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A great way to live longer Two major studies, one on heart disease (MONICA) and the other on cancer (EPIC), re giving researchers a new look at the connection between diet and disease. They offer the hope of saving hundreds of thousands of lives a year by adjusting the way we feed ourselves. The studies leave little doubt that many of us—especially in wealthy countries — are eating ourselves into an early grave. Of the two studies, MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) has covered the most ground. It was started ten years ago by the World Health Organisation (WHO), and the ￡ 33-million project is the most ambitious study ever undertaken on heart and vascular disease. Using standardized data-collection techniques, WHO’’s correspondents gathered statistics on more than ten million men and women in more than 39 population centers, ranging from Siberia to California, Australia to Israel. The study rapidly disclosed some startling facts. MONICA showed that in Finland, for example, men die of coronary disease 11 times more often than they do in Japan, while in Glasgow women die of heart disease 12 times more often than those in north-eastern Spain or southern France. Compass points. As the results flowed in, a clear pattern emerged: in Europe, the further north you live, the more likely you are to die from a heart attack. Two more likely you are to die from a heart attack. Two cities typical of this north-south gradient are Belfast and Toulouse, in south-western France. In the most recent period studied, the heart-disease death rate for men aged 45 to 54 is 237 per 100 000 population in Belfast, but only 56 in Toulouse. For the age group 55 to 64, the contrast is even more striking: 761 for Belfast, 175 for Toulouse—a difference of 4.3 to 1. EPIC (European Prospective Investigation into Cancer and Nutrition) is a more recent study. Organized in seven European countries including Britain, by the Lyons-based International Agency for Research on Cancer, it began collection data in 1993, and already shows a remarkably similar outcome: for most forms of cancer, the north is dangerous and the south relatively benign. Luxembourg and Belgium lead the mortality figures for men (Denmark and the UK for women), while Greece, Portugal and Spain are at the bottom. Split results. Why should residence in the developed north, with all its wealth and public services, make death by cardiovascular disease or cancer more likely than in the generally poorer south The question seems to be all the more puzzling because MONICA found no significant differences in smoking, high-blood pressure or cholesterol — the three classic indicators of heart trouble—to explain the regional disparities. The further the investigations progress, the more one factor presents itself as the likely answer: diet Clearly, southern Europeans know something about eating that their northern brethren do not. The most confounding information is in the MONICA data from France, the country with the western world’’s highest life expectancy. The French outlive Americans, for example, by more than four years, suffer less than half as much from coronary heart disease and yet smoke more, drink more and have blood pressure and cholesterol counts just as high — while enjoying the diet that has made French cuisine a byword for high living. Those startling facts are the basis of "the French paradox". Dr Serge Renaud, epidemiologist and director of nutritional studies at France’’s National Institute of Health and Medical Research, had been studying the relation between nourishment and heart disease for more than 30 years in serene anonymity. Then the MONICA figures revealed the differences between France and more other industrialized nations: Scotland, Finland, the United States and Australia were at the top of the scale for premature deaths from heart disease, while France was nearly at the bottom, edged out only by rice-and-fish-eating Japan. Renaud was suddenly besieged with queries. Could he shed some light on the puzzle He could indeed. His five-year study of some 600 Lyons-area cardiac patients, completed in Spring 1993, proved to be a show-piece for the influence of diet on health. Safe and sound. Renaud put half of his volunteers on the medically recommended diet for heart-attack victims, and the other half on a diet he developed himself, reducing red-meat consumption and calling for greater amounts of bread, fresh and dried vegetables, fruits, fish and white meat. His diet also replaced butter with a margarine-style spread developed in his laboratory. Renaud’’s greater emphasis on fruits, grains, vegetables and his margarine cut the chances of death from a second heart attack by 76 per cent. In Europe, the further north you live, the more likely you are to die from diabetes.