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Childhood and Adolescent Environmental Risk Factors for Multiple Sclerosis: A Systematic Review With Meta-Analysis

Bruno Kusznir Vitturi1, Maria Cellerino2, Daniele Boccia2

  • 1Department of Neurology, University Hospital Schleswig-Holstein, Kiel University, Campus Kiel, Germany.

European Journal of Neurology
|October 28, 2025
PubMed

Insights

Childhood environmental exposures like infections, smoking, and obesity significantly increase multiple sclerosis (MS) risk. Early life prevention is crucial for reducing MS incidence.

Area of Science:

  • Pediatric Environmental Health
  • Neuroepidemiology

Background:

  • Multiple sclerosis (MS) etiology involves complex interactions between genetic and environmental factors.
  • Identifying pediatric environmental risk factors is crucial for understanding MS development and informing prevention strategies.

Purpose of the Study:

  • To synthesize current evidence on pediatric environmental exposures linked to multiple sclerosis (MS) risk.
  • To provide an updated literature review on environmental determinants of MS in early life.

Main Methods:

  • Systematic literature search across PubMed, SciVerse ScienceDirect, and Web of Science.
  • Inclusion of clinical studies assessing MS occurrence in relation to childhood/adolescent environmental exposures.
  • Meta-analysis of pooled unadjusted effect sizes (OR) with random-effects models.

Main Results:

  • Analysis of 87 studies revealed significant associations between pediatric exposures and MS risk.
  • Epstein-Barr virus (EBV) infection showed a strong positive association (ES=2.38).
  • Factors like childhood smoking, obesity, antibiotic/chemical exposures, and vitamin D deficiency were linked to increased MS risk, while breastfeeding showed limited protection.

Conclusions:

  • Childhood and adolescence represent critical windows for MS development influenced by environmental factors.
  • The first two decades of life offer a key opportunity for MS prevention through targeted interventions.
Abstract

Keywords:
demyelinating diseasesenvironmental exposuremultiple sclerosisrisk factors

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