Supervisors info:
Νάσκα Ανδρονίκη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών
Λάγιου Παγώνα, Καθηγήτρια, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών
Μπενέτου Βασιλική, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών
Summary:
Background: Dietary factors are involved in the aetiology of many chronic diseases, thereby contributing to geographic and longitudinal variations in morbidity and mortality worldwide.
Objectives: This ecological study aimed at assessing time trends in dietary data and the crude mortality rates (overall, cardiovascular disease, total malignant neoplasms, colorectal cancer) over the time periods between 1961-2017 and 1979-2015, respectively, in Greece. This study also aimed at examining the association between the observed number of deaths (overall, cardiovascular disease, total malignant neoplasms, colorectal cancer) and the per capita food supply during the period 1979-2015.
Methods: The dietary data (per capita food supply) was extracted from the Food Balance Sheets (FAO,1961-2017). The data on the number of deaths per year was collected from the WHO Mortality Database (1979-2015) as well as the country’s population to determine the crude mortality rates. The Joinpoint analysis was used to assess time trends. Poisson regression was applied to examine the association between the per capita food supply and the number of deaths, from 1979 to 2015. Also, negative binomial distribution was utilized due to the presence of overdispersion.
Results: The consistent decrease of plant-based products and olive oil supply, and also the increase of red meat supply may have contributed to the rise of the crude mortality rates (total, malignant neoplasms). The results from the multivariate analysis showed that the per capita supply of olive oil and cereals was inversely associated with risk of cardiovascular mortality (cereals: IRR 0,86, 95% CI 0.76 - 0.97; olive oil: IRR 0.88, 95% CI 0.83 -0.93). Also, the per capita supply of vegetables was significantly and inversely associated with overall and cancer mortality (IRR 0.97, 95% CI 0.96 -0.99; IRR 0.98, 95% CI 0.96 - 0.99; respectively). Α positive, albeit not statistically significant association was also observed between the supply of red meat and mortality from cardiovascular disease or colorectal cancer (IRR 1.09, 95%CI 0.97 -1.22; IRR 1.01, 95%CI 0.99 - 1.02, respectively).
Conclusions: The overtime changes in mortality rates may be shaped by various factors, including alterations in diet. However, due to the inherent limitations of ecological studies, this approach does not allow for robust inferences in terms of individual-based associations between food intake and disease risk. These data, however, can be used to generate hypotheses which can then be investigated further through well-designed individual-based epidemiological studies.
Keywords:
Ecological study, Food supply, Crude mortality rates, Time trends, Ecological correlations
