    Article  CAS  PubMed  Google Scholar 

  13. Embry AF, Snowdon LR, Vieth R (2000) Vitamin D and seasonal fluctuations of gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis. Ann Neurol 48:271-72

    Article  CAS  PubMed  Google Scholar 

  14. Eyles DW, Brown J, Mackay-Sim A, McGrath J, Feron F (2002) Vitamin D3 and brain development. Neuroscience. 1-4

  15. Feskanich D, Willett WC, Colditz GA (2003) Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 77:504-11

    CAS  PubMed  Google Scholar 

  16. Fukazawa T, Yabe I, Kikuchi S, Sasaki H, Hamada T, Miyasaka K, et al. (1999) Association of vitamin D receptor gene polymorphism with multiple sclerosis in Japanese. J Neurol Sci 166:47-2

    Article  CAS  PubMed  Google Scholar 

  17. Goldberg P, Fleming MC, Picard EH (1986) Multiple sclerosis: decreased relapse rate through dietary supplementation with calcium, magnesium and vitamin D. Med Hypotheses 21:193-00

    Article  CAS  PubMed  Google Scholar 

  18. Holick MF (1994) McCollum Award Lecture, 1994: vitamin D–new horizons for the 21st century. Am J Clin Nutr 60:619-30

    CAS  PubMed  Google Scholar 

  19. Holick MF (2004) Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr 79:362-71

    CAS  PubMed  Google Scholar 

  20. Hollis BW (2005) Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr 135:317-22

    CAS  PubMed  Google Scholar 

  21. Jablonski NG, Chaplin G (2000) The evolution of human skin coloration. J Hum Evol 39:57-06

    Article  CAS  PubMed  Google Scholar 

  22. Jorde R, Waterloo K, Saleh F, Haug E, Svartberg J (2005) Neuropsychological function in relation to serum parathyroid hormone and serum 25-hydroxyvitamin D levels The Tromso study. J Neurol

  23. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444-452

    CAS  PubMed  Google Scholar 

  24. Lemire JM (1992) Immunomodulatory Role of 1,25-Dihydroxyvitamin D3. Journal of Cellular Biochemistry 49:26-1

    Article  CAS  PubMed  Google Scholar 

  25. Lemire JM, Archer DC (1991) 1,25-dihydroxyvitamin D3 prevents the in vivo induction of murine experimental autoimmune encephalomyelitis. J Clin Invest 87:1103-107

    Article  CAS  PubMed  Google Scholar 

  26. Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498-07

    CAS  PubMed  Google Scholar 

  27. Mahon BD, Gordon SA, Cruz J, Cosman F, Cantorna MT (2003) Cytokine profile in patients with multiple sclerosis following vitamin D supplementation. J Neuroimmunol 134:128-32

    Article  CAS  PubMed  Google Scholar 

  28. Munger KL, Zhang SM, O'Reilly E, Hernan MA, Olek MJ, Willett WC, Ascherio A (2004) Vitamin D intake and incidence of multiple sclerosis. Neurology 62:60-5

    CAS  PubMed  Google Scholar 

  29. Nieves J, Cosman F, Herbert J, Shen V, Lindsay R (1994) High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis. Neurology 44:1687-692

    CAS  PubMed  Google Scholar 

  30. Niino M, Fukazawa T, Yabe I, Kikuchi S, Sasaki H, Tashiro K (2000) Vitamin D receptor gene polymorphism in multiple sclerosis and the association with HLA class II alleles. J Neurol Sci 177:65-1

    Article  CAS  PubMed  Google Scholar 

  31. Nowson CA, Margerison C (2002) Vitamin D intake and vitamin D status of Australians. Med J Aust 177:149-52

    PubMed  Google Scholar 

  32. Paty DW, Oger JJ, Kastrukoff LF, Hashimoto SA, Hooge JP, Eisen AA, Eisen KA, Purves SJ, Low MD, Brandejs V et al. (1988) MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT. Neurology 38:180-85

    CAS  PubMed  Google Scholar 

  33. Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227-31

    Article  CAS  PubMed  Google Scholar 

  34. Roxburgh RH, Seaman SR, Masterman T, Hensiek AE, Sawcer SJ, Vukusic S, Achiti I, Confavreux C, Coustans M, le Page E, Edan G, McDonnell GV, Hawkins S, Trojano M, Liguori M, Cocco E, Marrosu MG, Tesser F, Leone MA, Weber A, Zipp F, Miterski B, Epplen JT, Oturai A, Sorensen PS, Celius EG, Lara NT, Montalban X, Villoslada P, Silva AM, Marta M, Leite I, Dubois B, Rubio J, Butzkueven H, Kilpatrick T, Mycko MP, Selmaj KW, Rio ME, Sa M, Salemi G, Savettieri G, Hillert J, Compston DA (2005) Multiple Sclerosis Severity Score: using disability and disease duration to rate disease severity. Neurology 64:1144-151

    CAS  PubMed  Google Scholar 

  35. Salonen JT, Tuomilehto J, Nissinen A, Kaplan GA, Puska P (1989) Contribution of risk factor changes to the decline in coronary incidence during the North Karelia project: a within-community analysis. Int J Epidemiol 18:595-01

    Article  CAS  PubMed  Google Scholar 

  36. Simmons RD, Ponsonby AL, van der Mei IA, Sheridan P (2004) What affects your MS? Responses to an anonymous, Internet-based epidemiological survey. Mult Scler 10:202-11

    Article  PubMed  Google Scholar 

  37. Sipe JC, Knobler RL, Braheny SL, Rice GP, Panitch HS, Oldstone MB (1984) A neurologic rating scale (NRS) for use in multiple sclerosis. Neurology 34:1368-372

    CAS  PubMed  Google Scholar 

  38. Soilu-Hanninen M, Airas L, Mononen I, Heikkila A, Viljanen M, Hanninen A (2005) 25-Hydroxyvitamin D levels in serum at the onset of multiple sclerosis. Mult Scler 11:266-71

    Article  CAS  PubMed  Google Scholar 

  39. Steckley JL, Dyment DA, Sadovnick AD, Risch N, Hayes C, Ebers GC (2000) Genetic analysis of vitamin D related genes in Canadian multiple sclerosis patients. Canadian Collaborative Study Group. Neurology 54:729-32

    CAS  PubMed  Google Scholar 

  40. Studzinski GP, Moore DC (1995) Sunlight-can it prevent as well as cause cancer? Cancer Res 55:4014-022

    CAS  PubMed  Google Scholar 

  41. Trang HM, Cole DE, Rubin LA, Pierratos A, Siu S, Vieth R (1998) Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr 68:854-58

    CAS  PubMed  Google Scholar 

  42. van der Mei IA, Ponsonby AL, Dwyer T, Blizzard L, Simmons R, Taylor BV, Butzkueven H, Kilpatrick T (2003) Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study. BMJ 327:316

    Article  CAS  PubMed  Google Scholar 

  43. Vieth R (1999) Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69:842-56

    CAS  PubMed  Google Scholar 

  44. Vieth R, Chan PC, MacFarlane GD (2001) Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr 73:288-94

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to I. A. F. van der Mei PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van der Mei, I.A.F., Ponsonby, AL., Dwyer, T. et al. Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia. J Neurol 254, 581–590 (2007). https://doi.org/10.1007/s00415-006-0315-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-006-0315-8

Key words

Navigation