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The burden of disease attributable to nutrition in Europe

Published online by Cambridge University Press:  22 December 2006

Joceline Pomerleau ,
Martin McKee ,
Tim Lobstein  and
Cécile Knai
Joceline Pomerleau*
Affiliation:
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Martin McKee
Affiliation:
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Tim Lobstein
Affiliation:
Food Commission, 94 White Lion Street, London N1 9PF, UK
Cécile Knai
Affiliation:
Nutrition and Food Security, WHO Regional Office for Europe, Scherfigsvej 8, 2100 Copenhagen, Denmark
*
*Corresponding author: Email: [email protected]
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Abstract

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Objective:

This review examines the extent to which differences in nutrition could explain the diversity of health in Europe and how dietary patterns might contribute to the overall burden of disease in the region.

Setting:

Europe.

Design:

Between-country variations and time trends in dietary and health patterns in Europe are described, taking into account recent evidence on east-west mortality differentials. Existing information on the contribution of dietary factors to the overall burden of disease in Europe and to the burden of cardiovascular diseases and cancer is then reviewed, including a discussion of the methodological challenges that face those seeking to quantify this burden accurately.

Results:

While evidence from ecological data have long suggested that variations in health patterns in Europe may be at least partly attributed to differences in dietary intake, recent research into the major risks to disease, disability and death is confirming the importance of poor nutrition to major health problems and overall disease burden in Europe. Findings from the Global Burden of Disease 2000 study suggest that 4.4% of the overall burden of disease in the region could be attributed to low fruit and vegetable intake, and 7.8% to overweight and obesity.

Conclusions:

The burden of disease attributed to poor nutrition in Europe appears to be substantial and probably underestimated. However, better quantification of the contribution of nutrition to the region's burden of disease awaits further research to assess the dietary intake of Europeans and to explore the relationship between nutritional factors and health outcomes in diverse parts of Europe.

Keywords

NutritionDietFruitVegetablesHealth trendsMorbidityMortalityEuropeEpidemiology
Type
Research Article
Information
Public Health Nutrition , Volume 6 , Issue 5 , August 2003 , pp. 453 - 461
Copyright
Copyright © The Authors 2003

References

1Murray, CJ, Lopez, AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997; 349: 1436–42.CrossRefGoogle ScholarPubMed
2World Health Organization (WHO). The World Health Report 2002. Reducing Risks, Promoting Healthy Life. Geneva: WHO, 2002.Google Scholar
3World Health Organization (WHO). Diet, Nutrition and The Preventation of Chronic Diseases. Technical Report Series No. 797. Geneva: WHO, 1990.Google Scholar
4European Heart Network. Food, Nutrition and Cardiovascular Disease Prevention in Europe. Brussels: European Heart Network, 1998.Google Scholar
5World Cancer Research Fund/American Institute for Cancer Research (AICR). Food, Nutrition and The Prevention of Cancer: A Global Perspective. Washington, DC: AICR, 1997.Google Scholar
6Nutrition and Diet for Healthy Lifestyles in Europe: Science and Policy Implications. Proceedings of the European Conference, Crete, Greece, 18–20 May 2000. In: Kafatos, AG, Codrington, CA, eds. Eurodiet Report and Proceedings [special issue]. Public Health Nutrition 2001; 4(2A): 337–436.Google Scholar
7McKee, M, Jacobson, B. Public health in Europe. Lancet 2000; 356: 665–70.CrossRefGoogle ScholarPubMed
8World Health Organization (WHO) Regional Office for Europe. Health in Europe 1997. WHO Regional Publications, European Series No. 83. Copenhagen: WHO Regional Office for Europe, 1998.Google Scholar
9World Health Organization (WHO) Regional Office for Europe. Health for All Database. Copenhagen: WHO Regional Office for Europe, 2002.Google Scholar
10James, WPT, Ferro-Luzzi, A, Isaksson, B, Szostak, WB. Healthy Nutrition. Preventing Nutrition-related Diseases in Europe. Copenhagen: World Health Organization Regional Office for Europe, 1988.Google ScholarPubMed
11Keys, A. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Cambridge, MA: Harvard University Press, 1980.CrossRefGoogle Scholar
12Willett, WC, Sacks, F, Trichopoulou, A, Drescher, G, Ferro-Luzzi, A, Helsing, E, et al. Mediterranean diet pyramid: a cultural model for healthy eating. American Journal of Clinical Nutrition 1995; 61(Suppl.): 1402S–6.CrossRefGoogle ScholarPubMed
13de-Lorgeril, M, Renaud, S, Mamelle, N, Salen, P, Martin, JL, Monjaud, I, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994; 343: 1454–9.CrossRefGoogle ScholarPubMed
14Trichopoulou, A, Lagiou, P. Healthy traditional Mediterranean diet: an expression of culture, history, and lifestyle. Nutrition Reviews 1997; 55: 383–9.CrossRefGoogle ScholarPubMed
15Kouris-Blazos, A, Gnardellis, C, Wahlqvist, ML, Trichopoulos, D, Lukito, W, Trichopoulou, A. Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. British Journal of Nutrition 1999; 82: 57–61.CrossRefGoogle ScholarPubMed
16Assman, G, Sacks, F, Awad, AB, Bonanome, A, Booyse, FM, Carmena, R, et al. Dietary fat, the Mediterranean diet and lifelong good health. 2000 International Conference on the Mediterranean Diet. 2000 Consensus Statement [online]. London: Royal College of Physicians, January 2000. Available at http://www.chd-taskforce.de/2000consensusstatement/index_e.html. Accessed 25 September 2002.Google Scholar
17Food and Agriculture Organization (FAO). FAOSTAT Database [online]. Rome: FAO, 2001. Available at http://www.apps.fao.org/1. Accessed 1 December 2001.Google Scholar
18Lobstein, T, Longfield, J. Improving Diet and Health through European Union Food Policies. London: Health Education Authority, 1999.Google Scholar
19Lang, T. Food and nutrition. In: Weil, O, McKee, M, Brodin, M, Oberlé, D, eds. Priorities for Public Health Action in Europe. Brussels: European Commission. 1999; 138–56.Google Scholar
20La Vecchia, C, Levi, F, Lucchini, F, Negri, E. Trends in mortality from major diseases in Europe, 1980–1993. European Journal of Epidemiology 1998; 14: 1–8.CrossRefGoogle ScholarPubMed
21Sans, S, Kesteloot, H, Kromhout, D on behalf of the Task Force. The Burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. European Heart Journal 1997; 18: 1231–48.CrossRefGoogle Scholar
22British Heart Foundation Health Promotion Research Group. European Cardiovascular Disease Statistics [online]. Oxford: British Heart Foundation. Available at http://www.dphpc.ox.ac.uk/bhfhprg/stats/2000/europe/introduction.html. Accessed 25 September 2002.Google Scholar
23Levi, F, Lucchini, F, Negri, E, La Vecchia, C. Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world. Heart 2002; 88: 119–24.CrossRefGoogle ScholarPubMed
24Bobak, M, Marmot, M. East-west mortality divide and its potential explanations: proposed research agenda. British Medical Journal 1996; 312: 421–5.CrossRefGoogle ScholarPubMed
25Marmot, M, Wilkinson, RG. Social Determinants of Health. Oxford: Oxford University Press, 1999.Google Scholar
26Roks, C, Galloway, R, Brown, L. Prospects for Improving the Nutrition Situation in Eastern Europe and Central Asia. Washington, DC: World Bank, 2000.Google Scholar
27Food and Agriculture Organization (FAO). The State of Food Insecurity in the World. Rome: FAO, 1999.Google Scholar
28Bobak, M, Hense, HW, Kark, J, Kuch, B, Vojtisek, P, Sinnreich, R, et al. An ecological study of determinants of coronary heart disease rates: a comparison of Czech, Bavarian and Israeli men. International Journal of Epidemiology 1999; 28: 437–44.CrossRefGoogle Scholar
29WHO MONICA Project Principal Investigators. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. Journal of Clinical Epidemiology 1988; 41: 105–14.CrossRefGoogle Scholar
30Witzum, JL. The oxidation hypothesis of atherosclerosis. Lancet 1994; 344: 793–5.CrossRefGoogle Scholar
31Jha, P, Flather, M, Lonn, E, Farkouh, M, Yusuf, S. The antioxidant vitamins and cardiovascular disease. A critical review of epidemiologic and clinical trial data. Annals of Internal Medicine 1995; 123: 860–72.CrossRefGoogle ScholarPubMed
32EURONUT-SENECA. Nutrition and the elderly in Europe. European Journal of Clinical Nutrition 1991; 45(Suppl. 3): 1–196.Google Scholar
33Kristenson, M, Ziedén, B, Kucinskienë, Z, Abaravicius, A, Razinkovienë, L, Schäfer, Elinder L, et al. Antioxidant state and mortality from coronary heart disease in Lithuanian and Swedish men: concomitant cross sectional study of men aged 50. British Medical Journal 1997; 314: 629–33.CrossRefGoogle ScholarPubMed
34Gjonca, A, Bobak, M. Albanian paradox, another example of protective effect of Mediterranean lifestyle? Lancet 1997; 350: 1815–7.CrossRefGoogle ScholarPubMed
35Shapo, L, Coker, R, McKee, M. Tracking diabetes in Albania: a natural experiment on the impact of modernisation on health. Diabetic Medicine 2002; 19: 87–8.CrossRefGoogle Scholar
36Zatonski, WA, McMichael, AJ, Powles, JW. Ecological study of reasons for sharp decline in mortality from ischaemic heart disease in Poland since 1991. British Medical Journal 1998; 316: 1047–51CrossRefGoogle ScholarPubMed
37Ebrahim, S, Davey, Smith G. Ecological studies are a poor means of testing aetiological hypotheses. British Medical Journal 1998; 317: 678.CrossRefGoogle ScholarPubMed
38Klerk, M, Jansen, MCJF, van't, Veer P, Kok, FJ. Fruits and Vegetables in Chronic Disease Prevention. Part II: Update and Extension (literature up to early 1998). Wageningen: Wageningen Agricultural University, 1998.Google Scholar
39Van't, Veer P, Jansen, MCJF, Klerk, M, Kok, FJ. Fruits and vegetables in the prevention of cancer and cardiovascular disease. Public Health Nutrition 2000; 3: 103–7.CrossRefGoogle Scholar
40Ness, AR, Powles, JW. Fruit and vegetables, and cardiovascular disease: a review. International Journal of Epidemiology 1997; 26: 1–13.CrossRefGoogle ScholarPubMed
41Melse, JM, Essink-Bot, M-L, Kramers, PGN, Hoeymans, N. A national burden of disease calculation: Dutch disability-adjusted life-years. American Journal of Public Health 2000; 90: 1241–7.Google ScholarPubMed
42National Institute of Public Health (NIPH). Determinants of the Burden of Disease in the EU. Stockholm: NIPH, 1997.Google Scholar
43Yong, LC, Brown, CC, Schatzkin, A, Dresser, CM, Slesinski, MJ, Cox, CS, et al. Intake of vitamins E, C, and A and risk of lung cancer. The NHANES I epidemiologic followup study. First National Health and Nutrition Examination Survey. American Journal of Epidemiology 1997; 146: 231–43.CrossRefGoogle Scholar
44Committee on Diet and Health. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: National Academy Press, 1989.Google Scholar
45Joffe, M, Robertson, A. The potential contribution of increased vegetable and fruit consumption to health gain in the European Union. Public Health Nutrition 2001; 4: 893–901.CrossRefGoogle ScholarPubMed
46Tobias, M. The Burden of Disease and Injury in New Zealand. Public Health Intelligence Occasional Bulletin No. 1. Wellington: New Zealand Ministry of Health, 2001.Google ScholarPubMed
47Mathers, C, Vos, T, Stevenson, C. The Burden of Disease and Injury in Australia. AIHW Catalogue No. PHE 17. Canberra: Australian Institute of Health and Welfare (AIHW), 1999.Google Scholar
48Vos, T, Begg, S. The Victorian Burden of Disease Study: Mortality. Melbourne: Public Health and Development Division, Victorian Government Department of Human Services, 1999.Google Scholar
49World Health Organization (WHO) Regional Office for Europe. The First Action Plan for Food and Nutrition Policy. WHO European Region 2000–2005. Copenhagen: WHO Regional Office for Europe, 2000.Google Scholar
50Doll, R, Peto, R. The Causes of Cancer. Oxford: University Press, 1981.Google ScholarPubMed
51Doll, R. The lessons of life. Keynote address to the nutrition and cancer conference. Cancer Research 1992; 52: 2024S–9S.Google Scholar
52Browner, WS, Westenhouse, J, Tice, J. What if Americans ate less fat? A quantitative estimate of the effect on mortality. Journal of the American Medical Association 1991; 265: 285–91.Google ScholarPubMed
53Willett, WC. Will high-carbohydrate/low-fat diets reduce the risk of coronary heart disease?. Proceedings of the Society for Experimental Biology and Medicine 2000; 225: 187–90.Google ScholarPubMed
54Willett, WC. Diet, nutrition and avoidable cancer. Environmental Health Perspectives 1995; 103:(Suppl.): 165–70.Google ScholarPubMed
55Committee on Medical Aspects of Food Policy. Nutritional Aspects of the Development of Cancer. London: HMSO, 1998.Google Scholar
56Riboli, E, Decloitre, F, Collet-Ribbing, C. Alimentation et cancer: évaluation des données scientifique? Paris: Editions Techniques et Documentation, Lavoisier, 1996.Google Scholar
57Papas, AM, ed. Antioxidant Status, Diet, Nutrition, and Health. Boca Raton: FL: CRC Press, 1998.Google Scholar
58Murray, C, Lopez, AD. On the comparable quantification of health risks: lessons from the Global Burden of Disease Study. Epidemiology 1999; 10: 594–605.CrossRefGoogle ScholarPubMed
59Greenland, S, Rothman, KJ. Measures of effect and measures of association. In: Rothman, KJ, Greenland, S, eds. Modern Epidemiology, 2nd ed. Philadelphia, PA: Lippincott-Raven Publishers, 1998; 47–66.Google Scholar
60Ezzati, M, Lopez, AD, Rodgers, A, Vander, Hoorn S, Murray, CJL and the Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360: 1347–60.CrossRefGoogle ScholarPubMed
61Lock, K, Pomerleau, J, Causer, L, McKee, M. Global burden of disease due to low fruit and vegetable consumption. In: Ezzati, M, Lopez, AD, Rodgers, A, Murray, CJL, eds. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Due to Selected Major Risk Factors. Geneva: WHO, 2003; in press.Google Scholar
62European Commission. Improvement in Knowledge of Food Consumption with a View to Protection of Public Health by Means of Exchanges and Collaboration between Database Managers. Reports on Tasks for Scientific Cooperation, EUR 17528 (EN). Brussels: European Commission, 1997.Google Scholar
63Bingham, SA, Paul, AA, Haraldsdottir, J, Løken, EB, van Staveren, WA. Methods of data collection at an individual level. In: Cameron, ME, van Staveran, WA, eds. Manual on Methodology for Food Consumption Studies. Oxford: Oxford University Press, 1988; 53–106.Google Scholar
64Willett, W, ed. Nutritional Epidemiology. Oxford: Oxford University Press, 1998.CrossRefGoogle Scholar
65Powles, J, Day, NE, Sanz, MA, Bingham, SA. Protective foods in winter and spring: a key to lower vascular mortality? Lancet 1996; 348: 898–9.CrossRefGoogle Scholar
66Terry, P, Giovanucci, E, Michels, KB, Bergvist, L, Hansen, H, Holmberg, L, et al. Fruit, vegetables, dietary fiber and risk of colorectal cancer. Journal of the National Cancer Institute 2001; 93: 525–33.CrossRefGoogle ScholarPubMed
67Law, MR, Morris, JK. By how much does fruit and vegetable consumption reduce the risk of ischaemic heart disease? European Journal of Clinical Nutrition 1998; 52: 549–56.CrossRefGoogle ScholarPubMed
68Egger, M, Schneider, M, Davey Smith, G. Spurious precision? Meta-analysis of observational studies. British Medical Journal 1998; 316: 140–4.CrossRefGoogle ScholarPubMed
69Ness, AR, Egger, M, Davey Smith, G. Meta-analysis seems to exclude benefit of vitamin C supplementation. British Medical Journal 1999; 319: 577.CrossRefGoogle ScholarPubMed
70Cameron, ME, van Staveren, WA. Manual on Methodology for Food Consumption Studies. Oxford: Oxford University Press, 1988.Google Scholar
71McKee, M, Shkolnikov, V, Leon, DA. Alcohol is implicated in the fluctuations in cardiovascular disease in Russia since the 1980s. Annals of Epidemiology 2001; 11: 1–6.CrossRefGoogle ScholarPubMed
72Ness, A, Egger, M, Powles, J. Fruit and vegetables and ischaemic heart disease: systematic review or misleading meta-analysis? European Journal of Clinical Nutrition 1999; 53: 900–2.CrossRefGoogle ScholarPubMed
73World Health Organization (WHO) Regional Office for Europe. Food and Health in Europe: A New Basis for Action; Copenhagen: WHO Regional Office for Europe, 2003; in press.Google Scholar
74Gonzalez, CA. Dietary patterns in Europe – preliminary results of dietary habits in the EPIC Study. European Prospective Investigation on Cancer and Nutrition. European Journal of Cancer Prevention 1997; 6: 125–6.Google Scholar
75World Health Organization (WHO) Regional Office for Europe. Development of the First Food and Nutrition Action Plan for the European Region. Report of a WHO Consultation, Malta, 8–10 November 1999. Copenhagen: WHO Regional Office for Europe, 2000.Google Scholar
76McColl, K, Pomerleau, J, Weill, C, Oberlé, D, Brodin, M, Lefebvre, A, et al. Health and Human Nutrition: Element for European Action. Collection Santé & Société no. 10. Paris: Société Française de Santé Publique, 2000.Google Scholar