Day 036 - 13 Oct 94 - Page 46


     
     1        perhaps, have been consuming a high-fat diet.
     2
     3   Q.   So, in other words, if all obese people were taken out of
     4        the final figures?
     5        A.  Yes.
     6
     7   Q.   That would be an unfair bias of the results?
     8        A.  That is an important point that has been shown in many
     9        lines of research.  We see it with diabetes as well.  When
    10        one removes the factor of obesity, it can mute the
    11        apparent effect of dietary factors; yes, that is correct.
    12
    13   Q.   In your opinion is this one of the things which may
    14        explain why some of these studies -- you have said many
    15        things but you did not say that -- it is just another
    16        thing which may explain why some of these case-control or
    17        these kind of things that we are referring to, the Yvonne
    18        Jones, may not be showing up associations?
    19        A.  In some cases that could be true and that would add to
    20        the difficulties that are really quite pronounced, say, in
    21        that study of the rather narrow range of nutrient intake.
    22        There are some studies, perhaps, for example, the Toniolo
    23        study which I referred to, I believe, on Tuesday, in which
    24        they specifically responded to the very issue that you
    25        have raised in which, say, the age at early menarche was
    26        taken into account and yet an influence of fat intake was
    27        still shown.  Perhaps I could come back to that?
    28
    29   Q.   Did you want to take us through some of the studies or
    30        something?
    31        A.  Well, I would be prepared to describe in just a little
    32        bit more detail the Toniolo study, which I mentioned on
    33        Tuesday, but there is a bit of that that is responsive to
    34        your question.  Why do I not take two minutes and do
    35        this?
    36
    37   Q.   Yes.  We were not prepared for that.  Your own study
    38        No. 24, your own reference No. 24?
    39        A.  The first thing that is, perhaps, noteworthy about
    40        this document, which I will not go over in any detail
    41        because I already raised it, but it appeared in the
    42        Journal of the National Cancer Institute in 1989, February
    43        15th of that year, so early 1989.
    44
    45        The second thing that is perhaps noteworthy regarding the
    46        Toniolo study is its summary finding in the abstract,
    47        which I read before, but just briefly to describe again:
    48        In the abstract about eight or, well, starting at the end
    49        of the sixth line, it says -----
    50 
    51   MR. JUSTICE BELL:  Yes, I am sorry.  I was making a note on 
    52        another matter.  Where do I find the Toniolo? 
    53
    54   MS. STEEL:  No. 24 in Dr. Barnard's references.
    55
    56   MR. JUSTICE BELL:  Thank you, yes.
    57
    58   THE WITNESS:  Again, from the Journal of the National Cancer
    59        Institute, February 15th 1989, starting at the sixth line
    60        down in the Abstract it says:  "In multivariate analyses,

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