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To the Editor:
We read with interest the article by Munger et al.1 A protective effect of sunlight on multiple sclerosis (MS) risk was first suggested by Acheson et al.2 Vitamin D is a potential mediator of this relationship. We are sympathetic to the hypothesis being tested3 by Munger et al. but have the following concerns.
1) NHS studied women age >30, but more than half of female patients with MS have onset below this age. Of those accrued, some 50,000 were excluded from analysis.1 Was this done before testing the vitamin D hypothesis? What were the characteristics, when known, of exclusions for calculated vitamin D estimates compared to those retained? Perhaps MS risk can be altered after age 30, but earlier ages are implicated from migration studies.
2) 61 and then 130 questions were asked in the NHS and NHS II questionnaires. Was correction made for multiple analyses? Could the authors explain the assumptions and approach used to calculate …
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