Colon
L. Lyon,3
M.D.
in a low-risk and
Ann
ABSTRACT state population Colon cancer large
Data
(Mormons)
incidence
who
of Mormons
18% below the meat, fat, and fiber
was
a whole.
are presented
on
colon
Am.
J. Clin.
abstain
was
United States consumption Nutr.
2
Ph.D.
mortality
in Utah.
had 34% fewer deaths from colon cancer incidence was also studied for the years
subgroup
cancer
W. Sorenson,4
population1’
37%
from
below
average. between
tobacco
the
Methods
and
United
For
the
years
1950
the average United to 1970, both for alcohol
States
A preliminary the population
31: S227-S230,
Differences in the risk of acquiring cancer have been noted in populations through the world and within the United States (1, 2). These differences may be related to a number of factors, including diet, social customs, occupation, and genetics (3, 4). Previous studies have reported a low incidence of certain cancers, including colon cancer, in Utah (5, 6). Over the last 20 years, Utah has had an average age-adjusted total white cancer mortality of 22% below and a colon cancer mortality of 34% below the United States average (6). The Utah population is unique in the reigious and cultural background of its residents. The region encompassing the state was colonized by the Church of Jesus Christ of Latter-Day Saints (commonly called Mormon) between 1847 and 1900, creating an ethnically homogeneous population with a high degree of uniformity in social practices (7). Church doctrine prohibits the use of alcohol, tobacco, coffee, and tea and counsels moderation in the use of meats (8). The 1970 population of Utah was 1,059,273, approximately 72% of whom were Mormon.
than 1966
for
average,
dietary of Utah
religious
and
to
1969,
the
States population. the state and for reasons;
that
the
a
colon
of non-Mormons
survey found little difference and that of the United States
in as
1978.
The central Church file was searched twice at different times by different researchers for the name of each cancer patient. A positive match required agreement between name, year of birth, place of residence, and date of death (if deceased). For verification, the religious preference of patients known to be dead (56%) was also ascertained from the obituary files of the local newspapers and compared to the earlier matching. Those identified by obituaries as Mormon, but not found in the Church files (1% of the cases), were classified as Church members. The Mormon population in Utah for mid-1968 was obtained by linear interpolation of Utah census reports and the Church’s 1971 census. The age distribution of this population was estimated from a 5% random sample drawn from the central file in 197 1 . The non-Mormon population was estimated for each age group by subtraction of the Mormon population from that of the state. The incidence ofcancer in the two groups was compared to the United States Third National Cancer Survey (TNCS) (9) by the use of standardized incidence ratios (SIR). The incidence ratio, expressed in percent, is the ratio of observed to expected cases times 100. We calculated the expected cases for the Mormon and nonMormon populations by applying the white age- and sex-specific incidence rates (in S-year age intervals) from the TNCS to each population. (Utah has a 2.6% nonwhite population.) We determined statistical significance of the difference for each group from the TNCS for each site, assuming
the
number
of Utah
Poisson
cases
distribution,
were
compared
where
the
to those
observed
expected,
requires that all cancer cases be reported, except cancer other than melanoma. In 1966, the Utah Cancer Registry was established to register and follow the progress of all cancer patients within the state. A more detailed description of cancer registration in Utah is given elsewhere (5). The 10,641 cases of cancer occurring in 1966 to 1970 were classified according to membership in the Mormon Church. This classification was made possible by the existence of a central Church file, founded in 1941, of all living and deceased Mormon Church members.
I From the Department of Family and Community Medicine, University of Utah College of Medicine, and the University of Utah College of Nursing, Salt Lake City, Utah. 2 Address reprint requests to: Dr. Joseph L. Lyon, Department of Family & Community Medicine, University of Utah College of Medicine, Salt Lake City, Utah 84132. 3 Assistant Professor, Department of Family and Community Medicine, University of Utah College of Medicine. Assistant Professor, University of Utah College of Nursing.
The American
1978,
Utah
state
law skin
Journal
ofClinical
Nutrition
31:
OCTOBER
pp. 5227-5230.
Printed
in U.S.A.
5227
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/10/S227/4656101 by East Carolina University user on 16 January 2019
Joseph
cancer
LYON
S228 based on Differences populations
x2,
TNCS white age- and sex-specific between the Mormon and were tested by Mantel-Haenszel
controlled
for sex and
AND
SORENSON
rates ( 10). non-Mormon summary
age ( 1 1).
Results Of the
10,605 cases included in the study, classified as Mormon and 4, 193 as non-Mormon. Application of TNCS rates to the Mormon and non-Mormon populations over the 5-year period yielded 8,477 and 4,466 cases expected, respectively. Compared to the TNCS, the Mormon population had 2,066 cases less than expected, with an incidence ratio of 75.6; the non-Mormon population had 273 cases less than expected, with an incidence ratio of 93.9. There were 845 cases of colon cancer observed and 1,2 15 expected, giving an SIR of 69.5. For colon cancer, 6,4 1 2 were
U LI
ALL
MALE
SITES
FEMALE ESOPHAGUS
L
LUNG
I
I
0 FIG.
I 20
1. Utah
I 40
I
SIRs
I
I
for all sites
a
MORMON
LII
NON-MORMON
I
I
60 and
too
80 for
smoking
and
alcohol-related
sites.
0’
ALL
SITES
I ESOPHAGUS
LUNG
I
I
0 FIG.
2.
SIRs
I
I
20
40
for all sites,
smoking
I
I
J
60 and
I
80 alcohol-related
00 sites,
Mormon
and
non-Mormon.
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/10/S227/4656101 by East Carolina University user on 16 January 2019
Mormons had 493 observed and 784 cxpected, with an SIR of 62.9, and non-Mormons had 352 observed and 421.5 expected, giving an SIR of 81.6. Figures. 1 and 2 show the overall cancer incidence for Utah and the incidence ratios for lung cancer and esophageal cancer. Use of alcohol and tobacco have been strongly correlated with these types of cancer. The Mormon population experienced a significantly lower risk of cancer of these two sites as compared to the non-Mormon. Figure 3 shows colon cancer SIRs for the population of Utah. The male rates were lower than female rates. Incidence ratios by religious group reveal that the Mormon population, both men and women, had rates 36 to 38% below those of the TNCS population, and non-Mormon men also had 28% less
COLON
CANCER
IN
LOW-RISK
of the Mormon diet, but unpublished data gathered by the Utah Beef Council report per capita beef consumption of 59 kg/year in Utah for 1972, as compared to 52 kg/year in the United States. Subsequent unpublished figures from the Beef Council show continuation of this trend. The anatomic distribution of colonic cancer was not significantly different between religious groups and was consistent with that found in other nonvegetarian populations (18). Since consistent differences according to religion were not found, and since Utah residents do not appear to adhere to a vegetarian diet, one must question the effect of a vegetarian diet on colonicrectal cancer, at least in this population. Dietary data were collected as part of a nutrition program serving rural residents 60 years or older in southern Utah. Analysis of three 24-hr dietary recalls showed little change in nutrient intake over a year, with the exception of seasonal increases of vitamins A and C in the fall. The consumption oftotal protein was 142%
Discussion Recent studies on colonic and rectal cancer have implicated dietary fat, meat, and fiber as important factors in their origin (14-16). The overall incidence of colonic and rectal cancer in Utah is below that reported for California Seventh-Day Adventists (standard mortality ratio of 72%), who claim a 50% compliance with a vegetarian diet (17). Currently, no data are available on the fat content
.
5229
MALE NON-MORMON
LII
FEMALE
UTA
H
MORMON
I
!
I
40
60
I
0
20
FIG.
3.
Colon
cancer
SIRs
for
I
I
80 Utah,
100
Mormon,
and
I
U
a
MORMON
LI
NON-MORMON
1
non-Mormon.
CORPUS
BREAST
OVARIAN
II
0
I
I
I
I
20 FIG.
40 4.
SIRs
I
I
60 for
female
I
80 cancers
said
COLON
I
100 to be related
to diet.
UTERI
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/10/S227/4656101 by East Carolina University user on 16 January 2019
colon cancer. Non-Mormon women had rates only 8% below TNCS. Figure 4 presents standardized incidence ratios for the two groups for sites said to be correlated with colon cancer (12, 13); i.e., breast, endometrium, and ovarian cancers. Non-Mormon women, with rates of colon cancer close to the TNCS, also had SIRs close to expectation at the other three sites; however, Mormon women with low colon cancer rates were also significantly below the TNCS at these three additional sites.
POPULATION
LYON
5230
AND
References 1. DUNHAM, cancer
Cancer
L. J., mortality Inst. 41:
AND
J. C.
BAILAR.
rates and frequency 155, 1968. F. W. MCKAY, R.
World
ratios.
maps
of
J. Natl.
T. J., HoovER, W. J. BLOT AND J. R. FRAUMENI, JR. Atlas of Cancer Mortality for U. S. Counties: 1950-1969. DHEW Publication no. (NIH) 75-780. Washington, D. C.: Government Printing Office, 1975. 3. SEIDMAN, H. Cancer death rates by site and sex for 2.
MASON,
and
religious 4.
5.
6.
7. 8.
9.
socioeconomic
groups
in
New
York
City. Environ. Res. 3: 234, 1970. SALBER, E. J., E. TRICHOPOULOS AND B. MACMAHON. Lactation and reproductive histories of breast cancer patients in Boston, 1965-66. J. Natl. Cancer Inst. 43: 1013, 1969. LYON, J. L., M. R. KLAUBER, J. W. GARDNER AND C. R. SMART. Cancer incidence in Mormons and non-Mormons. New EngI. J. Med. 294: 129, 1976. MASON, T. J., AND F. W. MCKAY. U. S. Cancer Mortality by County: 1950-1969. DHEW Publication No. (NIH) 74-615. Washington, D. C.: Goverment Printing Office, 1974. ARRINGTON, L. J. Great Basin Kingdom. Cambridge: Harvard University Press, 1958. Doctrine and Covenants. Salt Lake City: Church of Jesus Christ of Latter-Day Saints, 1957, sections 49 and 89. ANON. The Third National Cancer Survey, Advanced Three Year Report, 1969-1971 Incidence.
DHEW
Publication
No. (NIH) 74-637. Washington,
D. C.: Government Printing Office, 1974. 10. BAILAR, J. C., III, AND F. EDERER. Significance factors for the ratio of a Poisson variable to its expectation. Biometrics 20: 639, 1964. 1 1. MANTEL, N. Chi-square tests with one degree of freedom: Extensions of the Mantel-Haenszel procedure. J. Am. Statis. Assoc. 58: 690, 1963. 12. BERG, J. W. Can nutrition explain the pattern of international epidemiology of hormone-dependent cancers? Cancer Res. 35: 3345, 1975. 13. MACMAHON, B., P. COLE AND J. BROWN. Etiology of human breast cancer: a review. J. NatI. Cancer
Inst. 50: 21, 1973. 14.
REDDY,
B. S., A. MASTROMARINO
DER.
Further
large
bowel
leads
on
metabolic
AND
E. L.
epidemiology
WYNof
cancer. Cancer Res. 35: 3403, 1975. 15. HAENSZEL, W., J. W. BERG, M. SEGI, K. MIN0Ru AND F. B. Locx..a. Large bowel cancer in Hawaiian Japanese. J. Natl. Cancer Inst. 51: 1765, 1973. 16. BURKITT, D. P. Epidemiology ofcancer of the colon and rectum. Cancer 28: 3, 1971. 17. PHIWP5, R. L. Role of life-style and dietary habits in risk of cancer among Seventh-Day Adventists. Cancer Res. 35: 3513, 1975. 18. HAENSZEL, W., AND P. CORREAN. Cancer of the colon and rectum and adenomatous polyps. Cancer 28: 14, 1971.
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/10/S227/4656101 by East Carolina University user on 16 January 2019
(for men) and 135% (for women) higher than recommended daily allowances. For dietary fat, men had 93% and women had 90% of RDA. Of the three types of fat in the diet (linoleic, oleic, and saturated), saturated fat was consumed at a p/s ratio of 0.23 for men and 0.25 for women. Crude fiber levels were 69 and 67% for men and women, respectively, of 100 mg/kg standard. While no data were available as to the religion of the participants, the geographic area is 90% Mormon. This area, along with all rural areas of the state, has lower rates of colon cancer than urban areas. However, while non-Mormons have higher rates of colon cancer in the urban areas, Mormons do not. A high proportion of the Mormons probably follow the prohibition on use of alcohol and tobacco. However, the admonition to be moderate in the use of meat does not appear to differentiate between Mormons and other populations in the United States. Our data do not support the current hypothesis relating meats, fats, and fiber to colon cancer. An investigation is now underway to characterize the dietary practices of colon cancer patients and a population control group in Utah, and will provide descriptive data on diet for future hypothesis testing. U
SORENSON
L. Lyon,3
M.D.
in a low-risk and
Ann
ABSTRACT state population Colon cancer large
Data
(Mormons)
incidence
who
of Mormons
18% below the meat, fat, and fiber
was
a whole.
are presented
on
colon
Am.
J. Clin.
abstain
was
United States consumption Nutr.
2
Ph.D.
mortality
in Utah.
had 34% fewer deaths from colon cancer incidence was also studied for the years
subgroup
cancer
W. Sorenson,4
population1’
37%
from
below
average. between
tobacco
the
Methods
and
United
For
the
years
1950
the average United to 1970, both for alcohol
States
A preliminary the population
31: S227-S230,
Differences in the risk of acquiring cancer have been noted in populations through the world and within the United States (1, 2). These differences may be related to a number of factors, including diet, social customs, occupation, and genetics (3, 4). Previous studies have reported a low incidence of certain cancers, including colon cancer, in Utah (5, 6). Over the last 20 years, Utah has had an average age-adjusted total white cancer mortality of 22% below and a colon cancer mortality of 34% below the United States average (6). The Utah population is unique in the reigious and cultural background of its residents. The region encompassing the state was colonized by the Church of Jesus Christ of Latter-Day Saints (commonly called Mormon) between 1847 and 1900, creating an ethnically homogeneous population with a high degree of uniformity in social practices (7). Church doctrine prohibits the use of alcohol, tobacco, coffee, and tea and counsels moderation in the use of meats (8). The 1970 population of Utah was 1,059,273, approximately 72% of whom were Mormon.
than 1966
for
average,
dietary of Utah
religious
and
to
1969,
the
States population. the state and for reasons;
that
the
a
colon
of non-Mormons
survey found little difference and that of the United States
in as
1978.
The central Church file was searched twice at different times by different researchers for the name of each cancer patient. A positive match required agreement between name, year of birth, place of residence, and date of death (if deceased). For verification, the religious preference of patients known to be dead (56%) was also ascertained from the obituary files of the local newspapers and compared to the earlier matching. Those identified by obituaries as Mormon, but not found in the Church files (1% of the cases), were classified as Church members. The Mormon population in Utah for mid-1968 was obtained by linear interpolation of Utah census reports and the Church’s 1971 census. The age distribution of this population was estimated from a 5% random sample drawn from the central file in 197 1 . The non-Mormon population was estimated for each age group by subtraction of the Mormon population from that of the state. The incidence ofcancer in the two groups was compared to the United States Third National Cancer Survey (TNCS) (9) by the use of standardized incidence ratios (SIR). The incidence ratio, expressed in percent, is the ratio of observed to expected cases times 100. We calculated the expected cases for the Mormon and nonMormon populations by applying the white age- and sex-specific incidence rates (in S-year age intervals) from the TNCS to each population. (Utah has a 2.6% nonwhite population.) We determined statistical significance of the difference for each group from the TNCS for each site, assuming
the
number
of Utah
Poisson
cases
distribution,
were
compared
where
the
to those
observed
expected,
requires that all cancer cases be reported, except cancer other than melanoma. In 1966, the Utah Cancer Registry was established to register and follow the progress of all cancer patients within the state. A more detailed description of cancer registration in Utah is given elsewhere (5). The 10,641 cases of cancer occurring in 1966 to 1970 were classified according to membership in the Mormon Church. This classification was made possible by the existence of a central Church file, founded in 1941, of all living and deceased Mormon Church members.
I From the Department of Family and Community Medicine, University of Utah College of Medicine, and the University of Utah College of Nursing, Salt Lake City, Utah. 2 Address reprint requests to: Dr. Joseph L. Lyon, Department of Family & Community Medicine, University of Utah College of Medicine, Salt Lake City, Utah 84132. 3 Assistant Professor, Department of Family and Community Medicine, University of Utah College of Medicine. Assistant Professor, University of Utah College of Nursing.
The American
1978,
Utah
state
law skin
Journal
ofClinical
Nutrition
31:
OCTOBER
pp. 5227-5230.
Printed
in U.S.A.
5227
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/10/S227/4656101 by East Carolina University user on 16 January 2019
Joseph
cancer
LYON
S228 based on Differences populations
x2,
TNCS white age- and sex-specific between the Mormon and were tested by Mantel-Haenszel
controlled
for sex and
AND
SORENSON
rates ( 10). non-Mormon summary
age ( 1 1).
Results Of the
10,605 cases included in the study, classified as Mormon and 4, 193 as non-Mormon. Application of TNCS rates to the Mormon and non-Mormon populations over the 5-year period yielded 8,477 and 4,466 cases expected, respectively. Compared to the TNCS, the Mormon population had 2,066 cases less than expected, with an incidence ratio of 75.6; the non-Mormon population had 273 cases less than expected, with an incidence ratio of 93.9. There were 845 cases of colon cancer observed and 1,2 15 expected, giving an SIR of 69.5. For colon cancer, 6,4 1 2 were
U LI
ALL
MALE
SITES
FEMALE ESOPHAGUS
L
LUNG
I
I
0 FIG.
I 20
1. Utah
I 40
I
SIRs
I
I
for all sites
a
MORMON
LII
NON-MORMON
I
I
60 and
too
80 for
smoking
and
alcohol-related
sites.
0’
ALL
SITES
I ESOPHAGUS
LUNG
I
I
0 FIG.
2.
SIRs
I
I
20
40
for all sites,
smoking
I
I
J
60 and
I
80 alcohol-related
00 sites,
Mormon
and
non-Mormon.
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/10/S227/4656101 by East Carolina University user on 16 January 2019
Mormons had 493 observed and 784 cxpected, with an SIR of 62.9, and non-Mormons had 352 observed and 421.5 expected, giving an SIR of 81.6. Figures. 1 and 2 show the overall cancer incidence for Utah and the incidence ratios for lung cancer and esophageal cancer. Use of alcohol and tobacco have been strongly correlated with these types of cancer. The Mormon population experienced a significantly lower risk of cancer of these two sites as compared to the non-Mormon. Figure 3 shows colon cancer SIRs for the population of Utah. The male rates were lower than female rates. Incidence ratios by religious group reveal that the Mormon population, both men and women, had rates 36 to 38% below those of the TNCS population, and non-Mormon men also had 28% less
COLON
CANCER
IN
LOW-RISK
of the Mormon diet, but unpublished data gathered by the Utah Beef Council report per capita beef consumption of 59 kg/year in Utah for 1972, as compared to 52 kg/year in the United States. Subsequent unpublished figures from the Beef Council show continuation of this trend. The anatomic distribution of colonic cancer was not significantly different between religious groups and was consistent with that found in other nonvegetarian populations (18). Since consistent differences according to religion were not found, and since Utah residents do not appear to adhere to a vegetarian diet, one must question the effect of a vegetarian diet on colonicrectal cancer, at least in this population. Dietary data were collected as part of a nutrition program serving rural residents 60 years or older in southern Utah. Analysis of three 24-hr dietary recalls showed little change in nutrient intake over a year, with the exception of seasonal increases of vitamins A and C in the fall. The consumption oftotal protein was 142%
Discussion Recent studies on colonic and rectal cancer have implicated dietary fat, meat, and fiber as important factors in their origin (14-16). The overall incidence of colonic and rectal cancer in Utah is below that reported for California Seventh-Day Adventists (standard mortality ratio of 72%), who claim a 50% compliance with a vegetarian diet (17). Currently, no data are available on the fat content
.
5229
MALE NON-MORMON
LII
FEMALE
UTA
H
MORMON
I
!
I
40
60
I
0
20
FIG.
3.
Colon
cancer
SIRs
for
I
I
80 Utah,
100
Mormon,
and
I
U
a
MORMON
LI
NON-MORMON
1
non-Mormon.
CORPUS
BREAST
OVARIAN
II
0
I
I
I
I
20 FIG.
40 4.
SIRs
I
I
60 for
female
I
80 cancers
said
COLON
I
100 to be related
to diet.
UTERI
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/10/S227/4656101 by East Carolina University user on 16 January 2019
colon cancer. Non-Mormon women had rates only 8% below TNCS. Figure 4 presents standardized incidence ratios for the two groups for sites said to be correlated with colon cancer (12, 13); i.e., breast, endometrium, and ovarian cancers. Non-Mormon women, with rates of colon cancer close to the TNCS, also had SIRs close to expectation at the other three sites; however, Mormon women with low colon cancer rates were also significantly below the TNCS at these three additional sites.
POPULATION
LYON
5230
AND
References 1. DUNHAM, cancer
Cancer
L. J., mortality Inst. 41:
AND
J. C.
BAILAR.
rates and frequency 155, 1968. F. W. MCKAY, R.
World
ratios.
maps
of
J. Natl.
T. J., HoovER, W. J. BLOT AND J. R. FRAUMENI, JR. Atlas of Cancer Mortality for U. S. Counties: 1950-1969. DHEW Publication no. (NIH) 75-780. Washington, D. C.: Government Printing Office, 1975. 3. SEIDMAN, H. Cancer death rates by site and sex for 2.
MASON,
and
religious 4.
5.
6.
7. 8.
9.
socioeconomic
groups
in
New
York
City. Environ. Res. 3: 234, 1970. SALBER, E. J., E. TRICHOPOULOS AND B. MACMAHON. Lactation and reproductive histories of breast cancer patients in Boston, 1965-66. J. Natl. Cancer Inst. 43: 1013, 1969. LYON, J. L., M. R. KLAUBER, J. W. GARDNER AND C. R. SMART. Cancer incidence in Mormons and non-Mormons. New EngI. J. Med. 294: 129, 1976. MASON, T. J., AND F. W. MCKAY. U. S. Cancer Mortality by County: 1950-1969. DHEW Publication No. (NIH) 74-615. Washington, D. C.: Goverment Printing Office, 1974. ARRINGTON, L. J. Great Basin Kingdom. Cambridge: Harvard University Press, 1958. Doctrine and Covenants. Salt Lake City: Church of Jesus Christ of Latter-Day Saints, 1957, sections 49 and 89. ANON. The Third National Cancer Survey, Advanced Three Year Report, 1969-1971 Incidence.
DHEW
Publication
No. (NIH) 74-637. Washington,
D. C.: Government Printing Office, 1974. 10. BAILAR, J. C., III, AND F. EDERER. Significance factors for the ratio of a Poisson variable to its expectation. Biometrics 20: 639, 1964. 1 1. MANTEL, N. Chi-square tests with one degree of freedom: Extensions of the Mantel-Haenszel procedure. J. Am. Statis. Assoc. 58: 690, 1963. 12. BERG, J. W. Can nutrition explain the pattern of international epidemiology of hormone-dependent cancers? Cancer Res. 35: 3345, 1975. 13. MACMAHON, B., P. COLE AND J. BROWN. Etiology of human breast cancer: a review. J. NatI. Cancer
Inst. 50: 21, 1973. 14.
REDDY,
B. S., A. MASTROMARINO
DER.
Further
large
bowel
leads
on
metabolic
AND
E. L.
epidemiology
WYNof
cancer. Cancer Res. 35: 3403, 1975. 15. HAENSZEL, W., J. W. BERG, M. SEGI, K. MIN0Ru AND F. B. Locx..a. Large bowel cancer in Hawaiian Japanese. J. Natl. Cancer Inst. 51: 1765, 1973. 16. BURKITT, D. P. Epidemiology ofcancer of the colon and rectum. Cancer 28: 3, 1971. 17. PHIWP5, R. L. Role of life-style and dietary habits in risk of cancer among Seventh-Day Adventists. Cancer Res. 35: 3513, 1975. 18. HAENSZEL, W., AND P. CORREAN. Cancer of the colon and rectum and adenomatous polyps. Cancer 28: 14, 1971.
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/10/S227/4656101 by East Carolina University user on 16 January 2019
(for men) and 135% (for women) higher than recommended daily allowances. For dietary fat, men had 93% and women had 90% of RDA. Of the three types of fat in the diet (linoleic, oleic, and saturated), saturated fat was consumed at a p/s ratio of 0.23 for men and 0.25 for women. Crude fiber levels were 69 and 67% for men and women, respectively, of 100 mg/kg standard. While no data were available as to the religion of the participants, the geographic area is 90% Mormon. This area, along with all rural areas of the state, has lower rates of colon cancer than urban areas. However, while non-Mormons have higher rates of colon cancer in the urban areas, Mormons do not. A high proportion of the Mormons probably follow the prohibition on use of alcohol and tobacco. However, the admonition to be moderate in the use of meat does not appear to differentiate between Mormons and other populations in the United States. Our data do not support the current hypothesis relating meats, fats, and fiber to colon cancer. An investigation is now underway to characterize the dietary practices of colon cancer patients and a population control group in Utah, and will provide descriptive data on diet for future hypothesis testing. U
SORENSON
