Middelhavskost og Ny nordisk kost i forebyggelsen af kræft

Dietary differences between the Mediterranean and the Nordic countries and the related risks of developing cancer

 

Across Europe many different dietary patterns and ways of living will be found. It is known that these factors regarding food, nutrition and body composition are important aspects in development of cancer.[1]

 

Dietary patterns across Europe

The European Prospective Investigation into Cancer and Nutrition (EPIC) study showed clear differences in the dietary patterns among southern and northern European countries. The dietary patterns of the southern European countries, like Italy, Greece and Spain, primarily consisted of foods from the plant-origin such as fruits, vegetables and vegetable oils besides pasta, rice and grains rather than margarine, potatoes and non-alcoholic beverages like soft drinks, coffee, juice and tea.[2] This plant-based diet shares the same principles of the Mediterranean diet which is mainly characterized by fruits, vegetables and vegetable oils and has shown to lower risks of heart diseases, cancer and early death.[3]

The Northern countries, like Denmark, Norway, Sweden, UK and Germany showed a more sweet-and-fat-dominated dietary pattern based on sweets, added fat, dairy products and to some degree also eggs, meat, bread and alcoholic beverages. Denmark especially had a very low consumption of legumes and vegetable oils but a very high consumption of meat, alcoholic and non-alcoholic beverages .[4]

Records from WHO showed that the total alcohol consumption for a Danish capita (15+) was 3,03 units per day for men and 1,4 units per day for women.[5] This amount is for both sex more than the recommended which The World Cancer Research Fund (WCRF) defines as 2 units per day for men and 1 per day for women.[6] Records regarding Italy showed an alcohol consumption of 2,06 units per day for men and 1,25 units per day for women, which only is close to the recommended consumption but still a bit above.

The consumption of alcohol consists mostly of wine (66%) and only a small amount of spirits and beer in Italy where in Denmark the consumption of alcohol is higher for spirits and beer (52%) than wine.[7]  

Also, the way of consuming alcohol is different in Northern countries and southern countries. In the Nordic countries alcohol is mostly consumed without meals and not evenly distributed during the days of the week, but binge consumed on the weekends. In the southern countries alcohol is mostly consumed along with a meal and evenly distributed during the week.[8][9]  

Cancer frequency by country

In 2012 the World Cancer Research Fund has performed an age-standardized rate for all cancers for the countries with the fifty highest rates of cancer.

Denmark was found as number one, with the highest rate of cancers with 338.1 cases per 100,000 people. Italy appeared as number twenty-one on the list with 278.6 cases per 100,000 people. When stratified by gender Denmark still remained number one for women and number eight for men proposing that Danes, especially females, have a much higher risk of developing cancer than Italians, which could be due to the Nordic/western lifestyle and dietary pattern.[10]

Cancer risk

Alcohol - Consumption of alcohol is linked with increased risk of developing six different cancers. For cancer prevention, it is best not to drink alcohol at all.[11] A Danish study on alcohol consumption and mammographic density from 2017 indicated that high consumption of spirits, not beer or wine, in early adulthood (20-29 years) is associated with higher mammographic density which is correlated with increased risk of breast cancer. This indicate that the Danish alcohol consumption pattern could be associated with a higher risk of breast cancer due to the high intake of alcohol and spirits in specific compared with the Italian alcohol pattern, which is mainly based on wine.[12]

Overweight - Being overweight is a recognized risk factor of developing eleven different cancers. Different growth factors are elevated in overweight people compared with lean people, along with increased insulin production which can promote cancer development. Overweight is furthermore associated with a low chronic inflammatory state that too can promote growth of cancer cells.[13]

The dietary pattern found in the northern countries, dominated by sweets and fatty foods can most likely lead to overweight due to the high intake of sugar, fat, meat, and alcohol together with low consumption of fruits, vegetables and legumes which are dominant components in the Mediterranean dietary patterns.

Red and processed meat – Consumption of red and processed meat has been associated with increased risk of different cancers. The World Cancer Research Fund (WCRF) recommend people to limit their consumption or red meat to less than 500g per week very little of which can be processed meat. An average Danish male consumes approximately 665g of red meat and 392g of processed meat per week which results in 1077g per week. An average Danish female consumes 427g of red meat and 203g of processed meat per week which gives a total of 630g per week. The Danish men consume more than the double amount of what is recommended where the Danish women consume just a bit more than the recommendation [14] An average Italian consumes approximately 200g of red meat and 175g of processed meat per week which add up to only 375g per week, well below the recommendations.[15]  

Cancer prevention

Fruits, vegetables and whole grains – Fruits is a great source of antioxidants and vitamin C that protects against oxidation damage which can promote development of cancer. Also, non-starchy vegetables potentially contain antioxidants and fibers. Both vegetables and wholegrains are great sources of fibers that ferment in the bowels to short fatty acids, reducing the transit time and the risk of cancer. Other than that, wholegrains contain great number of vitamins and minerals. [16]  Vegetables, fruits, grains and vegetable oil play a big role in the dietary patterns of the Mediterranean countries representing a big share of the daily intake of which only a small part consisted of starchy-vegetables. Opposite to the Mediterranean countries the Northern countries revealed a low consumption of fruits, non- starchy vegetables, legumes and vegetable oils and a high intake of starchy vegetables such as potatoes. For that reason, the Mediterranean dietary pattern indicate a more preventive effect against cancer than the Nordic dietary pattern.[17]

The Mediterranean Diet (MD)

Many aspects point towards the Mediterranean diet being the most preventive against development of cancer. A study from 2017 that examines the Mediterranean diet’s risk reducing effect on mortality and prostate cancer, found that the main component of the Mediterranean diet, olive oil, along with tomato sauce have protective effects against cancer. The cancer preventive effect of olive oil is due to the high content of vitamin E which is associated with lower risk of (prostate) cancer.

Lycopene which is found in tomatoes and other red fruits, berries and vegetables is accountable for the reducing risk of cancer. Lycopene is best absorbed if cooked and eaten along with fats, like e.g. pasta with tomato sauce cooked with olive oil which could be a typical Italian lunch or dinner dish.[18]

Italy has also shown to be the Mediterranean country with the highest adherence to a Mediterranean diet[19]. Not all Mediterranean countries practice the Mediterranean diet, France for instance showed in the EPIC study to practice a more Westernized dietary pattern. Also, other Mediterranean countries follow the same tendency of an evolution from a more traditional Mediterranean diet towards a more western diet with an increased consumption of animal food and decreased consumption of cereals. This change, which is happening in both Mediterranean and northern European countries, reducing the different traditional dietary patterns between European countries is accelerating among young generations towards a more western and alike dietary pattern among all European countries.[20] From a cancer prevention view this evolving trend will increase Europeans risk of developing caners.

The New Nordic Diet (NND)

The Northern European countries joined in 2004 to develop a New Nordic Diet to improve traditional dietary patterns towards being healthier and more sustainable.

The New Nordic Diet is based on many of the same principles of the Mediterranean diet, and can generally be described as the Nordic version of the Mediterranean diet. It relies on regional and seasonal vegetables, fruits, wholegrains, fish and rapeseed oil instead of olive oil which the Mediterranean diet relies on.[21] 

Cancer prevention recommendations

Both the NND and the MD empathizes a dietary pattern rich in plant foods, grains and vegetables oils and low consumption of animal foods.

The World Cancer Research Fund has made certain recommendations, that rests very close to the MD and NND’s principles, on how people can reduce their risk of developing cancer in order to decrease/minimize the evolution towards a westernized dietary pattern which is followed with increased risk of cancer.

A section of the recommendations is defined as the following:

  • Eat more grains, vegetables, fruits and beans
  • Limit red meat and avoid processed meat
  • Keep weight low within a healthy range and be physical active for at least 30 min. everyday
  • Limit consumption of salty foods and foods processed with salt
  • Avoid high-calorie foods and sugary drinks

For cancer prevention, don’t drink alcohol[22]

 

 

[1] World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.

[2] Bamia C, Orfanos P, Ferrari P, et al. Dietary patterns among older Europeans: the EPIC study. British Journal of Nutrition. January 2005;94:100-113

[3] Novak D, Stefan L, Prosoli R, et al. Mediterranean Diet and Its Correlates among Adolescents in Non-Mediterranean European Countries: A Population-Based Study. Nutrients. Feb 2017,9,177;doi:10.3390

[4] Bamia C, Orfanos P, Ferrari P, et al. Dietary patterns among older Europeans: the EPIC study. British Journal of Nutrition. January 2005;94:100-113

[5] http://www.who.int/substance_abuse/publications/global_alcohol_report/pr...

[6] https://www.wcrf.org/int/research-we-fund/cancer-prevention-recommendati...

[7] http://www.who.int/substance_abuse/publications/global_alcohol_report/pr...

[8] http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/...

[9] Allamani A, Beccaria F and Voller F. The puzzle of Italian drinkin. Nordic studies on alcohol and drugs. 2010;27:465-478

[10] https://www.wcrf.org/int/cancer-facts-figures/data-cancer-frequency-country

[11] World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.

[12] Jacobsen K, Lynge E, Tjoenneland A, et al. Alcohol consumption and mammographic density in the Danish Diet, Cancer and Health cohort. Cancer Cause Control. Sep 2017 28: 1429-1439

[13] World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.

[14] http://www.food.dtu.dk/nyheder/2016/03/roedt-eller-forarbejdet-koed-er-t...

[15] http://www.assica.it/UserFiles//file/IARC_position%20paper_ENG_per%20sit...(002).pdf

[16] World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.

[17] Bamia C, Orfanos P, Ferrari P, et al. Dietary patterns among older Europeans: the EPIC study. British Journal of Nutrition. January 2005;94:100-113

[18] Capurso C and Vendemiale G. The Mediterranean Diet Reduces the Risk and Mortality of the Prostate Cancer: A Narrative Review. Frontiers in Nutrition. Aug 2017, 4, 38

[19] Novak D, Stefan L, Prosoli R, et al. Mediterranean Diet and Its Correlates among Adolescents in Non-Mediterranean European Countries: A Population-Based Study. Nutrients. Feb 2017,9,177;doi:10.3390

[20] Slimani N, Fahey M, Welch A, et al. Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Public Health Nutrition. 2002, 5(6B) 1311-1328