SAMT VOL 75 18 FEB 1989 167

The contribution of different food groups to theenergy, fat and fibre intake· of the Coronary RiskFactor Study (CORIS) population

P. WOLMARANS, M. L. LANGENHOVEN, M. VAN ECK, A. S. P. SWANEPOEL

Summary

A dietary survey done in 1979 on a randomly selected 15%subsample (454 males and 659 females, 15 - 64 years old) ofthe 1979 Coronary Risk Factor Study (CORIS) populationshowed that this population consumed a typical Westerndiet. In order to identify specific weaknesses in the dietaryhabits of the 'population, additional analyses were performedon the data. Foods c'onsumed by the respondents weregrouped into 8 groups and the percentage contribution ofeach of these food groups to total energy intake, total macro­nutrients, dietary cholesterol and dietary fibre intake wasdetermined. A reference, an 8,4 MJ diet, calculated accordingto the prudent diet guidelines, was also analysed as describedabove. The results showed that the CORIS respondents'dietary intake compared unfavourably with the values of thereference diet. The meat group was the main source of totalfat, saturated fat and dietary cholesterol. The fat group wasthe second most important source of total fat in the diet, whilethe milk group was the second most important source ofsaturated fat. The study population preferred refined cerealsand had a low fruit and vegetable intake. These resultsrevealed specific shortcomings in the dietary habits of theCORIS population and emphasised the need for changesnecessary to meet the requirements for a prudent diet.

S Air Med J 1989; 75: 167-171.

In 1979 the baseline survey of the Coronary Risk Factor Study(CORIS) was undertaken to establish the prevalence andintensity of coronary risk factors in a white South Africanpopulation group. 1.2 It was reported that hypercholesterolaemiawas exceedingly common in this group, and that subjects alsoconsumed a Western-type diet. ',2 Both these factors are asso­ciated with the development of coronary heart disease (CHD)3and are therefore important considerations in interventionstrategies for reducing CHD risk.

Usually a prudent diet is recommended for Western popula­tions consuming a diet high in total fat, saturated fat anddietary cholesterol and low in polyunsaturated fat. 4 Prudentdietary guidelines with the aim of reducing the risk of CHDinclude recommendations to reduce red meat intake and eatwhite meat instead, use skim milk and skim-milk productsinstead of whole milk and whole-milk products, limit the

Research Institute for Nutritional Diseases of the SouthAfrican Medical Research Council, Parowvallei, CPP. WOLMARANS, H.Se. HONS (DIET.)M.·L. LA 1GENHOVEN, M.Se. (DIET.)

Institute for Biostatistics of the South African MedicalResearch Council, Parowvallei, CPM. VAN ECK, B.se. (Present address: Computing Cenue, SouthAfrican Medical Research Council)Department of Health Services and Welfare, Administra­tion: House of Assembly, PretoriaA. S. P. SWA 1EPOEL, M.Se. (DIET.)

Accep[ed 22 Feb 1988.

weekly intake of egg yolks, use polyunsaturated margarine andoil instead of hydrogenated margarine, butter and dripping,and lastly increase the intake of dietary fibre derived fromfruit, vegetables, legumes and unrefined cereals. 5

The prudent dietary guidelines are only general guidelinesand distract attention from the potential existence of specificdietary shortcomings requiring special attention. Comparisonof the CORIS data with prudent guidelines is thereforeimperative to identify the specific weaknesses in the dietaryintake of this population. Information obtained from such acomparison would not only identify specific problem areas butwould also allow more specific recommendations to be made.In this article baseline data for 1979 are further analysed andcompared with the prudent dietary guidelines.

Methods

In March, April and May 1979 the CORIS baseline surveywas undertaken on the total white population (aged 15 - 64years) in the disuicts of Robertsoa, Swellendam and Riversdale.The response rate was 82% (7 188 subjects). The main aims ofthe CORIS and the methods used in the study have beendiscussed in detail.' As part of this cross-sectional study,dietary information was collected simultaneously from a 15%randomly selected subsample (1113 respondents). Ten dieti­tians, trained in the use of the 24-hour dietary recall method,conducted the dietary interviews. Food models, householdmeasures and pre-prepared dishes were used in the trainingprogramme to standardise dietitians' assessment of food portionsizes. During the interviews, food models and householdmeasures were used to assist in the estimation of the quantitiesof food consumed. The National Research Institute for Nutri­tional Diseases ( 1RIND) Food Composition Tables (1981)6were used by one dietitian to code the dietary intakes. Thebaseline dietary data have been published.2

For the additional analyses of the baseline dietary data,foods consumed by the respondents were grouped into one of8 groups, any of 5 basic food groups (milk, meat, fruit andvegetables, cereals and fat), or into the confectionery, sugar oralcohol group.

The milk group included all dairy products except butter.When milk comprised the main ingredient (more than 70%) ofa dish, it was also included in the milk group. The milk groupwas then subdivided into whole milk and whole-milk products,skim milk and skim-milk products, full-fat and low-fat hardcheese, and cottage cheese.

For the meat group the following subgroups were distin­guished: red meat (beef, mutton and pork), white meat (poultryand fish), meat and fish (red meat, meat pies, organ meats,white meat and seafoods), meat, fish and eggs (red meat, meatpies, organ ijleats, white meat, seafoods and eggs) and nuts(nuts, peanut butter and dry legumes). In nutrition educationthe latter is included in the meat group because of its relativelyhigh protein content. Prepared meat dishes, for example meatstews, meat pies and commercially processed meats, were alsoincluded in the meat group.

TABLE I. FOODS INCLUDED ON THE 7-DAY PRUDENTDIET MENU

cholesterol intake of the popularion, the mear group was themain contributor (Table Ill). Approximately 91 % of the malesand 83% of the females reported intake of red meat on the dayof recall, compared with only 27% of males and feIl)ales whoreported intake of white meat. For fish the figures were evenlower, 16% for both males and females. Among both male andfemale consumers red meat made a bigger contribution to totalfat, saturated fat and dietary cholesterol intake and a smallercontribution to polyunsaturated fat intake than white meat(Figs 1 and 2). Eggs were responsible for approximately 60%of the dietary cholesterol intake in consumers of eggs. However,because only 38% of the males and 32% of the females reportedintake of eggs on the day of recall, the contribution of eggs tothe' daily total cholesterol intake of the total srudy populationwas only 22% for males and 20% for females.

The fat group was the second most important source of totalfat in the diet (Table Ill). For the population, the fat groupwas also the main source of polyunsarurated fat in the diet andwas responsible for approximately 39% of the total polyunsaru­rated fat intake for males and 37% for females. The percentagecontribution of buner and cream to the saturated fat intake ofthe consumers was 26% for males and 23% for females, that ofhard margarine 13% for males and 12% for females, and that ofpolyunsarurated margarine 11% for both male and female

168 SAMJ VOL 75 18 FEB 1989

The fruit and vegetable group was divided into ascorbicacid-rich fruit and vegetables, carotene-rich fruit and vege­tables, other fruit and vegetables, potatoes and sweet potatoes.

The cereal group included all kinds of bread and porridge,breakfast cereals, rice, crackers and scones. It was subdividedinto unrefined and refmed cereal foods. Cereal foods containingadded sucrose, for example rusks, cakes, tarts and puddings,were included in the confectionery group. .

The fat group was subdivided into the following: buner andother mainly sarurated fats, e.g. beef!munon gravy, beef!munon tallow, lard, suet, chicken fat, desiccated coconut,coconut oil and mock cream; hard margarine and other mainlymono-unsarurated fats, e.g. olive oil and avocado; polyunsatu­rated margarin.e and other mainly polyunsarurated fats, e.g.plant oils other than coconut and olive oil, French saladdressing, and commercial and homemade mayonnaise.

Sugar, honey, sweets (including chocolate), cold drinks andjam fell into the sugar group. Alcoholic beverages were includedin the alcohol group. Condiments, coffee, tea, soup and sauceswere not grouped into a specific food group.

The mean percentage contribution of each of these foodgroups to total intake of energy, total protein and animalprotein, total fat, sarurated and polyunsarurated far, dietarycholesterol, total carbohydrate, added sucrose and dietary fibrewas calculated for the total diet study population (1113 respon­dents) as well as for the consumers, i.e. those respondents whoate a specific food on the day of recall.

An 8,4 MJ prudent diet was calculated as a reference diet tocompare with the dietary intakes of the CORIS dietary popula­tion. The Dietary Goals of the USA were used to define thereference diet. 4

,7 Taking the South Mrican Western type offood preferences into consideration, a 7-day prudent dietmenu was plarmed (Table I) and analysed for nutrients as wellas for the contribution of the different food groups to totalenergy content of the diet.

Results

The comparison between the calculated prudent diet and theCORIS dietary intake for percentage contribution of the dif­ferent food groups to the total energy intake of the populationis shown in Table Il. The main source of energy in the diets ofmales aged 20 - 64 years and females aged 15 - 34 and 45 - 64years was the meat group. The cereal group was the mainsource of energy in the diets of males 15 - 19 years of age.Approximately two-thirds of the energy contributed by themeat group came from red meat, while a very small percentage(2-4%) came from white meat. Only a small percentage of thedaily total energy intake of the population was contributed byeggs (1 - 3%), the reason for this being the fact that only one­third of the respondents reported intake of eggs on the day ofrecall.

Refined cereals made a bigger contribution to the daily totalenergy intake than unrefined cereals (Table Il). In combination,the cereal and confectionery groups were the main source ofenergy for all females as well as for males aged 15 - 19 and45 - b4 years (Table Il).

Although energy intake from the fruit and vegetable groupdecreased with age among females, their intake was still higherthan that for males (Table ll).

Energy intake from milk decreased with age for males, whilethere was a slight increase for females (Table ll). Of the fivebasic food groups, the fat group made the smallest contributionto daily total energy intake in all the various sex and agegroups.

When the food groups were ranked in order of their percen­tage contribution to the total fat, sarurated fat and dietary

Foods allowed*

Milk groupSkim milkFull-cream milkLow-fat cottage cheeseFull-fat hard cheese

Meat groupFor 7 light meals per week

Dry beansEggsBeef, leanHam, lean

For 7 main meals per weekMutton, leanBeef, leanChicken, without skinFish, white, e.g. hake

Fat groupPolyunsaturated margarinePolyunsaturated oil

Cereal groupWhole-wheat breadCooked porridgeWhole-wheat rusksBrown rice

Fruit and vegetable groupFruit

Ascorbic acid-richOther

VegetablesCarotene-richOtherPotatoesSweet potatoes

SugarJam

>Ready to eat.

Times per week. and amount at a time

7 x 250 ml3x 250 ml2 x 50 92 x 30 9

1 x 200 g2 x 1 egg2 x 30 g2 x 30 9

2 x 90 93 x 90 91 x 90 91 x 90 9

7 x 20 97 x 10 9

7 x 3 (40 9 slices)7 x 200 g7 x 2 (30 9 each)2 x 120 9

7 x 200 g7 x 140 9

7 x 100 g21xl00g

3 x 200 92 x 125 97 x 25 97 x 15 9

SAMT VOL75 18FEB1989 169

TABLE 11. MEAN PERCENTAGE CONTRIBUTION OF THE DIFFERENT FOOD GROUPS TO TOTAL ENERGY INTAKE OF THETOTAL POPULATiON

Prudent CORIS.1979diet* Males Females

Age (yrs) 15 -19 20-34 35 - 44 45-64 15 -19 20-34 35-44 45-64No. 96 164 121 73 91 254 185 129Food groupMeat 13 19 25 27 26 23 24 23 26

Red meat 8 13 17 18 18 16 16 15 16White meat 2 2 3 4 3 3 4 3 4Eggs 1 2 2 3 2 1 2 3 2Dry beans, nuts 2 2 2 1 2 3 2 1 3

Cereals 26 27 22 22 24 22 22 23 23Refined cereals 5 15 14 11 13 14 12 12 13Unrefined cereals 21 12 8 11 11 8 10 11 10Confectionery 13t 5 3 3 3 6 5 4 4Cereals and 39 32 25 25 27 28 27 27 27Confectionery

Fruit and 20 14 15 14 14 19 18 17 17vegetablesMilk 10 12 11 10 9 10 12 11 12Fat 12 9 8 8 8 7 8 8 8Sugar 7 6 4 2 2 6 3 3 3Alcohol NC 0,2 3 4 4 0,2 1 1 0,5

"See 'Methods' for calculation.tCalculation for 2 whole-wheat rusks (see Table I).NC = not calculated.

2

3

NA

3

3

NA

Foods

Fruit andvegetables

Fat group

Meat groupMilk groupConfectionerygroupCereal group

Mean MeanFoods contribution (%) Foods contribution (%)

M F M FMeat group 39 37 Meat group 42 40Fat group 24 22 Milk group 25 26Milk group 15 16 Fat group 17 15

Cereal group 9 10 Fruit and 7 7vegetables

Fruit and 8 9 Cereal group 5 6vegetablesConfectionery 4 5 Confectionery 4 5group group

M =males; F = females; NA = not applicable.

TABLE Ill. RANKING OF FOODS IN ORDER OF THEIR MEAN PERCENTAGE CONTRIBUTION TO THE TOTAL FAT,SATURATED FAT AND DIETARY CHOLESTEROL INTAKES OF THE POPULATION

Total fat Saturated fat Dietary cholesterol

Meancontribution (%)

M F71 6718 20

3 6

consumers. Buner consumption was responsible for 13% of thecholesterol intake of males and 10% of that of females. Hardmargarine was used by 48% of males and 49% of females.Polyunsaturated margarine was used by 41 % of males and 36%of females, while 15% and 11 % of males and females respectivelyused buner.

The milk group was the second most important source ofsaturated fat in the diet and also made a considerable contribu­tion to daily cholesterol intake (Table Ill). Full-cream milkmade an important contribution to the total fat (approximately13% for males and females), saturated fat (approximately 20%for males and 21 % for females) and dietary cholesterol intakes(15% for males and females) of male and female consumers.Eighty-eight per cent of males and 85% of females wereconsumers of full-cream milk. For consumers of skim milk,

skim milk was responsible for a mean total fat intake of onlyI % for males and 2% for females, a saturated fat intake of 2%for males and 4% for females, and a dietary cholesterol intakeof 3% for males and 6% for females. Only 7% of males and 13%of females used skim milk in one form or another.

The contrIbutions of the fruit and vegetable and cerealgroups to total fat and saturated fat intake were of the sameorder (Table Ill). As far as dietary fibre intake of the popula­tion is concerned, fruit and vegetables were responsible for42% of the total intake for males and 52% for females, whereasthe cereal group contributed 49% for males and 39% forfemales. .

The confectionery group made the smallest contribution tototal fat and saturated fat intake for both sexes. However,among females this group was the next most important source

170 SAMJ VOL. 75 18 FEB 1989

Discussion

Fig. 1. Percentage contribution of red meat and white meat tototal fat, saturated fat, polyunsaturated fat and dietary cholesterolintake in male consumers 15 - 64 years of age.

prudent reference diet (Table Il), in which the cereal groupand not meat is the main source of energy.

The prudent diet calculation for added sugar, 7% of energy(7% E), was exceeded by both the males (12 - 15% E) and thefemales (11- 15% E) of the CORIS population.2 This popula­tion's intake of alcohol was within the long-term NationalAdvisory Committee for Nutrition Education (NACNE) goalof 4% of energy intake.

In order to meet the prudent dietary guidelines,4 modificationin the dietary intake of the CORIS population was aimed at byincreasing the percentage of energy from the cereal and fruitand vegetable groups and decreasing the percentage of energyfrom the meat group (Table Il). Snowdon er al. 9 showed adose-response relationship between meat consumption andischaemic heart disease, which emphasises the importance oflowering the contribution of the meat group to daily totalenergy intake. Although the 24-hour dietary recall methoddoes not necessarily reflect food preferences, the results showedthat the majority of respondents reported the intake of redmeat on the day of recall. Red meat contributed more to theintake of saturated fat and less to the intake of polyunsaturatedfat than white meat. This also contributed to the low dietary .polyunsaTUrated/saturated fat (PIS) ratios in the study popula­tion, i.e. 0,52 for males and 0,55 for females. 2 For the calculatedprudent diet the PIS ratio was 1.

Only 16% of the CORIS respondents reported intake of fishon the day of recall. In the Honolulu Heart Program, alsousing the 24-hour dietary recall method, 44% of Japanese menate fish on the day of recall. 10 Studies have shown an inverseassociation between fish consumption and the risk of coronarydeath. ll

.12 Attention should therefore be given to the more

frequent inclusion of fish in the diet. The use of fish (PIS1,0-2,0) and chicken (PIS 0,8) more often in the diet, insteadof red meat (PIS 0,1), could help to increase the dietary PISratio of the study population (PIS ratios calculated fromGouws and Langenhoven6). Oliver '3 calculated that increasingthe dietary PIS ratio from 0,4 to 1,0 without lowering total fatintake could lower serum cholesterol levels by 0,47 mmol/l.However, an even better lowering of 0,75 mmol/l was achievedwhen the PIS ratio was increased and total fat, saturated fatand dietary cholesterol intake were decreased. 13

The contribution of eggs to cholesterol intake in the averageAmerican diet was 46% and that in 20 developed countries39%,14 while it was only 22% for CORIS males and 20% forCORIS females. Eggs were not the major source of dietarycholesterol in the CORIS population, probably because onlyone-third of the respondents reported intake of eggs on theday of recall, resulting in a population daily mean intake of 0,4eggs (unpublished data). However, for those respondents whoreported the intake, eggs made an important contribution tocholesterol intake. To meet the prudent dietary goal of lessthan 300 mg cholesterol per day intake of egg yolks should berestricted, preferably to 2 per week (Table I).

The fat group is the main source of fat in the prudent diet(Table Il), as it was in the American diet (1977).15 In theCORIS dietary study, the main source of fat in the diet wasthe meat group. This could be due to coding methodology andthe characteristics of the Food Composition Tables since, formany food items, fat added to food during preparation was notcounted as being part of the fat group, but as fat contributedby that food group.

Mean daily milk intake for CORIS males and females was375 ml and 250 ml respectively (unpublished data); and themajority of males (87%) and females (85%) used full-creammilk. A. lowering of total fat and saturated fat intake couldtherefore be achieved in this population by substituting skimmilk for at least part of the full-cream milk. Rossouw er al. 16

demonstrated the cholesterol lowering effect of skim milkwhich could in part be due to its low fat content.

L3!-1 LI •

: 37 : 37: 35: :

L5

'-,

37.: 31 : .3G• : : 28 :

: 26 :

.

..

)0 :30:

'3

30

26

11 11.

10 IQ

12

23 22

25 26 27

o WHITE MEAT

o WHIfE MEAT

.. ..1!. •. .

38 39 37

·12 •

• : s

AGE(yearsl

30

SATURATED FAT POLYUNSATURATED DIETARYFAT CHOLESTEROL

L8

SATURATED FAT POLYUNSATURATED DIET ARYFAT CHOLESTEROL

50

· . . .: 12 : 12 : 13 : lL· ...· ..· .

!!J RED MEAT

36 36 35 35

!!J REO MEAT

.2i •.

31 32 32

TOTAL FAT

: 16: :

: : 13 :. .10 • •

50

w~30>­ZWuffi 20CL

50

TOTAL FAT

w~ 30 29 ~O 29 29>-Z •.w •uffi 20 :: 19 : 20CL : 17 : la: :. . . .· . .· . .

10 :

···

o,,,.,\\).,\,,.I.~,,.\)1. ,,,,,\\):,,\,,.1.\,,,\)1. ",''\\)''\''1.1.1."'\)1. ,,,A,\\)"'~,,.I.\,,.\)1.

AGE(years)

of dietary cholesterol after the meat and milk groups (TableIll). The percentage of consumers of the confectionery groupdecreased with age. In the youngest age group approximately46% of males and females reported the intake of food from theconfectionery group, compared with only 22% in the oldestmale and 29% in the oldest female groups.

Fig. 2. Percentage contribution ot" red meat and white meat tototal fat, saturated fat, polyunsaturated fat and dietary cholesterolintake in female consumers 15 - 64 years of age.

The mean energy and macronutrient intakes previously reportedfor the CORIS population showed that only small percentagesof respondents met any of the prudent dietary guidelines, e.g.only 17% of males and females had a saTUrated fat intake ofless than 10% of energy.2 The majority consumed a typicalWestern-type diet/ as can be seen from the percentage contri­bution of different food groups to the respondents' nutrientintakes. In the study group the contribution of different foodgroups to total energy intake was far removed from that of a

Because the majority of respondents used hard margarine,and because this population had low dietary PIS ratios, thesubstitution of polyunsaturated margarine for hard margarineand buner could improve dietary PIS ratios. Although bunerand cream made a small contribution to the cholesterol intakeof consumers, these products should not be overlooked as asource of cholesterol in the diet.

Fraser er alY remarked that an increased intake of dietaryfibre could explain the extra lowering of blood lipid levelswhich could not be explained by changes in dietary lipidintake alone. Mean daily dietary fibre intake of CORIS malesand females was 19,6 g and 14,2 g respectively, and only 15%of the males and 34% of the females met the prudent dietaryguideline for fibre. 2 It was therefore justified to encourage thispopulation to increase dietary intake of fibre, especially fromfruit and vegetables in the case of males. There are indicationsthat dietary fibre from these sources may have a better choles­terol lowering effect than wheat bran. IS The main source ofdietary fibre in the diets of males was, however, the cerealgroup and not the fruit and vegetable group.

Comparison of the diets of the CORIS respondents in 1979and the prudent guidelines revealed specific weaknesses. Thedietary sources of fat, cholesterol and fibre were identified andshowed why the diet of this population did not meet therequirements for a prudent diet. This atherogenic diet, whichcould in part be responsible for the adverse CHD risk profilefound in the CORIS population, required change. A populationshift to a prudent diet could improve this risk profile. lnforma­

.tion obtained from this study was consequently used in anintervention programme that was started in 1980 after theCORIS baseline survey.

SAMT VOL 75 18 FEB 1989 171

REFERENCES

I. Rossouw JE, Du Plessis JP, Benade AJS e! of. Coronary risk factorscreening in three rural communities: the CORIS baseline study. S Afr MedJ 1983; 64: 430-436.

2. Wolmarans P, Langenhoven ML, Benade AJS, Swanepoel ASP, KoueTJvW, Rossouw JE. Intake of macronutrients and their relationship withtotal cholesterol and high-density lipoprotein cholesterol: the Coronary RiskFactor Study, 1979. S AfrMedJ 1988; 73: 12-15.

3. Keys A, ed. Seven Countries: A Mulcivariace Analysis of Deach and CoronaryHearc Disease. Cambridge, Mass.: Harvard Universiry Press, 1980: 248-262.

4. American Dietetic Association. Dietary Goals for the United States (2ndedition).J Am Die! Assoc 1979; 74: 529-533.

5. Robinson CH, Lawler MR. Nonnal and Therapeucic Nucricion. 16th ed. NewYork: Macmillan, 1982: 629-645.

6. Gouws E, Langenhoven ML, comps. NRIND Food Composicion Tables 1981.ParowvaIIei, CP: National Research Institute for Nutritional Diseases of theSouth African Medical Research Council, 1982.

7. Grundy SM, ed. AHA Special Report. Recommendations for treatment ofhyperlipidemia in adults: a Joint Statement of the Nutrition Comminee andthe Council on Arteriosclerosis. Circulacion 1984; 69: 1067A-109OA.

8. Nelson M. Nutritional goals from COMA and NACNE: how can they beachieved? Hum NuCT Appl NuCT 1985; 39A: 456-464.

9. Snowdon DA, Phillips RL, Fraser GE. Meat consumption and fatal ischemicheart disease. Prev Med 1984; 13: 490-500.

10. Curb JD, Reed DM. Fish consumption and mortality from coronary heartdisease (Correspondence). N EnglJ Med 1985; 313: 821.

11. Kromhout D, Bosschieter EB, Coulander CdeL. The inverse relation betweenfish consumption and 20-year mortality from coronary heart disease. N EnglJ Med 1985; 312: 1205-1209.

12. Shekelle RB, Missell L, Paul 0, Shryock AM, Stamler J. Fish consumptionand mortality from coronary heart disease (Correspondence). N Engl J Med1985; 313: 820.

13. Oliver MF. Diet and coronary heart disease. Hum NuCT Clin NuCT 1982; 36C:413-427.

14. MeGill HC jun. The relationship of dietary cholesterol to serum cholesterolconcentration and to atherosclerosis in man. Am J Clin Nucr 1979; 32:2664-2702.

15. Molitor GTT. The food system in the 1980s.J Nucr Educ 1980; 12: 103-111.16. Rossouw JE, Burger E-M, Van der Vyver P, Ferreira 11. The effect of skim

milk, yoghurt, and full cream milk on human serum lipids. Am J Clin NuCT1981; 34: 351-356.

17. Fraser GE, Jacobs DR jun, Anderson JT, Foster N, Palta M, Blackburn H .The effect of various vegetable supplements on serum cholesterol. Am J ClinNUlr 1981; 34: 1272-1277.

18. Jenkins DJA, Leeds AR, Newton C, Cummings JH. Effect of pectin, guargum and wheat fibre on serum-cholesterol. Lancet 1975; I: 1116-1117.

Disease profiles for white and black adultand geriatric patientsAn analysis of 2008 hospital medical admissions

C. D. W. MORRIS

Summary

A prospective analysis of 2008 discharge diagnoses revealedimportant differences in disease incidence between blackand white adult and geriatric patients treated in the Depart·ment of Medicine, Frere Hospital, East London. Amonggeriatric patients the major differences were the increased .incidences among blacks of tuberculosis, pulmonary circu­latory disorders and cardiomyopathy, as opposed to ischaemicheart disease, cerebrovascular disorders and chronic ob­structive pulmonary disease among whites. Among blackshypertension was less common than had been expected andoccurred predominantly in females. .

Department of Medicine, Frere Hospital, East London, CPC. D. W. MORRIS, M.D, F.C.P. (S.A)

Accepted 12 Nov 1987.

Tuberculosis affected 14% of blacks but only 1,6% ofwhites. It was also the commonest cause of medical deathsand responsible for 31% of deaths of black patients.

Analysis of age patterns showed that 68% of whites and31% of blacks were over 60 years old; 18% of whites and 3%of blacks were over 80 years old. These figures indicate theneed to extend hospital facilities for geriatric patients, and formore comprehensive training in geriatric medicine for doctorsand nurses.

S Air Med J 1989; 75: 171-174.

The reasons for analysing hospital diagnoses are various. Firstly,valuable morbidity and mortality statistics are provided whichmay be compared with national trends; regional variations andracial and a~e differenc~s also. em~r.pe. More of this epi­demlOloglcallnformatlon IS reqUIred..- Secondly, the hospitalis provided with the data required for bed allocations, planningfor future requirements, and amendment of nursing and medicaltraining schemes if necessary.