BMJ 2002;324:238 ( 26 January )

Letters

Diet-heart disease hypothesis is wishful thinking

The first 150 words of the full text of this article appear below.

EDITORMann et al and Hu et al list several shortcomings in the trials reviewed by Hooper et al that explain why dietary treatments for patients with coronary heart disease were ineffective.^1-3 Inferior studies with negative results are prevalent, but where is the positive evidence that justifies the dietary recommendations?

Mann et al point to the improved outcome in the subgroup analysis of the five prolonged trials. But in that analysis Hooper et al excluded the Sydney diet-heart study, where total mortality was significantly increased, and included the Veterans Administration Trial, which was biased by a significant higher number of heavy smokers in the control group.

Mann et al also say that there is an enormous body of descriptive epidemiology that supports the link between dietary fat, cholesterol concentrations, and coronary heart disease. The accumulated epidemiology actually strongly contradicts such a link, as illustrated by a systematic review.⁴ In . . . [Full text of this article]

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Rapid Responses:

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Another perspective on diet and disease

Eric Freedland
bmj.com, 25 Jan 2002 [Full text]