Advisory from Disability Compensation Branch

No 3/99

Please note: For further information in relation to Malignant Neoplasm of the Prostate and Consumption of Animal Fat refer to Advisory Note 1 of 2007.

This is an advisory note only.  Disability Compensation Branch and Legal Services Group have agreed this policy view.  It is not a Repatriation Commission Guideline or a Departmental Instruction.   The advice is not intended to conflict with the proper application of the Veterans' Entitlements Act 1986 or the judgements of the Courts.  It may be subject to change as a result of further interpretation by the Courts of the legislation.  Nevertheless it represents a considered view that should be taken into account by all delegates.

ANIMAL FAT CONSUMPTION

THE DR RUTH ENGLISH REPORT

AND

SUPPORTING PAPERS

Introduction

This paper is intended to assist decision-makers in applying the animal fat consumption factors in the Statements of Principles for malignant neoplasm of the prostate.  The paper is based on a report on animal fat in the Australian diet prepared for the Department of Veterans' Affairs in August 1998 by Dr Ruth English as well as results from a national household dietary survey conducted in 1936-8.

The paper deals predominantly with WW2 veterans, as they are the main group to whom the SOPs apply.

The relevant SOP factors

Reasonable Hypothesis cases - Instrument 191 of 1996, Factor 1(b).

“increasing animal fat consumption by at least 40%, and to at least 70gms/day for at least 20 years before the clinical onset of malignant neoplasm of the prostate”

Balance of Probabilities cases - Instrument 192 of 1996, Factor 1(b).

“increasing animal fat consumption by at least 40%, and to at least 70gms/day for at least 25 years before the clinical onset of malignant neoplasm of the prostate”

Daily fat consumption

In relation to WW2 veterans, the requirement to have animal fat consumption of at least 70gms/day is easily satisfied, as both civilian and military diets at that time typically had animal fat content well in excess of that level.  The requirement to maintain an intake of at least 70gms/day for 20 or 25 years is also easily satisfied, as typical Australian diets contained animal fat in excess of that level until at least the 1970s.

This means that there is no general claim that a military diet was “fattier” than the previous civilian diet.  Individual claims must be treated on their merits.

The SOP factor requirement for an increase in consumption by at least 40% is the real test to be satisfied.  This is because an average civilian diet before and during WW2 contained more animal fat than most service rations.  In addition the SOP factors require that increased level of consumption to be maintained for 20 or 25 years and for that increased consumption to be attributable to service.

What questions need to be asked?

There are four questions that need to be answered.  It requires a “yes” answer to all of them for the SOP factors to be satisfied.

1. Did animal fat intake in the diet increase by at least 40%?

2. Was that increased intake maintained for at least 20 years (rh) / 25 years (bop)?

3. Was the initial increase in animal fat consumption attributable to service?

4. Was the increased intake over the next 20/25 years attributable to service?

Animal fat in civilian diet versus service diet - WW2

Dietary animal fat comes from two sources, (i) dairy products and (ii) meat and related products (including lard and offal).

A dietary survey conducted in 1936-38 indicates that the typical adult male civilian diet of that time contained around 114 to 130 grams (gms) of animal fat per day.  A further survey in 1944 points to an average animal fat intake of approximately 122 gms/day.  Dairy products provided slightly more than half of the animal fat content of that diet (56.5%) with butter being the single largest component (32%).

The animal fat content of service rations varied with the time and location of service.  The predominant source of animal fat in military diets was meat and related products (51 to 61%).  The daily animal fat contents of service rations issued during WW2 are detailed in the following table.

Table 1. Daily animal fat content of Australian diets/rations in WW2 era:

Diet	Animal fat (gms)
Average civilian diet (1944 survey) Military ration scales WW2:	122
1  Eastern and northern command       Standard military ration scale: Sep '39 to Aug '42	95.8
2  Temperate Australia       NSW, Victoria, SA, Tas, South WA, Qld - Rockhampton and south: from Aug '42	100.5
3  Tropical Zone       NT, northern WA, Qld - north of Rockhampton incl. Torres Islands: from Aug '42       NG and Pacific: Aug '42 to Apr '43	108.4
4  Middle East	117.4
5  New Guinea and Pacific  Apr '43 to Jan '44 6  New Guinea and Pacific  Feb '44 to Oct '45	113.2               131.8

Note: These service rations applied across all three services

To satisfy the SOP, animal fat intake must have increased by 40%.  Taking the Middle East ration as an example the following calculations can be made:

Maximum pre-service civilian diet animal fat content that would permit a 40% increase to 117.4 gms (ie civilian diet animal fat + 40% = 117.4 gms)	= 83.9 gms
Corresponding total civilian fat intake (using method from Dr English's report)	= 96.4 gms
Percentage of Australian adult male population with total fat content less than 100gms/day in 1938 survey (see appendix, table 7)	= 8.2%

Thus, approximately 92% of Australian adult males in 1938 had a diet that would exceed the maximum animal fat intake that would allow the SOP criterion to be met  in relation to service in the Middle East.

The corresponding figures for the other service ration scales are detailed in the following table:

Table 2. Civilian versus service daily fat intake necessary to meet SOP criterion, plus percentage of adult males with pre-service fat intake at or below relevant level

Ration scale †	Service Animal fat (gms)	Max. civilian Animal fat (gms)	Corresponding civilian total fat  (gms)		% adult males with total fat intake less than: ‡
1	95.8	68.4	78.7		80 gms =	1.96%
2	100.5	71.8	82.5
3	108.4	77.4	89.0		90 gms =	3.75%
4	117.4	83.9	96.4		100 gms =	8.16%
5	113.2	80.9	92.9
6	131.8	94.1	108.2		110 gms =	15.37%

†  See previous table

‡  Results only available in bands of 10 gms (see appendix, table 7)

For a veteran to satisfy the 40% increase requirement in the SOP, his pre-service animal fat intake would have to have been significantly below average (114 to 130 gms) and indeed lower than the great majority of the male population.  This would have required a diet very low in dairy products (for which substitutes were not generally available) and/or very low in meat products.

Trends in animal fat consumption over time

Total fat consumption over the decades since WW2 has declined slightly from an estimated 133.5gms/day in 1938-39 to 117.5gms/day in 1993-94.  However, animal fat consumption has declined considerably, from an estimated 116.9gms/day in 1938-39 to 56.0gms/day in 1993-94 (Appendix, table 3).  Animal fat has been replaced in the diet to a large extent by vegetable oils, including margarine.  Widespread consumption of vegetable oils commenced in 1972.

This increase in consumption of vegetable oils has meant that it would have been increasingly difficult to maintain an animal fat intake in excess of 70gms/day from around the early 1980s onward.

Rationing

The availability of butter and meat products was adversely affected by civilian rationing during and after WW2.  Butter was rationed from June 1942 to June 1950 and meat from January 1944 to June 1948 (Appendix, table 6).  The effect was to limit the availability of meat and butter, resulting in a diet lower in animal fat content.  As a consequence the consumption of animal fat is estimated to have fallen from 116.9 gms/head/day in 1938-39 to 102.5 gms/head/day in 1948-49.  It would therefore have been difficult in the immediate post-war years to maintain a diet with the same level of animal fat as service rations.

Accuracy of recalled past diet

The validity of a recalled dietary history is very much dependent on the individual's memory.  The accuracy of recall decreases with:

• Increasing time interval;
• Increasing age;
• Changes in the diet over time.

Problems identified in studies examining dietary recall include:

• Failure to report consumption of some foods actually eaten;
• Recollection of foods that were never eaten;
• Exaggeration of nutritional quality of diet, with reporting of what individuals perceive should have been eaten, rather than what they actually ate;
• Recall of past diet influenced by current diet.

These problems lead to inaccuracies in the recall of amounts and kinds of foods eaten, such that the correlation between the reported diet and the actual diet may be quite poor.  Dietary recall by a surrogate such as a spouse may well be less reliable than that obtained from the individual.

Factors influencing food choices

The evidence in the literature that supports the English Report suggests that food choice is not a simple process.  An individual's food patterns result from a wide range of factors that are complex and inter-related.

Factors affecting dietary patterns and practices are:

• Physiological factors including age, sex, level of physical activity and health status
• Food accessibility, the availability and affordability of food and the food selection practices in the household
• Food characteristics such as familiarity, physical appearance and flavour
• Environmental influences including parental and peer pressure, media advertising, knowledge about diet-health relationships and food-related customs and traditions
• Psychological influences including moods, emotions and events.

Food preferences, appetite and acceptance are developed through exposure to physical characteristics of foods in combination with environmental and psychological influences.  Past experience and attitudes are at least as important as the physiological state of the person and the sensation elicited by the food.  In particular, the experiences in the early years of life (prior to the age of 16 years) are among the strongest controlling factors in food preferences.

Bully Beef – a consideration

It is a common contention that “bully beef” (preserved meat provided as part of service rations), was a major component of some service diets and was high in fat.

The fat content of preserved meat in service rations was quite low, particularly compared to other forms of meat.  The animal fat content of preserved meat (including bully beef) was 11.2%.  This compares with 28.2% for ham and bacon, 32.7% for mutton and lamb, and 13.2% for beef.  Biscuits, fruitcake and ice cream had levels of 11.9, 13.9 and 11.0% respectively.

Based on the ration scales, the preserved meat component of servicemen's diets provided approximately 11 to 12 gms of animal fat per day in the Middle East, New Guinea and the Pacific Islands, and considerably less in Australia.  However, in operational areas, preserved meat was often substituted for fresh meat, which may have slightly reduced total animal fat intake, due to the lower fat content in preserved meat compared to fresh and frozen meat.

Conclusion

The reports of Dr English and the supporting reports and papers need to be considered as a whole and a judgement made about the circumstances of each claim in relation to what is now known to have been the situation in Australia, prior to, during and after World War 2.  Further information on the application of the English paper and the operation of the SOP may be forthcoming in the AAT when Deledio, which has been reheard, is decided.

W.R. Maxwell

Branch Head

Disability Compensation

28 January 1999

Appendix

Table 3. Animal fat consumption trends

in civilian Australian diets

Year	Animal fat (gms)
1938-39	116.9
1948-49	102.5
1958-59	110.7
1968-69	97.4
1978-79	75.8
1983	63.4
1988-89	55.2
1993-94	56.0

Table 4. Typical animal fat content

of various foods

Food	% animal fat
Lard	100
Butter	85.9
Cream	36.7
Mutton	32.7
Bacon/Ham	19.3 – 32.7
Cheese	29.0
Dried milk	23.7 – 26.2
Pork	18.0
Sausage	17.6
Beef	13.5
Preserved meat	11.2
Condensed milk	10.0
Fresh milk	4.3

Table 5. Contribution of different foods

to overall animal fat intake in typical 1944 civilian diet

Food	% of intake
Butter	32.0
Mutton	22.0
Beef	10.6
Fresh milk	8.0
Cakes, biscuits, scones	5.2
Condensed milk	4.7
Dried milk	3.4
Sausage	3.2
Dripping, oil, other fat	2.6
Bacon/Ham	2.5
Cheese	2.5
Lard	0.9
Pork	0.6
Cream	0.3
Preserved meat	0.2

Table 6. World War 2 era

Civilian rationing in Australia (adults)

Commodity	Date began	Rate/head/wk	Change	Rate	Change	Rate
Meat	17.1.44	2.25lb	26.2.45	2.10lb	7.4.45	1.84lb
Butter	7.6.42	8oz	5.6.44	6oz

Table 7. Frequency distribution of total daily intake

of fat (grams) for adult males in Australia 1936-8.

Intake (grams)		Brisbane	Sydney	Melbourne	Adelaide	Perth	Total	%	cumulative %
40.1	- 50	1		1		1	3	0.17%	0.17%
50.1	- 60	1		0		2	3	0.17%	0.34%
60.1	- 70	2		2		1	5	0.28%	0.61%
70.1	- 80	0	3	6	9	6	24	1.34%	1.96%
80.1	- 90	2	4	7	13	6	32	1.79%	3.75%
90.1	- 100	11	11	8	25	24	79	4.42%	8.16%
100.1	- 110	24	23	14	45	23	129	7.21%	15.37%
110.1	- 120	27	37	42	81	37	224	12.52%	27.89%
120.1	- 130	40	37	31	69	34	211	11.79%	39.69%
130.1	- 140	37	49	35	54	40	215	12.02%	51.70%
140.1	- 150	40	54	54	43	44	235	13.14%	64.84%
150.1	- 160	25	44	46	35	33	183	10.23%	75.07%
160.1	- 170	26	43	44	19	20	152	8.50%	83.57%
170.1	- 180	22	26	36	13	15	112	6.26%	89.83%
180.1	- 190	14	9	23	5	6	57	3.19%	93.01%
190.1	- 200	9	14	18	2	6	49	2.74%	95.75%
200.1	- 210	5	6	7	7	5	30	1.68%	97.43%
210.1	- 220	7	0	6	2	2	17	0.95%	98.38%
220.1	- 230	2	3	6	0	1	12	0.67%	99.05%
230.1	- 240	1	3	0	0	1	5	0.28%	99.33%
240.1	- 250	1	0	1	1	1	4	0.22%	99.55%
250.1	- 260	0	0	0	0	0	0	0.00%	99.55%
260.1	- 270	0	0	0	0	0	0	0.00%	99.55%
270.1	- 280	1	0	1	0	0	2	0.11%	99.66%
280.1	- 290	0	0		0	0	0	0.00%	99.66%
290.1	- 300	0	0		1	0	1	0.06%	99.72%
300.1	- 310	0	0			0	0	0.00%	99.72%
310.1	- 320	0	0			0	0	0.00%	99.72%
320.1	- 330	0	0			0	0	0.00%	99.72%
330.1	- 340	1	1			0	2	0.11%	99.83%
340.1	- 350	1				0	1	0.06%	99.89%
350.1	- 360					1	1	0.06%	99.94%
630.1	- 640					1	1	0.06%	100.00%
Total		300	367	388	424	310	1789	100.00%