American Journal of Epidemiology Vol. 145, No. 9: 842-849
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
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Association of Sauropus androgynus and Bronchiolitis Obliterans Syndrome: A Hospital-based Case-Control Study
1Department of Medical Education and Research, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan, ROC
2Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan, ROC
3Department of Medicine, Veterans General Hospital-Kaohsiung, Kaonsiung, Taiwan, ROC
Reprint requests to Luo-Ping Ger, Department of Medical Education and Research, Veterans General Hospital-Kaohsiung, 386 Ta-Chung 1st Rd, Kaohsiung, Taiwan, ROC.
In late April 1995, an outbreak of a poorly defined respiratory illness related to the ingestion of leaves of Sauropus androgynus was observed in southern Taiwan. To further evaluate the association between S. androgynus and bronchiolitis obliterans syndrome, a hospital-based case-control study was conducted with one case group and three different control groups at Veterans General Hospital-Kaohsiung between April and September 1995. A total of 54 cases (50 females, 4 males), 54 age- and sex- matched neighborhood controls, 54 matched routine physical check-up controls, and 54 matched self-referred patron controls (who had ingested S. androgynus yet without obstructive physiology) were interviewed for clinical symptoms, history of S. androgynus consumption, and potential confounding factors. All 54 cases (100%) ingested S. androgynus compared with only five (9%) neighborhood controls (matched odds ratio (OR) incalculable, p < 0.001) and two (4%) physical check-up controls (matched OR incalculable, p < 0.001). In the univariate analysis of 54 cases and 54 self-referred patron controls, factors associated with an increased risk of bronchiolitis obliterans syndrome were methods of food preparation (uncooked juice vs. stir fried or boiled dishes, matched OR 10.3 (95% confidence interval (Cl) 1.3–84.4)); preparer of the S. androgynus-containing food (vendor only vs. patient only or patient plus vendor, matched OR 2.8 (95% Cl 1.1–7.1)); total S. androgynus consumption quantity (>4, 500 vs. 413–2, 063 g, matched OR 10.0 (95% Cl 1.9–53.0)); duration of consumption (>45 vs. 6–24 days, matched OR 2.1 (95% Cl 1.2–3.8)); and midterm interruption (<2 vs. 2–5 days per week, matched OR 2.6 (95% Cl 1.1–6.1)). Additionally, multiple conditional logistic regression analysis of cases and self-referred patron controls revealed that a larger total amount of S. androgynus consumption, preparation of S. androgynus food without cooking, and ingesting S. androgynus food prepared by a vendor were the significant risk factors associated with bronchiolitis obliterans syndrome. Am J Epidemiol 1997; 145: 842-9.
bronchiolitis obliterans; case-control studies; cookery; diet; food fads; vegetables