LESSONS FROM CHINA 83 CHART 4.6: FAT CONTENT OF SAMPLE FOODS Food Percent of calories derived from fat Butter 100% McDonald's Double Cheeseburger 67% Whole Cow's Milk 64% Hom 61% Hotdog 54% Soybeans 42% "Low-Fat" (or 2%) Milk 35% Chicken 26% Spinach 14% Wheaties Breakfast Cereal 8% Skim Milk 5% Peas 5% Carrots 4% Green Beans Whole Baked Potatoes 3.5% 1% With a few exceptions, animal-based foods contain considerably more fat than plant-based foods 24 This is well illustrated by comparing the amount of fat in the diets of different countries The correlation between fat intake and animal protein intake is more than 90%.25 This means that fat intake increases in parallel with animal protein intake In other words, dietary fat is an indicator of how much animal-based food is in the diet It is almost a perfect match FAT AND A FOCUS ON CANCER The 1982 National Academy of Sciences (NAS) report on Diet, Nutrition and Cancer, of which I was a co-author, was the first expert panel report that deliberated on the association of dietary fat with cancer This report was the first to recommend a maximum fat intake of 30% of calories for cancer prevention Previously, the U.s Senate Select Committee on Nutrition chaired by Senator George McGovern 26 held widely publicized hearings on diet and heart disease and recommended a maximum intake of 30% dietary fat Although the McGovern report THE (HINA STUDY 84 generated a public discourse on diet and disease, it was the 1982 NAS report that gave momentum to this debate Its focus on cancer, as opposed to heart disease, increased public interest and concern It spurred additional research activity and public awareness of the importance of diet in disease prevention Many of the reports at the time 20, 27, 28 were centered on the question of how much dietary fat was appropriate for good health The unique attention given to fat was motivated by international studies showing that the amount of dietary fat consumed was closely associated with the incidence of breast cancer, large bowel cancer and heart disease These were the diseases that kill the majority of people in Western countries before their time Clearly, this correlation was destined to attract great public attention The China Study was begun in the midst of this environment The best known study,29 in my view, was that of the late Ken Carroll, professor at the University of Western Ontario in Canada His findings showed a very impressive relationship between dietary fat and breast cancer (Chart 4.7) This finding, which corresponded to the earlier reports of others,3,3O became especially intriguing when compared with migrant studies 31 , 32 These studies showed that people who migrated from one area to another and who started eating the typical diet of their new reSidency assumed the disease risk of the area to which they moved This strongly CHART 4.7: TOTAL FAT INTAKE AND BREAST CANCER NETHERLANDS UK • DENMARK CANADA • NEW ZEALAND SWITZERLAND IRELAND • • US BELGIUM AUSTRALIA •• SWEDEN 25 FEMALE ci o a o 20 o o d o AUSTRIA •• GERMANY • ITALY NORWAY FRANCE CZECH • • FINLAND • PORTUGAL HUNGARY -; 15 '" cr:: s ~ HONG KONG • POLAND CHilE • • • BULGARIA SPAIN •• GREECE 10 '0 VEN~;~~A·· ~ V> => ~ ~~~~~~VI: PHILIPPINES COLOMBIA PUERTO RICO • • • MEXICO JAPAN TAIWAN • CEYLON THAllA~D El SALVADOR cV C\