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recently, adolescent obesity has been added to this list Less established factors include exposure to organic solvents and night shift work, which associate with increased risk, whereas oral tobacco use, cytomegalovirus infection, alcohol use and coffee consumption associate with decreased risk Some of these factors should be considered in primary prevention Most lifestyle and environmental factors seem to have the greatest effect during a particular time window adolescence Certain factors, such as EBV infection, smoking and adolescent obesity interact with human leukocyte antigen MS risk genes, with substantial risk increases in individuals who carry genes that predispose them to MS The interaction with these immune response genes provides strong evidence that these lifestyle and environmental factors act on adaptive immunity, leading to autoimmune attack on the nervous system Abstract Genetic predisposition to multiple sclerosis (MS) only explains a fraction of the disease risk