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Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study.

ABSTRACT: Background: Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease of the motor neurons. The etiology of ALS remains largely unknown, particularly with reference to the potential environmental determinants. Methods: We performed a population-based case-control study in four provinces from both Northern and Southern Italy in order to assess non-genetic ALS risk factors by collecting through tailored questionnaires information about clinical and lifestyle factors. We estimated ALS risk by calculating odds ratio (OR) with its 95% confidence interval (CI) using unconditional logistic regression models adjusted for sex, age and educational attainment. Results: We recruited 230 participants (95 cases and 135 controls). We found a possible positive association of ALS risk with trauma, particularly head trauma (OR = 2.61, 95% CI 1.19-5.72), electric shock (OR = 2.09, 95% CI 0.62-7.06), and some sports, although at a competitive level only. In addition, our results suggest an increased risk for subjects reporting use of private wells for drinking water (OR = 1.38, 95% CI 0.73-2.27) and for use of herbicides during gardening (OR = 1.95, 95% CI 0.88-2.27). Conversely, there was a suggestion of an inverse association with overall fish consumption (OR = 0.27, 95% CI 0.12-0.60), but with no dose-response relation. Consumption of some dietary supplements, namely those containing amino acids and, in the Southern Italy population, vitamins and minerals such as selenium, seemed associated with a statistically imprecise increased risk. Conclusions: Our results suggest a potential etiologic role a number of clinical and lifestyle factors with ALS risk. However, caution is needed due to some study limitations. These include the small sample size and the low number of exposed subjects, which affect statistical precision of risk estimates, the potential for exposure misclassification, and the uncertainties about mechanisms underpinning the possible association between these factors and disease risk.

SUBMITTER: Filippini T

PROVIDER: S-EPMC7037077 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study.

Filippini Tommaso T Fiore Maria M Tesauro Marina M Malagoli Carlotta C Consonni Michela M Violi Federica F Arcolin Elisa E Iacuzio Laura L Oliveri Conti Gea G Cristaldi Antonio A Zuccarello Pietro P Zucchi Elisabetta E Mazzini Letizia L Pisano Fabrizio F Gagliardi Ileana I Patti Francesco F Mandrioli Jessica J Ferrante Margherita M Vinceti Marco M

International journal of environmental research and public health 20200130 3

<i>Background</i>: Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease of the motor neurons. The etiology of ALS remains largely unknown, particularly with reference to the potential environmental determinants. <i>Methods</i>: We performed a population-based case-control study in four provinces from both Northern and Southern Italy in order to assess non-genetic ALS risk factors by collecting through tailored questionnaires information about clinical and lifesty ...[more]

PMID: 32019087

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Project description:BackgroundAmyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a typical survival of three to five years. Epidemiological studies using paper-based questionnaires in individual countries or continents have failed to find widely accepted risk factors for the disease. The advantages of online versus paper-based questionnaires have been extensively reviewed, but few online epidemiological studies into human neurodegenerative diseases have so far been undertaken.ObjectiveTo design a Web-based questionnaire to identify environmental risk factors for ALS and enable international comparisons of these risk factors.MethodsA Web-based epidemiological questionnaire for ALS has been developed based on experience gained from administering a previous continent-wide paper-based questionnaire for this disease. New and modified questions have been added from our previous paper-based questionnaire, from literature searches, and from validated ALS questionnaires supplied by other investigators. New criteria to allow the separation of familial and sporadic ALS cases have been included. The questionnaire addresses many risk factors that have already been proposed for ALS, as well as a number that have not yet been rigorously examined. To encourage participation, responses are collected anonymously and no personally identifiable information is requested. The survey is being translated into a number of languages which will allow many people around the world to read and answer it in their own language.ResultsAfter the questionnaire had been online for 4 months, it had 379 respondents compared to only 46 respondents for the same initial period using a paper-based questionnaire. The average age of the first 379 web questionnaire respondents was 54 years compared to the average age of 60 years for the first 379 paper questionnaire respondents. The questionnaire is soon to be promoted in a number of countries through ALS associations and disease registries.ConclusionsWeb-based questionnaires are a time- and resource-efficient method for performing large epidemiological studies of neurodegenerative diseases such as ALS. The ability to compare risk factors between different countries using the same analysis tool will be of particular value for finding robust risk factors that underlie ALS.

Dataset Information

Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study.

Publications

Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study.

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