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Taking part in certain recreational activities, including gardening, golfing, woodworking, and hunting, may increase the risk of developing <a href="https://alsnewstoday.com/what-is-als/">amyotrophic lateral sclerosis</a> (ALS), especially for men, according to a new study.
While the <a href="https://alsnewstoday.com/causes-of-als/">causes of ALS</a> still are not well understood, several risk factors have been identified. There&#8217;s evidence that jobs in some specific professions — such as military service, as an electrician, and regularly working with toxic chemicals and pesticides — are associated with an increased risk of ALS.
However, this study shows that the recreational activities a person chooses to participate in may also affect ALS risk.
“We know that occupational risk factors, like working in manufacturing and trade industries, are linked to an increased risk for ALS, and this adds to a growing literature that recreational activities may also represent important and possibly modifiable risk factors for this disease,” Stephen Goutman, MD, director of the <a href="https://www.umich-als.org/">Pranger ALS Clinic</a> at the University of Michigan and the study&#8217;s first author, said in a <a href="https://www.michiganmedicine.org/health-lab/recreational-activities-such-golfing-gardening-may-be-associated-increased-als-risk-among-men">university press release</a>.
The study, &#8220;<a href="https://www.sciencedirect.com/science/article/abs/pii/S0022510X24000340?dgcid=author">Avocational exposure associations with ALS risk, survival, and phenotype: A Michigan-based case-control study</a>,&#8221; was published in the Journal of Neurological Sciences.
[recommended-reading id=88415]
<h3>Recreational activities tied to increased risk of ALS for men, but not women</h3>
To know more about how recreational activities impact ALS onset, the researchers surveyed 400 people with the neurodegenerative disease, asking about their histories of participation in a wide range of activities.
The scientists also surveyed 287 people without ALS to act as controls. In general, the ALS patients tended to be somewhat older and had less formal education, but otherwise, the two groups were similar in terms of demographics.
Using the survey results, the scientists constructed statistical models to look for activities that, after adjusting for other factors, were significantly more common among ALS patients.
&#8220;We leveraged our detailed exposure questionnaire to determine whether particular hobbies or exercise activities associate with ALS risk,&#8221; the team wrote.
The results identified more than half a dozen recreational activities with a statistically significant link to ALS. Among them were golfing, dancing, gardening or yard work, woodworking, and hunting or shooting.
The researchers then repeated the analysis by sex.
In male patients, many of these activities — and specifically golf, gardening, woodworking, and hunting — were significantly linked with ALS. Swimming and metal work also became significantly associated with ALS in male patients.
But among female patients, no recreational activities were significantly associated with ALS. This suggests &#8220;that the factors influencing ALS may differ between males and females,&#8221; the researchers wrote.
“It is surprising that the risk factors we identified appear to be specific to males,” said Goutman, also the associate director of the <a href="https://medicine.umich.edu/dept/mneuronet/about/als-center-excellence">ALS Center of Excellence at the University of Michigan</a>.
[recommended-reading id=89313]
<h3>Goal is to develop list of factors that could be used to decrease risk</h3>
The statistical models did not show any associations between recreational activities and survival in ALS patients. However, individuals who had participated in swimming or weightlifting tended to be younger when they first developed <a href="https://alsnewstoday.com/symptoms-of-als/">disease symptoms</a>, the researchers noted.
The scientists said that further research will be needed to verify these results and to understand exactly why these associations exist. But the bigger takeaway here, according to the team, is that recreational activities may affect ALS risk, so these activities should be considered in addition to occupation when studying ALS risk factors.
&#8220;Future studies should include these activities to pinpoint how they can be understood in the context of ALS prevention, diagnosis and treatment,” Goutman said.
[quote=&#8221;center&#8221;]Our goal is to understand what occupations and hobbies increase ALS risk because identifying these activities provides the first step towards ALS prevention.[/quote]
The team hopes that better understanding the factors that increase the risk of ALS will pave the way for new strategies to prevent the disease.
Eva Feldman, MD, PhD, a professor at the University of Michigan and the study&#8217;s senior author, said the ultimate goal is to determine any particular activities that may warrant extra vigilance.
“Our goal is to understand what occupations and hobbies increase ALS risk because identifying these activities provides the first step towards ALS prevention,” Feldman said.
“For a disease like Alzheimer’s, we know that a list of factors — including smoking, obesity and high lipids — can increase risk by 40%,&#8221; Feldman added. &#8220;Our goal is to establish a similar list for ALS to create a roadmap to decrease risk. With apologies to Robert Frost, it is currently the ‘road not taken’, and we want to change that.”

Taking part in certain recreational activities may increase risk of ALS

Cigarette smoking, either currently or in the past, significantly increases the likelihood of developing <a href="https://alsnewstoday.com/what-is-als/">amyotrophic lateral sclerosis</a> (ALS), particularly for women, according to a pooled meta-analysis of 32 studies.
A risk of the neurodegenerative condition was higher in current smokers, and it increased in a non-linear manner with more intense smoking — meaning, it rose continuously up to a certain level of smoking, and then stabilized or decreased slightly with additional packs per year.
&#8220;One of our most pivotal findings was the dose-response analysis, revealing an inverted U-shaped curve,&#8221; Yun Hak Kim, a professor at Pusan National University in South Korea and the study&#8217;s senior author, said in a <a href="https://www.prnewswire.com/news-releases/pusan-national-university-researchers-decode-the-link-between-smoking-and-amyotrophic-lateral-sclerosis-risk-302047458.html">university news release</a>. 
&#8220;This curve highlights that the risk associated with smoking isn&#8217;t a linear progression. Instead, it peaks and then starts to decrease or plateau, suggesting that the risk of ALS is influenced by the intensity of smoking,&#8221; Kim added.
[recommended-reading id=89361]
<h3>Cigarette smoking is among reported ALS risk factors</h3>
The study, “<a href="https://www.tobaccoinduceddiseases.org/Association-of-smoking-with-amyotrophic-lateral-sclerosis-A-systematic-review-and,175731,0,2.html">Association of smoking with amyotrophic lateral sclerosis: A systematic review, and meta-analysis, including dose-response analysis</a>,” was published in the journal <a href="https://tobaccoinduceddiseases.biomedcentral.com/">Tobacco Induced Diseases</a>.
ALS is a neurodegenerative disorder that primarily affects the voluntary motor nervous system — the nerves responsible for controlling voluntary movements, such as walking, talking, and swallowing.
Cigarette smoking has been extensively studied as a potential environmental <a href="https://alsnewstoday.com/causes-of-als/">risk factor for ALS</a>. However, while some studies indicate <a href="https://alsnewstoday.com/als-and-smoking/">smoking increases ALS risk</a>, others find <a href="https://alsnewstoday.com/news/smoking-not-seen-to-increase-risk-of-als-uk-study/">no link between tobacco and ALS </a>whatsoever.
A need exists for “a more thorough comprehension of the potential causal link between smoking and ALS,” the scientists wrote.
When faced with conflicting outcomes from different studies, a meta-analysis — the combination of results from multiple separate studies to gain greater statistical power — can help in reaching an overall understanding of the evidence.
Researchers conducted such a meta-analysis on 32 studies, published by scientists worldwide between 1981 and 2022, that investigated a relationship between smoking and ALS.
Four were cohort studies, and 28 were case-controlled. The cohort studies examined the occurrence of ALS in smokers versus nonsmokers. Case-control studies measured the frequency and amount of smoking among those with (cases) and without (controls) ALS, matched by sex and age. Follow-up periods ranged from seven to 28 years.
<h3>25% higher risk for female smokers, after adjusting for age, education, etc.</h3>
After pooling data from all 32 studies, there was a statistically significant 14% increase in the likelihood of ALS among current and past smokers. When the comparison was adjusted for factors that may influence the results, including sex, age, education, and socioeconomic status, the likelihood was still higher, at 12%.
When past smokers were excluded from the calculations, the risk of ALS rose to 28% among current smokers, with and without statistical adjustments.
Looking at patients by sex, researchers found that women smokers faced a 20% increased chance of developing ALS and a 25% higher risk after adjustments. There was no significant relationship between smoking and ALS among men.
&#8220;We have identified a significant association between smoking and ALS in females, while no significant association was observed in males,&#8221; the scientists wrote. This sex difference, they added, might be due to men being &#8220;more exposed to other potential risk factors for ALS, such as pesticides or organic solvents, during their occupational activities.&#8221;
<h3>Being a heavy smoker, up to a certain point, further elevates risk</h3>
Five studies included information on dose-response — the number of cigarettes smoked and odds of ALS — as measured by pack-years. A pack-year describes how many cigarettes have been smoked in a lifetime, with a pack equal to 20 cigarettes. For example, 20 pack-years equals smoking one pack a day for 20 years or two packs a day for 10 years.
Data showed a significant increase in ALS risk with increasing pack-years, which appeared to peak at about 30 pack-years and then declined through 50 pack-years. The team noted that this result might have been influenced by the limited number of higher pack-year studies, with these results mostly attributed to one study.
“Our study showed that there is a positive relationship between smoking and the risk of ALS,” the researchers wrote.
The quality of the selected studies then was assessed with a scale that describes studies as &#8220;good,&#8221; &#8220;fair,&#8221; or &#8220;poor&#8221; based on the selection of study groups, how well these groups can be compared, and how smoking exposure or outcomes were determined.
Among the 28 case-control studies, eight were rated as &#8220;good&#8221; and 20 as &#8220;poor,&#8221; while among cohort studies, two were rated as &#8220;good&#8221; and the other two as &#8220;fair.&#8221; Researchers said the higher &#8220;poor&#8221; rating among case-control studies was because the “assessment of exposure was not based on medical records or blinded interviews, and the response rate was either not mentioned or inconsistent between case and control group.”
There were no signs of publication bias, which occurs when studies with positive findings are more likely to be published.
“Our study provides evidence of a positive relationship between smoking and the risk of ALS,” the team wrote. “To mitigate the risk of developing ALS, discontinuing smoking, which is a modifiable risk factor, may be crucial.”

Cigarette smoking tied to greater risk of ALS, especially for women

Exposure to certain toxic airborne chemicals used in industry significantly increases — by up to six times — the odds of developing <a href="https://alsnewstoday.com/what-is-als/">amyotrophic lateral sclerosis</a> (ALS), a study suggests.
Findings underscore the importance of surveillance programs testing exposure to these airborne pollutants, especially among populations at risk.
The study, “<a href="https://www.sciencedirect.com/science/article/abs/pii/S0013935123025239?via=ihub">Exposure to ambient air toxicants and the risk of amyotrophic lateral sclerosis (ALS): A matched case control study</a>,” was published in the journal <a href="https://www.sciencedirect.com/journal/environmental-research">Environmental Research</a>.
[recommended-reading id=88532]
<h3>Specific chemicals carried on air spotted as possible ALS risk factors</h3>
Almost anyone can be exposed to some level of toxic chemicals, such as heavy metals and pesticides, outdoors, at home, or at work. Besides being breathed in, these chemicals enter the body through foods and water, or be absorbed through the skin.
It is thought that ALS arises from a combination of <a href="https://alsnewstoday.com/causes-of-als/#Genetics_of_ALS">genetic</a> and <a href="https://alsnewstoday.com/causes-of-als/#Environmental_and_lifestyle_factors">environmental factors</a>, and that breathing in airborne <a href="https://alsnewstoday.com/news/bmaa-formaldehyde-other-enviromental-toxins-tied-als-risk/">toxic chemicals</a> may place people at a higher risk of developing the disease.
Researchers in the U.S. set out to add to evidence of this link by comparing exposure to 34 toxic chemicals in 267 people <a href="https://alsnewstoday.com/als-diagnosis/">diagnosed with ALS</a> and, as controls, 267 healthy individuals of the same age and sex who lived in the same county.
Nearly two-thirds of patients (62.6%) were men, and the group&#8217;s average age at diagnosis was 61.4. Most of these patients (84.3%) were diagnosed after 2011.
Data on toxic chemicals came from the U.S. Environmental Protection Agency’s 2011 National Air Toxics Assessment, which provided models of air concentrations that year for about 180 compounds. This was matched to each person&#8217;s ZIP code.
Results showed that exposure to at least one of five compounds was associated with the likelihood of developing ALS, with the 25% of people with the highest levels of exposure being significantly more likely to have the disease than the 25% with the lowest levels.
These compounds were cadmium, a heavy metal used in batteries, solar cells, and pigments; carbon disulfide, used in many industries to make rubber and other materials; 2,4-dinitrotoluene, an aromatic solvent used to produce polyurethane, explosives, and dyes; an organic/chlorinated solvent named vinyl chloride; and cyanide, widely used in steel and chemical industries.
The link between ALS and exposure to these five compounds then was examined, taking into account smoking and education levels, which also are thought to impact ALS risk.
<h3>Cyanide exposure raised risk by 4.3 times, vinyl chloride by 6 times</h3>
A higher exposure to cadmium or carbon disulfide increased the likelihood of developing ALS by about three times, compared with the lowest-exposure group, data showed. In addition, cyanide increased risk by 4.3 times, 2,4-dinitrotoluene by 5.5 times, and vinyl chloride by six times.
&#8220;When examining each compound individually, ALS cases compared to controls were exposed to higher levels of 2,4-dinitrotoluene, vinyl chloride, carbon disulfide, cadmium, and cyanide and this was independently associated with increased ALS risk,&#8221; the researchers wrote.
In contrast, exposure to selenium, another heavy metal, linked with lower odds of developing ALS.  &#8220;But this evidence was relatively weak,&#8221; they noted.
An analysis by chemical groups also tied exposure to higher levels of chlorinated solvents (a class of chemicals used as paint thinners or in dry cleaning) with 2.62 times higher odds of developing ALS, after accounting for smoking and education.
Overall, the study “provides evidence of an increased ALS risk in cases compared to controls for several neurotoxic compounds, underscoring the importance of ongoing surveillance of potential exposures for at-risk populations,” the researchers wrote.
Measuring only 2011 levels of these pollutants to determine ALS risk, particularly in people already diagnosed at that time, was pointed out as a study limitation.
“Future studies with larger sample sizes that are able to link residences over time are warranted to determine if these relationships of ambient toxicants with ALS can be confirmed,” the team concluded.

Five toxic chemicals in air may raise, by 3 to 6 times, risk of ALS

A person&#8217;s degree of exposure to multiple environmental pollutants — reflected by their presence in the blood — may be used to predict <a href="https://alsnewstoday.com/what-is-als/">amyotrophic lateral sclerosis</a> (ALS) risk and survival, according to new research.
Greater exposure to these chemicals was associated with increased odds of an individual developing ALS, as well as a higher mortality risk among ALS patients in Michigan.
“Our results emphasize the importance of understanding the breadth of environmental pollution and its effects on ALS and other diseases,” Eva Feldman, MD, PhD, the study&#8217;s senior author and a professor at the University of Michigan (UM) and its medical school, said in a <a href="https://www.michiganmedicine.org/health-lab/drawing-tube-blood-could-assess-als-risk-environmental-toxin-exposure">university news story</a>.
“When we can assess environmental pollutants using available blood samples, that moves us toward a future where we can assess disease risk and shape prevention strategies,” added Feldman, also the director of the NeuroNetwork for Emerging Therapies at Michigan Medicine.
The study, &#8220;<a href="https://jnnp.bmj.com/content/early/2023/09/27/jnnp-2023-332121">Environmental risk scores of persistent organic pollutants associate with higher ALS risk and shorter survival in a new Michigan case/control cohort</a>,&#8221; was published in the <a href="https://jnnp.bmj.com/">Journal of Neurology, Neurosurgery &amp; Psychiatry</a>.
[recommended-reading id=75053]
<h3>Levels of 24 environmental pollutants found to impact survival in ALS</h3>
ALS is believed to arise from a combination of <a href="https://alsnewstoday.com/causes-of-als/">genetic and environmental risk factors</a>, such as exposure to pesticides, heavy metals, or electromagnetic fields.
The scientists previously found that concentrations of persistent organic pollutants (POPs) were <a href="https://alsnewstoday.com/news/pesticide-exposure-may-als-risk-factor/">higher in the blood of ALS patients</a> compared with the general population. POPs are hazardous chemicals that are widely distributed and live in the environment for a very long time. The most common ones are pesticides or insecticides used for agriculture.
In a follow-up study, the team found that high exposure to these pollutants was associated with <a href="https://alsnewstoday.com/news/exposure-to-environmental-pollution-reduces-survival-rates-of-als-patients-study-reports/">lower survival among ALS patients</a>.
Now, the scientists aimed to validate their findings in a new group of patients, using the information to develop an environmental risk score (ERS) based on these exposures that could predict ALS risk and survival.
The team examined blood levels of 36 different POPs among 164 ALS patients seen at UM&#8217;s Pranger ALS clinic, as well as 105 people from the general Michigan population, who served as controls.
Characteristics between the two groups were similar, except that the ALS patients were older, and had lower educational attainment than the controls. The ALS group also had a higher proportion of men.
Several individual pollutants were significantly associated with ALS. Still, the researchers found that the highest risk of the neurodegenerative disease didn&#8217;t arise from just one of them, but rather a mixture of several. That mixture was used to generate a risk score for predicting the likelihood of ALS.
The results showed that scores in the 75th percentile — the threshold for the highest 25% of exposure — were significantly linked to 2.58 times greater odds of developing ALS compared with patients in the 25th percentile, or the threshold for the lowest 25% of exposure.
“For the first time, we have a means collecting a tube of blood and looking at a person’s risk for ALS based on being exposed to scores of toxins in the environment,” said Stephen Goutman, MD, director of the Pranger Clinic, associate director of the ALS Center of Excellence at UM, and the study&#8217;s first author.
Overall, 24 of 36 POPs were found to have a negative effect on ALS survival. However, survival time was best predicted by taking into account all 36 of the toxins.
Survival ERSs based on exposure to all toxins indicated that greater exposure was associated with shorter survival, as expected.
Particularly, the 25% of patients with the highest exposure had a 2.31 times greater mortality risk than the 25% of those with the lowest exposure — corresponding to a survival benefit of 0.88 years for that group.
[quote=&#8221;center&#8221;]For the first time, we have a means collecting a tube of blood and looking at a person’s risk for ALS based on being exposed to scores of toxins in the environment.[/quote] 
Of the individual POPs, organochlorine pesticides, known as OCPs, were most strongly associated with ALS risk and survival, which the researchers noted is in line with multiple previous analyses. OCPs are a class of pesticides that have been used since the mid-1900&#8217;s for agriculture and mosquito control.
While many previous studies have estimated environmental exposures using geographical location or occupational history, the researchers believe that directly measuring their levels in the blood may be a more accurate and quantifiable way of assessing exposure.
Still, &#8220;replication in other non-Michigan cohorts is beneficial to determine the national and global distribution of this risk,&#8221; the researchers wrote.
The findings also highlight the possible use of ERSs for understanding the impact of environmental pollutants on human disease.
“Environmental risk scores have been robustly associated with other diseases, including cancers, especially when coupled with genetic risk. This is a burgeoning application that should be further studied as we deal with the consequences of pollutants being detected throughout the globe,” Feldman said.

Tag: ALS risk factors

Taking part in certain recreational activities may increase risk of ALS

Cigarette smoking tied to greater risk of ALS, especially for women

Five toxic chemicals in air may raise, by 3 to 6 times, risk of ALS

Environmental pollutants in blood linked to ALS risk, survival