AUTHOR=Juntas-Morales Raul , Pageot Nicolas , Marin Gregory , Dupuy Anne-Marie , Alphandery Sébastien , Labar Laura , Esselin Florence , Picot Marie Christine , Camu William 

TITLE=Low 25OH Vitamin D Blood Levels Are Independently Associated With Higher Amyotrophic Lateral Sclerosis Severity Scores: Results From a Prospective Study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 11 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.00363

DOI=10.3389/fneur.2020.00363

ISSN=1664-2295

ABSTRACT=Background: ALS is a fatal neurodegenerative disorder characterized by progressive degeneration of upper and lower motoneurons. Prognosis is highly variable, ranging from few months to more than 30 years. 25OH Vitamin D (25 OH VD) blood levels have been associated with worse prognosis of the disease but these results remain in dispute. We addressed this controversy with a prospective study and multivariate analysis to study the influence of known clinical prognostic factors of the disease and 25OH VD levels on ALS severity score (ASS), as defined by the monthly rate of decline of ALSFRS-R score, to identify the factors most closely linked to the risk of worsening of the disease.
Results: This prospective cohort of ALS patients recruited 127 individuals, and 105 of them met inclusion criteria. Mean age of onset was 62.2 ± 12.1 years, 32 % of subjects had bulbar onset, and gender ratio was 1.44 (Male/Female). Mean 25OH VD level was 26.8 ± 10.8 ng/mL, and was similar between males and females. Patients with 25OH VD levels <15 ng/mL had significantly higher ASS than those with normal levels (>30ng/mL), p = 0.011. In There was no correlation between ASS and 25OH vitamin D levels (r=-0.19; p = 0.084). Univariate analysis showed that ASS correlated with 25OH VD levels, ALS duration at inclusion, slow vital capacity (SVC) at inclusion and SVC loss. Multivariate model showed that 25OH VD levels were independently associated with ASS: r=-0.0125, p = 0.033. Log Rank test with Kaplan-Meier curves did not show significant differences of survival between the groups defined by 25OH VD levels: <15 ng/mL, >15 and <30 ng/mL and > 30 ng/mL, p = 0.88.
Conclusions: This prospective study in ALS patients confirmed previous retrospective results: ASS is significantly higher in patients with severe vitamin D deficiency. For the first time, multivariate analysis showed that 25OH VD level was an independent prognostic factor correlated to ASS, suggesting that discrepancies between previous works were due to confounders. It would be important that the present work be replicated in larger samples to confirm the present findings.