Prospective Study of Vitamin D and MS Risk in African Americans

项目总结 尽管多发性硬化症(MS)在治疗方面取得了进展，并有望获得新的药物，但它仍然是一种慢性疾病 进行性疾病，对受影响者、其家庭和社会的生活质量有很大影响。此外， 在美国黑人和世界上几个地区所有种族的女性中，多发性硬化症的发病率正在上升。 这些快速增长不能用遗传因素来解释，而且强烈表明环境因素， 可能是可修改的，有助于确定MS风险。维生素D很可能是这些因素之一，但 关于维生素D在多发性硬化症中的作用仍然存在疑问，特别是在黑人中。十年前，我们发表了一份 一篇里程碑式的论文报道，年轻健康的非西班牙裔白人成年人的血清水平较高，为25- 羟基维生素D(25(OH)D)患多发性硬化症的风险比低水平者低62%。这一发现， 后来在多项研究中得到证实，具有重大的公共健康影响，因为它支持 认为增加维生素D水平可以阻止或逆转多发性硬化症发病率的持续增加。一个 然而，重要的局限性是，维生素D和多发性硬化症风险之间的这种负相关不能 推广到黑人。此外，目前尚不清楚维生素D水平是否只在儿童时期和 青春期还是成年时期，以及男女之间在维生素方面是否存在差异 阻止MS所需的D水平回答这些问题对于能够翻译研究结果是至关重要的 转变为健全有效的公共卫生干预措施。拟议的研究依赖于独特的数据和血液 从1000多万名美国军队现役军人和60多万名军人身上收集的样本 国防部血清储存库中储存了100万份血清样本。多种血液的可获得性 多发性硬化症发病前每个个体的样本可以准确估计长期平均25(OH)D 水平，研究人群的多样化构成将首次能够获得准确的估计 关于美国黑人中维生素D和多发性硬化症风险的关系，以确定两者之间的关系 25(OH)D和MS的风险随年龄或性别而改变，并探索基因与环境的相互作用 潜在的重要公共卫生影响。

PROJECT SUMMARY In spite of progress in treatment and promising new drugs multiple sclerosis (MS) continues to be a chronic progressive disease with a high impact on the quality of life of those affected, their families, and society. Further, MS incidence is increasing among US Blacks and among women of all races in several regions in the world. These rapid increases cannot be explained by genetic factors, and strongly suggest that environmental factors, possibly modifiable, are contributing to determine MS risk. Vitamin D is likely to be one of these factors, but questions remain on the role of vitamin D in MS particularly among blacks. Ten years ago, we published a landmark paper reporting that young healthy non-Hispanic white adults with higher serum levels of 25- hydroxyvitamin D (25(OH)D) had a 62% lower risk of developing MS than those with lower levels. This finding, which has been later confirmed in multiple studies, has major public health implications because it supports the notion that the ongoing increase in MS incidence could be halted or reversed by increasing vitamin D levels. An important limitation, however, is that this inverse association between vitamin D and MS risk cannot be generalized to blacks. Further, it remains unclear whether vitamin D levels important only during childhood and adolescence or also during adult life, and whether there are differences between men and women in the vitamin D levels needed to prevent MS. Answering these questions is critical to be able to translate the research findings into sound and effective public health interventions. The proposed study relies on the unique data and blood samples collected from over 10 million individuals during their active duty within the US military and over 60 million serum samples stored in the Department of Defense Serum Repository. The availability of multiple blood samples from each individual prior to MS onset allows an accurate estimate of long term average 25(OH)D levels, and the diverse composition of the study population will allow for the first time to obtain accurate estimates of the relation between vitamin D and MS risk among US blacks, to determine whether the relation between 25(OH)D and MS risk is modified by age or gender, and to explore gene-environment interactions that have potentially important public health implications.