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S0091674909X00102_cov200hComplementary and alternative medicines (CAMs) are used in more than 80% of the world’s population and are becoming an increasing component of the US health care system, with more than 70% of the population using CAM at least once and annual spending reaching as much as $34 billion. Since the inception of the National Center for Complementary and Alternative Medicine, there has been an enormous increase in the number of basic science and therapy-based clinical trials exploring CAM.

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A 12-year study that followed over 60,000 Britons, half of whom were vegetarian, suggests that vegetarians had a lower risk of developing cancer than meat-eaters. The results showed that overall, vegetarians were 12 per cent less likely to develop cancer than meat eaters, while fish eaters were 18 per cent less likely (however fish eaters was also a smaller sample and potentially a less reliable statistic).

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Although dietary factors have been extensively studied in many chronic diseases, the role of diet in the epidemiology of rheumatoid arthritis (RA) has received little attention. Fruit and vegetables and dietary antioxidants are thought to play a protective role in the pathogenesis of CVD and some cancers, but few studies have investigated these dietary components in the aetiology of RA.

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Rheumatoid arthritis (RA) is characterized by inflammation of the synovial tissues in the joints. A number of papers related to dietary components that are associated with this inflammation are reviewed. In addition, the ecological approach is used to study the links between diet and RA. Multi-country data for prevalence of RA for females from eight and fifteen countries were compared statistically with components of national dietary supply.

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OBJECTIVE: Many studies have examined the role of diet in the management of established rheumatoid arthritis (RA), warranting several recent reviews. However, none have considered the possible link between diet and the onset of RA in detail. Studies investigated a possible effect of individual components of diet and the development of RA, but the lack of a systematic review means there is no unbiased assessment of the evidence.

METHODS: We systematically reviewed studies with comparison groups that examined dietary intake or biological markers prior to the onset of RA. Four electronic databases were searched to identify relevant reports. Six quality criteria were agreed, against which the studies were assessed. The main outcome measure was a diagnosis of RA according to the ARA 1958 or revised ACR 1987 classification criteria.

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