Nutrition and cardiovascular mortality in Belgium. For the B.I.R.N.H. Study Group.

Significant differences in nutrition exist between the northern and the southern regions of Belgium. The most important differences are a lower saturated fat intake, a higher polyunsaturated fat intake and a higher P/S ratio in the north. Total protein, animal and vegetal protein, salt from processed foods and fiber intake are also higher in the north. The intake of butter is higher in the south and the intake of total and dietetic margarine and of fish are higher in the north. All causes, total cardiovascular, IHD (only in men), stroke and residual cardiovascular mortality are higher in the south, consistent with the regional distribution of fat intake. However, within each region there is no correlation between these mortality patterns and fat intake. This phenomenon can be explained by the presence of confounding factors: salt intake from processed foods, fish, alcohol intake and smoking habits, all of them having a different and sometimes inverse distribution among the counties. The geographical association of fat intake and cardiovascular mortality is strengthened by a similar association between trends in fat intake and trends in cardiovascular mortality. From 1968 onwards until about 1975 a decrease in saturated fat and a marked increase in polyunsaturated fat occurred together with a decreasing dietary cholesterol and salt intake. An important decrease in IHD occurred in Belgium, particularly between 1972 and 1979, and is still the highest in Europe (1968-1984). Belgium is ranked among the five top countries of Europe where stroke mortality (age 45-74 years) is declining most. The nutritional situation of Belgium and the level of mortality, though improving, are still far from ideal. The total fat, saturated fat and salt intake are much higher than recommended by W.H.O. Continued vigorous action will be necessary in order to achieve the W.H.O. goals. A comparison of what occurred in Belgium and in other countries with regard to cardiovascular mortality and nutrition underlines the role of nutrition as a key factor in public health.