It seems to me that the evidence is that the industries, given some time, can adapt to changing food patterns and food consumption. Certainly that is what has happened all the time.

We believe that the recommendations we are making offer opportunities for the food industry as well as some limitations.

I must say, I do not know how one would try to balance health benefits versus economic benefits.

Mr. BROWN. What about the fact that in this case the Food and Nutrition Board apparently did not give high weight to epidemiologic studies for reasons which presumably would be the quality and significance of such studies, which are admittedly difficult in human populations?

Are you in a position to suggest or to recommend procedures by which we could improve upon the quality of human epidemiologic studies as they relate to this field?

Dr. HEGSTED. I would not presume to be an expert in epidemiology, Mr. Brown, but I think anyone familiar with this field would feel that epidemiology has been a major contributor to our knowledge.

I would point out that Dr. Ancel Keys, who has done extensive epidemiological studies in seven countries, has recently examined the data and published a book on it. It is noteworthy that, in spite of the long list of risk factors that we can identify, the two that are consistent risk factors under all these various conditions are hypercholesterolemia and high blood pressure.

Apparently, smoking is not a maior risk factor everywhere. Obesity is not, at least, strong enough to be identified.

I think we have to conclude that epidemiologic data have been tremendously helpful and very important. I think epidemiology may be like nutrition. We need more and better epidemiologists.

I am not prepared to say how to get those.

Mr. BROWN. Was this not one of the differences between the study done by the Department and the study done by the Academy?

Dr. HEGSTED. We feel that they essentially ignored the epidemiologic evidence and relied only upon clinical trials. We think clinical trials have great limitations in view of the fact that atherosclerosis probably develops over a 20- to 30-year period.

The surprising thing might be that one gets any response when you take a group of atherosclerotic men and modify their diets. I do not think many people believe that the lesion is reversible.

Therefore, to rely almost solely on those kinds of studies, I think, is simply unfortunate and really not correct.

Mr. BROWN. Thank you very much.

Mr. RICHMOND. Thank you, Mr. Brown. Mrs. Heckler?

Mrs. HECKLER. I would like to pursue the question of the methodology used by the panel in making its recommendations.

Mr. Brown mentioned the risk/benefit theory and referred to the risks in one sense and the benefits as related to the benefits to industry. What I would like to have you discuss is the risk/benefit ratio, the basis on which such recommendations are made.

It was my understanding that the risk would be quite clear in terms of a potential health hazard but the benefit would be the benefit to the individual in terms of health, not the benefits to a segment of the food industry. Were such economic factors considered in terms of the recom

mendations of this panel? Is the risk/benefit ratio related to economic factors such as the beef industry or the dairy industry, or any other industry, might obtain? Is that what the benefit is interpreted to mean?

Dr. HEGSTED. I do not know that I am prepared to discuss the benefits of the industrial side, but I would point out that this report says that when we are uncertain about the benefits we should be sure that our recommendations are not harmful. I would say that I do not believe the Board considered that in terms of fat and cholesterol.

I would like to point out that one of the committees that was reviewing the role of salt in the diet, the GRAS, Generally Regarded as Safe Committee, says: "The evidence on sodium chloride is not sufficient to determine that adverse effects-", I do not have the quote quite right. In any case, the evidence is not sufficient to conclude that there are no adverse effects from current levels of salt consumption. That is the essence of the statement.

I think that is the proper position to take. The evidence is not sufficient to conclude that our current levels of fat and cholesterol are not deleterious.

It seems to me that is more important than to conclude that we have to wait forever until we can quantify all the changes that should be made.

I assume, Mrs. Heckler, that that is not a very good response to your question but we might pursue it a little bit.

Mrs. HECKLER. I would like to understand your response. Let us try to dispose of the question of this economic benefit. Was that a consideration by the Board in its recommendations?

Dr. HEGSTED. I cannot answer that as far as the Board is concerned. They do not mention it in their report.

I would say that in trying to interpret the dietary guidelines, which we are now in the process of doing, we are trying to pay some attention to the current dietary habits. We recognize that there is no point in recommending diets that nobody is going to eat. We are trying to adapt-we think one can-the American diet without great distortion and still provide improvements along the dietary lines that we are talking about.

Mrs. HECKLER. Is it not true, Dr. Hegsted, that the risk/benefit relates to the risk of disease and the benefit otherwise of balanced nutrition? The benefit in that equation is generally a health benefit. Is that correct?

Dr. HEGSTED. I think that is entirely true. I would point out that we do not think there are any identifiable risks with lower consumptions of fat and cholesterol. We do not know of anyone who recommends high levels or assumes that there are benefits from high levels of fat and cholesterol consumption. The benefits of limiting fat and cholesterol are not yet quantifiable but they are certainly highly likely and we see no risk at all to these recommendations.

Mrs. HECKLER. Dr. Hegsted, what percentage of the American adult population over 40 would be healthy enough for no specific cholesterol reduction to be advisable?

Dr. HEGSTED. The way I interpret those data, any levels of serum cholesterol over 180 would be associated with increased risk. There are

very few adult American men who can eat like most of us do and maintain a serum cholesterol level that low.

If you combine that with the other risk factors I would say that there are very few Americans who are not at risk. Therefore, they should be advised to moderate their consumption.

Mrs. HECKLER. Some suggestion has been made by our colleagues on the committee that perhaps there has been a disproportionate response, a furor, created over this report which is not warranted. How would you respond to that? Were you surprised by this report and by the recommendations on cholesterol and fat?

Dr. HEGSTED. I would have to say that I was surprised. We recognized, of course, that some of the people involved were not convinced that the recommendation to lower fat and cholesterol is appropriate. But I had assumed that they would not simply say that most Americans did not need to pay any attention to these issues.

Mrs. HECKLER. I would just like to ask one further question. What percentage of the American adult population over 40 would you say presently would be those among whom there is a positive heart disease risk factor that may be significant?

Dr. HEGSTED. I think our response to that would be that 30 to 50 percent of Americans die of heart attacks. Therefore, 30 to 50 percent are at risk of having a heart attack.

Our ability to identify those at risk is not very good. If it were much better, perhaps our dietary recommendations might be more specific. We believe there are good reasons for general advice to the public. Even children have to learn how to eat to preserve their own health and to prevent problems that are going to develop later.

Mrs. HECKLER. You are saying that between 30 and 40 percent of the adult population over 40 has positive heart disease risk factors. Dr. HEGSTED. They die of heart attacks, so they must be

Mrs. HECKLER. We are talking about millions and millions of Americans who have every reason to be cautious in their dietary practices. Is that right?

Dr. HEGSTED. I think we all have reason to be cautious.

Mr. RICHMOND. Thank you, Mrs. Heckler. Mr. Panetta?
Mr. PANETTA. Thank you, Mr. Chairman.

I am trying to pinpoint the differences. I would take it that there really is not much difference between the report and you as to the impact of cholesterol on those who are high risk individuals, either who have hypertension or are obese, or what have you. I think everyone concurs that cholesterol intake for those individuals is a high risk program. The real difference, I guess, is with regard to the healthy

person.

Dr. HEGSTED. Yes.

Mr. PANETTA. The Board states generally that they make no recommendation as to cholesterol intake for the healthy person. I take it that is where you would differ.

I would ask you, Dr. Hegsted, for the healthy person in America what would be your recommendation as to cholesterol? What advice. what guidance, would you give that individual?

Dr. HEGSTED. Our advice has to be that we should moderate our cholesterol intake. I am not quite prepared to define that in terms of quantity. As I indicated, we are working to develop what we think

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are reasonable and acceptable diets that are more moderate in fact levels than are current diets.

This disagreement is a little more than that, Mr. Panetta, because one has to define either who is abnormal or who is a healthy person. This report does not define who is abnormal or who is healthy.

In fact, our ability to identify those people is not very good. Therefore, we think there are good reasons to make general

recommendations.

Mr. PANETTA. Your problem then is defining exactly what a healthy person is and thereby isolating one group from others. Your basic approach would be to advise low cholesterol for all Americans at this point. Is that correct?

Dr. HEGSTED. Yes. It gets to the point: What do we mean by low? We are saying a moderate intake. We think that is generally advisable for everyone.

Mr. PANETTA. Let me ask you what moderate intake means. Everybody talks about a balanced diet. I am not sure a balanced diet has ever been defined. What is your interpretation or definition of either "moderate intake" or "balanced diet?""

Dr. HEGSTED. As I say, we are trying to evaluate what we mean by moderate and the only way that we can think to do that is to look at dietary patterns in the United States and consider what kind of modifications might reasonably be made in products without great changes in present dietary practices.

It appears to us that one can put together, for example, acceptable diets for American men that have 300 to 400 milligrams of cholesterol. I would say that somewhere within that range would be a definition of reasonable.

I think moderation in fat intake will mean somewhere between 30 and 35 percent of the calories.

Mr. PANETTA. You would define it in terms of the numbers you just mentioned.

Dr. HEGSTED. I think those are ballpark figures. I think that is where we would expect it to be.

Mr. PANETTA. One of the conclusions of the Board is this. I quote from page 10: "It apears, therefore, that although high serum cholesterol and LDL levels"-which I think are low-density lipoproteins "are positive risk factors for coronary heart disease, it has not been proven that lowering these levels by dietary intervention will consistently effect the rate of new coronary events."

Do you agree or disagree with that conclusion?

Dr. HEGSTED. The evidence that dietary changes will reduce heart attacks is not as good as we would like to have it. Most of the studies that have been done have indicated some improvement, but I would simply like to point out that we do not believe that in a disease that takes 20 to 30 years to develop, like atherosclerosis, one can rely solely upon these types of experimentation.

The proper experiment would be to start with some young men or boys, have them eat a diet that would not let their serum cholesterol go up, and then see what happens over a 30- or 40-year period. That is a horrendous experiment. I do not think we are ever going to do it. We can point to the reverse experiment that is going on all over the world, where populations are becoming affluent, moving toward the American diet, and developing disease patterns such as we have.

Mr. PANETTA. Thank you. Let me ask you this. One other recommendation that the Board made was this, on page 11:

The Board recommends that the fat content be adjusted to a level appropriate for the caloric requirements of the individual. Infants, adolescent boys, pregnant teenage girls, as well as adults performing heavy manual labor, probably have no need to reduce the fat level of their diets below 40 percent of calories.

Do you agree or disagree with that?

Dr. HEGSTED. I would disagree with that. I think that if we are going to modify the diets of the public, people have to learn what an acceptable and better diet is. They should learn that as children, I believe.

Whether people engaged in very heavy physical labor or exercise should reduce their fat intake, I think, we simply do not know. It is a possibility that if we all got out and exercised we could cope with our affluent diet better than we do. I think that is an area of research.

Mr. PANETTA. What percentage would you use? They say 40 percent.
Dr. HEGSTED. We think it ought to be 35 percent or lower.
Mr. PANETTA. Thank you. Thank you, Mr. Chairman.

Mr. RICHMOND. Thank you, Mr. Panetta.

Mr. Grassley?

Mr. GRASSLEY. One of the main allegations circulating about this report is that it was produced by the Food and Nutrition Board with industry funding, thus making the report biased toward industry. Would you agree with that allegation?

Dr. HEGSTED. Not necessarily. I do not believe that the source of funding necessarily makes any difference, but I think the fact

Mr. GRASSLEY. Could you be more specific and tell me to what extent you agree or disagree?

Dr. HEGSTED. I guess I woud say that I disagree with the statement but I think the information should at least be known.

Mr. GRASSLEY. All right.

Dr. HEGSTED. It may influence somewhat.

Mr. GRASSLEY. May I ask you to what extent you, as a scientist, may have received industry funding and if the source of it ever colored your thinking?

Dr. HEGSTED. I think the only grant I ever had was from the meat industry about 30 years ago. Unfortunately, we concluded that people could get along without meat in their diets if they had to. That was in wartime. [Laughter.]

Mr. GRASSLEY. That was not influenced by the Defense Department, was it? [Laughter.]

Dr. HEGSTED. Not as far as I know.

Mr. GRASSLEY. What you are saying, in this particular instance, that you just cited is that the sources of funding did not influence your thinking at all.

Dr. HEGSTED. I think that is true.

Mr. GRASSLEY. The Department's recent dietary guidelines call for a reduction in fat, saturated fat, and cholesterol. On what scientific grounds would you support that recommendation as opposed to the Food and Nutrition Board's statement that "For the healthy population, there is not a need for cholesterol reduction."?

Dr. HEGSTED. There is voluminous literature and thousands of papers that have to be reviewed. The only immediate response I can make is there are at least 18 to 20 expert groups that have looked at this issue.