Abstract
Background: The association between lifestyle factors and Multiple Sclerosis (MS) disease severity and progression has been investigated to a lesser extent compared with susceptibility to the disease.Objective: We aimed to assess the impact of lifetime alcohol and cigarette smoking load on MS severity.Methods: Design: a cross-sectional study. Three hundred fifty-one patients consecutively admitted to the Department of Neurology were asked to complete the “Questionnaire of Lifestyle” (part of the European Prospective Investigation into Cancer and Nutrition project). An estimation of the cumulative lifetime cigarette smoking and alcohol load was calculated as the weighted sum of the mean number of cigarettes smoked and standard alcoholic drinks consumed per day at different ages. The measure of exposure was expressed in terms of pack-year and drink-year. Disease severity was estimated by the Multiple Sclerosis Severity Score (MSSS). Logistic regression analyses were performed using MSSS (first tertile vs. third tertile) as the outcome.Results: The median MSSS was higher (3.2 vs. 2.3, p = 0.002) in ever- vs. never-smokers, but we did not find a difference between ever- and never-drinkers (2.7 vs. 2.8, p = ns). Ever-smokers were almost twice as likely to fall in the upper MSSS tertile than never-smokers. Ever-drinkers did not show a statistically significant association between alcohol intake and MS severity. The risk of falling in the worst MSSS tertile for smokers was 10.81 (2.0–58.48; p < 0.01) if they were never-drinkers, whereas it was only 1.65 (0.89–3.03, p = 0.11) if they were also drinkers. On the other side, the risk of falling in the worst MSSS tertile for drinkers did not change as much, whether they also were smokers (0.46; 0.13–1.65; p = 0.23) or not (1.49; 0.55–4.04, p = 0.43).Conclusions: Cigarette smoking, unlike alcohol consumption, is associated with MS severity. Alcohol consumption may attenuate the effect of smoking on disease severity, acting as an effect modifier. The biological background of this effect is unknown. The limitations of our study are mostly due to its cross-sectional design.
Highlights
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system with a heterogeneous clinical course, characterized by multifocal inflammatory demyelination and secondary axonal degeneration, in which the interaction between environmental and genetic protective and risk factors leads to the chronic activation of immune cells, and neuronal injury [1, 2].There is ample evidence that lifestyle habits, such as alcohol use and cigarette smoking, are risk factors for the development of autoimmune diseases
Modifiable lifestyle factors, such as alcohol consumption and cigarette smoking might play a role in MS progression, and this is essential from a clinical as well as an etiological point of view
In some studies the harmful effect of cigarette smoking on the course of already established MS was proved [6,7,8,9], whereas only a handle of studies had evaluated the relationship between alcohol intake and disease severity so far [5, 9, 10], and none of them had studied the combined effect of these two factors
Summary
There is ample evidence that lifestyle habits, such as alcohol use and cigarette smoking, are risk factors for the development of autoimmune diseases. The association of lifestyle factors with MS disease severity and progression is less explored compared with susceptibility to the disease. Modifiable lifestyle factors, such as alcohol consumption and cigarette smoking might play a role in MS progression, and this is essential from a clinical as well as an etiological point of view. The association between lifestyle factors and Multiple Sclerosis (MS) disease severity and progression has been investigated to a lesser extent compared with susceptibility to the disease
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