Comparison of cardiovascular disease and cancer prevalence between Mediterranean and north European middle-aged populations (The Cilento on Ageing Outcomes Study and The Malm\xf6 Offspring Study)

Widet Gallo,Marju Orho-Melander,Louise Brunkwall,Giovanni D’Arena,Filip Ottosson,Peter M Nilsson,Olle Melander,Salvatore Di Somma,Paola Antonini,Gaetano Pacente

doi:10.1007/s11739-020-02625-4

Abstract

Mediterranean diet protects from both cardiovascular disease (CVD) and cancer. In the 1960s, Ancel Keys defined the concept of Mediterranean diet in the South Italian region of Cilento and proposed it as a key factor for healthy ageing in the region. The aim of the current study was to compare the prevalence of CVD and cancer between a middle-aged population from Cilento and those of a Northern European population from Malmö, Sweden. We clinically characterized two middle-aged (50–67 years of age) population-based samples from Cilento (n = 809) and Malmö (n = 1025), Sweden, respectively. Logistic regression was used to calculate odds ratios (95% confidence interval) for disease prevalence in Malmö versus Cilento inhabitants adjusted for age and sex (model 1) and adjusted for all cardiometabolic risk factors (model 2). The prevalence of hypertension, current smoking, diabetes mellitus and levels of body mass index and triglycerides were lower, whereas HDL-cholesterol was higher in Malmö than in Cilento. LDL-cholesterol was higher and estimated glomerular filtration rate was lower in Malmö than in Cilento. The odds ratio for cardiovascular disease in Malmö versus Cilento inhabitants was 1.13 (0.69–1.87) (P = 0.62) in model 1, whereas it was significantly elevated in model 2 [2.03 (1.14–3.60) (P = 0.016)]. Moreover, the odds ratio for cancer in Malmö versus Cilento was 2.78 (1.81–4.27) (P < 0.001) in model 1 and 3.11 (1.97–4.92) (P < 0.001) in model 2. The higher odds of CVD and cancer in Malmö versus Cilento, when risk factors were accounted for, suggests the existence of unknown protective factors in Cilento.

Highlights

Cardiovascular disease (CVD) and cancer are the most common non-communicable diseases globally and account for the majority of morbidity, disability, impaired quality of life and reduction of life span [1, 2]
When adjusted for the differences in risk factor levels between the two populations on top of age and sex, the odds for cardiovascular disease was significantly higher in Malmö versus Cilento with an odds ratio (95% confidence interval) of 2.03 (1.14–3.60) (P = 0.016) (Fig. 1)
The prevalence of cancer in Cilento was about one-third as compared to Malmö, both before and after accounting for risk factors

Summary

Introduction

Cardiovascular disease (CVD) and cancer are the most common non-communicable diseases globally and account for the majority of morbidity, disability, impaired quality of life and reduction of life span [1, 2]. CVD mortality has fallen over the past 10-year period, which has been attributed to, among other things, a reduction of cigarette smoking, more effective prevention of high blood pressure and cholesterol and new treatment methods for myocardial infarction and stroke [1]. Both in Europe and globally there is a clear increase in obesity and. Individuals who follow a Mediterranean diet, which includes a large proportion of fruits and vegetables, olive oil, fish and a moderate daily intake of wine, have a lower risk of both CVD and cancer [2, 10,11,12]. The exact causes of this protective effect are still unknown but are probably related to the diet itself and to other co-varying lifestyle factors

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