Day 269 - 25 Jun 96 - Page 33


     
     1
     2   Q.   -- to play?
     3        A.   Yes.
     4
     5   Q.   That leaves only 30%, does it not, for things like physical
     6        inactivity, smoking, alcohol, overweight, higher tension
     7        and so on and so forth?
     8        A.   Well, higher tension is, in fact, induced by the same
     9        kind of diet that induces heart disease, but I think one of
    10        the pieces of evidence which may be helpful in this respect
    11        is the studies in children which we contributed to in the
    12        1970's and which have now been extensively documented in
    13        the USA.
    14
    15        The interesting thing is that if you compare children who
    16        are born into a low risk society, and we compared African
    17        children in Africa with European children in Africa, if you
    18        compare the children the question we asked was were they
    19        born different, the African children having virtually no
    20        risk of growing up to have heart disease, the European
    21        children with a high risk, the question we asked at that
    22        time was are they born differently or do they acquire the
    23        difference.
    24
    25        And it clear that in the first year of life the blood
    26        cholesterol levels which were used as the only relevant
    27        marker at that stage in the proceedings that we could deal
    28        with, was the same in the African versus the European
    29        children, but by six to eight years of age you could
    30        differentiate statistically the European children based on
    31        cholesterol levels.
    32
    33        Now, this kind of evidence is well ingrained in the
    34        literature.  What I would put to you, and I think it is
    35        helpful in discussing that, is that really basically
    36        children the world over are not smoking.  They are doing
    37        the same kind of exercise.  They are doing the same kind of
    38        things.  And really it is the environmental impact and
    39        almost certainly the nutritional impact which is creating
    40        this difference at this young age.  And I think the other
    41        factors that you talk about, namely the smoking, the lack
    42        of exercise and hypertension, are not influencing these
    43        differences at that stage in the proceedings.
    44
    45   Q.   Did you follow the groups of children through to the age at
    46        which they might have been expected to have a heart attack,
    47        a premature heart attack?
    48        A.   That is being done by Verbussem in the United States
    49        at this precise moment and what is interesting from that
    50        study is that the rise in childhood is predictive of a high
    51        risk, both in relation to raised blood cholesterol levels
    52        and raised blood pressure by the time they reach 20 years
    53        of age, which is the last time I saw the published data.
    54
    55   Q.   I was going to ask you where we might find those data.  Are
    56        they published in the New England Journal of Medicine?
    57        A.  They will be published in the American literature.  I
    58        would be happy to look them up for you, if you wish.
    59
    60   Q.   Also, I suppose it is possible at least that your African

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