The chronic, nutritionally related diseases just described are major causes of death and disability in rich industrialized countries. American and North European diets have tended to be high in animal foods (meat, dairy, fish, eggs) and low in foods of plant origin (grains, fruits, and vegetables). It is claimed by Garrow (44) that most of the chronic diseases in the Western society are the manifestation of the high availability and variety of foods leading to overconsumption. Only a small proportion of income is now required to be spent on food in the industrialized countries (45). Excessive intake of animal foods leads to a dietary pattern that is high in saturated fat and cholesterol and low in fiber.

In contrast, the southern European or the Mediterranean diet comprises fruits, vegetables, and grains with smaller amounts of meat, fish, eggs, and dairy products (46,47). Olive oil is often the major lipid, so that the diet is low in cholesterol and saturated fat and high in monounsaturated fatty acids. A comparative study between Italians and Americans was performed in the early 1950s. It was found that Italian diets were remarkably low in fat (20% of energy) or just half of the proportion observed in the diets of comparable American groups. The typical American diet, rich in meat and dairy fats was thus, to gether with higher concentrations of blood cholesterol, identified with increased risk of coronary heart disease (48). A seven-country study performed over 20 years confirmed these relationships (22). Recommendations for the "Mediterranean Diet" have become popular within the United States. This diet plan is indicated in Table 9 (49).

Ironically, while such diets are now being consumed by the affluent, recent dietary surveys carried out on the island of Crete have reported an increase in intake of meat, fish, and cheese and a decrease in intakes of bread, fruit, potatoes, and olive oil (50). Similar changes have been observed in Italy (51). An increased availability of animal foods throughout the Mediterranean area has also been documented (47). These dietary changes have been accompanied by increases in chronic disease risk factors such as higher concentrations of serum cholesterol, hypertension, and obesity as well as reduced levels of physical activity (50,52).

Chronic disease risk is increasing, not only in the Western society, but also in the more affluent classes of the developing countries (53). The rich in poor countries often have a similar pattern of food consumption to that observed in the affluent countries. They are also subject to many of the same lifestyle factors, including smoking and reduced physical activity.

Dietary Guidelines (Table 3) can help in reducing both heart disease and cancer risk. The guidelines now emphasize moderation in intake, especially of saturated fat, along with increased physical activity. Increasing intakes of fruits, vegetables, and complex carbohydrates are also recommended.

Paradoxically, these present recommendations for the affluent define diets and lifestyles closer to those common in the past for the less affluent. As a further paradox, these latter societies, as their wealth increases, are often attempting to emulate the diets and lifestyles of the West. Consequently, they are now increasingly subject to the same pattern of disease.

Table 9. The Mediterranean Diet Plan

Frequency of Foods consumption

In significant amounts

Daily Whole grains and grain products

(breads, pasta, rice, couscous, polenta, bulgur) and potatoes Fruits and vegetables Beans, other legumes, and nuts

In small or minimal amounts

Daily Cheese and yogurt

A few times a week Fish, poultry, eggs, and sweets A few times a month Red meat (or in small amounts more often)

In addition, regular physical activity is important. Moderate wine consumption is optional.

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