Influence of cigarette smoking on ALS outcome: a population-based study

Calvo, Andrea; Canosa, Antonio; Bertuzzo, Davide; Cugnasco, Paolo; Solero, Luca; Clerico, Marinella; Mercanti, Stefania De; Bersano, Enrica; Cammarosano, Stefania; Ilardi, Antonio; Manera, Umberto; Moglia, Cristina; Marinou, Kalliopi; Bottacchi, E.; Pisano, Fabrizio; Mora, Gabriele; Mazzini, Letizia; Chiò, Adriano

doi:10.1136/jnnp-2016-313793

Cited by 41 publications

(28 citation statements)

References 29 publications

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“…The positive association we found between ALS and smoking habits is consistent with previous studies [42,[45][46][47][48][49][50][51][52][53]. Despite a few studies reporting no difference or a decreasing risk in association with smoking [43,54,55], nevertheless, a detrimental effect of smoking has also been reported as a negative prognostic factor [56,57]. This strengths the relevance of quitting in either preventing the onset or delaying the progression of the disease.…”

Section: Discussionsupporting

confidence: 91%

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

Filippini

Fiore

Tesauro

et al. 2020

IJERPH

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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.

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Section: Discussionsupporting

confidence: 91%

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

Filippini

Fiore

Tesauro

et al. 2020

IJERPH

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“…Clinical predictors were sex, site of onset (spinal vs bulbar), age at onset of weakness or bulbar symptoms, revised El Escorial criteria (definite vs probable or possible ALS), 12 diagnostic delay (time from onset of weakness or bulbar symptoms to diagnosis), forced vital capacity (FVC; percentage of predicted based on normative values for age, sex, and body height), progression rate defined by the slope on the revised ALS Functional Rating Scale (ALSFRS-R), 15 premorbid body-mass index (BMI), 16 current smoking, 17 and cigarette pack-years. 6 Cognitive predictors were the presence of frontotemporal dementia according to the Neary or Rascovsky criteria, 18 and scores on the verbal fluency index, 19 the Frontal Assessment Battery, 20 and the ALS Frontotemporal Dementia Questionnaire (ALSFTD-Q).…”

Section: Methodsmentioning

confidence: 99%

Prognosis for patients with amyotrophic lateral sclerosis: development and validation of a personalised prediction model

Westeneng

Debray

Visser

et al. 2018

The Lancet Neurology

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“…Patients who live long enough to attend a specialist research clinic are different from those identified in population studies, and this difference can cause bias in the results. For instance, smok- ing has been shown to shorten survival in a population study, 67 so a case-control study selecting participants from clinics would find smokers underrepresented in the ALS group and would thus suggest that smoking either has no effect or might be protective. Similarly, ALS specialists report anecdotally that their patients tend to be athletic, slim, and very fit, 68 but if these factors slow disease progression rather than increase risk, such patients will be overrepresented at specialist centers.…”

Section: Insights Into Sporadic Alsmentioning

confidence: 99%