Similarities and differences between the epidemiology and possible dietary causes of coronary arterial disease and strokes

The findings of a previous statistical study of the relationship between food consumption and mortality from coronary arterial disease are compared with those of a new study of food consumption and cerebrovascular disease. The previous study found strong positive correlation between male mortality from coronary arterial disease and the consumption of two food items, milk and oats. Stroke mortality appears to be linked with the consumption of a wide variety of proteinaceous plants. These can be divided into two groups, one with an apparently strong and the other with an apparently mild effect. The strong group consists of the protein content of pulses, oats, maize and rye, the milder group of the protein content of wheat, rice, barley, potatoes and vegetables. The relative effect of the two groups of proteins is of the order of 6/1, but the proteins with a relatively mild effect are consumed in large quantities in comparison with those having a strong effect so that their effect is not negligible. The correlation coefficient between male cerebrovascular mortality in the younger age groups and the combined consumption of the two groups of plant proteins is 0.91. That between male mortality from coronary arterial disease and the consumption of milk and oats found in the previous study was 0.94.

Idiopathic sclerosing encapsulating peritonitis

Sclerosing encapsulating peritonitis (SEP) was diagnosed in two men, one middle-aged woman, and a prepubertal girl, none of whom had been treated with beta-blockers, peritoneal dialysis, or peritoneal shunting. Idiopathic SEP has hitherto been reported mainly in adolescent females. It is hypothesised that in these patients, who were from two adjacent districts of Rajasthan, an aetiological factor was consumption of cereals infected with fungus that contained biologically active amines.

[Contact eczematous dermatitis caused by wheat and oats]

A 58-year old male patient was affected by a chronic dermatitis of the hands, forearms and face. Lesions appeared six months before when he started to work as a pizza-maker and worsened when he touched wheat-fluor and when he washed with an oats-derived detergent. He had a familial but not a personal history of atopic diseases. Both the Prick tests and RAST with oats and wheat flour produced positive responses. Protein contact dermatitis is a rare allergic disease caused by the contact with protein substances. It is often seen in patients working in the food industries or in the kitchens. Many of them have no other signs of atopy.

Antithyroid and goitrogenic effects of millet: role of C-glycosylflavones

Pearl millet [Pennisetum millet (L.) leeke] is the main source of food energy for the rural poor in many areas of the semiarid tropics. Epidemiological evidence suggests that millet may play a role in the genesis of endemic goiter in these areas, and sparse experimental data in rats support this suspicion. This study was undertaken to determine in vivo in rats and in vitro using porcine thyroid slices and a thyroid peroxidase (TPO) assay the goitrogenic and antithyroid effects of millet diets, extracts of millet, and certain pure compounds contained therein. For use in these studies, whole grain millet was progressively dehulled to yield successively four bran and four flour fractions in which direct analyses revealed progressively lower concentrations of C-glycosylflavones. In vivo feeding of bran fraction 1, that richest in C-glycosylflavones, led to a significant increase in thyroid weight and antithyroid effects. Feeding of bran fraction 2, the next richest in C-glycosylflavones, produced similar, but less marked, changes. In vitro studies of 125I metabolism using porcine thyroid slices indicated that extracts of bran fractions 1 and 2 were most potent, producing changes similar to those produced by methimazole (MMI). At a concentration of 60 mumol/L, glucosylvitexin, the major C-glycosylflavone present in millet, had effects comparable to those of 1 mumol/L MMI. Similarly, in studies of porcine TPO, extracts of bran fraction 1 caused pronounced (85%) inhibition of enzyme activity, and progressively less inhibition was induced by extracts of bran fractions 2, 3, and 4. Overall, the TPO-inhibiting activities of the various millet fractions closely correlated with their C-glycosylflavone concentrations. Three C-glycosylflavones present concentrations. Three C-glycosylflavones present in millet, glucosylvitexin, glycosylorientin, and vitexin, also inhibited TPO activity. Thus, in vivo and in vitro studies revealed that millet diets rich in C-glycosylflavones produce goitrogenic and antithyroid effects similar to those of certain other antithyroid agents and small doses of MMI. We conclude that in areas of iodine deficiency in which millet is a major component of the diet, its ingestion may contribute to the genesis of endemic goiter.

Chronic respiratory disorders related to farming and exposure to grain dust in a rural adult community

In a survey of chronic respiratory symptoms and airflow obstruction of a rural population aged 20-65 years, the effects of both farming and, in particular, the exposure to grain dust on the respiratory health of the people was examined. Of the 1,892 subjects (82% of the eligible population) studied, 924 were males and 968 females, with half living in the town. Three groups were identified: current, former, and never farmers. Almost all current farmers were exposed to grain for, on average, 2 months a year. There was no difference in atopic status between the groups. While there was a strong association between most symptoms and smoking, there was no association between symptoms and exposure to grain and farming category once age and smoking had been taken into account. Results of this study suggest that farmers do not have chronic respiratory symptoms or impairment of lung function because of their exposure to grain dust. Lung function of former farmers might have been affected by farming, and this may reflect more involvement with livestock in the past.

Kleingrass-associated hepatotoxicosis in horses

Chronic hepatic disease was diagnosed in 6 horses with history of anorexia and weight loss. These horses consistently had abnormally high serum gamma-glutamyltransferase activities, total and direct bilirubin and blood ammonia values, and sulfobromophthalein clearance times, whereas serum iditol dehydrogenase, aspartate transaminase, and alkaline phosphatase activities were variable. In the 6 horses, histologic examination of the liver revealed lesions of chronic hepatitis with varying degrees of fibrosis. All 6 horses had ingested kleingrass (Panicum coloratum) for variable periods. Three healthy horses fed kleingrass hay for 90 days developed hepatic lesions and increases in serum gamma-glutamyltransferase activities similar to those in the 6 horses with chronic hepatitis. Characteristic hepatic lesions in both groups of horses included bridging hepatic fibrosis, cholangitis, and hepatocellular regeneration.

Hypersensitivity to wheat flour in bakers

Eleven bakers and 4 pastry cooks with hypersensitivity to wheat flour underwent skin tests to flours (wheat, barley, rye, oats), pollens (wheat, barley, rye, oats, grasses), mites (dermatophagoides pteronyssinus, dermatophagoides farinae), molds (alternaria, aspergillus) and weeds (parietaria judaica). The levels of serum immunoglobulins (IgG, IgA, IgM and IgE) were studied and the values of specific IgE (RAST) in the presence of wheat flour and the histamine release test for wheat flour, grass pollens, mites, molds and weeds were assessed. All the patients underwent a nasal challenge test to wheat flour. The results demonstrated the existence of cross reactions between the extracts of barley and rye flour with wheat flour (15/15) as well as between the pollens of cereals and cereal flours. The levels of specific IgE (PRU greater than .35) and the percentages of histamine release (greater than 10%) were positive in 14/15 cases. The nasal challenge test was positive for all the 15 patients under study. Of the patients studied, 11 received immunotherapy for periods ranging from 12 to 18 months. Of these patients, 9/11 continued working in the same occupation whereas the 2 who left their jobs in the industry corresponded to the cases of severe asthma which were polysensitized (flour, mites, molds).

Diet and coronary arterial disease: a statistical study

Statistical analysis comparing mortality rates from coronary arterial disease with food consumption in 21 countries belonging to the Organisation of Economic Cooperation and Development is presented. In a preliminary process correlation coefficients are calculated for coronary mortality and all food items appearing in statistics collected for food consumption as well as for some combinations of food items. The highest correlations obtain with oats, milk proteins (other than the protein content of cheese), milk fats and sugar. These items are investigated in greater detail with respect to mortality from coronary arterial disease in males and females in various age groups and for various time intervals between the dates of mortality and statistics for food consumption. Correlations tend to increase in the older age groups and with longer time intervals. The highest correlation coefficient found is 0.94 for deaths due to coronary arterial disease for males in the 65-74 age group with the combined consumption of oats and milk proteins.

Farm animal feeders: another group affected by cereal flour asthma

Asthma induced by cereal flour is a long recognized entity. We present studies of three patients affected by asthma related to exposure to cereal flour contained in animal formula feeds. Skin prick test performed with the formula feed components showed positive reactions to cereal flours (wheat, rye and barley) and negative to the other substances in these formulas. Specific anti-wheat, rye and barley flour IgE antibodies were found by RAST. Bronchial provocation tests (BPT) with wheat flour (patients 1 and 2) and barley flour (patient 3) all showed immediate responses. These findings suggest that our patients' symptoms were caused by an IgE-mediated hypersensitivity to cereal flours from animal formula feeds. We call attention to the importance of cereal flours in animal formula feeds as a cause of occupational asthma in farm and animal feeders.

Does seasonal employment in grain elevators increase nonspecific airways responsiveness?

Grain handling and increased airways responsiveness (AR) have been independently associated with an accelerated decline in forced expiratory volume in 1 sec. We performed methacholine inhalation bronchial challenge tests in 45 river port grain handlers during layoff and again during employment to determine whether short-term exposure increased AR. To assess bias, due to seasonal/temporal influences, AR was also measured in 56 nonexposed men of similar age and socioeconomic status. AR, slightly higher among laid-off grain handlers than the comparison group, fell more among grain handlers during employment than among the comparison group during the same time period. Our results do not support the hypothesis that seasonal exposure to grain dust increases AR.

Food allergens: structure and immunologic properties

Few of the food allergens have been purified and characterized. Complex mixtures of allergens seem to exist in some commonly allergenic foods. Much further research will be necessary to develop any detailed understanding of the chemistry of food allergens.

Renal lesions in cattle fed sodium hydroxide-treated barley

Ten 14-week-old calves were fed a diet containing 87.5% NaOH-treated barley, and killed after 29, 65, 75, 117, 140, 179, 314, 338, and 408 days. Eight control calves were fed a diet in which untreated rolled barley was substituted for alkali-treated grain. Calves receiving NaOH-treated barley became polyuric with urine pH ranging from 9.0 to 9.5, and had significantly raised plasma creatinine levels on day 29. Other clinical findings were normal, and there were no other significant alterations in blood. At necropsy, bilateral renal lesions consisted of white cortical foci, medullary stippling, and the presence of uroliths in the renal papillae and calyces. Microscopic changes included tubular dilatation, atrophy, necrosis, and mineralization, interstitial fibrosis with mononuclear cell invasion and consequent glomerular changes. It appeared that glomerular and interstitial changes were secondary to primary tubular damage. No abnormalities were detected in control calves. Feeding of NaOH-treated barley can result in nephrotoxicosis in cattle.

An analysis of cereals that react with serum antibodies in patients with coeliac disease

Sera from six children with active coeliac disease, and elevated titres against gliadins and from six age-matched controls, were examined for IgG antibodies against different cereal proteins by a solid-phase radioimmunoassay. Antibodies to the major wheat proteins and the prolamines of other cereals were present in low titre in all control sera. In coeliac sera, significantly higher titres were found against A-gliadin, as well as against hexaploid and tetraploid wheat whole gliadins. Gliadin peptic-tryptic digest retained a significant antigenic activity, completely lost by peptic-tryptic-pancreatic digest. High titres were also found when coeliac sera were tested against wheat glutenins, albumins, and globulins, as well as against barley, oats, and maize prolamines; rice prolamines gave lower titres. Serum from whole gliadins and A-gliadin immunized rabbits showed a similar spectrum of reactivity against prolamines as coeliac sera. Our results indicate a dissociation between immunogenic properties of cereal proteins and toxicity in coeliac disease.

Respiratory and allergic disorders in workers exposed to grain and flour dusts

Symptoms suggestive of chronic bronchitis or chronic productive cough were found in 29.0% of 100 workers exposed to flour dust in a flour mill, 26.0% presenting with chronic cough and 29.0% with phlegm. In the control group, the prevalence of chronic cough and phlegm was only 6.6% in each category. While 22.0% of the workers complained of chest tightness on exposure, and 18.0% developed symptoms and signs of bronchial asthma, only 3.3% of the controls complained of chest tightness and 3.3% of asthma. Respiratory measurements before and after the working shift showed a significant drop (p less than .001) in the forced expiratory volume in 1 sec (FEV1.0) and forced vital capacity (FVC) in the exposed group. Fifty-eight percent of the exposed workers experienced a drop in FEV1.0 and FVC measurements. A positive skin reaction to wheat flour extract was recorded among 31% of the exposed workers vs. 10% of the controls. The prevalence of other associated allergic symptoms was 17.0% and 19.0% for sinusitis and conjunctivitis, respectively; in the unexposed group, the prevalence of the same symptoms ranged between 3.3% and 6.6%. A strong association was revealed between exposure to grain and flour dusts and the prevalence of respiratory and allergic disorders.

Symptoms and longitudinal changes in lung function in young seasonal grain handlers

A total of 119 seasonal grain handlers (mean age 23) were assessed before and towards the end (mean work period 18 days) of the 1983 Western Australian grain harvest to determine if respiratory symptoms that occur with exposure to grain dust are associated with changes in ventilatory capacity or non-specific bronchial reactivity to methacholine. Eighteen per cent of subjects had wheeze, breathlessness, or chest tightness and 18% had cough or sputum production at work. Subjects complaining of wheeze, chest tightness, or breathlessness at work had a significantly greater decline in FEV1 than subjects who did not experience these symptoms (p less than 0.05). Symptoms were not associated with changes in bronchial reactivity. In young grain handlers who develop respiratory symptoms on short term exposure to grain dust changes in FEV1 but not in non-specific bronchial reactivity have been demonstrated.

Separation of mycotoxin-containing sources in grain dust and determination of their mycotoxin potential

Two distinct reservoirs of mycotoxins exist in fungal-infected cereal grains--the fungal spores and the spore-free mycelium-substrate matrix. Many fungal spores are of respirable size and the mycelium-substrate matrix can be pulverized to form particles of respirable size during routine handling of grain. In order to determine the contribution of each source to the level of mycotoxin contamination of dust, we developed techniques to harvest and separate mycelium-substrate matrices from spores of fungi. Conventional quantitative chromatographic analyses of separated materials indicated that aflatoxin from Aspergillus parasiticus, norsolorinic acid from a mutant of A. parasiticus, and secalonic acid D from Penicillium oxalicum were concentrated in the mycelium-substrate matrices and not in the spores. In contrast, spores of Aspergillus niger and Aspergillus fumigatus contained significant concentrations of aurasperone C and fumigaclavine C, respectively; only negligible amounts of the toxins were detected in the mycelium-substrate matrices of these two fungi.

Toxicity of mycotoxins for the rat pulmonary macrophage in vitro

The presence of mycotoxins in grains is well documented. Workers in grain handling occupations are commonly exposed to grain dust aerosols. Work in our laboratory has shown that T-2 toxin is highly toxic to rat alveolar macrophages in vitro, causing loss of viability, release of radiolabeled chromium, inhibition of macromolecular synthesis, inhibition of phagocytosis, and inhibition of macrophage activation. Similarly, patulin caused a significant release of radiolabeled chromium, decrease in ATP levels, significant inhibition of protein and RNA synthesis, and inhibition of phagocytosis. The data show that both T-2 toxin and patulin are highly toxic to rat alveolar macrophages in vitro. The data further suggest that the presence of these mycotoxins in airborne respirable dust might present a hazard to exposed workers.

Prevalence of IgE antibodies to grain and grain dust in grain elevator workers

IgE-mediated allergic reactions have been postulated to contribute to respiratory reactions seen in workers exposed to grain dusts. In an attempt better to define the prevalence of IgE antibodies in workers exposed to grain dusts, we performed the radioallergosorbent test (RAST) on worker sera using both commercial allergens prepared from grain and worksite allergens prepared from grain dust samples collected at the worksite. We found that the two types of reagents identified different populations with respect to the specificity of IgE antibodies present. The RAST assay performed using worksite allergens correlated well with skin test procedures. These results may allow us to gain better understanding of allergy associated with grain dust exposure, and document the utility of the RAST assay in assessment of occupational allergies.

Methanol extract of grain dust shows complement fixing activity and other characteristics similar to tannic acid

We have found several similarities between tannic acid and grain dust extract prepared with methanol. Both formed a precipitate with IgG, and these interactions were inhibited by albumin. In addition, both preparations fixed complement; this activity was heat stable and was removed by prior adsorption of the preparations with hide powder. Adsorption with polyvinyl polypyrrolidone reduced the complement-fixing activity of tannic acid but not that of the methanol grain dust extract. The similarities between tannic acid and the methanol grain dust extract are consistent with the presence of a tannin or tanninlike material in grain dust.

Acute symptoms following exposure to grain dust in farming

History of acute symptoms (cough, wheezing, shortness of breath, fever, stuffy nose, and skin itching/rash) following exposure to grain dust was obtained from 661 male and 535 female current and former farmers. These symptoms were relatively common: 60% of male and 25% of female farmers reported at least one such symptom on exposure to grain dust. Association of cough, wheezing, shortness of breath, and stuffy nose with skin reactivity and capacity to form IgE is consistent with an allergic nature of these symptoms. Barley and oats dust were perceived as dust most often producing symptoms. On the other hand, grain fever showed a different pattern, i.e., it was not associated with either skin reactivity or total IgE. Smoking might modify the susceptibility to react to grain dust with symptoms. Only those who reported wheezing on exposure to grain dust may have an increased risk to develop chronic airflow obstruction.