Role of Dietary Fat in Human Nutrition III. Diet and the Epidemiology of Coronary Heart Disease Ancel Keys, and Francisco Grande CopyRight https://doi.org/10.2105/AJPH.47.12.1520 Published Online: August 29, 2011
The effect of increasing the level of daily physical activity on the serum cholesterol concentrtaion was studied in 9 clinically healthy University students. The physical activity was increased by walking on the motor-driven treadmill at a rate which required 1280 cal. for 2 hours. The caloric intake was increased by 900 cal. but the proportion of calories derived from fat was held constant. There was no change in the serum cholesterol concentration. It is concluded that the results are consistent with the hypothesis that the serum cholesterol concentration is related to the proportion of total calories derived from fat.
The differentiation between normal and abnormal changes in conventional electrocardiography is substantially improved by consideration of normal age trends. For clinical application of spatial vectorcardiography, consideration of age trends is equally important. On the basis of statistical evaluation of magnitude, azimuth and elevation of mean spatial QRS and T vectors in 105 healthy young men and 178 healthy older men, upper and lower limits were determined for each age group. The age differences were highly significant for all items of vector analysis.
Data from a recent electrocardiographic survey provide no support for the claim that people in the town of Roseto, Pa, are relatively protected from myocardial infarction. The evidence offered from death data for 1955 to 1961 does not prove that in those years the people of Roseto differed significantly from average US white residents in the rate of death from arteriosclerotic heart disease. Consideration of the diet suggests that in the past Rosetans should have enjoyed considerable protection from arteriosclerotic heart disease. Failure to establish that fact could be expected from the inadequate size of the population concerned. There is no basis to propose a protective effect of the emotional climate of Roseto.
Many questions about the processes and events in the reduction of obesity in man are still obscure or even unexplored, in spite of a very large number of clinical and experimental studies. The reverse situation, the production of obesity in man, has had practically no detailed attention except for scattered clinical observations in rare pathological states. That obesity develops whenever a positive calorie balance is maintained over a long period of time, is axiomatic but not very informative. Positive calorie balance may, of course, reflect increased calorie intake, decreased output, or both, and the details of metabolism and physiological adjustments are not necessarily the same in these several conditions. It would be expected, in fact, that the effects of a sharp reduction in physical activity without change in the diet must be quite different from those of increased diet and no alteration in activity. In the natural (spontaneous) development of obesity in organically healthy man which is so common in our modern society, alterations both in calorie intake and output are probably involved and, in addition, the character of the diet is often changed. What factors, then, are responsible for the various morphological, biochemical, and physiological differences between the person before and after the development of obesity ? Animal experiments on these questions are useful, of course, but the relationships in the production of obesity in the rat or other laboratory animals are not quantitatively transferable to the human situation. We have elected to begin the study of these questions in man by the experimental production of obesity by simple overfeeding without substantial change in physical activity, using for this purpose a diet in which the calorie increase is provided one-third by fat and two-thirds by
It is generally agreed that the fluid balance between blood and tissue is a resultant between hydrostatic and osmotic forces not greatly different from that pictured originally by Starling ( 1896).The analysis of the exchanges across the capillary membrane involves, necessarily, acceptable data for both the hydrostatic pressure and the effective osmotic pressure at the site of the exchanges, or, alternatively, figures for one of these factors together with a detailed knowledge of the character of the capillary wall as a permeable membrane.The efforts of Starling and his successors (see, e.g., Schade and Claussen, 1924;Landis, 1926;Krogh, 1929) were directed toward proving that the capillary blood pressure and the osmotic pressure of the plasma colloids are so nearly equivalent to each other that the observed state of balance between blood and tissue fluid would be obtained in a passive system with a membrane permeable to everything except substances of colloidal dimensions.These efforts have been regarded as generally successful but, as Drinker and Field (1933) point out, perhaps they are quantitatively too successful in demonstrating complete equality of the two opposing forces considered.Drinker and Field have collected a convincing body of data to show that not only thoracic duct lymph but also true tissue lymph contains a considerable amount of protein which exerts a proportionate osmotic force (Loewen, Field, and Drinker, 1931).Moreover, this tissue lymph is in constant, though slow, circulation, and Drinker and Field make it probable that this lymph is derived 55