Journal
SEMINARS IN NEUROLOGY
Volume 36, Issue 2, Pages 103-114Publisher
THIEME MEDICAL PUBL INC
DOI: 10.1055/s-0036-1579693
Keywords
multiple sclerosis; epidemiology; vitamin D; infection; environment
Categories
Funding
- NIH [R01 NS47467, R01 NS042194, R01 NS046635, R01 NS073663]
- NMSS grant [RG4875A5/1, RG5146A1]
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Although genetic susceptibility explains the clustering of multiple sclerosis (MS) within families and the sharp decline in risk with increasing genetic distance, it cannot fully explain the geographical variations in MS frequency and the changes in risk that occur with migration, which support the action of strong environmental factors. Among these, vitamin D status, obesity in early life, infection with the Epstein-Barr virus, and cigarette smoking are the most consistent environmental predictors of MS risk. The authors review the epidemiological data, critically discuss the evidence for causality of these and other associations, and briefly review the possibility of interventions to reduce MS risk.
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