The early cross-cultural associations were repeated using 25-year and 50-year CHD mortality data for serum cholesterol and saturated fat intake and later extended with associations on carbohydrates, flavonoids, and dietary patterns.
Are these cross-cultural associations causal?
Ecological or cross-cultural associations are frequently viewed as the lowest level of evidence about causality. However, to demean ecological associations is to fail to recognize the powerful indication they provide about the population burden of disease – and thus the potential for prevention – when correlations among populations are congruent with sound clinical evidence, with significant correlations at the level of individuals within populations, and with known mechanisms.
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