European Journal of Epidemiology

, Volume 20, Issue 3, pp 237–242

Proportionate mortality of Italian soccer players: Is amyotrophic lateral sclerosis an occupational disease?

Neuro-epidemiology

Abstract

Objectives: The objective of the study is to investigate the mortality experience of Italian soccer players and to discuss the findings in the light of possible long term effects of doping. Methods: Standardized proportionate mortality ratio (SPMR) and standardized proportionate cancer mortality ratio (SPCMR) were computed for 350 deceased subjects deriving from a list of about 24,000 active Italian soccer players from 1960 to 1996 in the three top leagues (A, B and C). Results: When considering SPMRs, there is a substantial adherence of observed to expected mortality, with the only exception of mortality for diseases of the nervous system (13 obs. vs. 6 exp.) mainly explained by an excess of amyotrophic lateral sclerosis (8 obs. vs 0.69 exp.). As far as SPCMRs are concerned, some digestive cancers (namely: colon cancer, liver cancer and pancreas cancer) show a doubled risk. Conclusions: A high risk for amyotrophic lateral sclerosis is observed among Italian soccer players. Epidemiological data on association between sport and Amyotrophic Lateral Sclerosis (ALS) are contrasting. On the basis of the overall available evidence we suggest a possible connection between dietary supplements or drugs used to enhance sporting performance and ALS pathogenesis. Further epidemiological studies are needed to confirm these specific mortality risks among soccer players.

Keywords

Amyotrophic lateral sclerosis Branched chain amino acids Dietary supplements Doping Mortality Soccer players 

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References

  1. 1.
    Kujala, UM, Tikkanen, HO, Sarna, S, Pukkala, E, Kaprio, J, Koskenvuo, M 2001Disease specific mortality among elite athletesJAMA2854445PubMedGoogle Scholar
  2. 2.
    Parssinen, M, Kujala, U, Vartiainen, E, Sarna, S, Seppala, T 2000Increased premature mortality of competitive powerlifters suspected to have used anabolic agentsInt J Sports Med21225227PubMedGoogle Scholar
  3. 3.
    Poznanska, A, Gajewski, AK 2001Mortality of male members of the Polish olympic teams in 1981–1998Przegl Epidemiol55305312PubMedGoogle Scholar
  4. 4.
    Rothman, KJ, Greenland, S 1998

    Types of epidemiologic studies

    Rothman, KJGreenland, S eds. Modern epidemiology.Lippincott-RavenPhiladelphia6778
    Google Scholar
  5. 5.
    Checkoway, HPearce, NKriebel, D eds. 2004Research methods in occupational epidemiologyOxford University PressNew York7072Google Scholar
  6. 6.
    Marsh, GM, Preininger, M 1980A user-oriented occupational cohort analysis programAm Stat34245246Google Scholar
  7. 7.
    Fox, AJ, Collier, PF 1976Low mortality rates in industrial cohort studies due to selection for work and survival in the industryBr J Prev Soc Med30225230PubMedGoogle Scholar
  8. 8.
    Goldsmith, JR 1975What do we expect from an occupational cohortJ Occup Med17126127PubMedGoogle Scholar
  9. 9.
    Enterline, PE 1975Not uniformly true for each cause of deathJ Occup Med17127128Google Scholar
  10. 10.
    McMichael, AJ 1976Standardized mortality ratios and the “Healthy Worker Effect”: Scratching beneath the surfaceJ Occup Med18165168PubMedGoogle Scholar
  11. 11.
    Moulin, JJ 1997A meta-analysis of epidemiologic studies of lung cancer in weldersScand J Work Environ Health23104113PubMedGoogle Scholar
  12. 12.
    Morin Doody, M, Mandel, JS, Lubin, JH, Boice, JD 1998Mortality among United States radiologic technologists, 1926–90Cancer Cause Control96775Google Scholar
  13. 13.
    Frome, EL, Cragle, DL, Watkins, JP,  et al. 1997A mortality study of employees of the nuclear industry in Oak Ridge, TennesseeRadiation Res1486480PubMedGoogle Scholar
  14. 14.
    Creagh, TM, Rubin, A, Evans, AJ 1988Hepatic tumors induced by anabolic steroids in an athleteJ Clin Pathol41441443PubMedGoogle Scholar
  15. 15.
    Cleveland, DW, Rothstein, JD 2001From Charcot to Lou Gehrig: Deciphering selective motor neuron death in ALSNat Rev Neurosci2806819PubMedGoogle Scholar
  16. 16.
    De Pedro-Cuesta, J, Litvan, I 1991

    Epidemiology of motor neuron disease

    Anderson, DWSchoenberg, DG eds. Neuroepidemiology: A tribute to Bruce SchoenbergCRC PressBoca Raton265296
    Google Scholar
  17. 17.
    Kurland LT, Mulder DW. Epidemiologic investigations of amyotrophic lateral sclerosis. I Preliminary report on geographic distribution, with special reference to the Mariana Islands, including clinical and pathological observations. Neurology 1954; 4: 355–378, 438–448.Google Scholar
  18. 18.
    Yase, Y, Yoshida, S, Kihira, T, Wakayama, I, Komoto, J 2001Kii ALS dementiaNeuropathology21105109PubMedGoogle Scholar
  19. 19.
    Cox, PA, Sacks, OW 2002Cycad neurotoxins, consumption of flying foxes, and ALS-PDC disease in GuamNeurology58956959PubMedGoogle Scholar
  20. 20.
    Heath, PR, Shaw, PJ 2002Update on the glutamatergic neurotransmitter system and the role of excitotoxicity in amyotrophic lateral sclerosisMuscle Nerve26438458PubMedGoogle Scholar
  21. 21.
    Felmus, MT, Patten, BM, Swanke, L 1976Antecedent events in amyotrophic lateral sclerosisNeurology26167172CrossRefPubMedGoogle Scholar
  22. 22.
    Gregoire, N, Serratrice, G 1991Risk factors in amyotrophic lateral sclerosis. Initial results apropos of 35 casesRev Neurol147706713PubMedGoogle Scholar
  23. 23.
    Roelofs-Iverson, RA, Mulder, DW, Elvebak, LR, Kurland, LT, Molgaard, CA 1984ALS and heavy metals: A pilot case–control studyNeurology34393395PubMedGoogle Scholar
  24. 24.
    Kurtzke, JF, Beebe, GW 1980Epidemiology of amyotrophic lateral sclerosis: 1. A case–control comparison based on ALS deathsNeurology30453462PubMedGoogle Scholar
  25. 25.
    Granieri, E, Carreras, M, Tola, R,  et al. 1988Motor neuron disease in the province of Ferrara, Italy, in 1964–1982Neurology3816041608PubMedGoogle Scholar
  26. 26.
    Scarmeas, N, Shih, T, Stern, Y, Ottman, R, Rowland, LP 2002Premordid weight, body mass and varsity athletics in ALSNeurology59773775PubMedGoogle Scholar
  27. 27.
    Longstreth, WT, Nelson, LM, Koepsell, TD, Belle, G 1991Hypotheses to explain the association between vigorous phisical activity and amyotrophic lateral sclerosisMed Hypotheses34144148PubMedGoogle Scholar
  28. 28.
    Vanacore N. Premorbid weight, body mass, and varsity athletics in ALS. Neurology 2003; 61: 1024 (Letter).Google Scholar
  29. 29.
    Beretta, S, Carrì, MT, Beghi, E, Chiò, A, Ferrarese, C 2003The sinister side of Italian soccerLancet Neurol2656657PubMedGoogle Scholar
  30. 30.
    Dempsey, RL, Mazzone, MF, Meurer, LN, Milwaukee, MPH 2002Does oral creatine supplementation improve strength? A meta-analysisJ Fam Practice51945951Google Scholar
  31. 31.
    Tarnopolsky, MA, Beal, MF 2001Potential for creatine and other therapies targeting cellular energy dysfunction in neurological disordersAnn Neurol49561574PubMedGoogle Scholar
  32. 32.
    Vielhaber, S, Kaufmann, J, Kanowski, M,  et al. 2001Effect of creatine supplementation on metabolite levels in ALS motor corticesExp Neurol172377382PubMedGoogle Scholar
  33. 33.
    Klivenyi, P, Ferrante, RJ, Matthews, RT,  et al. 1999Neuroprotective effects of creatine in a transgenic animal model of amyotrophic lateral sclerosisNat Med20347350Google Scholar
  34. 34.
    Suryawan, A, Hawes, JW, Harris, RA, Shimomura, Y, Jenkins, AE, Hutson, SM 1998A molecular model of human branched-chain amino acid metabolismAm J Clin Nutr687281PubMedGoogle Scholar
  35. 35.
    Daikhin, Y, Yudkoff, M 2000Compartmentation of brain glutamate metabolism in neurons and gliaJ Nutr1301026S1031SPubMedGoogle Scholar
  36. 36.
    Kennedy, MC 2000Newer drugs used to enhance sporting performanceMed J Aust173314317PubMedGoogle Scholar
  37. 37.
    Chen, L, Lund, PK, Burgess, SB, Rudisch, BE, Mcllwain, DL 1997Growth hormone, insulin-like growth factor I and motoneuron sizeJ Neurobiol32202212CrossRefPubMedGoogle Scholar
  38. 38.
    Groeneveld, GJ, Veldink, JH, Van der Tweel, I,  et al. 2003A randomized sequential trial of creatine in amyotrophic lateral sclerosisAnn Neurol53437445PubMedGoogle Scholar
  39. 39.
    Smith, RA, Melmed, S, Sherman, B, Frane, J, Munsat, TL, Festoff, BW 1993Recombinant growth hormone treatment of amyotrophic lateral sclerosisMuscle Nerve16624633PubMedGoogle Scholar
  40. 40.
    The Italian ALS Study Group. Branched-chain amino acids and amyotrophic lateral sclerosis: A treatment failure? Neurology 1993; 43: 2466–2470.Google Scholar
  41. 41.
    Tandan, R, Bromberg, MB, Forshew, D,  et al. 1996A controlled trial of amino acid therapy in amyotrophic lateral sclerosis: IClinical, functional and maximum isometric torque data. Neurology4712201226Google Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  1. 1.Department of Environment and Primary Prevention (DACPP)Istituto Superiore di SanitàRomeItaly
  2. 2.Istituto Superiore di Sanità, National Centre for Epidemiology, Surveillance and Health Promotion RomeItaly

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