Rainer Frentzel-Beyme

Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies

We combined data from 5 prospective studies to compare the death rates from common diseases of vegetarians with those of nonvegetarians with similar lifestyles. A summary of these results was reported previously; we report here more details of the findings. Data for 76172 men and women were available. Vegetarians were those who did not eat any meat or fish (n = 27808). Death rate ratios at ages 16-89 y were calculated by Poisson regression and all results were adjusted for age, sex, and smoking status. A random-effects model was used to calculate pooled estimates of effect for all studies combined. There were 8330 deaths after a mean of 10.6 y of follow-up. Mortality from ischemic heart disease was 24% lower in vegetarians than in nonvegetarians (death rate ratio: 0.76; 95% CI: 0.62, 0.94; P<0.01). The lower mortality from ischemic heart disease among vegetarians was greater at younger ages and was restricted to those who had followed their current diet for >5 y. Further categorization of diets showed that, in comparison with regular meat eaters, mortality from ischemic heart disease was 20% lower in occasional meat eaters, 34% lower in people who ate fish but not meat, 34% lower in lactoovovegetarians, and 26% lower in vegans. There were no significant differences between vegetarians and nonvegetarians in mortality from cerebrovascular disease, stomach cancer, colorectal cancer, lung cancer, breast cancer, prostate cancer, or all other causes combined.

Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies

OBJECTIVE To compare the mortality rates of vegetarians and non-vegetarians. DESIGN Collaborative analysis using original data from five prospective studies. Death rate ratios for vegetarians compared to non-vegetarians were calculated for ischaemic heart disease, cerebrovascular disease, cancers of the stomach, large bowel, lung, breast and prostate, and for all causes of death. All results were adjusted for age, sex and smoking. A random effects model was used to calculate pooled estimates of effect for all studies combined. SETTING USA, UK and Germany. SUBJECTS 76,172 men and women aged 16-89 years at recruitment. Vegetarians were those who did not eat any meat or fish (n = 27,808). Non-vegetarians were from a similar background to the vegetarians within each study. RESULTS After a mean of 10.6 years of follow-up there were 8330 deaths before the age of 90 years, including 2264 deaths from ischaemic heart disease. In comparison with non-vegetarians, vegetarians had a 24% reduction in mortality from ischaemic heart disease (death rate ratio 0.76, 95% CI 0.62-0.94). The reduction in mortality among vegetarians varied significantly with age at death: rate ratios for vegetarians compared to non-vegetarians were 0.55 (95% CI 0.35-0.85), 0.69 (95% CI 0.53-0.90) and 0.92 (95% CI 0.73-1.16) for deaths from ischaemic heart disease at ages <65, 65-79 and 80-89 years, respectively. When the non-vegetarians were divided into regular meat eaters (who ate meat at least once a week) and semi-vegetarians (who ate fish only or ate meat less than once a week), the ischaemic heart disease death rate ratios compared to regular meat eaters were 0.78 (95% CI 0.68-0.89) in semi-vegetarians and 0.66 (95% CI 0.53-0.83) in vegetarians (test for trend P< 0.001). There were no significant differences between vegetarians and non-vegetarians in mortality from the other causes of death examined. CONCLUSION Vegetarians have a lower risk of dying from ischaemic heart disease than non-vegetarians.

Mortality Pattern of German Vegetarians after 11 Years of Follow-up

A cohort of 1,904 vegetarians and persons leading a health-conscious life-style in the Federal Republic of Germany was identified in 1978. After a follow-up of 11 years, mortality from from all causes was reduced by one-half compared with the general population [the standardized mortality ratio (SMR) 0.44 for men, 0.53 for women]. Among the 858 men, 111 deaths were observed, with 255 expected; among the 1,046 women, 114 deaths were observed, with 215 expected. The lowest mortality was found for cardiovascular diseases (SMR = 0.39 for men, 0.46 for women); in particular, for ischemic heart diseases, mortality was reduced to one-third of that expected. Cancer mortality was reduced by one-half in men (SMR = 0.48), but only by one-quarter in women (SMR = 0.74). The deficit in cancer deaths was mainly observed for lung cancer and gastrointestinal cancers in males and for gastrointestinal cancers in females. Deaths from diseases of the respiratory and digestive systems were also reduced by about 50%. An excess of deaths occurred only for anemia. When the strict and the moderate vegetarians were analyzed separately, the strongest differential was found for ischemic heart diseases, which were much less frequent among strict vegetarians for both sexes. Some nondietary factors, such as higher socioeconomic status, virtual absence of smoking, and lower body mass index, may also have contributed to the lower mortality of the study participants. (Epidemiology 1992;3:395–401)

Vegetarian diets and colon cancer: the German experience.

The study assessed mortality and morbidity risks as related to nutritional status of moderate and strict vegetarians in Germany. The total cohort of 1904 self-identified persons was followed up for 11 y. Compared with national mortality rates for Federal Republic of Germany, the observed deaths for all causes were below expectation by a factor of 0.44 for men and 0.53 for women. The mortality for colon cancer was reduced [standardized mortality ration (SMR 44.1 for men and 77.9 for women]. No deaths were observed from rectal cancer. A vegetarian lifestyle of long duration (> or = 20 y) was associated with decreased overall and cancer mortality. Other determinants of decreased cause-specific mortality were physical activity, body weight, and strictness of adherence to the life-style. The relationship between a vegetarian and fiber-rich diet and a decreased risk for colon cancer has been reported in many studies. In this study, the influence of other factors such as health-conscious behavior and a healthy lifestyle seem to indicate partly stronger effects than nutrition itself. This may explain the generally better health of moderate vegetarians.

Mortality of Short-term Workers in Two International Cohorts

The purpose of this study was to compare the pattern of mortality of blue-collar workers employed less and more than 1 year in the man-made vitreous fiber (MMVF) and the reinforced plastic industries, the latter group being exposed to styrene. We conducted an analysis among 21,784 workers with less than 1 year of employment (short-term workers) and 19,117 workers with 1 or more years of employment (long-term workers) employed in eight European countries. We conducted analyses based on external as well as internal comparisons. In both cohorts, the standardized mortality ratio for all causes among short-term workers was approximately 40% higher, compared with that for longer-term workers. In internal comparisons, the difference was reduced to 9% in the MMVF cohort and 11% in the styrene cohort. Workers with less than 1 month of employment displayed an increased mortality in both cohorts and in most countries. The increased mortality among short-term workers was not concentrated shortly after they quit employment. In both cohorts, short-term workers had a higher mortality from external causes, while little difference was seen in mortality from ischemic heart disease and malignant neoplasms. Although extra-occupational factors may contribute to increase the mortality of short-term workers and, in particular, of those employed for less than 1 month, the difference observed in analyses adjusted for characteristics of employment suggested a relatively small difference in mortality from most causes.

Regional nutritional pattern and cancer mortality in the federal republic of Germany

Regional age-adjusted mortality rates of the Federal Republic of Germany from 1976 to 1980 were correlated with regional nutritional data from a national survey on income and consumption. This survey was conducted in 1973 and covered a sample of 50,000 households. The mortality rates due to carcinomas of the stomach, colon, rectum, liver, gallbladder, pancreas, breast, and prostate and the consumption data of 15 nutrients and other compounds are shown for the 11 Federal States. For alcohol, vitamin C and calcium variations range about 20%, whereas deviations in the consumption of protein, fat, and most carbohydrates appear of minor importance. Some of the 45 correlation coefficients significant at the 5% level (out of 210) may have etiologic importance. The associations that coincide in both sexes are alcohol and disaccharide consumption with stomach cancer and protein intake with pancreatic cancer. Because previous habits and consumption may have a stronger etiologic influence than do present ones in the induction of chronic diseases, the utilization of existing information from the 1930s (e.g., Atlas of Ethnic Studies) and the assessment of habits in previous decades by means of case-control studies are emphasized.

REGIONAL RISK FACTORS FOR STOMACH CANCER IN THE FRG

A multicentric, hospital-based, case-control study was conducted in high- and low-risk areas for stomach cancer in the Federal Republic of Germany, by which means a low intake of dietary vitamin C (relative risk [RR] = 2.32, 95% confidence interval [CI] 1.22-4.43 for lowest against highest quintile), noncentralized water supply (RR = 2.17, CI 1.14-4.13 against central water supply), refrigerator use for less than 25 years (RR = 1.33, CI 0.82-2.15 against more than 30 years), and the use of spruce for smoking meat at home (RR = 3.33, CI 1.56-7.12 against not smoking meat at home), were identified as factors potentially causally related to stomach cancer occurrence. The attributable risk for gastric carcinoma among the population (AR) was 37.5% for low vitamin C intake, 37.2% for noncentralized water supply, 10.6% for late refrigerator use, and 4.15% for use of spruce for smoking meat at home in this analysis. The overall ARp amounted to 68.3%. These personally linked factors also showed a strong regional distribution, in that the low-risk area had more favorable categories of exposure. Traditional nutritional habits around 1910 were recorded during a survey by ethnologists in 1965. This material was used to contrast those in high and low stomach cancer risk areas with the habits in the south of Germany in general. Vegetable use was most common in the low-risk area, whereas mashed potatoes, cabbage, and farinaceous dishes dominated in the high-risk area. Tomatoes were introduced several years later into the high-risk area, both in terms of consumption and cultivation.(ABSTRACT TRUNCATED AT 250 WORDS)

Validity of cause of death statements from relatives

SummaryIn countries where death certificates are inaccessible for various reasons, cause of death statements made by relatives may gain greater importance. The validity of the cause of death of a deceased family member as stated by relatives compared to the underlying cause as stated on the death certificate has been examined in 310 cases. The sensitivity and the rate of confirmation are highest for neoplasms (both 89.6%). For cardiovascular diseases, the sensitivity (70%) is lower than the rate of confirmation (90%), indicating a certain amount of underreporting. The sensitivity is found to be lowest (50%) for diseases of the respiratory system. Violent deaths, on the other hand, were detected in 93.7%, although confirmed for only 75%. Closer relatives were able to report the cause of death more accurately. The time elapsed since the death of the family member, however, did not affect the recall of the relative. The concrete additional information from relatives, especially for cancer cases, is recommended in the absence of other data sources.

Morbus Hodgkin (Lymphogranulomatose)

Uber die Epidemiologie der Lymphogranulomatose (M. Hodgkin) ist, gemessen an ihrer Haufigkeit und gesundheitspolitischen Bedeutung, verhaltnismasig viel bekannt [99]. Die hochsten Inzidenzraten sind in der Schweiz (4.7 fur Manner und 3.7 fur Frauen in Vaud), die niedrigsten in Japan mit 0.6 und 0.3 zu finden. Im europaischen Vergleich sind in Sudeuropa hohe Raten (Italien 4.0 bzw. 2.1, Spanien 4.5 bzw. 2.5), in Osteuropa (mit 1.6 fur Manner in Ungarn und 1.0 fur Frauen in Rumanien) niedrige Raten zu verzeichnen. Die Bundesrepublik liegt mit 3.0 in Hamburg und 2.3 im Saarland fur Manner, sowie 1.7 fur Frauen in beiden Registern im Bereich mittlerer Haufigkeiten.

Neuropsychological Effects of Chronic Exposure to Environmental Dioxins and Furans1

The environmental contamination by dioxins and furans (PCDD/PCDF) of a local area in southwest Germany due to pyrolytic processes led to a survey of health consequences in the exposed population. 2, 3, 7, 8-TCDD (8000 ng/kg TE (ppt)) was found in the soil and up to 585000 ng/kg TE in attic dust in private homes. In a randomized study group of definitively exposed persons, a neuropsychological test battery was applied and its value as a diagnostic tool investigated. A total group of 19 persons participated in a standard neuropsychological examination including common procedures to evaluate mnestic and attentional performance and psychomotor speed (e.g., WAIS, WMS-R, TMT, and symptom and mood checklists). The range of PCDD/PCDF between 16 and 80 (mean 31) ppt did not vary substantially from blood fat values in a national sample. Results of neuropsychological testing showed only slight deviations from the expected range. Nevertheless, in a high-level exposure group, a reduction of verbal conceptualization, mnestic organization of verbal and visual stimuli, and psychomotor slowing was found. Among other correlations visual exploration speed (TMT) was most directly related to TE. Affective symptoms (such as irritability and emotional instability) were also related to exposure. Results indicate that standard neuropsychological testing can be recommended for the routine evaluation of chronic dioxin exposure.