Day 256 - 04 Jun 96 - Page 54


     
     1        you can see some quite significant associations being
     2        noted.  Then there is a third way of adjusting for various
     3        and sundry things in each case, and some of that
     4        disappears.  Some of that relative risk previously seen
     5        tends to disappear, so then of course what are the
     6        adjustments for to cause those low numbers suddenly to
     7        appear, and if we examine that a little more closely, you
     8        can see that there is an adjustment for example for energy
     9        intake, this is note E, and some non-dietary risk factors
    10        in Shanghai and Tianjin as listed above, and if we go and
    11        examine what were those things we are were adjusting for.
    12
    13   MR. JUSTICE BELL:  The C for Shanghai, the D for Tianjin, and
    14        the E in the total are all the same, are not they?
    15        A.  I am not sure.  Not quite the same but similar, not
    16        quite the same.
    17
    18   Q.   They are very ----
    19        A.  They are very similar.
    20
    21   Q.   They are not exactly the same but they are very similar;
    22        are they not?
    23        A.  They are.  You are correct.
    24
    25   Q.   I mean, C and D are not the same but they are quite
    26        similar.
    27
    28   MR. RAMPTON:  They are quite similar.
    29
    30   MR. JUSTICE BELL: And then E is all of them for whichever city.
    31        Yes, I see.
    32        A.  One of the things they are adjusting for, or 2 or 3,
    33        are those things that actually do have a rather significant
    34        relationship with dietary fat intake, age at menarche, and
    35        the things we discussed before, and so ----
    36
    37   MR. RAMPTON:  Well, they may do, Professor, I grant you but, in
    38        any event, that is an indirect route, is it not, an
    39        indirect route you have to get past as with your passage
    40        early about plasma cholesterol.  You say there is a
    41        correlation between intake of fat and serum cholesterol
    42        levels and then a further correlation between that and the
    43        cancer; is that right?
    44        A.  Right.
    45
    46   Q.   Equally here, with age of menarche, you have got to get to
    47        that before the age of menarche leads on perhaps to an
    48        increased risk of cancer if it is early; is that right?
    49        A.  What really happens in that particular case is that a
    50        child consuming a certain kind of diet tends to consume the 
    51        same kind of diet more or less the rest of theirs lives in 
    52        most cases.  So, a child that is raised on a higher fat 
    53        diet, a diet higher in animal products grows faster,
    54        slightly faster, often times incidentally immeasurable but
    55        nonetheless reach age of menarche earlier.  They stay on
    56        that diet.  As a result, they sustain higher levels, in
    57        women at least, of oestrogen.  So all of sudden you have
    58        all these things coming into play that subsequently, when
    59        examined, appear to have these independent effects on the
    60        cancer risk but, nonetheless, they can all be placed with

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