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August 25, 2017

No association between dietary sodium intake and the risk of multiple sclerosis

September 26, 2017 issue
89 (13) 1322-1329

Abstract

Objective:

To prospectively investigate the association between dietary sodium intake and multiple sclerosis (MS) risk.

Methods:

In this cohort study, we assessed dietary sodium intake by a validated food frequency questionnaire administered every 4 years to 80,920 nurses in the Nurses' Health Study (NHS) (1984–2002) and to 94,511 in the Nurses' Health Study II (NHSII) (1991–2007), and calibrated it using data from a validation study. There were 479 new MS cases during follow-up. We used Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the effect of energy-adjusted dietary sodium on MS risk, adjusting also for age, latitude of residence at age 15, ancestry, body mass index at age 18, supplemental vitamin D intake, cigarette smoking, and total energy intake in each cohort. The results in both cohorts were pooled using fixed effects models.

Results:

Total dietary intake of sodium at baseline was not associated with MS risk (highest [medians: 3.2 g/d NHS; 3.5 g/d NHSII] vs lowest [medians: 2.5 g/d NHS; 2.8 g/d NHSII] quintile: HRpooled 0.98, 95% CI 0.74–1.30, p for trend = 0.75). Cumulative average sodium intake during follow-up was also not associated with MS risk (highest [medians: 3.3 g/d NHS; 3.4 g/d NHSII] vs lowest [medians: 2.7 g/d NHS; 2.8 g/d NHSII] quintile: HRpooled 1.02, 95% CI 0.76–1.37, p for trend = 0.76). Comparing more extreme sodium intake in deciles yielded similar results (p for trend = 0.95).

Conclusions:

Our findings suggest that higher dietary sodium intake does not increase the risk of developing MS.

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Information & Authors

Information

Published In

Neurology®
Volume 89Number 13September 26, 2017
Pages: 1322-1329

Publication History

Received: January 11, 2017
Accepted: June 5, 2017
Published online: August 25, 2017
Published in print: September 26, 2017

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Authors

Affiliations & Disclosures

Marianna Cortese, MD
From the Departments of Clinical Medicine and Global Public Health and Primary Care (M.C.), University of Bergen; The Norwegian Multiple Sclerosis Competence Center (M.C.), Haukeland University Hospital, Bergen, Norway; Departments of Nutrition (M.C., C.Y., A.A., K.L.M.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) Novartis Norway, speaker honorarium for national MS meeting
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) The Western Norway Regional Health Authority, PhD scholarship during 3 years
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Changzheng Yuan, ScD
From the Departments of Clinical Medicine and Global Public Health and Primary Care (M.C.), University of Bergen; The Norwegian Multiple Sclerosis Competence Center (M.C.), Haukeland University Hospital, Bergen, Norway; Departments of Nutrition (M.C., C.Y., A.A., K.L.M.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Tanuja Chitnis, MD
From the Departments of Clinical Medicine and Global Public Health and Primary Care (M.C.), University of Bergen; The Norwegian Multiple Sclerosis Competence Center (M.C.), Haukeland University Hospital, Bergen, Norway; Departments of Nutrition (M.C., C.Y., A.A., K.L.M.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
Dr. Chitnis has served on clinical trial advisory boards for Novartis Pharmaceuticals, and Genzyme-Sanofi.
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Dr. Chitnis has served as a one-time consultant for Biogen-Idec, Novartis, Teva Neurosciences, Genzyme-Sanofi and Genentech-Roche.
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Dr. Chitnis receives research support from (1) EMD- Serono, (2) Novartis, (3) Biogen (4) Verily, in the form of Independent Investigator Awards.
Research Support, Government Entities:
1.
NIH
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Dr. Chitnis receives research support from the National Multiple Sclerosis Society, the Peabody Foundation, the Consortium for MS Centers and the Guthy-Jackson Charitable Foundation.
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Alberto Ascherio, MD, DrPH
From the Departments of Clinical Medicine and Global Public Health and Primary Care (M.C.), University of Bergen; The Norwegian Multiple Sclerosis Competence Center (M.C.), Haukeland University Hospital, Bergen, Norway; Departments of Nutrition (M.C., C.Y., A.A., K.L.M.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Excemed 2016, honorarium for teaching
Editorial Boards:
1.
1) Multiple Sclerosis and Related Disorders, Associate Editor 2) Journal of Parkinson Disease, Associate Editor
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH R01 NS046635; 2008-2015; Role: PI NIH R01 ES019188; 2010-2015; Role: Co-Investigator NIH R01 NS071082; 2010-2015; Role: PI NIH R01 NS072494; 2011-2015; Role Co-Investigator NIH R01 NS073633; 2011-2017; Role: PI DoD W81XWH-14-1-0131; 2014-2019; Role: PI NIH R01 NS045893; 2013-2018; Role: PI NIH 1U01NS-90259; 2015-2020; Role: PI of subcontract NIH R01 NS089619-01A1; 2015-2020; Role: PI NIH R01 NS097723; 2016-2021; Role: Co-Investigator
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NMSS RG4875A/1; 2013-2016; Role: PI NMSS RG5146-A-1; 2014-2017; Role: Co-Investigator NMSS RG1501-03068; 2015-2016; Role: Co-Investigator ALS Association; 2015-2018; Role: PI ALS Finding a Cure; 2015-2017; Role: PI
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Kassandra L. Munger, ScD
From the Departments of Clinical Medicine and Global Public Health and Primary Care (M.C.), University of Bergen; The Norwegian Multiple Sclerosis Competence Center (M.C.), Haukeland University Hospital, Bergen, Norway; Departments of Nutrition (M.C., C.Y., A.A., K.L.M.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; Partners Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital; and Channing Division of Network Medicine, Department of Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
1) Travel/honorarium. Sponsor: Croatian International Conference on Multiple Sclerosis and Related Autoimmune Disorders. Invited Speaker, Zagreb, Croatia March 5-7, 2015 2) Travel/honorarium. Sponsor: American Society for Experimental NeuroTherapeutics. Invited Speaker, Bethesda MD March 19, 2016
Editorial Boards:
1.
1) Multiple Sclerosis Journal, Editorial Board member, 2013-present 2) Frontiers in Neurology: Neuroepidemiology, Associate Editor, 5/2017-present
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH-NINDS, 1 R01 NS046635, Co-investigator, 6/1/08-present
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
1) National Multiple Sclerosis Society
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Dr. Cortese: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Marianna Cortese contributed to data analysis and interpretation and to drafting and revising the manuscript and figures. Changzheng Yuan contributed to data analysis and interpretation and to revising the manuscript and figures. Tanuja Chitnis contributed to data acquisition and interpretation and to revising the manuscript and figures. Alberto Ascherio contributed to obtaining funding, study concept and design, data analysis and interpretation, and revising the manuscript and figures. Kassandra L. Munger contributed to obtaining funding, study concept and design, data analysis and interpretation, and drafting and revising the manuscript and figures.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Study Funding

This study was supported by a research grant from the National Multiple Sclerosis Society (PI: K.L. Munger) and by the US NIH (grants UM1 CA186107, UM1 CA176726).

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