Prospective study of vitamin D and MS risk in African Americans

项目摘要 尽管在治疗和有前途的新药方面取得了进展，但多发性硬化症（MS）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，本发明还 MS发病率在美国黑人和世界几个地区的所有种族的妇女中正在增加。 这些快速增长不能用遗传因素来解释，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可能是其中一个因素，但 关于维生素D在多发性硬化症中的作用，特别是在黑人中的作用，仍然存在疑问。十年前，我们出版了一本 具有里程碑意义的论文报道，年轻健康的非西班牙裔白色成年人血清中25- 羟基维生素D（25（OH）D）比低水平的人患MS的风险低62%。这一发现， 后来在多项研究中得到证实，具有重大的公共卫生意义，因为它支持了 认为MS发病率的持续增加可以通过增加维生素D水平来停止或逆转。一个 然而，重要的局限性是，维生素D和MS风险之间的这种负相关性不能被 一般是黑人。此外，目前还不清楚维生素D水平是否仅在儿童时期重要， 青春期或成年期，以及男性和女性之间的维生素 D水平需要防止MS.回答这些问题是至关重要的，能够翻译的研究结果 健全有效的公共卫生干预措施。这项拟议中的研究依赖于独特的数据和血液 在美国军队服役期间收集了超过1000万人的样本， 储存在国防部血清库的100万份血清样本。多种血液的可用性 MS发作前每个个体的样本可以准确估计长期平均25（OH）D 水平，以及研究人群的多样化组成将首次允许获得准确的估计 维生素D与美国黑人患MS风险之间的关系，以确定 25（OH）D和MS风险受年龄或性别的影响，并探索基因-环境相互作用， 潜在的重大公共卫生影响。

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.