Cholesterol and Beyond: The Research on Diet and Coronary Heart Disease 1900–2000
1
BOOK REVIEWCholesterol and Beyond: The Research on Diet and Coronary Heart Disease 1900–2000 Truswell AS. Springer, New York, 2010, 227 pages, $39.95 , ISBN 978-90-481-8874-1 In Cholesterol and Beyond, A. Stewart Truswell has docu- mented for nutrition practitioners and health professionals the research on diet and heart disease between 1900 and 2000. An emeritus professor in the Human Nutrition Unit at The University of Sydney, Truswell himself has contributed over 500 papers to our understanding of diet and disease, starting in the 1960s with his studies on the hunter-gatherer !Kung people of the Kalahari Desert in Botswana who showed few conditions like heart disease. Truswell takes the reader on a journey from the identifi- cation of coronary heart disease as a cause of mortality and morbidity to the unravelling of the complex links between diet and heart disease risk factors and outcomes. The book is structured on topics in short, concise chap- ters. Truswell has not attempted to do a systematic review on each dietary factor and its relationship to heart disease, but instead describes the timing of landmark studies and the key researchers that contributed to the diet/HD puzzle. Truswell explains how inventions like the electrocardiograph by the 1924 Nobel Prize winner William Einthoven provided the means of diagnosing heart disease in the first half of the century. The invention of gas-liquid chromatography around 1950 allowed for the more effective testing of the effect of different fats. And a better understanding of study method- ology shifted the focus of researchers from case control studies to large, well-funded prospective studies in the 1950s and 1960s, like the Framingham study and the Seven Countries study, and to dietary intervention trials to build the evidence base. Truswell also gives us insight into the reasons the science of diet and heart diseases did not move along more quickly to address what had become the major cause of death in developed counties by the mid-century and continued to climb after World War 2. These included the confusion between cholesterol in the diet and cholesterol in the blood and what constitutes ‘normal’ cholesterol levels, issues that nutritionists continue to struggle with when helping their patients today. Another was the sceptics and critics of the fat-cholesterol hypothesis in the late 1970s, supported by dairy, egg and meat industries and by journalists! Nutritionists could update their understanding of the reasons they should recommend eating fatty fish or fish oils, wholegrains and fruit and vegetables for the prevention of CHD (coronary heart disease) by simply referring to clearly marked chapters on these topics. Given that Australians eat almost twice the recommended intake of saturated fat and half the amount of polyunsatu- rated fats recommended, I would recommend as essential reading to nutrition practitioners and health policy makers the evidence on the importance of replacing saturated fat with polyunsaturated fat (Chapter 25). The contribution of a landmark study, the US Nurses health study, was significant in identifying that higher levels of linoleic acid in the diet were associated with a decreased risk of CHD. In Chapter 29, Truswell walks the reader through the controversial story of the link between salt and high blood pressure since 1954. The reader might find it interesting to note that the baby food manufacturers took the lead in reducing the salt levels of baby foods in the 1970s, but it has taken the rest of the food industry another 20–30 years to voluntarily start lowering the sodium levels of popular food products both in Australia and overseas. Cholesterol and Beyond is the best summary of the research of the last century on diet and heart disease that I have read in my 20 years of working in this field translat- ing science into practice. This would be essential reading for practitioners and researchers new to the field of diet and heart disease, and responsible health journalists looking to bring facts to a story (without having to read almost 900 references). The nutrition profession thanks Professor Truswell for taking the time to summarise 100 years of research, hypoth- eses and discoveries to ensure that any patient advice, popu- lation interventions and public health policy decisions are made on the best evidence available at the time. Cholesterol and Beyond also reminds us that researchers will continue to be motivated to piece together the gaps in our knowledge on diet and heart disease while cardiovascular disease remains Australia’s number one killer. Susan Anderson, B app Sc (Food and Nutrition), Post grad Dip (Dietetics), MPH National Director – Healthy Weight National Heart Foundation of Australia Melbourne, Victoria, Australia Nutrition & Dietetics 2011; 68: 170 DOI: 10.1111/j.1747-0080.2011.01517.x © 2011 The Author Nutrition & Dietetics © 2011 Dietitians Association of Australia 170
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Transcript of Cholesterol and Beyond: The Research on Diet and Coronary Heart Disease 1900–2000
BOOK REVIEWndi_1517 170
Cholesterol and Beyond: The Researchon Diet and Coronary Heart Disease1900–2000
Truswell AS. Springer, New York, 2010, 227 pages,$39.95 , ISBN 978-90-481-8874-1
In Cholesterol and Beyond, A. Stewart Truswell has docu-mented for nutrition practitioners and health professionalsthe research on diet and heart disease between 1900 and2000. An emeritus professor in the Human Nutrition Unit atThe University of Sydney, Truswell himself has contributedover 500 papers to our understanding of diet and disease,starting in the 1960s with his studies on the hunter-gatherer!Kung people of the Kalahari Desert in Botswana whoshowed few conditions like heart disease.
Truswell takes the reader on a journey from the identifi-cation of coronary heart disease as a cause of mortality andmorbidity to the unravelling of the complex links betweendiet and heart disease risk factors and outcomes.
The book is structured on topics in short, concise chap-ters. Truswell has not attempted to do a systematic review oneach dietary factor and its relationship to heart disease, butinstead describes the timing of landmark studies and the keyresearchers that contributed to the diet/HD puzzle. Truswellexplains how inventions like the electrocardiograph by the1924 Nobel Prize winner William Einthoven provided themeans of diagnosing heart disease in the first half of thecentury. The invention of gas-liquid chromatography around1950 allowed for the more effective testing of the effect ofdifferent fats. And a better understanding of study method-ology shifted the focus of researchers from case controlstudies to large, well-funded prospective studies in the1950s and 1960s, like the Framingham study and the SevenCountries study, and to dietary intervention trials to buildthe evidence base.
Truswell also gives us insight into the reasons the scienceof diet and heart diseases did not move along more quicklyto address what had become the major cause of death indeveloped counties by the mid-century and continued toclimb after World War 2. These included the confusionbetween cholesterol in the diet and cholesterol in the bloodand what constitutes ‘normal’ cholesterol levels, issues thatnutritionists continue to struggle with when helping theirpatients today. Another was the sceptics and critics of thefat-cholesterol hypothesis in the late 1970s, supported bydairy, egg and meat industries and by journalists!
Nutritionists could update their understanding of thereasons they should recommend eating fatty fish or fish oils,wholegrains and fruit and vegetables for the prevention ofCHD (coronary heart disease) by simply referring to clearlymarked chapters on these topics.
Given that Australians eat almost twice the recommendedintake of saturated fat and half the amount of polyunsatu-rated fats recommended, I would recommend as essentialreading to nutrition practitioners and health policy makersthe evidence on the importance of replacing saturated fatwith polyunsaturated fat (Chapter 25). The contribution of alandmark study, the US Nurses health study, was significantin identifying that higher levels of linoleic acid in the dietwere associated with a decreased risk of CHD.
In Chapter 29, Truswell walks the reader through thecontroversial story of the link between salt and high bloodpressure since 1954. The reader might find it interesting tonote that the baby food manufacturers took the lead inreducing the salt levels of baby foods in the 1970s, but it hastaken the rest of the food industry another 20–30 years tovoluntarily start lowering the sodium levels of popular foodproducts both in Australia and overseas.
Cholesterol and Beyond is the best summary of theresearch of the last century on diet and heart disease that Ihave read in my 20 years of working in this field translat-ing science into practice. This would be essential readingfor practitioners and researchers new to the field of dietand heart disease, and responsible health journalistslooking to bring facts to a story (without having to readalmost 900 references).
The nutrition profession thanks Professor Truswell fortaking the time to summarise 100 years of research, hypoth-eses and discoveries to ensure that any patient advice, popu-lation interventions and public health policy decisions aremade on the best evidence available at the time. Cholesteroland Beyond also reminds us that researchers will continue tobe motivated to piece together the gaps in our knowledge ondiet and heart disease while cardiovascular disease remainsAustralia’s number one killer.
Susan Anderson, B app Sc (Food and Nutrition),Post grad Dip (Dietetics), MPH
National Director – Healthy WeightNational Heart Foundation of Australia
Melbourne, Victoria, Australia
Nutrition & Dietetics 2011; 68: 170 DOI: 10.1111/j.1747-0080.2011.01517.x
© 2011 The AuthorNutrition & Dietetics © 2011 Dietitians Association of Australia
170
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