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Nutritional Epidemiology Branch
Division of Cancer Epidemiology and Genetics
National Cancer Institute, NIH, DHHS
6120 Executive Boulevard
EPS, Room 3030
Rockville, MD 20852
E-mail: trastogi{at}post.harvard.edu
Dear Sir:
We appreciate the comments provided by Chacko et al regarding our recent article on diet and risk of ischemic heart disease in India (1). Most of our study participants were indeed men, despite the fact that we recruited only incident myocardial infarction cases from 8 different hospitals in New Delhi and Bangalore. Although it is true that women in India are primarily involved in cooking foods, we qualitatively observed that men are often involved in the shopping for food items, particularly those items purchased in bulk, such as flour, rice, and cooking oils. Thus, men are knowledgeable about the oils used in food preparation. Moreover, our analysis did not consider the amount of oil used in cooking but simply the type of oil used.
Concerning the comment about Table 4, it is important to consider the possibility that some variables may not have been significant in the univariate analyses because of confounding. Ignoring variables that are not significant in univariate analyses from further consideration could, thus, lead to biased results. Because this was one of the first epidemiologic studies of diet and heart disease in India, we believed it prudent to present the findings for all food groups because these preliminary findings could stimulate further research.
Stress is an important factor in coronary heart disease risk. Unfortunately, we did not have the opportunity to examine the association between stress and risk of coronary heart disease in our study. However, we believe it unlikely that stress would have confounded our results because the diets of individuals in our study population were determined, to a large extent, by the overall dietary pattern of their families.
ACKNOWLEDGMENTS
None of the authors had a conflict of interest.
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