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To the Editor.— Dr Meydani and colleagues¹ report interesting data about vitamin E supplementation and in vivo immune response in healthy elderly subjects. One important confounder that was not considered in the study is smoking. Smoking is known to lead to immunosuppression^2-3 and to increase the requirements for vitamin E.⁴ Indexes of sustained oxidant stress in smokers are partially ameliorated by vitamin E supplementation.⁵ Moreover, recent data show that vitamin E may have pro-oxidant activity in nonsmokers at high and prolonged intakes.⁴ Accordingly, it is relevant for the authors to clarify the number of smokers in each study group.

Håkan Melhus, MD, PhD
Uppsala University Hospital
Uppsala, Sweden

1. Meydani SN, Meydani M, Blumberg JB, et al. Vitamin E supplementation and in vivo immune response in healthy elderly subjects. JAMA. 1997;277:1380-1386. ABSTRACT 2. Geng Y, Savage SM, Razanai-Boroujerdi S, Sopori ML. Effects of nicotine on the immune response: chronic nicotine treatment induces T cell anergy. J Immunol. 1996;156:2384-2390. ABSTRACT 3. Johnson JD, Houchens DP, Kluwe WM, Craig DK, Fisher GL. Effects of mainstream and environmental tobacco smoke on the immune system in animals and humans: a review. Crit Rev Toxicol. 1990;20:369-395. ISI | PUBMED 4. Brown KM, Morrice PC, Duthie GG. Erythrocyte vitamin E and plasma ascorbate concentrations in relation to erythrocyte peroxidation in smokers and nonsmokers: dose response to vitamin E supplementation. Am J Clin Nutr. 1997;65:496-502. FREE FULL TEXT 5. Duthie GG, Arthur JR, James WP. Effects of smoking and vitamin E on blood antioxidant status. Am J Clin Nutr. 1991;53:10615-10635.

To the Editor.— The article by Dr Meydani and colleagues¹ seems to be another example of drug house–sponsored deception by omission of adverse facts. The authors underplay their financial support from the study sponsor, Hoffmann-LaRoche, Inc, and fail to mention that this . . . [Full Text of this Article]

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