Reference 10
NUTRITIONAL MEDICINE RESEARCH
UK

Selected sections from
Archives of Neurology
December, 1988; 45: 1350-1353
AMA Journals
 

Case-Control Study of Early Life Dietary Factors in Parkinson's Disease
GOLBE, LAWRENCE I.; FARRELL, TIMOTHY M.; DAVIS, PATRICIA H.
CORPORATE SOURCE: Accepted for publication June 20, 1988. From the Department of Neurology, the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick (Dr Golbe and Mr Farrell); and Department of Neurology, Louisiana State University School of Medicine, Shreveport (Dr Davis). Reprint requests to Department of Neurology, CN-19, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08903 (Dr Golbe).

Studies of the amyotrophic lateral sclerosis parkinsonism dementia complex of Guam direct suspicion to a heat-labile component of vegetables found in greatest concentation in seeds. We therefore surveyed patients with Parkinson's disease (PD) regarding early adult consumption of fruits and vegetables usually eaten raw, with seeds that are swallowed or scraped with the teeth. We administered a pretested questionnaire by telephone to 81 nondemented patients with PD and to a same-sex married sibling without PD. Our data are consistent with the hypothesis that vitamin E, as an antioxidant, may have prophylactic value against PD. The role of long-term dietary habits in the etiopathogenesis of Parkinson's disease (PD) has not been satisfactorily studied. The observation that an exogenous pyridine-derived toxin can produce a state that closely resembles clinical PD stimulated interest in an environmental cause.  For reasons cited above, we confined the inquiry to fruits and vegetables commonly eaten raw with their seeds. On the pretest the following ten items gave insufficiently reliable results: apple juice, blackberries, blueberries, figs, paprika, peanuts, green peppers, pomegranates, sesame seeds, and tomato juice. Seventeen items remained for analysis by the main survey: bananas, blueberries, cherries, cucumbers, grapes, melon, mustard, nuts (other than peanuts), olives, peaches, pears, pickles, plums, raisins, salad oil or dressing, strawberries, and tomatoes.
Although we undertook this survey to test a hypothesis of the cause of PD and chose our questionnaire items accordingly, our technique could as easily reveal PD-protective factors. Indeed, many case-control surveys deliberately include some items suspected of causing the condition in question and some items suspected of protecting against it. Dietary histories obtained over the telephone have been used in other case-control studies of neurologic disorders. Thus, the quality of the data in this study should suffice to detect major differences between the patients and the control group. Previous analytical epidemiologic studies of PD have suggested that rural living, well water use, and proximity to pulp mills and vegetable farms are associated with the presence of PD whereas cigarette smoking is associated with its absence.
A more hopeful explanation for the parkinsonian patients' premorbid hypoconsumption of nuts, plums, and salad oil is the relatively high vitamin E content of these foods. The US recommended daily allowance of vitamin E is 10 mg for men and 8 mg for women. The average American daily intake of alpha-tocopherol is 4 to 9 mg.
Furthermore, young onset may signal a more intense exposure to a causative agent (and/or more complete nonexposure to a protective agent) that may be more easily detected with epidemiologic techniques. Since there are relatively few young-onset patients at any one center, a multicenter study or a mail survey may be necessary to adequately address the question of PD-prophylaxis by vitamin E in retrospective fashion.

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