While the global prevalence of Multiple Sclerosis (MS) is increasing, there is emerging evidence underscoring the influence of modifiable environmental and lifestyle factors not only in MS susceptibility but also in its progression. Thorough study and understanding of these often synergistically acting factors can provide critical insights for therapeutic strategies and disease management.
In addition to vitamin D deficiency and low ultraviolet B exposure that exhibit a strong association with disease progression and disability, epidemiological data suggest that gestational factors, such as birth month, may also influence long-term outcomes, with January births showing increased risks for mobility impairments (1). The implications of EBV infection in MS susceptibility has been confirmed across various studies, and is linked with neurodegeneration and accelerated disease progression, though the exact mechanisms remain unclear (1).
The role of lifestyle factors has been highlighted, with obesity showing faster disease progression, lower quality of life and rapid cognitive decline (2). Smoking exhibits aggravates MS severity and its combination with obesity can increase brain atrophy rates (1). Moreover, despite data supporting the association of environmental tobacco smoke (ETS) with MS development, this did not seem to influence disease progression (3). Air pollution, is less understood, but evidence supports its role in disease severity (1). Additionally, altered gut microbiota in active MS further underscores its importance in disease progression (1).
Targeting modifiable factors with personalized interventions may aid mitigate disease progression and optimize long-term outcomes for people with MS, aligning with the “brain health” concept (1).
Key Points:
• Modifiable factors like EBV, vitamin D deficiency, and smoking can impact MS progression.
• Disability accrual can be exacerbated by synergistic effects of obesity, smoking, and air pollution.
• Early interventions regarding modifiable environmental factors may aid slow MS progression and improve quality of life, aligning with the “brain health” concept.
• Gestational and microbiota influences offer new insights for therapeutic exploration.
References:
- Gouider R, Souissi A, Mrabet S, Gharbi A, Abida Y, Kacem I, Gargouri-Berrechid A. Environmental factors related to multiple sclerosis progression. J Neurol Sci. 2024 Sep 15;464:123161. doi: 10.1016/j.jns.2024.123161. Epub 2024 Aug 6. PMID: 39137699.
- Wu J, Alfredsson L, Olsson T, Hillert JA, Hedström AK. Obesity Affects Disease Activity and Progression, Cognitive Functioning, and Quality of Life in People With Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm. 2025 Jan;12(1):e200334. doi: 10.1212/NXI.0000000000200334. Epub 2024 Nov 13. PMID: 39536290; PMCID: PMC11563565.
- Schlindwein MAM, de Moura Campos MH, Breis LC, Chara BS, Scherer CS, Caminski VAP, Matta A, Gonçalves MVM. Impacts of environmental tobacco smoke on the onset and progression of multiple sclerosis: a systematic review. Arq Neuropsiquiatr. 2024 Mar;82(3):1-10. doi: 10.1055/s-0044-1779271. Epub 2024 Mar 15. PMID: 38490261; PMCID: PMC10942830.
Publish on behalf of the Scientific Panel on Neuroepidemiology