American Journal of Clinical Nutrition, Vol 61, 1351S-1359S, Copyright © 1995 by The American Society for Clinical Nutrition, Inc

ORIGINAL RESEARCH COMMUNICATIONS

How could changes in diet explain changes in coronary heart disease mortality in Spain? The Spanish paradox

L Serra-Majem, L Ribas, R Tresserras, J Ngo and L Salleras
Department of Public Health, University of Barcelona, Spain.

We review and compare trends in coronary heart disease (CHD) and stroke mortality in Spain from 1966 to 1990 and changes in food consumption at national and regional levels. Since 1976, a decrease in cardiovascular disease (CVD) mortality in males and females has been observed, and standardized CHD mortality rates have fallen. Stroke mortality decreased during the same period. Trends in food consumption show increases in intakes of meat, dairy products, fish, and fruit, but decreases in consumption of olive oil, sugar, and all foods rich in carbohydrates. Although fat and saturated fat intakes increased, these changes were not accompanied by an increase in CHD mortality rates. This paradoxical situation can be explained by expanded access to clinical care, increased consumption of fruit and fish, improved control of hypertension, and a reduction in cigarette smoking. Diet appears to have an important role in this paradox, but it may not be as critical as other factors. Nevertheless, we suggest dietary guidelines for prevention of CHD in Spain.

This article has been cited by other articles:

				J. Mataix, M. Lopez-Frias, E. Martinez-de-Victoria, M. Lopez-Jurado, P. Aranda, and J. Llopis Factors Associated with Obesity in an Adult Mediterranean Population: Influence on Plasma Lipid Profile J. Am. Coll. Nutr., December 1, 2005; 24(6): 456 - 465. [Abstract] [Full Text] [PDF]

				E Fernandez-Jarne, E Martinez-Losa, M Prado-Santamaria, C Brugarolas-Brufau, M Serrano-Martinez, and M. Martinez-Gonzalez Risk of first non-fatal myocardial infarction negatively associated with olive oil consumption: a case-control study in Spain Int. J. Epidemiol., April 1, 2002; 31(2): 474 - 480. [Abstract] [Full Text] [PDF]

				M. T. Montoya, A. Porres, S. Serrano, J. C. Fruchart, P. Mata, J. A. G. Gerique, and G. R. Castro Fatty acid saturation of the diet and plasma lipid concentrations, lipoprotein particle concentrations, and cholesterol efflux capacity Am. J. Clinical Nutrition, March 1, 2002; 75(3): 484 - 491. [Abstract] [Full Text] [PDF]

				M. C. Ramirez-Tortosa, G. Urbano, M. López-Jurado, T. Nestares, M. C. Gomez, A. Mir, E. Ros, J. Mataix, and A. Gil Extra-Virgin Olive Oil Increases the Resistance of LDL to Oxidation More than Refined Olive Oil in Free-Living Men with Peripheral Vascular Disease J. Nutr., December 1, 1999; 129(12): 2177 - 2183. [Abstract] [Full Text]

				A R P Walker Coronary Heart Disease and Public Health Policy The Journal of the Royal Society for the Promotion of Health, April 1, 1996; 116(2): 121 - 122.