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This study was carried out to ascertain whether, as has been suggested, the ingestion of a serum-cholesterol-lowering diet would be conducive to cholelithiasis. The prevalence of gallstones was studied in autopsied male and female patients of two mental hospitals in connection with a long-term controlled trial on prevention of coronary heart disease by means of a diet with a high polyunsaturated/saturated fatty acid ratio. The prevalence of gallstones was in men: 20/89 (equals 22.5%) on cholesterol-lowering diet and 11/44 (equals 25%) on normal diet; and in women: 151/262 (equals 42%) on cholesterol-lowering diet and 29/62 (equals 47%) on normal diet. It was concluded that in our trial the cholesterol-lowering diet was not lithogenic.

A controlled intervention trial, with the purpose of testing the hypothesis that the incidence of coronary heart disease (CHD) could be decreased by the use of serum-cholesterol-lowering (SCL) diet, was carried out in 2 mental hospitals near Helsinki in 1959--71. The subjects were hospitalized middle-aged men. One of the hospitals received the SCL diet, i.e. a diet low in saturated fats and cholesterol and relatively high in polyunsaturated fats, while the other served as the control with a normal hospital diet. Six years later the diets were reversed, and the trial was continued another 6 years. The use of the SCL diet was associated with markedly lowered serum-cholesterol values. The incidence of CHD, as measured by the appearance of certain electrocardiographic patterns and by the occurrence of coronary deaths, was in both hospitals during the SCL-diet periods about half that during the normal-diet periods. An examination of a number of potential confounding variables indicated that the changes in them were small and failed to account for the considerable reduction in the incidence of CHD. It is concluded that the use of the serum-cholesterol-lowering diet exerted a substantial preventive effect on CHD.

Summary In this paper the development of fertility and mortality in Finland, and their interrelations with each other and with economic factors is discussed. An analysis by individual years shows that rises and falls in mortality and fertility rates did not always coincide with poor and good harvests. Fertility in Finland decreased slightly at the turn of the eighteenth and nineteenth centuries, but fell sharply over the period 1876-1925. This fall corresponded closely to changes in the death rate, especially for infants, and appears to justify the conclusion that the changes were connected. These population shifts have been called the first and second demographic transitions, of which the latter was the more dramatic. Factors tending to reduce mortality among infants and in other age groups during the second demographic transition are obvious; those underlying the first demographic transition are less clear. In this connection, the importance of breast feeding and campaigns designed to favour the practice are stressed. These helped to reduce infant mortality and were one of the main reasons for the first demographic transition. Finnish material also suggests that some kind of family planning existed during the pre-industrial period; it is only by making this assumption that the various figures can be made compatible.