Day 036 - 13 Oct 94 - Page 13


     
     1        5,485 women, including 99 breast cancer cases (those being
     2        34 premenopausal women and 65 postmenopausal at NHANES 1
     3        base-line), was examined for associations with dietary
     4        intake of fat, per cent energy from fat, total energy,
     5        saturated fat, polyunsaturated fat, monosaturated fat, and
     6        cholesterol on the basis of a 24 hour recall administered
     7        at the baseline NHANES 1 examination.  No significant
     8        differences in dietary fat intake between cases and
     9        non-cases were evident when mean intakes for each group
    10        were compared.  For total fat in grammes and saturated fat
    11        in grammes, a significant inverse association was
    12        indicated in proportional hazards analyses.  Adjustment of
    13        fat for total energy intake resulted in a smaller effect
    14        that was no longer statistically significant.  Adjustment
    15        for accepted breast cancer risk factors did not change
    16        these findings".
    17
    18        Pausing there, Dr. Barnard, the accepted breast cancer
    19        risk factors must be other than those considered in this
    20        study, must they not?
    21        A.  One would presume so.
    22
    23   Q.   "This prospective study of a sample from the US population
    24        does not support the hypothesis that high dietary fat
    25        intake increases breast cancer risk.  Indeed, some lower
    26        risk associated with high-fat intake may be indicated,
    27        although this result may be influenced by methodologic
    28        problems with the dietary assessment".  If we turn
    29        over ----?
    30        A.  Pardon me, let me amend my earlier answer.  I am not
    31        quite sure what they were referring to in that statement
    32        regarding "other cancer risk factors".  If that is
    33        important, I would be glad to read the study in order to
    34        see what they are referring to.
    35
    36   Q.   I do not believe it is.  It is a feature of epidemiology
    37        and studies of this kind, is it not, that what you try to
    38        do is to make adjustments so as to remove as many of the
    39        confounding variables as you possibly can?
    40        A.  Also in recognition that there is more than one way to
    41        get cancer.
    42
    43   Q.   Yes, exactly.  That would be a confounding variable, would
    44        it not?
    45        A.  It could be, yes, potentially.
    46
    47   Q.   Please turn to page 469.  Here is the qualification, as
    48        I take it, which was expressed in the Abstract.  In the
    49        right-hand column:  "It should be noted that the
    50        distribution of dietary fat intakes examined in this 
    51        analysis is heavily shifted toward relatively high 
    52        intakes.  Thus the disparity between these findings and 
    53        cross-cultural studies may be because fat exerts an effect
    54        only up to a certain threshold level (eg. 15 or 25 per
    55        cent of energy), which could not be addressed in this
    56        sample.  It may also be that dietary fat intake exerts its
    57        major influence early in life, such as during puberty, and
    58        an analysis of diets in adult women is not relevant. In
    59        addition, the influence of any dietary changes that may
    60        have occurred after the baseline dietary assessment could

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