Day 014 - 20 Jul 94 - Page 47


     
     1        diverticular disease, appendicitis, large bowel cancer,
              haemorrhoids and constipation."   Professor Wheelock, what
     2        do you understand by the phrase "population studies"?
              A.  That would be taking a very large number of people,
     3        maybe even the entire population in the one country.
 
     4   Q.   That is a form of epidemiological study, is it?
              A.  I would say so, yes.
     5
         Q.   "However, there are many confounding factors in the
     6        interpretation of these data, both in diet and in
              lifestyle.  In the diet particularly, the nature and
     7        amount of starch has been virtually ignored, as has the
              fact that high NSP diets are usually low in fat and animal
     8        protein.  Furthermore few reports are supported by
              measurements using modern methodology for dietary
     9        assessment or reliable analysis of the NSP content of
              foods eaten.  It is clear that in some populations, such
    10        as the Japanese or urban South African blacks, low NSP
              intakes are not associated with high risk of large bowel
    11        diseases.  Nevertheless no study has reported an
              association between high NSP and high risk of large bowel
    12        disease. It is not currently possible to identify NSP as a
              major dietary factor in the aetiology of these diseases.
    13        At best the aetiology may be ascribed to the consumption
              of a type of diet characterised by low starch, low NSP,
    14        high fat.  Better epidemiological studies are needed".
              That was the view of the panel in 1991.  Professor
    15        Wheelock, can you improve on that as a view in 1994?
              A.  No, I cannot.
    16
         Q.   Can we then jump right through -----
    17
         MR. JUSTICE BELL:  So, is this an over simplification of what
    18        it means, that any association with the prevalence of
              large bowel cancer etc. is more likely to go with the high
    19        fat element of the diet of a person who does not eat many
              vegetables, for instance, rather than the fact that he
    20        does not eat many vegetables?
              A.  Yes.  If I understand you correctly, I think it is
    21        difficult to distinguish between whether, if these
              diseases arise, whether it is due to the fact that there
    22        is low fibre or there is high fat or there is something
              else about the diet.
    23
         Q.   But "the something else" includes high fat?
    24        A.  It does, yes.  Usually, you would find that a diet
              which is low in fibre is high in fat.
    25
         Q.   Is it too simplistic to say that many people who have high 
    26        fat diets tend not to eat many fresh or lightly cooked 
              vegetables? 
    27        A.  That would usually be the case.
 
    28   Q.   Might that be part of the reason?
              A.  Clearly, if people are eating largely animal products,
    29        for example, which animal products do not have any fibre
              in them anyway, and then very little bread, breakfast
    30        cereals, fresh fruit and vegetables, then they are not
              going to have much fibre in their diet.

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