Divergent risk of multiple sclerosis in two anabaptist communities in America☆

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Summary

A lowered risk of multiple sclerosis (MS) has been reported in the Hutterite community residing mainly in southern Canada. In another anabaptist community, the Old Colony Mennonites (OCM), settled in Canada and spread to Latin America, only a large pedigree with an increased risk of autoimmune diseases, including type I diabetes and three cases of MS, was reported. The prevalence of MS in the pedigree (3,158 per 100,000), even when observing its confidence interval, seems rather high, and the MS prevalence in the Mennonite general population is assumed at least to be equal to the Canadian rates. Based upon an extended study of the literature, the hypothesis that smoking and curing with nitrate/nitrite plays any role, by interaction with inflammatory intestinal changes in childhood infections, is supported. In addition, tobacco smoking and short-term breast-feeding as possible risk factors are also in line with a higher MS risk in OCM, whereas insecticides and herbicides can be excluded as risk factors in MS.

Section snippets

MS in anabaptist Hutterites and Old Colony Mennonites (OCM)

In spite of numerous epidemiological, genetical and virological studies, the aetiology of multiple sclerosis (MS) is still unknown. Thus the disease pattern in selected populations may give important clues. The prevalence of MS is decreased to about one third of the Canadian rates in a protestant anabaptist community, the Schmiedeleut Hutterites in Southern Manitoba, Canada [1]. In Saskatchewan, Canada, Hutterites, which belong to the more conservative Dariusleut and Lehrerleut [2], the risk

Short history of the Hutterites and OCM

Both communities have their origin in the early time of reformation in the first half of the 16th century [19], [20], but their regional descent differs: the Hutterites mainly originated from Austria and Southern Germany, and moved, after a liberal and flowering period in Moravia, to Transylvania and, later on, to Valachia in Romania [19], whereas the OCM came from the Netherlands and Northern Germany and migrated, in the 16th century, to the Vistula Delta in Prussia [20]. During the reign of

Common lifestyle factors

Beside practising baptism of the adult, both communities share a strong scepticism to the modern way of life, which is also reflected by their antiquated languages (an old Carinthian dialect with many eastern-European loan-words among the Hutterites [21], and a Low-German language [Plautdeutsch;22] among the OCM, respectively), and their traditional dress. A high degree of endogamy, a low basic school system (but still lower in OCM), and agricultural activity as subsistence activity are also

Genes

A genetic contribution to the disease among OCM, which is lacking among Hutterites, might play a role. A genetic study revealed, for both communities, a drift in divergent directions from the genes in the rather closely accumulated central European populations [23]. HLA-DR4 is common in the OCM pedigree [15], but occurs in only 22.8% in males and 18.0% in females in the Schmiedeleut Hutterites (i.e. one of the three sections, mainly living in Manitoba and South Dakota), whereas the haplotype

Conclusions

Epidemiological studies on MS are urgently needed in OCM. The industrialisation of agriculture, including the use of fertilisers and insecticides, can be excluded in the aetiology of MS, because it is heavy in Hutterites. Besides the hypothesis that a low frequency of certain infections might protect the Hutterites from MS [14], the heavy use of pork produce (in comparison to poultry), and its preservation by smoking and curing with nitrate/nitrite in OCM are supported as possible risk factors

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    ☆

    The study was funded, until November 1998, by Gemeinnützige Hertie Stiftung, Frankfurt am Main, Germany.

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