Contributions
Abstract: 169
Type: Scientific Session
Abstract Category: Clinical aspects of MS - Epidemiology
Background: Obesity and vitamin D insufficiency have been identified as risk factors for multiple sclerosis (MS). Vitamin D levels have been associated with inflammatory outcomes in established MS and with brain volume changes early in the disease, while obesity-related comorbidities appear to be linked with overall morbidity and mortality in people with MS. We capitalized on a five-year cohort study of patients with longer duration MS/clinically isolated syndrome (CIS) to determine if body mass index (BMI) or vitamin D status is associated with MRI measures of neurodegeneration.
Methods: EPIC is a longitudinal MS cohort study at the University of California, San Francisco. Participants had clinical evaluations, brain MRI, and blood draws annually. We evaluated patients with CIS or relapsing-remitting MS (RRMS) at baseline. In multivariate repeated measures analyses adjusted for age, sex, ethnicity, smoking status, and use of MS treatments, annual 25-hydroxyvitamin D levels and BMI were evaluated for their association with subsequent brain volumes (normalized brain parenchymal (nBPV), gray matter (nGMV), and white matter (nWMV) volumes, as determined by SIENAX).
Results: Among 469 subjects with RRMS/CIS, each 1 kg/m2 higher BMI was independently associated with reduced nGMV in multivariate models (-1.1 mL, 95% CI [-1.8, -0.5], p=0.001; Table 2). BMI was likewise independently associated with greater declines in nBPV in multivariate models (nBPV per 1 kg/m2 greater BMI: -1.1 mL, 95% CI [-2.1, -0.05], p=0.039). Vitamin D levels, on the other hand, did not appear to be meaningfully associated with brain volumes.
Conclusions: Higher BMI appears to be associated with accelerated reductions in nGMV and nBPV, relevant since in particular nGMV loss portends greater longer-term disability. Since obesity is modifiable, further studies should explore these relationships in detail, and evaluating the effect of reducing BMI on imaging and clinical outcomes in MS may be warranted.
Disclosure: The study was funded by the NIH (EMM: K23NS067055; DP:R01NS062885), GlaxoSmithKline, and Biogen Idec. The sponsors did not participate in the design or conduct of the study, the data analysis and interpretation, or any aspect of the manuscript preparation or approval. CEM and RRL report no disclosures. Dr. Mowry reports serving as site PI for clinical trials and studies sponsored by Biogen and SunPharma, has research support from Sanofi Genzyme and Biogen for investigator-initiated trials, receives free medication for a clinical trial, of which she is PI, from Teva Neuroscience. and receives royalties for editorial duties from UpToDate. Dr. Azevedo received consulting fees for scientific advisory boards for Genzyme, Guerbet, and Genentech. Dr. Okuda received lecture fees from Acorda Therapeutics, Genentech, Genzyme, and Teva, advisory and consulting fees from Celgene, EMD Serono, Genentech, Genzyme, and Novartis and research support from Biogen. Dr. Waubant volunteers her time on a clinical trial advisory board for Novartis, is site PI for trials with Novartis and Roche, and is co-chief editor of MSARD and section editor of ACTN. Dr. Hauser currently serves on the SAB of Symbiotix, Annexon, Bionure, and Molecular Stethoscope and on the BOT of Neurona, and he has received travel reimbursement and writing assistance from F. Hoffman-La Roche Ltd. for CD20-related meetings and presentations. Dr. Pelletier has served on scientific advisory boards and received honoraria for providing consulting services for Biogen, Sanofi Genzyme, Hoffman LaRoche, Novartis, and EMD-Serono.
Abstract: 169
Type: Scientific Session
Abstract Category: Clinical aspects of MS - Epidemiology
Background: Obesity and vitamin D insufficiency have been identified as risk factors for multiple sclerosis (MS). Vitamin D levels have been associated with inflammatory outcomes in established MS and with brain volume changes early in the disease, while obesity-related comorbidities appear to be linked with overall morbidity and mortality in people with MS. We capitalized on a five-year cohort study of patients with longer duration MS/clinically isolated syndrome (CIS) to determine if body mass index (BMI) or vitamin D status is associated with MRI measures of neurodegeneration.
Methods: EPIC is a longitudinal MS cohort study at the University of California, San Francisco. Participants had clinical evaluations, brain MRI, and blood draws annually. We evaluated patients with CIS or relapsing-remitting MS (RRMS) at baseline. In multivariate repeated measures analyses adjusted for age, sex, ethnicity, smoking status, and use of MS treatments, annual 25-hydroxyvitamin D levels and BMI were evaluated for their association with subsequent brain volumes (normalized brain parenchymal (nBPV), gray matter (nGMV), and white matter (nWMV) volumes, as determined by SIENAX).
Results: Among 469 subjects with RRMS/CIS, each 1 kg/m2 higher BMI was independently associated with reduced nGMV in multivariate models (-1.1 mL, 95% CI [-1.8, -0.5], p=0.001; Table 2). BMI was likewise independently associated with greater declines in nBPV in multivariate models (nBPV per 1 kg/m2 greater BMI: -1.1 mL, 95% CI [-2.1, -0.05], p=0.039). Vitamin D levels, on the other hand, did not appear to be meaningfully associated with brain volumes.
Conclusions: Higher BMI appears to be associated with accelerated reductions in nGMV and nBPV, relevant since in particular nGMV loss portends greater longer-term disability. Since obesity is modifiable, further studies should explore these relationships in detail, and evaluating the effect of reducing BMI on imaging and clinical outcomes in MS may be warranted.
Disclosure: The study was funded by the NIH (EMM: K23NS067055; DP:R01NS062885), GlaxoSmithKline, and Biogen Idec. The sponsors did not participate in the design or conduct of the study, the data analysis and interpretation, or any aspect of the manuscript preparation or approval. CEM and RRL report no disclosures. Dr. Mowry reports serving as site PI for clinical trials and studies sponsored by Biogen and SunPharma, has research support from Sanofi Genzyme and Biogen for investigator-initiated trials, receives free medication for a clinical trial, of which she is PI, from Teva Neuroscience. and receives royalties for editorial duties from UpToDate. Dr. Azevedo received consulting fees for scientific advisory boards for Genzyme, Guerbet, and Genentech. Dr. Okuda received lecture fees from Acorda Therapeutics, Genentech, Genzyme, and Teva, advisory and consulting fees from Celgene, EMD Serono, Genentech, Genzyme, and Novartis and research support from Biogen. Dr. Waubant volunteers her time on a clinical trial advisory board for Novartis, is site PI for trials with Novartis and Roche, and is co-chief editor of MSARD and section editor of ACTN. Dr. Hauser currently serves on the SAB of Symbiotix, Annexon, Bionure, and Molecular Stethoscope and on the BOT of Neurona, and he has received travel reimbursement and writing assistance from F. Hoffman-La Roche Ltd. for CD20-related meetings and presentations. Dr. Pelletier has served on scientific advisory boards and received honoraria for providing consulting services for Biogen, Sanofi Genzyme, Hoffman LaRoche, Novartis, and EMD-Serono.