Day 017 - 25 Jul 94 - Page 38
1 increased. However, all such evidence is crude and
indirect and for causation to be invoked persuasively,
2 individual women must be shown to have a higher than
average fat intake. Moreover, since this may simply
3 reflect high energy requirements as determined by body
size, physical activity or individual metabolism, affected
4 women should ideally be shown to obtain a higher
proportion of calories from total fat than do controls."
5
Then Dr. Kinlen reviews the existing evidence as at 1991,
6 first of all, Case-control studies. Then he comes back to
re-examine International correlations. Dr. Arnott, notice
7 table 2, these are cohort studies as we pass. We find
that the population samples, the studies in Japan based on
8 population of samples, that there was a positive
relationship, but in the other four studies, the
9 Adventists, the nuns in this country, the nurses in
America and the population sample in America, there was no
10 positive correlation found. Those are cohort studies.
11 On the right hand, page 465, Dr. Kinlen mentions all the
things that you have mentioned, high menarche, other
12 fertility factors, obesity and then the page, food
wastage, obesity and survival. Then he mention animal
13 studies and other aspects of diet. I will read that, if I
may: "A protective effect of green vegetables has been
14 found in several case-control studies. The possibility
that this reflects an effect of Beta carotene was
15 supported by a prospective study of plasma carotene levels
in relation to breast cancer. However, later findings
16 from this as well as from two other similar studies have
cast doubt on this relationship. An intriguing greater
17 caloric intake from a variety of foods by cases than
controls has been reported which persisted after
18 adjustment for body weight.
19 Conclusion: There are well founded reasons concerning
obesity and coronary heart disease for reducing
20 consumption of animal fat." Dr. Arnott, I know you are
not a cardiologist, but I assume you have some general
21 medical knowledge passing beyond a study of cancer ---
A. A little, yes.
22
Q. -- do you regard the evidence associating a high intake of
23 fat, particularly saturated fat, with coronary heart
disease as convincing?
24 A. I am convinced by it, yes.
25 Q. Might one reason for that be that we understand the
pathogenis of coronary heart disease rather better than we
26 do that of cancer?
A. I think that is a fair comment, yes.
27
Q. Dr. Kinlen goes on: "As a cause of breast cancer,
28 however, the contradictory nature of the evidence prevents
any definitive conclusion. Much of the international data
29 that suggests a relationship may simply reflect the
effects of calorie restriction during growth in certain
30 countries" -----
