Self-reported use of vitamin D supplements is associated with higher physical quality of life scores in multiple sclerosis

https://doi.org/10.1016/j.msard.2021.102760Get rights and content

Highlights

  • Sun exposure associated with higher quality of life (QoL) at follow-up.

  • Self-reported vitamin D supplement use associated with higher QoL at follow-up.

  • Baseline self-reported vitamin D supplement use predicted increase in physical QoL.

Abstract

Background

Sun exposure and vitamin D, including intake and serum levels, have been associated with reduced risk of MS onset and less progression and may affect quality of life (QoL). We investigated the prospective relationship of these factors with QoL from baseline to 2.5 years’ follow-up, in an international cohort of people with MS.

Methods

Data derive from the HOLISM international cohort. Sun exposure and vitamin D supplement use were queried at both timepoints. QoL was assessed by MSQOL-54, estimating physical and mental health QoL composite scores. Characteristics of QoL were assessed by linear regression, adjusted for age, sex, socioeconomic status, treated comorbidity number, MS type, disability, clinically significant fatigue, prescription antidepressant medication use, and ongoing relapse symptoms, and baseline QoL score, as appropriate, estimating adjusted coefficients (aβ).

Results

At 2.5-year review, QoL scores were higher among those reporting taking vitamin D supplements (physical: aβ=3.58, 95%CI=1.35-5.80; mental: aβ=3.08, 95%CI=0.72-5.44), particularly average daily dose over 5,000IU/d. Baseline-reported vitamin D supplementation was associated with greater increase in physical (aβ=1.02, 95%CI=0.22-1.81), but not mental QoL (aβ=0.11, 95%CI=-1.00-1.23). Sun exposure was cross-sectionally associated with higher QoL scores at follow-up but was not associated with change in QoL.

Conclusions

Self-reported vitamin D supplement use was cross-sectionally associated with higher physical and mental QoL, but prospectively only with increased physical QoL.

Section snippets

Background

Multiple sclerosis (MS) is a progressive demyelinating condition of the central nervous system. Symptoms include motor, sensory and cognitive dysfunction, all of which have a significant impact on quality of life (QoL). QoL is difficult to measure compared to more objective parameters like disability. A commonly used and validated tool for assessing QoL in people with MS is the MSQOL-54, a 54-question instrument which combines the SF-36 (Ware et al., 1993) with 18 MS-specific questions (

Participants and data collection

Participants were enrolled in the HOLISM study for which methodology has been described previously (Hadgkiss et al., 2013; Weiland et al., 2018a). Participants were recruited via online platforms, and SurveyMonkey® was used to provide respondents with a participant information sheet and questionnaire. Inclusion criteria required participants be at least 18yo and self-reporting a physician diagnosis of MS. The University of Melbourne Health Sciences Human Ethics Sub-Committee provided ethical

Sample characteristics

The analysis sample comprised 1,401 participants who participated at both timepoints (Table 1). 1,155 (82.4%) provided data for P-QoL and 1,316 (93.9%) for M-QoL composite scores. The average P-QoL at baseline was 63.36 (IQR: 45.53-80.13), essentially unchanged at follow-up (median=64.36; IQR: 45.27-81.80). The median M-QoL at baseline was 76.10; IQR: 57.95-85.43, essentially unchanged at follow-up (median=76.13; IQR: 55.36-86.96). Subdomains were largely unchanged between baseline and 2.5-year

Discussion

Through analysing data from a large international sample of people with MS followed over 2.5 years, we found that self-reported vitamin D supplement use, sun exposure, and sun-related attire were cross-sectionally associated with higher P-QoL and M-QoL, in keeping with our baseline results (Jelinek et al., 2015), though the cross-sectional nature of these analyses and the potential for reverse causality precludes causal interpretation. Prospectively, self-reported vitamin D supplement use,

Conclusion

QoL in this international population of people with MS was relatively stable over a 2.5-year period. Self-reported vitamin D supplement use was a predictor of improved QoL, adding weight to current hypotheses about MS pathogenesis and progression. Were these results substantiated in other longitudinal studies, particularly those using objective measures of serum vitamin D, and thence by randomised clinical trials, vitamin D supplementation would be an inexpensive and safe intervention that

Ethics approval and consent to participate

The Health Sciences Human Ethics Sub-Committee at The University of Melbourne provided ethical approval for the study (Ethics ID: 1545102). Participants were asked to read the participant information and to consent before entering the survey.

Availability of data and material

Data may not be shared due to the conditions approved by our institutional ethics committee, in that all data are stored as re-identifiable information at The University of Melbourne in the form of password-protected computer databases, and only the listed investigators have access to the data. All data have been reported on a group basis, summarising the group findings rather than individual findings so personal information cannot be identified. Therefore, we can supply aggregate group data on

Author statement

Conceptualisation: GAJ, TW, SSY; Methodology: SSY; Software: N/A; Validation: SSY; Formal analysis: SSY; Investigation: SSY; Resources: GAJ, TW, SN, SSY; Data Curation: SSY; Writing - original draft: SSY; Writing - review & editing: SSY, PJ, TW, NN, SN, GAJ; Visualisation: SSY; Supervision: SN; Project Administration: GAJ, TW, SN, NN, SSY; Funding acquisition: GAJ, TW, SN.

Funding

The study was funded by Wal Pisciotta and anonymous philanthropic funders, for which we are thankful.

Declaration of Competing Interest

GJ receives royalties for his books, Overcoming Multiple Sclerosis and Recovering from Multiple Sclerosis. GJ and SN received remuneration for conducting lifestyle educational workshops for people with MS.

Acknowledgements

We thank all the participants in the HOLISM study for participating in the study and Wal Pisciotta and other anonymous philanthropic funders for supporting this study.

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