The PURE study seemed to provide pretty strong evidence for a positive relationship between eating saturated fat and living longer, but this doesn’t tell us what we really want to know: If we eat more saturated fat, will that cause us to live longer? This is because we don’t know whether there is a direct causal relationship between eating saturated fat and living longer. The data are consistent with such a relationship, but they are equally consistent with some other factor causing both higher saturated fat and longer life. For example, it is likely that people who are richer eat more saturated fat and richer people tend to live longer, but their longer life is not necessarily due to fat intake — it could instead be due to better health care, reduced psychological stress, better food quality, or many other factors. The PURE study investigators tried to account for these factors, but we can’t be certain that their efforts completely removed the effects of other variables. The fact that other factors may explain the relationship between saturated fat intake and death is an example of why introductory statistics classes often teach that “correlation does not imply causation”, though the renowned data visualization expert Edward Tufte has added, “but it sure is a hint.”
Although observational research (like the PURE study) cannot conclusively demonstrate causal relations, we generally think that causation can be demonstrated using studies that experimentally control and manipulate a specific factor. In medicine, such a study is referred to as a randomized controlled trial (RCT). Let’s say that we wanted to do an RCT to examine whether increasing saturated fat intake increases life span. To do this, we would sample a group of people, and then assign them to either a treatment group (which would be told to increase their saturated fat intake) or a control group (who would be told to keep eating the same as before). It is essential that we assign the individuals to these groups randomly. Otherwise, people who choose the treatment might be different in some way than people who choose the control group – for example, they might be more likely to engage in other healthy behaviors as well. We would then follow the participants over time and see how many people in each group died. Because we randomized the participants to treatment or control groups, we can be reasonably confident that there are no other differences between the groups that would confound the treatment effect; however, we still can’t be certain because sometimes randomization yields treatment versus control groups that do vary in some important way. Researchers often try to address these confounds using statistical analyses, but removing the influence of a confound from the data can be very difficult.
A number of RCTs have examined the question of whether changing saturated fat intake results in better health and longer life. These trials have focused on reducing saturated fat because of the strong dogma amongst nutrition researchers that saturated fat is deadly; most of these researchers would have probably argued that it was not ethical to cause people to eat more saturated fat! However, the RCTs have show a very consistent pattern: Overall there is no appreciable effect on death rates of reducing saturated fat intake.