Lifestyle and risk factor trends, mortality trends, and public health perspectives

Abstract

In Scandinavia, interest in nutritional problems and especially the question of a possible relationship between the composition of dietary fat and the development of atherosclerotic diseases dates back to the time of the Second World War. It was then observed (4) that during the lean years of the war mortality from such diseases temporarily decreased in Sweden as well as in Finland and Norway. But in Denmark, where food was not so scarce, no such decrease was found. Investigations by Kinsell (3), Groen (2), and others were soon able to show that the composition of dietary fat is of great importance; one must distinguish between saturated and unsaturated fat. It was also shown in animal experiments that a certain amount of polyunsaturated fat is necessary to prevent the development of atherosclerosis (5). Owing to the high mortality from myocardial infarction, the composition of dietary fats soon received attention from the point of view of public health. It was obviously urgent to try to change dietary habits. With this in view, an official recommendation was published in 1968 to persuade all people to eat less saturated and more polyunsaturated fat (7). Swedes, like other Scandinavians, are fond of sandwiches and drink a lot of milk. To facilitate the use of polyunsaturated fat instead of saturated fat it was considered necessary to get the food industry to manufacture fat-modified food products. Several such products, especially dairy and margarine products, were gradually placed on the market. These contain less fat and some part of the saturated fat has been replaced by polyunsaturated fat. These fat-modified products are satisfactory as far as taste is concerned. Low-fat milk, which contains only 0.5% fat, tastes very good and has been generally accepted by both children and adults. It is now widely used in the entire country. The taste of margarine cheese, made from sunflower seed oil and skim milk, is likewise satisfactory and a successful alternative. It is now exported to the U.S. as well. Liquid margarine, though good from a theoretical point of view, is not widely used. Swedes have not yet learned to use liquid vegetable oil for cooking. As for other food products rich in fat, no radical changes have been made in the composition or the amount of fat used. It is true that a large part of milk drunk is of the low-fat type, which contains only 0.5% fat, and much of the margarine used is