Between its origin in the 1950s and its endorsement by a consensus conference in 1984, the diet–heart hypothesis was the subject of intense controversy. Paul et al. (1963) is a highly cited prospective cohort study that reported findings inconvenient for this hypothesis, reporting no association between diet and heart disease; however, many other findings were also reported. By citation context and network analysis of 343 citing papers, I show how Paul et al. was cited in the 20 years after its publication. Generally, different findings were cited by different communities focusing on different risk factors; these communities were established by either research foci title terms or via cluster membership as established via modularity maximization. The most frequently cited findings were the significant associations between heart disease and serum cholesterol (n = 85), blood pressure (n = 57), and coffee consumption (n = 54). The lack of association between diet and heart disease was cited in just 41 papers. Yet, no single empirical finding was referred to in more than 25% of the citing papers. This raises questions about the value of inferring impact from citation counts alone and raises problems for studies using such counts to measure citation bias.

This content is only available as a PDF.

Author notes

Handling Editor: Ludo Waltman

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. For a full description of the license, please visit