Day 252 - 20 May 96 - Page 07


     
     1        of research, that dietary cholesterol really had no
     2        appreciable affect at all in people who are consuming a
     3        normal diet, and consequently the recommendation was
     4        revised.  They recommended that the cholesterol consumption
     5        should not be changed.  In fact, that report had no
     6        specific recommendation about dietary cholesterol at all.
     7        In the most recent report, dietary cholesterol has come
     8        back into the picture because as a result of the public's
     9        response, and I am surprised because the public does not
    10        respond, certainly as I would like, to nutritional
    11        information, the public had reduced its dietary cholesterol
    12        to such an extent that the average blood cholesterol in
    13        people in the UK had been lowered, and it then became
    14        tentative to an increase in dietary cholesterol.  So the
    15        current recommendation is that dietary cholesterol should
    16        not be increased.  So, that is an example where a
    17        recommendation about a particular factor has been changed
    18        considerably with the success of COMA publications, and I
    19        think the next issue of COMA publication on heart disease
    20        well have different things to say.
    21
    22   Q.   That was the only thing I was going to ask you about this
    23        written report of yours.  You write at the bottom of page 6
    24        in the last line but one: "The cause of vascular
    25        disease..."   Do you have it?
    26        A.   Yes.
    27
    28   Q.   The last two lines:  "The cause of vascular disease is
    29        multifactorial.  Diet is only one factor."
    30        A.  Yes.
    31
    32   Q.   Professor Naismith, without going into any detail at all
    33        can you just summarise for us what, according to modern
    34        scientific thinking, which is what you just explained may
    35        change, are the other factors which may contribute to
    36        cardiovascular disease?
    37        A.   Well, there are a great many factors which are
    38        believed to contribute to cardiovascular disease.  I think,
    39        in fact, two new ones have come into play in the last
    40        months or so.  There is obviously a general ethical
    41        factor.  People are predisposed to having cardiovascular
    42        disease.  Smoking is a factor.  It is an important factor.
    43        It probably has a greater effect in the development of
    44        cardiovascular disease than does diet.  I am very pleased
    45        to see that in this report of cardiovascular disease the
    46        question of physical activity has been addressed.  I think
    47        personally this is an important factor, given that the
    48        instance of obesity has increased in men in the last ten
    49        years with no change in the composition of the diet.
    50        Clearly, overweight is a very important factor, and at last 
    51        it is being addressed by the Government in its report. 
    52        There are other factors, such as fibre content of the diet, 
    53        which may have an effect.  There is a great deal of
    54        interest in antioxidants and nutrients which promote the
    55        degenerative aspects of atherosclerosis and, more recently,
    56        folic acid which is one of the B vitamins has come into the
    57        picture as a factor involved in the metabolism of a
    58        particular folic acid where, if the metabolism is
    59        defective, there is an accumulation more consistent with
    60        levels in people with atherosclerosis.  So, the picture

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