To examine the relationship between early life nutrition and pediatric Multiple Sclerosis.

Vitamin D insufficiency is considered a risk factor for CNS demyelination.

Children with incident CNS demyelination and healthy controls were prospectively enrolled in a longitudinal study that queried breastfeeding and the quantity-per-day (frequency X dose or serving size) of vitamin D supplements and vitamin D-enriched foods from birth in two-year intervals before incident demyelination and in the two months preceding questionnaire completion. Breastfeeding was compared using Fisher’s Exact test; duration of breastfeeding and quantity of vitamin D intake with Kruskal-Wallis tests. Multivariable logistic regression assessed sex, age at onset, duration of breastfeeding and cumulative vitamin D intake with MS risk.

294 children were diagnosed with monoADS, 102 with MS and 133 were healthy controls. The proportion of breastfed children was lowest in the MS group (70.8%, vs monoADS 80.4%, vs controls 82.4%, p=0.377); and the median (IQR) duration of breastfeeding was shortest among children with MS (5.00 (7.00) months, vs monoADS (7.00 (7.875)), vs healthy controls (7.75 (8.75)), p=0.3578).  

Only 17.4% of MS, 21% of monoADS and 3% of controls consumed a median of ≥400 IU/D vitamin D prior to ADS. In the two months prior to questionnaire completion, MS patients endorsed higher vitamin D supplementation (1000 IU/D (1000)) vs monoADS (350 (1000) or controls (0 (173.21), p<0.0001.

Older age at onset (OR=1.41, 95% CI 1.21-1.71; p<0.001) was associated with increased likelihood of MS. Sex, breastfeeding duration, vitamin D supplementation and formula/milk ingestion before incident demyelination did not influence MS risk.

Breastfeeding and early life vitamin D nutrition were not protective against MS. The low overall adherence to recommended daily vitamin D supplements limits the ability to determine a protective effect, but adherence to vitamin D supplementation is high after MS diagnosis.