To the Editor. —
The article by Hopkins et al1 is interesting, but it did not consider several factors that may influence the outcome of the study. Seventh-Day Adventists are not strict vegetarians. In fact, about 50% of them do eat some meat, although much less than the general population.2,3 Also, a vegetarian Adventist is quite likely to use milk and eggs. There is some evidence that Helicobacter pylori infection may be a zoonosis.4 Intrafamilial clustering of H pylori infection has also been noted.5 Thus, an important question must also be, how many of these Adventists were involved in handling and cooking meat for non-Adventist family members. I suspect that among the strict vegetarians who do not handle meat, H pylori infection occurs less often than among the general population.