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Dietary habit profile in european communites with different risk of myocardial infarction: the impact of migration as a model of gene/environment interaction


Risk factors influenced by both nutrition and genetic polymorphisms will be studied in 3 European communities by general practitioner's networks. Firstly, 270 Be/Be couples in Belgium will be compared with 270 age- and sex-matched It/It couples in Italy and 270 UK/UK couples in U.K. Migration of Italians to Belgium will be used as a model of interaction between nutrition and genetics, to explain differences in the prevalence of cardiovascular risk across Europe. For this purpose, 270 mixed couples, formed in Belgium by a It/Be marriage, with the same range of age of the It/It, Be/Be and UK/UK couples, will be recruited. Members of the mixed couples will be compared between them and with It and Be couples. A new Multilanguage food frequency questionnaire (FFQ) will be developed to evaluate dietary factors and analysed with an adapted program, using integrated tables of food composition.
The IMMIDIET project has reached all its deliverables and milestones. It has produced an enormous amount of data that have contradicted several common believes and should have a strong impact on national and European public health policies. First of all, the so called "North-South" gradient of risk and probably mortality for cardiovascular disease is disappearing. England that was considered the country at highest risk of cardiovascular disease, is improving successfully its situation, at least in some of its regions. Although not representative of the whole country situation, these data demonstrate that by modifying life style, such as dietary habits, smoking habits, physical activity and so on, it is possible to stop and even revert the increase in the risk of cardiovascular disease. Particularly worrying is the observation on blood pressure and sodium clearance. There is a clear-cut trend for blood pressure to increase from England to Belgium to Italy. This is more evident amongst women but is present also in men, at least for systolic blood pressure. In men and women combined there is also a clear-cut trend for urinary sodium excretion (marker of salt intake) to increase from England to Belgium to Italy. This trend is evident amongst women. In men, however, Italians have much greater salt intake than both northern European countries.

A positive ecological association was found between levels of salt intake and blood pressure, that suggests that the higher level of blood pressure in Italians is dependent on the high salt intake with the diet. These factors may be significant contributors to an increased risk of stroke in Italy. Recent data of the "Progetto Cuore" show an increase in the incidence of stroke in the Italian population and in particular in Southern Italy women (131). Several campaigns against elevated salt intake have been conducted in England in the past 20 years with the results to have lowered salt intake and consequently the levels of blood pressure. Similar action should be taken in Italy and implemented in Belgium on the basis of the IMMIDIET results. Contrary to what we expected, the differences in dietary intake among groups were not so large, which could be interpreted as a trend toward homogenisation of the European populations in terms of nutrition. In other words, English and Italians did not behave so different by which can be seen in parallel with the trend toward less difference among countries in presence of cardiovascular risk factors and in the incidence of the disease. However, while this is a "good news" for England or Belgium, the situation is really worrying in Italy. Italians are loosing their protection and are acquiring detrimental life habits. This is especially true for women. The high prevalence of smokers, the lowest levels of physical activity, the high level of salt intake have all been observed in Italians. Moreover, dietary habits are slowly loosing the characteristics of the Mediterranean diet. Secondly, the results of this study have assigned a weaker role of genetics in determining the risk of population.

Although genetic factors are very important in the regulation of metabolic pathways and their study cannot be omitted in understanding the physiology and pathology of metabolic mechanisms, the role of environment is overcoming in determining the risk. Therefore genetics cannot be ever studied without taking simultaneously into consideration the environment. Migration and integration have really created a new improved culture from the health point of view. Mixed couples have the better risk profile. In particular they smoke less, drink less, have a good level of physical activity and maintain the great food habits of both cultures. Through the Immidiet study, local and international GP networks have been established and strengthened and are in place in preparation for future research. This successful example lends further support to the idea that the EU should continue - and perhaps increase - the level of commitment to funding primary care-based clinical research to allow such research to remain independent from the likely influence of the pharmaceutical industry.

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