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o rig in l om m un i tions

The Am erican Journa l o f C lin ic a l N u trition 25 : J uNE1972 , pp . 555 558 P rin ted in U .S .A .

55 5

In c idence o f os teopo ros is in vege ta rians

and om n ivo res

Frey R . E llis ,3 M .D ., F .R .C . Pa th o l., Schura H ole sh ,4 M .B .C hB ., F .F .R ., D .M .R .D .,

a nd Joh n W . E llis ,5 B .Sc .

Th is in ve s tiga tio n w as in itia ted b y the hy -

po the s is p ro posed by W achm an and B ern -

s te in 1 th at bo ne d isso lu tio n is co ns id ered

a s a p oss ib le m echan ism to b uffe r th e fix ed

ac id lo ad im posed b y th e ing es tion o f an

acid ash d ie t in m an . If th is hy po the s is is

fe a sib le , on e w ou ld ex pec t to o bserv e a

g rea ter d eg ree o f bo ne d isso lu tion in a d iet

tha t

co n ta ins m ea t a

p rim a ry sou rce o f acid

ash than in a veg eta r ian d ie t.

Var ious stud ies 2 , 3 have show n tha t

the re is an inc rea sed bon e loss w ith ag e; th is

lo ss b eg ins at ap prox im ate ly age 35 to 45 in

w om en and app ro x im a te ly 45 to 65 in m en .

The ra te o f lo ss

is

also g rea te r in fem a le s

than in m a le s.

The d iag nos is o f os teop o ro sis by su b je c tive

stud y of X -rays is in accu ra te u n le ss th e

ch an ge s a re g ro ss. A s a re su lt, va rio us q uan -

titiv e m eth od s h av e been dev ised fo r the

m easu rem en t o f bo ne d ens ity , e .g ., X -ray

and g am m a-ray densitom etry . Th e h an ds a re

u sua lly exam in ed , a s th is is m o re co nven ien t

fo r the sub jec t and th e re is le ss so ft tissue to

a ffect d ensity read in gs. W est and R eed 4 ,

how ev er, h av e fo und th e be s t re su lts by ex -

am ina tion of the fem ur. A no the r m eth od o f

a sse ssing bone den sity is by m easu ring th e

co rtica l th ickn es s an d the to ta l d iam e te r o f

the 2 nd m etaca rp al. T he resu lt is expressed

as co rtica l th ick ness to to ta l th ick ness ratio

becau se th is va lue is a fun ctio n of bo ne den-

sity ra the r than bone m ass and has a m uch

sm a ller s tan da rd dev ia tio n 5 , 6 .

Mater ia ls an d method s

A g roup of tw en ty -five B ritish v eg eta rians ov o-

lac to veg eta rian s , con sis ting of eigh t m a les and

seven teen fem ales w ith an age ran ge o f 53 to 79

yea rs, w a s stu d ied .

A blood sam ple w as taken fo r

la bo rato ry in ve stig atio n.

In th is sho rt p re lim ina ry in ve stig atio n , it

w as

decid ed to

use a s im p le m etho d o f testing bone

dens ity , pa rticu lar ly as th e m ore com plica ted ap-

para tus w as no t av ailab le an d pa tien ts cam e in te r-

m itten tly from various p arts o f the co un try .

T he r ig h t hand w as exam ined in a ll in s tan ces

excep t in tw o p atien ts w ho w ere le ft-h an ded . K odak

casse tte s w ith h igh reso lu tio n sc reens an d rap id

p roc ess film s w ere used . T he X -ray fa cto rs w ere

45 kv , 5 0 to 70 m a, at

58 inch es tube-focus d istance

to avo id as m uch m agn ific atio n as possib le . A

gradu ated a lum inum step-w edge 1 to 8 m m w as

pla ced on each film to ensu re un iform ity of d ens ity .

The processing of all X -rays w as by a 9 0-sec au to -

m atic a pparatu s

A s th e 3rd fin ge r w a s in the cen ter of th e X -ray

film , it w as d ec ided to de te rm ine th e d ensity o f

the cen te r o f the th ird m etacarpa l m edu lla an d the

prox im al pha lanx us in g a B aldw in R ad io lo g ical

D ens itom ete r. T he cen te rs o f these bon es w ere

accura te ly m easured and grea t care w as tak en to

p lace th is area in the cen te r o f th e d en sitom eter

ap er tu re . B ecause o f th e ag e of som e of the pa-

tien ts , the re w as no t a su ffic ien tly c lea r d istinc tio n

b etw een the m edu lla and cortex an d it w as felt

tha t co r tica l m easurem en ts w ould be inaccura te .

A ll the d ensitom ete r read ing s w ere de te rm ined on

the sam e day to ensure un ifo rm ity and accuracy .

T he hem oglob in and w hite ce ll coun t w ere de-

te rm ined on a C oulte r M ode l

5

t he s ed im en ta tio n

ra te b y the m eth od o f W este rgren , a nd the se rum

concen tratio ns of u rea , c ho lestero l, ca lc ium , p hos -

ph ate , an d pro te ins w ere d ete rm ined by sta nda rd

au tom ated labo rato ry te chn iqu es. Th e se rum B 12

w as de te rm ined by the Lac tob ac il u s le ichrnan n ii

F rom the K ings to n H osp ita l, K ing ston-u pon-

T ham es , S urrey , Eng lan d .

S upported by a gran t from th e S ou th W est

M etropo litan R eg iona l H o sp ita l B oard .

C onsu ltan t H aem ato log is t. C onsu ltan t R a-

d io log is t. R esearch A ssistan t.

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6 E L L I S E T L

method 7 and the serum folate by the method of

Chanari n 8 .

A control group of 25 omniv ores, matched for

age 3 years and sex , w ere also studied T able 1 .

Results

I n Table 2, the resul ts of the radiological

and laboratory investigati ons are given as the

mean

sD

of the tw o separate groups. T he

mean of the serum folate and proteins in the

control group w ere determ ined on groups of

21 and 24, respecti vely ; in al l other cases,

the means are for groups of

25 .

The signi f i cance w as determ ined by apply-

i ng a

t

test on the pai red observations and

the level of significance w as taken as

P