Interdependence and contributions of sun exposure and vitamin D to MRI measures in multiple sclerosis

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Abstract

Purpose

To assess the relationships of sun exposure history, supplementation and environmental factors to vitamin D levels in multiple sclerosis (MS) patients and to evaluate the associations between sun exposure and MRI measures.

Methods

This study included 264 MS patients (mean age 46.9±10 years, disease duration 14.6±10 years; 67.8% relapsing–remitting, 28% secondary progressive and 4.2% primary progressive MS) and 69 healthy controls. Subjects underwent neurological and 3 T MRI examinations, provided blood samples and answered questions to a structured questionnaire. Information on race, skin and eye colour, supplement use, body mass index (BMI) and sun exposure was obtained by questionnaire. The vitamin D metabolites (25-hydroxy vitamin D3, 1, 25-dihydroxy vitamin D3 and 24, 25-dihydroxy vitamin D3) were measured using mass spectrometry.

Results

Multivitamin supplementation (partial correlation rp=0.29, p<0.001), BMI (rp=−0.24, p=0.001), summer sun exposure (rp=0.22, p=0.002) and darker eye colour (rp=−0.18, p=0.015) had the strongest associations with vitamin D metabolite levels in the MS group. Increased summer sun exposure was associated with increased grey matter volume (GMV, rp=0.16, p=0.019) and whole brain volume (WBV, rp=0.20, p=0.004) after correcting for Extended Disability Status Scale in the MS group. Inclusion of 25-hydroxy vitamin D3 levels did not substantially affect the positive associations of sun exposure with WBV (rp=0.18, p=0.003) and GMV (rp=0.14, p=0.026) in the MS group.

Conclusions

Sun exposure may have direct effects on MRI measures of neurodegeneration in MS, independently of vitamin D.

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