ArticleJournal of neurology2020
Low sun exposure increases multiple sclerosis risk both directly and indirectly.
Article in Journal of neurology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
34 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Clinical and Imaging Outcomes after Vitamin D Supplementation in Patients with Multiple Sclerosis: A Systematic Review.Nutrients · 2023Pooled it
- Vitamin D did not reduce multiple sclerosis disease activity after a clinically isolated syndrome.Brain : a journal of neurology · 2024Trial
- Leisure-time physical activity, sun exposure, and multiple sclerosis risk: a population-based case-control study.Journal of neurology · 2026Article
- Reduced Childhood Outdoor Exposure Raises Pediatric Multiple Sclerosis (PedMS) Risk.Neurology and therapy · 2026Article
- Vitamin D as an Immuno-Endocrine Modulator: Discovering Its Role in Autoimmune Disorders and Host Defense Mechanisms.Journal of clinical medicine · 2026Review
- Opioid Signaling in Multiple Sclerosis: Emerging Targets for Repair.International journal of molecular sciences · 2026Review
- Epstein-Barr Virus, Lower Vitamin D, Low Sun Exposure, and HLA-DRB1*1501 Risk Variant Share Common Epigenetic Pathways Leading to Multiple Sclerosis Onset.Annals of neurology · 2026Article
- Disrupted Vitamin D Signaling and Metabolism in Neurodevelopmental and Neurodegenerative Disorders.ASN neuro · 2026Review
- Multiple sclerosis and the limits of classical autoimmune theory.Frontiers in immunology · 2026Review
- Review
- Impact of fish consumption on disability progression in multiple sclerosis.Journal of neurology, neurosurgery, and psychiatry · 2025Article
- Search for Disease-Specific Genetic Markers Originated from the Vitamin D Binding Protein Gene Polymorphisms in the Multiple Sclerosis Cohort in the Latvian Population.International journal of molecular sciences · 2025Article
- Immune Modulatory Effects of Vitamin D on Herpesvirus Infections.International journal of molecular sciences · 2025Review
- Season of conception and neurodevelopmental outcomes in singleton preterm infants less than 29 weeks gestation.Frontiers in pediatrics · 2025Article
- Factors associated with vitamin D levels in Mongolian patients with multiple sclerosis.PloS one · 2025Article
- Seasonal variation in sunlight exposure is differently associated with changes in T regulatory and T-helper 17 cell blood counts in adolescent and adults females: a pilot study.Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology · 2025Article
- Association between sun exposure habits and disease progression in multiple sclerosis.European journal of neurology · 2024Article
- Head trauma results in manyfold increased risk of multiple sclerosis in genetically susceptible individuals.Journal of neurology, neurosurgery, and psychiatry · 2024Article
- Long-Term Disability Outcomes in Relapsing-Remitting Multiple Sclerosis Patients: Impact of Clinical and Demographic Factors on Disease Progression.Journal of clinical medicine · 2024Article
- Adverse Childhood Experiences and the Risk of Multiple Sclerosis Development: A Review of Potential Mechanisms.International journal of molecular sciences · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveWe aimed to study (1) to what extent the influence of low sun exposure on multiple sclerosis (MS) risk is mediated by low vitamin D levels; (2) whether low sun exposure or vitamin D deficiency act synergistically with HLA-DRB1*15:01 and absence of HLA-A*02:01.
methodsWe used two population-based case-control studies (7069 cases, 6632 matched controls). Subjects with different HLA alleles, sun exposure habits and vitamin D status were compared regarding MS risk, by calculating odds ratios (OR) with 95% confidence intervals (CI) employing logistic regression. Mediation analysis was used to identify the potential mediation effect of vitamin D on the relationship between low sun exposure and MS risk.
resultsLow sun exposure increased MS risk directly as well as indirectly, by affecting vitamin D status. The direct effect, expressed as OR, was 1.26 (95% CI 1.04-1.45) and the indirect effect, mediated by vitamin D deficiency, was 1.10 (95% CI 1.02-1.23). Of the total effect, nearly 30% was mediated by vitamin D deficiency. There was a significant interaction between low sun exposure and vitamin D deficiency (attributable proportion due to interaction 0.3, 95% CI 0.04-0.5) accounting for about 12% of the total effect. Further, both factors interacted with HLA-DRB1*15:01 to increase MS risk.
interpretationOur findings indicate that low sun exposure acts both directly on MS risk as well as indirectly, by leading to low vitamin D levels. The protective effect of sun exposure thus seems to involve both vitamin D and non-vitamin D pathways, which is of relevance for prevention, in particular for those with a genetic susceptibility to MS.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.