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  • 1957 Yerushalmy Hilleboe Fat Diet Mortality Heart Disease

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    19 views12 pages

    1957 Yerushalmy Hilleboe Fat Diet Mortality Heart Disease

    Uploaded by

    Rayz C.O

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 12
    s response. “all the nous ther- hhere were ts treated. owed that afaney can ausea pre- omic preg vemia who. Prompt lable with, apt hemo- sncy." the ined with ide effects ts who do. and easier nd recent firm the for hemo- ron stores. completed ans desic- (request Lakeside 4. 96.731, 2S Ann, iM, and 6) joss, ay, EB 123} 1988 4. 96:550) SCIENTIFIC ARTICLES Fat in the Diet and Mortality from Heart Disease A Methodologic Note J. VERUSIALMY, PHD, BERKELEY, ¢ OKNIA, AND ERMAN HILLEROE, Mth, ALMANY, NEW YORK (Peon the Division of Biostatistics, Schwol of Public Health, Uniorsity of ifornia, Berkeley, California, ad ‘the New York Slate Department of Health, Albany New York [i stoning importance of tent disenses a a cause of disability and death has stinnlated widespread investigation into possible causative ctors, especially: those of e Within the last few years certain compo the diet, especially fat, have attracted increasing notice as suspected eausil agents. ‘The evidence which has been presented for the existence of a relationship between diet and heart disease, how= ever, is, for the most part, derived from indirect methods of stuly Tn these indirect methods the primary unit of observation is the group; in the direct method the primary unit of obser vation is the individual, Tt is a. common prar= tice to nse indirect methods to construct indices of the dietary habits of national, racial, sovial, or ‘other special groups, and to relate these indices to the frequencies of various forms of heart. dlisense in these groups. ‘The data in many eases fare Tased on vital statisties and on statisties concerning the foot supplies available fur con sumption in different countries. Ut is well Known that the indirect method Inerely suggests that there is an association hetwern the chairavteristies studied and mortality rates amd, further, that nu mutter how p such an association may appear, it is not in itself proof of a cause-effect rekitionship. But quota tion and repetition of the suxgestive association < the impression that the relationship Premnted at a geting of the At ny New orks April 3 is truly valid, and ultimately it acquires status asa. stupporting link ina eliain of presumed proof ‘There is no question that indirect methods of ve valuable when properly employed, ally as indicating suitable paths for further Thus, morbidity and-mortality es have been for clues as cope investigation from certain respiratory di eompared in urban andl rural to the role of air pollution; the trend of lung, ser mortality has been investigated in relation to ciguret. consumption, and death rates from specific diseases have been examined in census tracts which are distinguished by measurable ‘cnvironmental charaeteristies. Indeed, 50 coni= plex are current health problems that ssociations, hetween various characteristics of the environ= ment and morbidity and mortality: shouldbe itensively studied; the indirect, method is often the only practicable procedure, it Unfortunately, however, if used superficially id not properly angmented, the indirvet method has many weaknesses. ‘The most serious is the fuet that the app: often proves to be the re extraneous factors. Therefore, its necessary to probe further, to go beyond the simple, swsociation and to investigate related variables, This des not mean that the worker must undertake exhaustive studies to rule out all environmental factors other that the suspected one, In many eases systematic lusting of a few related environmental factors YERUSHALMY against one or two aclditional disease entities Will disclose whether the presuined association is valid Tn this presentation an attempt. is made, first, to determine the sort of supplementary investi- gation whieh ean nuke the indirect method a more dependable tool for studying the association between diseast entities amd environmental actors and, seem, to determine the validity fof the prestined association between national death rates from heart disease and national dlictary-fat levels, An aetual exaniple illustrates how the ianpres- sion that there is a strong assoctati mortality from heart disease aid proportion of fat available in the dict in different countries assumed the stature of a proved faet.* Tn 1953 Keys! published a chart (Big, 1) which shows the rulationship in six different comutries between the national death rate for inen aged forty-five to forty-nine and filty-five to fifty-nine from “arterioseletutic and degenerative heart disease” and the proportion of fat-ealories available in the respective national diets, ‘Takeu Iyy itself, the figute is impressive; there is regular and concurrent variability of the The author cautiously observed nehuded that divtary fat semehow is with eardiae ty atleast in middle aye.” IE Leitner reproduced this figure in ‘The Lancet, but his interpretation of it gave the ciation greater stature aud definitivencss: «appears ta he a strong if uot convincing correlation between the amount of fat inthe dict amid the death rate degenerative Theurt disease Int another publication Keys? neferted to the same evidence from his 1953 figure, Int this time he: interpreted Hie data in much stronger terme: intornativnal vital statistics shows steiking Featnee: when the at tists are studied int between progresiu two fuctors that “it must bee associated dTisense analysis of tinal food consanuption parallel, ‘Then it appears that for men aged forly th sixty: or seventy, that is, at the ages when the fital rosilts of athernselerisis re he nthe tne Sacer isons mortality al fat i later develnjsed, thewe were bane few mtriee and were of stionable validity. “On Tire psn tn the Tinted States the eid 8 sie st ensue the Shige tsp faster sta i lieu LWP MILLEBUE NERATIVE HEART 948-49, MEN ace 55-59 cor Yo australe ® DEATHS per 1000, 10 20 30 40 FAT CAL op % of TOTAL Mortality: from segenerative haet disease 42H aud 4 i the Revision of 18, wate i the Revision of 1948, Tnter- al vital statisties Crone official se of total ealoriee for 149 ied from national foul Stplied by. the Nutrition Divi nd Nar Culture Organisation of the United Nations. (hu ration and togened taken fiom Ress.) eourteyy of ural of Mount Sivai Hospital) nist prominent, there is a renearkable rekition- ship between the deatle rate from degenerative heart slisease and the proportion of fat calories inthe national diet, A- regular progression exits fram Japan through Italy, Sweden, Zngland and Wales, Canada and Australia to the United States, No other variable in the worle of life besides the Fat valories in the diet ix known whieh shows anything Fike stteb a ean sistent relationslip to the mortality rate from wrative heart disease.” Clearly it has become important to le whether these stitements reflect the known or ube facts, Bt to da so i is essential to vonsider questions of pethodology. nanely coronary ar deg scrta the elementary operations and procedures: by whieh it is possible ty determine whether the ssorintion ix vali The term * Hlisenssiow eVect pokationship sale assovintion, ss atsed in this does not uecessarily denote eats rather it sigwifies that Phat is, validity sasociation is “speeitiv New York Stated, Med: 4 2 implies ables is gated a with al of the ¥ stor whether related sitspivivt stituted This shure by precede the sat structed present asioiat rapt between inves Prelim Before ecluat ethene sthevted dat, a Devil the lint preliniin Jule 45, ace 45-49 2, 30 40 aL Live heart dis ion of 1988, cate of 1948, Inter: ties from oficial of total. ealories er data for 189 Pood “and Ascie Nations. il st eomtess thable relat in degenerative of fat calories F progression taly, Sweden, d Australia to ariuble in the ins in the divt ke such a emi Hity rate: from tte det the: known or it is essential logy procedures hy whether the bumuely s atsed inthis anote a cause hifies thats is, validity Beate, Mel FAT LN TH Kin. 2. Mortality fron vascular lesions affecting the eeutral-nervon sytem (B22) and fat ealorion Jer eont of total eaories in tvalen ffhy-Bve to Bly nine rare Fram six comntriee selected for this specific pur ost, Caleulated rn national fond balance data by FIALO. (ave text for definition! implies that he asoviation between two ables i& in fact between the variables investi foited and docs net merely reflert: relationships with x breuder yronp, of whieh one oF the other of the variables forms a prurt, Henee, the invese tigator must search for ways to determine wssocinition when a whether there is similar related factor is substituted for the one under suspivion or when other disease entities are she stituted for the disease hein sturied. This paper hes the elementary proces dures by whieh validity may be tested, These piveedures involve preliminary. evaluation of the data from whieh the indices lutve been cone structed and fave tests for “specitivity.” Tn the present vase this invalves examining: (1) the Hien between heart disease and dietary components other Han fat and (2) the between divtary fab and vauses of death other than diseases af the hart ese Preliminary Evaluation of Dat Before undertaking the sential evaluiting the “specificity” uf sociation, it is often nevessary tu examine the ethos by which the primary data have been selected, the definitions and limitations of the shits, satu the amount of detail required. es Pevially in“ grouping’ ewuses of death. Tn the dietary fat-leart disease problem all of the Dbrelininiry steps are important task of a scenning as ly 15, 1 MEV AND MORTALITY PROM HEART DISE HK SruLcrON oF Darac—tn studies of associte tion, as in any other study, the method of selectinye the data largely determines: whether the results can safely be generalized. For esaniple, the association shown in Fig. Land the conclusion drawn from it by its anthor convey the impression that it reflects a general phe- nomenon, Hence, it is of first importance to Kn on wheat basis the six eountr © selected, in oner to determine whether the findings for them ean be generalized ty other constries.* Since no infarnuation is given hy: Keys on how why the six countries were selected for Fig. 1, it is necessary to investi tween dietary fat and hea all coattries for which information is ‘This is shown in Fig. 3 for mules aye fifty fifty-nine years in 22 comntriess} Tt is immedti- ately obvious that the inclusion of all the eoun- ties greatly reduces the apparent asoriation For example, it pay’ be seen from Fig. 3 that inv the narrow band hetween 30 per rent and 40 per ee fal, there appears the entire amt of heart disease mortality, ranging from Joss than 300 per 100,000 for Austria, West G many, Sweden, Norway, Denmark, andthe Netherlands, to 600 oF more for Au aula, and Finland, and as much as United States. Tadeed, within this higher die- rv fut bund seven of the countries hase 400 or fewer deaths from heart disease per 100,000, while siv have mates of more than 400, ‘Thus, wwe see that in countries with approximately the sunie proportion of the diet available as fat, the 16 the association be it disease mortality in le Mie scl Tesona aeting the rental wero ed Interact Liat). Thee Tite ave bratnted for nie soutien Figs 2. Pigs be thken ne sunporting viens fork siveet amsoriatin betwen aad degenerative heart dirs mrt. 0 aie basis ne ns take Fi. 2a ii Teron fa ita diet eat rates fro creda Flaws Ot conse iin that aos Ipc foro Parent tial ms ht hy fart ghat oath tte ‘Noa TF Rke en titstive ty Altysioe is wae in thin tara figures a tabs because tho association show Tn Eye Te ge string for thie age zronp. However lat teil ving ea abe fo eon for agecudjisted eaten, Fhe detailed data for srl a0 flaare given iy ables and It of Apindic A. Dat lin presented forall countries for seh the itary sour of Mond Astute A Y ERUSUALAY 2 Pic th Mortality fran arterioweerosie and gener sige Beart disease (20) and Fae valor sm pr erat Br tatal calories in takes Blty-tive to ffty-nine years Crateatgted from national fad halanee data by PAO. 0 to lieartalisease mortality: ranges from yer 100,000. Henve, the selection of the tries, for whatever reason, th nee of the Jess, the seatter of points in Fig there is seme asoeiation in the conventional sense between the two variables; iis therefore necessary, first, toexaunine the bisie data further sand, eennd, to determine whether the assorkation is “specie” far the two variables, Derigtiioss avo Livrstioss oF Darac In studies of association involving indices of Vironmental charaecteristies sand mortality: fro

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