Acute appendicitis and dietary fibre: an alternative hypothesis.

This paper examines the time trends in acute appendicitis in Britain in relation to changes in consumption of fibre, meat, and sugar. Knowledge of previous case fatality rates, diagnostic criteria, and management are sufficient to infer general trends in incidence from mortality data. The incidence rose steeply from around 1895 and fell from the 1930s onwards. Contrary to previous statements there is no evidence that disease rates were greatly influenced by the dietary changes in the second world war. It is concluded that dietary changes do not explain the time trends in appendicitis and that the epidemiology of the disease is more readily explained by a primarily infectious aetiology.