ABSTRACT
The observation that populations with a low intake of fat, particularly saturated fat, and in whom a greater portion of dietary energy is derived from carbohydrate tend to have lower serum cholesterol levels and lower mortality rates from CHD compared with populations whose dietary energy is substantially derived from fat can largely be attributed to Ancel Keys.2 The incidence of diabetes seems to follow a similar pattern.3 Keys, an American scientist whose work on starvation had gained international attention, chaired the World Health Organization’s first commission on food and agriculture in Rome in 1950. He was struck by the low incidence of CHD in Italy compared with the growing epidemic back in the USA. He thus embarked on the most ambitious of epidemiological studies, the Seven Countries Study. For many years, more than 12 000 men aged 40-59 years from 16 communities in Italy, the Greek islands, Yugoslavia, the Netherlands, Finland, Japan and the USA were studied. These men were chosen because of their contrasting national diets set against the relative uniformity of their rural, agrarian backgrounds. Keys reported that in communities where fat was a major ingredient of almost every meal, such as the USA and more particularly Finland (where butter was often spread on cheese), serum cholesterol was highest and the age-standardized CHD mortality was greatest (Figure 8.1). In places where the diet contained fresh fruit and vegetables, bread, pasta and rice and was low in saturated fats, such as around the Mediterranean and Japan, serum cholesterol was low and CHD deaths uncommon.
