* We’re looking at a classic study this week. The Professor Pekka Puska paper, published in 2009, entitled “Fat and Heart Disease: Yes We Can Make a Change – The Case of North Karelia (Finland).”
* Finland generally and North Karelia specifically, are used as evidence that reducing fat, especially saturated fat, reduces heart disease.
* The Seven Countries Study, which was published in 1970, included two cohorts from Finland – west Finland and east Finland (North Karelia). It found that North Karelia had very high mortality from coronary heart disease; west Finland didn’t. All of the findings were for men. The Seven Countries Study did not include any women. This was typical of research at the time.
* A number of health interventions were started in North Karelia in 1972. The three major risk factors being addressed were blood cholesterol, blood pressure and smoking. It was assumed that dietary change would impact blood cholesterol levels.
* Puska, and the Finland/North Karelia literature, claim that reduced intake of saturated fat has led to an 80% reduction in annual cardiovascular disease (CVD) mortality rates among the working aged population.
* It cannot be assumed that (saturated) fat reduction made the difference to heart disease. Smoking among men more than halved, which is likely to have made the biggest difference.
* There is another significant factor. The Seven Countries Study comprised men aged 40-59 in 1956. These men were aged 29-48 in 1945, when World War II ended, and they were between 23-42 years old when World War II began. North Karelia was ravaged during World War II and virtually the entire population of Karelia was displaced. War and displacement would have caused high heart and all-cause mortality. Since people can’t die twice, deaths would have fallen following this traumatic period whether butter or margarine was put on bread.
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