Evan Allen🌱 Profile picture
Dec 13, 2017 7 tweets 3 min read Twitter logo Read on Twitter
Today we take a look at the Malmo Diet and Cancer Study published in 2007. This study was primarily to study cancer risk factors and looked at 28k people in Malmo, Sweden. They were followed for 5 years and food info was from 7 day diet entries.
The study did not record trans fat as a separate category, so most of the trans fats were counted as MUFA or PUFA. This is a pretty profound confounder and makes the study almost uninterpretable. journals.sagepub.com/doi/abs/10.109…
Another arm of the study actually looked at cancer death. 5-7 years is not a long study to examine cancer, but there was a statistically positive relationship between total dietary fat and cancer mortality in women.

Hardly good news for #LCHF promoters. onlinelibrary.wiley.com/doi/10.1111/j.…
As for cardiovascular mortality, the lowest quartile consumption was 13% calories from SFA. Once again, raising the temperature of a fire seemed to have no effect on the ashes, and so there were few statistically significant harmful or protective effects seen.
However, the authors did not mention a significant association in one of their analyses, the PUFA/SFA ratio in men was quite significant, showing that men who ate the highest SFA with low PUFA intake had higher CVD event rates.
Because TFA was counted as MUFA or PUFA, it is unsurprising that MUFA showed a trend towards increased CV events as well. In the end, this is once again a very homogenous population (a single Swedish city), looked at for a rather brief time. Hard to draw any strong conclusions.
Tomorrow we will look at the Nurses' Health Study.

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More from @EAllen0417

Jan 31, 2018
Chanced upon an interesting study from Sweden today. Sweden had some of the highest CVD mortality in the 1970s, so programs were put in place to decrease cholesterol. They were successful at getting reductions in serum cholesterol by decreasing SFA primarily in the 80s and 90s.
In 2004, the #LCHF movement got a lot of press and Swedes seemed to be convinced by social media campaigns to abandon their dietary guidelines and decrease carbohydrates and increase fats. You can see that they did exactly that from the graphs. What happened?
Cholesterol levels went up, in spite of a near doubling of the use of statin drugs. In addition, BMI continued an inexorable rise, no changes were seen in the trends for obesity and no reduction in cancer rates was seen. In fact, cancer continued a steady rise.
Read 7 tweets
Dec 21, 2017
Some final thoughts on S-T & K's meta-analysis on SFA and CVD. When this was published back in 2010, headlines and news articles repeatedly called it "new research." The same canards were recycled when Chowdhury published a similar study 4 years later.
Of course, none of that is true. These were not new studies. Medicine is a human endeavor and people who are told there is "new research" that exonerates SFA should be getting actual new research.
A meta-analysis of tens of studies that shows no effect of SFA, when a detailed analysis of the individual studies shows a relatively robust effect of SFA on CHD is a form of lying. Remember, all the research is known to the researchers before they crunch numbers.
Read 7 tweets
Dec 20, 2017
Our final, non-duplicate study in S-T and K's meta-analysis is another study of strokes out of Japan. The Adult Health Study (apparently rated R), looked at a single category of cerebral infarction in Japanese from Hiroshima and Nagasaki.
The answer to the question you have in your mind right now is, "Yes, they were all exposed to the atomic bombs." So this is not your typical run-of-the-mill nutritional epidemiological study. What it's doing in this analysis is really hard to justify IMO. stroke.ahajournals.org/content/35/7/1…
The infarction is a single category, with no breakout between hemorrhagic stroke and ischemic stroke. Does radiation exposure materially effect the risk of hemorrhagic stroke? One study suggests the possibility but I have seen no high quality research. bmj.com/content/340/bm…
Read 8 tweets
Dec 19, 2017
I want to take a final census of the studies we've looked at before doing the stroke studies from the S-T & K meta-analysis. Adopting the most favorable reading of all studies (studies with no overall significant results) it's 10-6 harmful vs. no harm.
None of the studies of CHD and SFA showed benefit to SFA, and when we read it critically, including all studies that showed harm from a subgroup, we get 14-2 harmful vs. no harm. I want to point out that all the studies excluded people with existing CHD.
This only makes sense if the process that leads to additional cardiac events in a patient with CHD is different than that which leads to the initial event. But there isn't much data to support this. One wonders what a meta-analysis that didn't exclude heart patients would show.
Read 11 tweets
Dec 18, 2017
Our final paper from ST-K's series on heart disease is the Strong Heart Study published in 2006 by Xu. This was a study of 3k people in Arizona, Oklahoma and the Dakotas. Conducted through the IHS, it used 24 hour dietary recall.
The patients were followed for about a decade, those with angina or known MI in the past were excluded. In patients under 60, there was a strong association between SFA and heart disease, that disappeared in those over 60. Trans fats had no association in all groups.
The risk ratios for those under 60 were quite significant, with SFA leading to a 5-fold higher rate of coronary death in the highest vs. lowest quartile in that age group. Curiously, MUFA led to a 3-fold increase in risk ratio. ncbi.nlm.nih.gov/pubmed/17023718
Read 7 tweets
Dec 15, 2017
Next up we have the Baltimore Longitudinal Study of Aging. This looked exclusively at 501 men free of disease at the outset that were followed for 18 years. Seven day diet records were recorded at multiple (up to 7x) intervals in the study.
The BLSA took so long that the nutrition calculations method were changed over the course of the study, but the investigators were scrupulous and unified the methods before the final analysis. The most interesting choice they made was dividing dichotomous variables into binaries.
So someone who ate 4 servings of fruit and vegetables daily was grouped with someone who had none, but someone who had 5 was grouped with someone who had 10. SFA was cut at 12% because almost nobody ate <10% SFA. jn.nutrition.org/content/135/3/…
Read 6 tweets

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