{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:32:27Z","timestamp":1780338747327,"version":"3.54.1"},"reference-count":34,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Multiple sclerosis (MS) is a chronic autoimmune condition that impacts the central nervous system and has a rising incidence globally, especially in Saudi Arabia. Materials and Methods: This study examines environmental, lifestyle, and familial risk factors associated with MS in the Aljouf Region by a cross-sectional analysis of 155 clinically diagnosed MS patients. Data were gathered using structured questionnaires and medical record examinations to evaluate sociodemographic characteristics, sun exposure, smoking, obesity, eating habits, and childhood infections. Results: Logistic regression research found insufficient daily sun exposure (&lt;15 min\/day), smoking, obesity, and childhood measles infection as significant risk factors, but substantial weekend sun exposure (&gt;4 h\/day), exclusive breastfeeding, and regular fish consumption were deemed protective. While familial history of MS was statistically significant (5.5%, p = 0.04), parental consanguinity (38.7%) did not show a significant association with MS risk (p = 0.07). Conclusions: The findings underscore the complex nature of MS and the pressing necessity for preventive efforts, such as advocating for vitamin D supplementation, smoking cessation, obesity prevention, and dietary adjustments. Mitigating these controllable risk factors may alleviate the prevalence of MS in Saudi Arabia.<\/jats:p>","DOI":"10.3390\/medicina61040730","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T08:11:39Z","timestamp":1744704699000},"page":"730","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Environmental and Familial Risk Factors for Multiple Sclerosis: Insights from a Saudi Arabian Cohort"],"prefix":"10.3390","volume":"61","author":[{"given":"Mubarak","family":"Alruwaili","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehana","family":"Basri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS","volume":"26","author":"Walton","year":"2020","journal-title":"Mult. Scler."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Al Jumah, M., Bunyan, R., Al Otaibi, H., Al Towaijri, G., Karim, A., Al Malik, Y., Kalakatawi, M., Alrajeh, S., Al Mejally, M., and Algahtani, H. (2020). Rising prevalence of multiple sclerosis in Saudi Arabia: A descriptive study. BMC Neurol., 20.","DOI":"10.1186\/s12883-020-1629-3"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"a028951","DOI":"10.1101\/cshperspect.a028951","article-title":"Genetics of multiple sclerosis: An overview and new directions","volume":"8","author":"Patsopoulos","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1177\/1352458518823940","article-title":"The role of infections in multiple sclerosis","volume":"25","author":"Marrodan","year":"2019","journal-title":"Mult. Scler. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1212\/WNL.0000000000000768","article-title":"Atlas of Multiple Sclerosis 2013: A growing global problem with widespread inequity","volume":"83","author":"Browne","year":"2014","journal-title":"Neurology"},{"key":"ref_6","first-page":"34","article-title":"Multiple sclerosis\u2014A disease on a dramatically rising trend in Iran: Review of possible reasons","volume":"16","author":"Sahraian","year":"2017","journal-title":"Iran. J. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"a028944","DOI":"10.1101\/cshperspect.a028944","article-title":"Lifestyle and environmental factors in multiple sclerosis","volume":"9","author":"Alfredsson","year":"2019","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.msard.2017.07.020","article-title":"Smoking and multiple sclerosis: A systematic review and meta-analysis using the Bradford Hill criteria for causation","volume":"17","author":"Degelman","year":"2017","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1038\/nri3871","article-title":"Immunopathology of multiple sclerosis","volume":"15","author":"Dendrou","year":"2015","journal-title":"Nat. Rev. Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/ane.12429","article-title":"Socioeconomic factors and immigrant population studies of multiple sclerosis","volume":"132","author":"Berg","year":"2015","journal-title":"Acta Neurol. Scand."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1055\/s-2007-1019126","article-title":"Epidemiology of multiple sclerosis: From risk factors to prevention","volume":"28","author":"Ascherio","year":"2008","journal-title":"Semin. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1177\/1352458515609794","article-title":"Smoking is a major preventable risk factor for multiple sclerosis","volume":"22","author":"Olsson","year":"2016","journal-title":"Mult. Scler."},{"key":"ref_13","first-page":"312","article-title":"Effect of smoking on multiple sclerosis: A meta-analysis","volume":"39","author":"Poorolajal","year":"2017","journal-title":"J. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1001\/jamaneurol.2019.4271","article-title":"Association between cigarette smoking and multiple sclerosis: A review","volume":"77","author":"Rosso","year":"2020","journal-title":"JAMA Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/B978-0-444-52001-2.00007-8","article-title":"Infections and multiple sclerosis","volume":"122","author":"Venkatesan","year":"2014","journal-title":"Handb. Clin. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100039","DOI":"10.1016\/j.jtauto.2020.100039","article-title":"Immune-mediated genesis of multiple sclerosis","volume":"3","author":"Cavallo","year":"2020","journal-title":"J. Transl. Autoimmun."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1080\/08916934.2018.1482883","article-title":"Complex interaction between mutant HNRNPA1 and gE of varicella zoster virus in pathogenesis of multiple sclerosis","volume":"51","author":"Kattimani","year":"2018","journal-title":"Autoimmunity"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.pediatrneurol.2017.09.007","article-title":"Breastfeeding during infancy is associated with a lower future risk of pediatric multiple sclerosis","volume":"77","author":"Brenton","year":"2017","journal-title":"Pediatr. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1177\/1352458512459683","article-title":"Breastfeeding is associated with lower risk for multiple sclerosis","volume":"19","author":"Conradi","year":"2013","journal-title":"Mult. Scler."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13052-017-0326-3","article-title":"Immunomodulatory constituents of human breast milk and immunity from bronchiolitis","volume":"43","author":"Li","year":"2017","journal-title":"Ital. J. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1177\/1352458512459291","article-title":"Prevalence, demographics and clinical characteristics of multiple sclerosis in Qatar","volume":"19","author":"Deleu","year":"2013","journal-title":"Mult. Scler."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Gustavsen, M.W., Page, C.M., Moen, S.M., Bjolgerud, A., Berg-Hansen, P., Nygaard, G.O., Sandvik, L., Lie, B.A., Celius, E.G., and Harbo, H.F. (2014). Environmental exposures and the risk of multiple sclerosis investigated in a Norwegian case-control study. BMC Neurol., 14.","DOI":"10.1186\/s12883-014-0196-x"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"808","DOI":"10.15537\/smj.2018.8.22864","article-title":"Sociodemographic, environmental and lifestyle risk factors for multiple sclerosis development in the Western region of Saudi Arabia: A matched case-control study","volume":"39","author":"Halawani","year":"2018","journal-title":"Saudi Med. J."},{"key":"ref_24","first-page":"69","article-title":"Risk factors of multiple sclerosis in Aseer region, Kingdom of Saudi Arabia: A case-control study","volume":"26","author":"Siddiqui","year":"2021","journal-title":"Neurosci. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1002\/acn3.50862","article-title":"Environmental and genetic risk factors for MS: An integrated review","volume":"6","author":"Waubant","year":"2019","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_26","first-page":"CD008422","article-title":"Vitamin D for the management of multiple sclerosis","volume":"9","author":"Jagannath","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s40120-017-0086-4","article-title":"Vitamin D and multiple sclerosis: A comprehensive review","volume":"7","author":"Sintzel","year":"2018","journal-title":"Neurol. Ther."},{"key":"ref_28","first-page":"6794837","article-title":"The effect of clothing on vitamin D status, bone turnover markers, and bone mineral density in young Kuwaiti females","volume":"2019","author":"AlOtaibi","year":"2019","journal-title":"Int. J. Endocrinol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1159\/000487640","article-title":"Estimating the marginal causal effect of fish consumption during adolescence on multiple sclerosis: A population-based incident case-control study","volume":"50","author":"Abdollahpour","year":"2018","journal-title":"Neuroepidemiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s00415-006-0395-5","article-title":"Outdoor activities and diet in childhood and adolescence relate to MS risk above the Arctic Circle","volume":"254","author":"Kampman","year":"2007","journal-title":"J. Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1177\/1352458514564490","article-title":"A systematic review of the incidence and prevalence of autoimmune disease in multiple sclerosis","volume":"21","author":"Marrie","year":"2015","journal-title":"Mult. Scler."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Azami, M., YektaKooshali, M.H., Shohani, M., Khorshidi, A., and Mahmudi, L. (2019). Correction: Epidemiology of multiple sclerosis in Iran: A systematic review and meta-analysis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0219466"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1126\/science.abj8222","article-title":"Longitudinal analysis reveals high prevalence of Epstein\u2013Barr virus associated with multiple sclerosis","volume":"375","author":"Bjornevik","year":"2022","journal-title":"Science"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s11481-010-9201-3","article-title":"Epstein\u2013Barr virus infection and multiple sclerosis: A review","volume":"5","author":"Ascherio","year":"2010","journal-title":"J. Neuroimmune Pharmacol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/730\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:14:47Z","timestamp":1760030087000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/730"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,15]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["medicina61040730"],"URL":"https:\/\/doi.org\/10.3390\/medicina61040730","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,15]]}}}