Day 023 - 13 Sep 94 - Page 13


     
     1        decreased over the last 20 years or so.  Also -----
     2
     3   Q.   Right.  You agreed yesterday that cancer can take ---
     4        A.  Yes.
     5
     6   Q.   -- is likely to take a long time to develop?
     7        A.  The other thing is that the differences in fat intake
     8        may be less marked than obviously appear to be the case
     9        from just looking at crude food balance tables where
    10        wastage is not taken into account.
    11
    12   Q.   But is it not fairly obvious to anybody working in the
    13        field, you know, from organisations such as the World
    14        Health Organisation or similar, that the type of diet
    15        eaten by people in, say, the USA or other western
    16        developed countries is far richer, they eat far more fat
    17        and sugar and things like that than, for example, the
    18        population of Africa, or something like that.  Is that not
    19        something that is pretty obvious?
    20
    21   MR. MORRIS:  Accepted?
    22        A.  Yes, there are differences in the diet, obviously,
    23        that is why people have tried to say that it is these
    24        differences in diet which can account for the different
    25        levels of cancer we see in these countries.  That is why
    26        people have then gone on to try to carry out these
    27        studies, either case-control studies or cohort studies,
    28        prospective studies, to try to see whether this apparent
    29        relationship is, in fact, a real relationship.  That is
    30        where the problem has begun.
    31
    32   MR. JUSTICE BELL:  Sit down and look at your notes.  (Pause).
    33
    34   MS. STEEL:   When you were talking about menarche, you
    35        mentioned something about nutritional deprivation, but
    36        would you agree that rather than saying people who are
    37        nutritionally deprived delay the start of menstruation, it
    38        might be more accurate to say that over nutrition gives
    39        rise to earlier menarche?
    40        A.  No, I do not think you can say that.
    41
    42   Q.   You do not think so?
    43        A.  No, most of the studies which have tried to look at
    44        this have looked at populations where there is energy
    45        restriction, you know, in South East Asia before it
    46        started to become developed Africa and so on, and it is
    47        from that point that the hypothesis has developed that
    48        people being better nourished may lead to the menarche
    49        occurring at an earlier age.
    50 
    51   Q.   But are they necessarily better nourished or is it that we 
    52        are over nourished?  I understand that over-nutrition in 
    53        western society is one of the main concerns in diet rather
    54        than malnutrition.
    55        A.  I think it is a question of what you mean by
    56        "over-nutrition".  Certainly, if you get to the point of
    57        obesity, we do know that obesity is harmful.  Whatever may
    58        be the cause of obesity, it is not just, for example, fat
    59        intake that is related to obesity.  It is all aspects of
    60        our diet, and there is also a relationship with activity,

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