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Cited by 77Multiple Sclerosis Research StudiesVitamin D Research StudiesPsoriasis: Treatment and Pathogenesis

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A systematic review of modifiable risk factors in the progression of multiple sclerosis

Hempel, Susanne, Graham, Glenn D, Fu, Ning, Estrada, Elena, Chen, Annie Y, Miake-Lye, Isomi, Miles, Jeremy N V, Shanman, Roberta, Shekelle, Paul G, Beroes, Jessica M, Wallin, Mitchell T·2017·Multiple Sclerosis Journal
DOI 10.1177/1352458517690270
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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; I 2 = 66%), smokers had an increased risk of MS progression (hazard ratio (HR) = 1.55; CI = 1.10, 2.19; I 2 = 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 makin…

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  • Smoking was the only environmental risk of 84 risks quantified in GBD 2016 that we judged to have sufficient evidence for a causal relationship with multiple sclerosis as an outcome.

    “Smoking was the only environmental risk of 84 risks quantified in GBD 2016 that we judged to have sufficient evidence for a causal relationship with multiple sclerosis as an outcome.24”

    From Global, regional, and national burden of multiple sclerosis 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 (2019) · cites this paper as [24]

  • A second major limitation was the lack of robust predictive covariates for multiple sclerosis to aid in population-based risk assessments, which was due partly to the limited pool of longitudinal neurological disability data that is representative of the multiple sclerosis population.

    “A second major limitation was the lack of robust predictive covariates for multiple sclerosis to aid in population-based risk assessments,24 which was due partly to the limited pool of longitudinal neurological disability data that is representative of the multiple sclerosis population.”

    From Global, regional, and national burden of multiple sclerosis 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 (2019) · cites this paper as [24]

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Metadata

Authors
Hempel, S., Graham, G. D., Fu, N., Estrada, E., Chen, A. Y., Miake-Lye, I., Miles, J. N. V., Shanman, R., Shekelle, P. G., Beroes, J. M., & Wallin, M. T.
Affiliations
  • RAND Corporation (US)
  • United States Department of Veterans Affairs (US)
  • VA West Los Angeles Medical Center (US)
Corresponding author
Hempel, Susanne
ORCID
Venue
Multiple Sclerosis Journal
Publisher
SAGE Publications
Published
2017-02-02
Volume
23
Issue
4
Pages
525-533
ISSN
  • 1352-4585 (ISSN-L)
  • 1477-0970
DOI
10.1177/1352458517690270
OpenAlex
W2585967513
Cited by
77
References
33
Citations by year
2026: 5 · 2025: 5 · 2024: 8 · 2023: 9 · 2022: 7 · 2021: 12 · 2020: 8 · 2019: 10 · 2018: 5 · 2017: 8
FWCI
1.35
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Multiple Sclerosis Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Vitamin D Research Studies
  • Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
Keywords
multiple sclerosis, disease progression, modifiable risk factors, vitamin D deficiency, smoking, disability progression, Expanded Disability Status Scale
MeSH terms
Humans, Multiple Sclerosis, Prospective Studies, Risk Factors, Smoking, Vitamin D, Disease Progression

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