Until few years ago, the populations of Southern Europe, and therefore also Italians, suffered less from this kind of disease than people living in Northern Europe.

The health of our heart is markedly influenced both by a genetic predisposition and by our lifestyle, mainly represented by diet. Since our childhood we can adopt wrong habits of life.

The typical Mediterranean diet that protected Italians' grandfathers from cardiovascular diseases is getting lost and we assist to an increase in overweight, obesity and diabetes, all conditions that enhance the risk of myocardial infarction.

Paradoxically, countries of Northern Europe, with high risk for cardiovascular diseases, are instead modifying their habits of life by adopting our Mediterranean diet.

Objectives

The general aim is to evaluate the impact of dietary habits on the risk profile of 3 European communities at different risk of myocardial infarction (MI).

Abruzzo in Italy
Limburg in Belgium
South-eastern London in England

As an index of MI, factors under the combined influence of both dietary and genetic determinants will be studied. Migration from Italy to Belgium will be used as a "natural" model in this context. Specific objectives will include the evaluation of:

differences in the variables studied in populations at different risk of MI and host countries for possible future immigrations;
changes in dietary habits and biomarkers of food intake of mixed couples as compared with those of the original population;
the effects of such changes on specific CAD risk also in relation to their genetic determinants.

This study will provide:

an integrated multilanguage questionnaire for food intake assessment to evaluate dietary habits in multicultural populations;
educational support for health care providers and promotion of healthy dietary habits for the prevention of CAD.

Description of the work

Couples will be recruited through networks of Belgian, Italian and British general practitioners suitably organized.

In a first phase of the study, 270 Belgian/Belgian couples living in Belgium (540 individuals) will be compared with 270 age- and sex-matched Italian/Italian couples living in Italy and with 270 UK/UK couples living in South England.

We will estimate the current difference in diet and in some genetic characteristics of these populations.

Then we will measure how, in these regions, diet and genetic predisposition can determine if an individual is protected or exposed to risk factors for cardiovascular diseases.

We will so be able to define if and how the Abruzzese diet changed compared to the Mediterranean diet and if and how Belgian and English diets approached it.

In the second phase, 270 mixed couples, formed in Belgium by a marriage between Italians and Belgians, with the same range of age as the population studied in the first phase will be recruited. Italian and Belgian members of the mixed couples will be compared with each other and with Italian and Belgian couples to see if the change of the Belgian partner's diet and the adoption of Abruzzese dietary habits through the marriage modify the risk for cardiovascular diseases of the Belgian partner in comparison with members of Belgian couples with typical Belgian dietary habits. At the same time we will be able to verify if the Abruzzese immigrants acquire an increased risk for cardiovascular diseases by getting used to Belgian cooking.

A new multilanguage food frequency questionnaire (FFQ) will be developed to evaluate dietary factors, on the basis of previously standardized Italian, Dutch and English questionnaires. Then, it will be analysed with an adapted statistical program for FFQ, by using cross-cultural tables of food composition.

The evaluation will include: diet composition, biomarkers of food intake (fatty acid composition of cellular membranes, selenium and zinc) anthropometric variables, blood pressure, as well as FVII, homocysteine, folic acid, vitamin B6 and B12 and oxydized-LDL levels, insulin resistance, fractional excretion of electrolytes; moreover FVII, MTHFR, alfa-adducin, angiotensinogen, G-proteins ß3 subunits, 11ß-DH steroid dehydrogenase, ß3-adrenergic receptor and leptin gene polymorphisms will be evaluated.

This study will allow us to organize prevention campaigns in Belgium, Italy and England underlining the importance of fundamental habits of life such as the diet.

As soon as the first results of the project are available, a dissemination phase will start for a general and more specialised public; for the latter, scientific papers and congress presentations will be produced; on the other hand, articles, conferences and booklets based on the information gathered will be produced for the general public.