Objective data trials are needed

doi:10.1136/bmj.312.7044.1479c

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George Davey Smith,
Yoav Ben-Shlomo

Professor of clinical epidemiology Senior lecturer in epidemiology Department of Social Medicine, University of Bristol, Bristol BS8 2PR

EDITOR,—Paul Knekt and colleagues' study showing an apparent protective effect of consumption of flavonoids on the risk of coronary death illustrates the pitfalls of such investigations.1 Intake of flavonoids shows the same association with both non-coronary and coronary mortality. It either reduces biological susceptibility to many diseases or it serves as a marker for a complex of sociobehavioural factors associated with the risk of death.

Observational studies of diet and health have two main problems. Firstly, dietary intakes are socially and culturally determined …