Research Article
Clin Oncol Res. 2018; 1(2): 1006.
Dietary Patterns and Oncological Morbidity in European and Mediterranean Countries
Radkevich LA and Radkevich DA*
FGBUN Center of Theoretical Problems of Physico- Chemical Pharmacology RAS, Kosygina, Moscow, Russia
*Corresponding author: Radkevich DA, FGBUN Center of Theoretical Problems of Physico-Chemical Pharmacology RAS; 119991, Kosygina st. 4, Moscow, Russia
Received: April 17, 2018; Accepted: August 23, 2018; Published: August 30, 2018
Abstract
Purpose of the study is an analysis of the impact of per capita income, latitude and nutrition structure on the cancer incidence in European (Euro) and Mediterranean (Med) countries.
Materials and Methods: Study design is observational. Nutrition structures for countries are presented as a general level of food consumption (g/person/ day) and as the percentage contribution of 4 blocks: animal products; grains and vegetables; fruit and drinks; alcoholic beverages.
Results: In European countries, compared with the Med countries, the incidence of 7 cancer types in Euro countries depend on per capita income and latitude. In Euro countries, the incidence of 5 cancer types depends on “clean” per capita income. The incidence of 5 cancer types depends on “clean” latitude. The incidence of 7 cancer types in Euro and Mediterranean countries does not depend on per capita income, nor on latitude.
The nutrition structure in Euro and Med countries depends on per capita income. The higher is per capita income in Euro countries, the higher is a share of animal products and alcoholic beverages in the nutrition structure. (p = 0.004). The level of macronutrients of animal in Euro countries is 1.5, 2.3 and 3.0 times higher than in Med countries and depends on per capita income (p = 0.001).
Conclusions: The nutrition structure as a risk factor for cancer in the Euro and Med countries depends on per capita income. The composition and sources of macronutrients play an important role in the nutrition structure.
Keywords: Dietarypatterns; Cancer; European; Mediterranean countries
Reductions
NCD: Chronic Noncommunicable Diseases; Euro: European countries; Med: Mediterranean Countries; BMI: Body Mass Index; BH: Blood Cholesterol Level; BG: Blood Glucose; BP: Blood Pressure; GDP: Per Capita Income; EEI: Ecological Efficiency Index; HDI: Human Development Index; QR: Interquartile Range; FAO: Food and Agriculture Organization of the United Nations.
Introduction
Each year, 15 million people die from a Chronic Noncommunicable Diseases (NCD) between the ages of 30 and 69 years; over 59% of these followed by cancers (8.8 million), which pose a threat to human longevity [1]. Cancer is the main cause of morbidity and mortality in developed countries [2].
It is shown that in the Mediterranean countries the incidence of breast cancer and Alzheimer’s disease are lower [3-9]. The authors point out the protective effect of the Mediterranean diet, with low share of animal protein containing products and high share of unsaturated fatty acids [3-9]. It is shown that eating disorders in prenatal period can contribute to predisposition to non-infectious chronic diseases (NCD) at an older age [10]. Diets with high share of fats and calories are risk factors for cancer [11,12]. There is little information about the risk of high-calorie diets with different sources of calories (fats, proteins, carbohydrates) [13,14]. We have shown that a risk factor for breast cancer may be a Western diet that contains the same level of total energy as the Mediterranean diet, but a different source of Proteins and Fats [6,7]. It is shown that food behavior, the regulation of which is complicated, may be a risk factor for obesity and breast cancer, as well as other cancer types [15,16]. But food is a modifiable factor. Therefore, the negative impact of nutrition on NCD can be reduced by developing safe, low-immune diets.
A number of authors believe that observational studies can be used to study nutrition as a risk of NCD, since they operate with large data sources [17-19]. However, observational analyzes based on correlation methods are considered weakly evidence-based. This is due to the possible influence of hidden variables [8]. At the same time, case-control studies on the effect of animal fats on the risk of breast cancer have not been repeated [9]. Objective: comparative analysis of oncological morbidity in European and Mediterranean countries. The study of the influence of GDP (per capita income) and latitude on the incidence of cancer of different locations and the nutrition structure, including macronutrients, in the European and Mediterranean countries.
Materials and Methods
Studies design is observational. Incidence rates in 160 countries standardized by age per 100,000 of population was selected from the GLOBOCAN database for 2008; WHO 2004 [20,21].
Data on and life expectancy were selected from the database of the Internet resource [22]. The level of food consumption for each country was selected from the FAO for 2005 [23]. The countries’ dietary patterns were presented as a general level of food consumption (g / person / day), and also in the form of 4 blocks as a percentage of the total consumption level: 1 - animal products; 2 - cereals and vegetables; 3 - fruit and drinks; 4 - alcoholic beverages (6).
In order to characterize the social conditions in countries, the following indicators were used: GDP (Per Capita Income), (Human development index) 2008 and 2016 ($/person/day) [24]; Health care Indices [25], Environmental Performance Index [26] and Happiness Index 2016 [27]. The geographical position of each country was judged by the latitude [28]. As predictors of the Metabolic Syndrome [29].
The statistical analysis of the comparative country samples was carried out using the nonparametric Mann-Whitney-Wilcoxon U-test for independent samples, since some of the country sample indicators were not normally distributed. The central trend in the distribution of data in the sample was represented by the Median. The variance of the data in the samples was estimated using the Interquartile range (QR) between the first and third quartiles, that is, between the 25th and 75th percentiles (StatSoft 13) [30].
Study Results
Analysis of the nutrition structure and cancer incidence in European and Mediterranean countries with a 2 times difference in per capita income
For the study were used 16 European countries, in which the average per capita income was 2 times higher than in 16 Mediterranean countries (Table 1). The per capita income of Euro countries was $39 (QR-6.7), in 16 Med countries it was $14 (QR-23.4), (p=0.001). Euro countries are located in high latitudes - 52°(QR-8.5), Med countries are located in mid-latitudes - 36°(QR-7.0) (p=0.001) (Table1).
Indicator
U n-16/16
Z
p-value
Median 1
Quartile 1
Median 2
Quartile 2
Total morbidity
Male - general morbidity (DALY - person/100 thousand) standardized by age
77
-1,90
0,0570
11573,8
1624,40
17060,8
6899,03
Female - general morbidity (DALY - person/100 thousand) standardized by age
83
-1,68
0,0935
9970,0
780,97
14739,8
6872,95
Humandevelopmentindex
32
3,60
0,0003
0,957
0,017
0,833
0,177
HealthRating
21
-4,01
0,0001
12,5
13,50
58,0
45,50
HappinessIndex 2016
18
4,13
0,0000
7,057
0,658
5,468
1,319
Ecologicalefficiencyindex
14
4,17
0,0000
77,8
4,04
57,0
14,34
Average life expectancy
Male life expectancy
90
1,41
0,1576
75,9
1,40
74,8
6,15
Female life expectancy
82
1,73
0,0830
82,2
1,95
79,9
7,35
Economic and geographical factors
Of GDP($) 2008 - per capita income
18
4,15
0,0000
38,7
6,65
13,9
23,35
lat°-geographical latitude
4
4,65
0,0000
51,6
8,45
36,2
6,95
Frequency of cancer diseases - person/100 thousand age-standardized population
Blader
109
0,72
0,4739
17,0
6,95
15,6
9,15
Brain
51
2,90
0,0037
6,6
0,70
5,6
2,40
Breast
47
3,05
0,0023
84,5
16,20
46,6
40,45
Cervix
62
2,47
0,0136
7,6
4,65
5,2
3,10
Colorect
38
3,37
0,0007
42,3
9,65
13,6
23,05
Corpusut
32
3,62
0,0003
12,8
3,55
8,1
7,70
Gollblad
87
1,55
0,1223
1,6
1,05
1,4
0,80
Hodgkin l
117
-0,40
0,6923
2,4
0,75
2,5
1,15
Kaposi s
128
0,02
0,9850
0,0
0,00
0,0
0,00
Kidney
40
3,30
0,0010
10,1
4,80
4,2
6,75
Laryngx
78
-1,87
0,0621
4,3
2,65
5,4
1,60
Leukaemia
75
2,00
0,0458
8,5
1,25
7,3
4,25
Liporal
58
2,62
0,0088
5,8
2,65
3,4
4,30
Liver
113
0,57
0,5718
4,7
2,80
3,7
5,40
Lung
87
1,53
0,1269
42,0
11,40
33,0
22,75
Melanoma
12
4,35
0,0000
11,4
4,35
2,4
5,25
Nasophar
15
-4,24
0,0000
0,4
0,20
1,1
1,70
Oesophar
24
3,90
0,0001
6,1
2,95
1,8
2,35
Ovary
29
3,73
0,0002
10,3
3,40
6,6
3,65
Pancreas
64
2,41
0,0159
8,1
2,80
4,5
4,50
Prostate
20
4,05
0,0001
82,9
29,30
19,1
43,15
Stomach
94
1,26
0,2067
9,1
2,65
7,3
6,75
Testis
11
4,39
0,0000
8,3
2,10
2,5
3,55
Thyroid
87
1,53
0,1269
2,2
1,10
1,2
2,15
Allcancer
28
3,75
0,0002
319,3
33,45
184,8
148,95
Table 1: Analysis of the nutrition structure and cancer incidence in European and Mediterranean countries with a 2 times difference in per capita income (Mann- Whitney U-test).
Metabolic Syndrome
Male BMI>25 (kg/m2) - body mass index
77
1,92
0,0546
64,6
7,10
Female BMI>25 (kg/m2) - body mass index
86
-1,56
0,1178
52,3
6,80
60,1
7,10
Male ch> 5.0 (mmol/L) - blood cholesterol level
30
3,67
0,0002
64,8
9,40
57,3
12,85
Female ch>5.0 (mmol/L) - blood cholesterol level
33
3,56
0,0004
62,8
7,45
43,8
22,75
Male glu>7.0 (mmol/L) - blood glucose level
123
0,17
0,8653
10,8
2,50
45,9
17,00
Female glu>7.0 (mmol/L) - blood glucose level
82
-1,71
0,0864
8,1
2,60
10,7
2,20
Male AD>140/90 (mmHg) - level of arterial blood pressure
45
3,11
0,0019
47,3
4,65
9,8
2,60
Female AD >140/90 (mmHg) - level of arterial blood pressure
84
1,64
0,1011
41,1
8,20
43,4
7,95
Male insact<60 minutes/day walking - low physical activity
62
-0,79
0,4273
39,6
16,30
38,3
6,00
Female insact<60 minutes / day walking - low physical activity
47
-1,61
0,1063
39,4
17,00
47,7
21,00
Dietary patterns
53,6
22,70
The general level of consumption (g/person/day)
97
1,17
0,2427
2192,0
206,00
2155,0
560,50
Animal products (%)
47
3,03
0,0024
35,9
7,46
25,0
10,17
Grain-vegetables (%)
6
-4,58
0,0000
35,9
5,18
58,4
16,80
Fruitdrinks (%)
56
2,71
0,0067
13,7
3,80
11,6
2,60
Alcoholicbeverages (%)
9
4,47
0,0000
14,7
4,80
1,9
6,81
Macro nutrients
Nutrients Animal products
Energy %
22
4,00
0,0001
31,5
5,50
19,0
17,00
?rotein %
37
3,43
0,0006
61,0
5,50
45,5
28,00
Fat %
37
3,43
0,0006
59,0
5,00
33,5
19,00
Percentage composition of Energy
Carboh %
69
-2,22
0,0262
51,0
2,00
59,0
12,50
Proteins %
118
0,36
0,7203
12,0
2,00
12,0
2,00
Fats %
71
2,15
0,0317
36,0
3,00
29,5
11,00
T?tal Energy 100%
Energy (kcal / person / day)2003-05
100
1,06
0,2913
3400,0
350,00
3300,0
435,00
Proteins (g/person / day) 2003-05
101
1,00
0,3179
104,0
10,00
96,5
27,50
Fats (g/person / day) 2003-05
72
2,09
0,0365
136,5
20,50
105,5
56,00
Proteins/Fats 2003-05 %
78
-1,87
0,0621
77,0
13,00
83,0
33,00
Micro nutrients
Animal origin2003-05
93
1,30
0,1935
3,5
0,80
2,8
2,75
Vit. ? 2003-05
59
2,60
0,0093
6,5
1,00
6,0
1,00
Vegetal origin 2003-05
52
-2,86
0,0042
9,5
2,60
13,3
3,00
Diversification of nutrition
Energy % 2003-05
39
3,34
0,0009
71,0
7,00
58,0
18,50
Proteins % 2003-05
48
3,00
0,0027
72,0
6,50
62,0
24,00
Fats % 2003-05 Fats %
65
2,36
0,0185
97,0
1,00
94,0
4,50
Table 1 of 2:
In Euro and Med countries, the total morbidity and life expectancy were statistically the same (p=0.1). But in Med countries, the Health Care Index, the Happiness Index and the Eco-Efficiency Index were lower than in Euro countries (p=0.001).
Cancer incidence: in Euro countries, the incidence of 13 out of the 25 cancer types (Brain, Breast, Cervix, Colorect, Corpus ut, Kidney, Lip oral, Melanoma, Oesophar, Ovary, Pancreas, Prostate, Testis) was 1.7 times higher (p=0.01). In Med countries, the incidence of Nasophar cancer was 2.5 times higher (p=0.0001). The incidence of 10 cancer types (Blader, Gollblad, Hodgkin, Kaposi s, Liver, Laryngx, Leukaemia, Lung, Stomach, Thyroid) had no statistical differences between Euro and Med countries (p=0.9).
In Euro and Med countries, the number of men and women (% of the population) with a BMI> 25kg/m2 was not statistically different (p=0.1), but was higher than 50%. In Euro countries, there were 1.7 times more men and women with a blood cholesterol level> 7mmol/L (p=0.001) and men with arterial pressure> 140/90mmHg (p=0.001). In Euro and Med countries, there were 45-50% of men and women with low physical activity.
Nutrition structure: In Euro countries, the nutrition structure was statistically different from that of Med countries. A share of animal products in Euro countries was 35.9%, in Med countries it was 25.0% (p=0.002). A share of grain and vegetables in Euro countries was 36.0%, in Med countries it was 58.4% (p=0.001). A share of alcoholic beverages in Euro countries was 14.7%, in the Med countries it was 1.9% (p=0.001). A share of fruits and drinks in Euro countries was 13.7%, in Med countries it was 11.6% (p=0.06). The level of total Energy in Euro and Med countries did not differ (p=0.4) and amounted to 3390 and 3300kcal /person/day, respectively. The general level of food consumption in Euro and Med countries did not differ and was 2185 and 2155 (g/person/day) (p=0.5). The composition of macronutrients in the total Energy (Carbohydrates, Proteins, Fats) did not differ (p=0.5) in Euro and Med countries. Macronutrient levels of animal products (Energy, Proteins and Fats) were 1.5-2 times higher in Euro countries than in Med countries (p=0.001). Diversification of nutrition in Euro countries was higher than in Med countries (p=0.001).
Thus, in Euro countries, despite the high standard of living, the incidence of 13 cancer types out of 24 was higher than in Med countries. The incidence of 10 cancer types did not differ from those of Med countries. It is logical to assume that in Euro countries with a higher per capita income, the number of the cancer types with a changed incidence will increase.
Analysis of the nutrition structure and cancer incidence in European and Mediterranean countries with a 4 times difference in per capita income
Euro2 included countries with the per capita income of $30 (QR- 6.2), four times higher than the per capita income of Med2, $7 (QR- 4.3) (p = 0.001) (Table 2). Latitude of Euro2 and Med2 countries was the same (p=0.7), which allowed to assess the “clear” impact of per capita income on the countries characteristics, that is without the influence of latitude.
Indicator
U m- 8/8
Z
p-value
Median 1
Quartile 1
Median 2
Quartile 2
Totalmorbidity
Male - general morbidity (DALY - person/100 thousand) standardized by age
-
-3,31
0,0009
10790,6
1521,19
17689,7
2,159,544
Female - general morbidity (DALY - person/100 thousand) standardized by age
-
-3,31
0,0009
9344,3
1532,85
16217,2
2,762,776
Human development index
-
3,31
0,0009
0,939
0,045
0,762
0,082
Health Rating
-
-3,31
0,0009
27,0
10,50
69,0
21,000
Happiness Index 2016
8
2,47
0,0136
6,169
0,966
5,087
0,762
Ecological efficiency index
5
2,78
0,0054
66,8
9,82
54,6
5,930
Average life expectancy
Male life expectancy
3
2,99
0,0028
77
1
71
4
Female life expectancy
2
3,15
0,0016
83
2
75
3
Economic and geographical factors
Of GDP ($)2008 - per capita income
-
3,31
0,0009
30,1
6,20
6,8
4,350
lat° - geographical latitude
20
1,21
0,2271
39,2
9,75
35,9
5,000
Frequency of cancer diseases - person/100 thousand age-standardized population
Blader
21
1,10
0,2701
17,0
8,80
15,6
10,200
Brain
10
2,26
0,0239
6,1
1,75
3,7
2,450
Breast
2
3,10
0,0019
69,9
32,65
33,4
14,300
Cervix
31
0,11
0,9164
6,0
2,75
5,3
5,850
Colorect
-
3,31
0,0009
37,9
17,70
10,9
5,150
Corpusut
-
3,31
0,0009
10,9
2,80
3,2
3,050
Gollblad
18
1,47
0,1415
1,7
0,95
1,2
1,250
Hodgkin l
17
1,52
0,1278
2,8
0,75
2,1
1,250
Kaposi s
32
-0,05
0,9581
0,0
0,00
0,0
0,000
Kidney
5
2,78
0,0054
9,4
5,50
2,6
1,750
Laryngx
29
0,32
0,7527
5,5
3,65
5,7
1,650
Leukaemia
4
2,89
0,0039
9,850
2,25
5,000
2,250
Liporal
13
2,00
0,0460
6,2
5,40
2,8
2,100
Liver
15
1,73
0,0831
6,5
6,95
2,3
3,350
Lung
13
1,94
0,0520
46,6
20,10
26,5
24,100
Melanoma
3
2,99
0,0028
6,8
5,05
0,5
1,350
Nasophar
15
-1,79
0,0742
0,9
0,60
1,6
3,000
Oesophar
20
1,26
0,2076
2,9
3,45
1,3
2,000
Ovary
5
2,84
0,0046
8,4
2,80
5,0
2,500
Pancreas
8
2,47
0,0136
7,2
1,75
2,7
1,750
Prostate
2
3,10
0,0019
53,2
12,30
10,7
10,800
Stomach
18
1,42
0,1563
10,0
5,75
5,9
9,500
Testis
2
3,10
0,0019
5,4
3,45
0,7
1,700
Thyroid
18
1,47
0,1415
3,2
2,50
1,2
0,550
Allcancer
2
3,10
0,0019
306,8
107,20
130,7
75,950
Metabolic Syndrome
Male BMI>25 (kg/m2) - body mass index
13
2,00
0,0460
63,3
6,10
59,2
17,200
Female BMI>25 (kg/m2) - body mass index
17
-1,52
0,1278
52,0
10,50
60,1
12,100
Male ch> 5.0 (mmol/L) - blood cholesterol level
-
3,31
0,0009
59,4
11,10
36,7
3,450
Female ch>5.0 (mmol/L) - blood cholesterol level
-
3,31
0,0009
56,9
8,45
41,4
5,650
Male glu>7.0 (mmol/L) - blood glucose level
18
1,47
0,1415
11,2
1,20
10,2
2,400
Female glu>7.0 (mmol/L) - blood glucose level
29
-0,26
0,7929
10,0
2,85
9,7
1,950
Male AD>140/90 (mmHg) - level of arterial blood pressure
11
2,21
0,0274
45,9
3,55
38,7
6,250
Female AD>140/90 (mmHg) - level of arterial blood pressure
18
1,42
0,1563
39,9
5,60
36,6
6,150
Male insact<60 minutes/day walking - low physical activity
12
-0,28
0,7768
47,7
23,20
39,5
19,850
Female insact<60 minutes/day walking - low physical activity
13
0,09
0,9247
56,3
38,20
44,8
13,850
Table 2: Analysis of the nutrition structure and cancer incidence in European and Mediterranean countries with a 4 times difference in per capita income (Mann- Whitney U-test).
Dietary patterns
The general level of consumption (g/person/day)
3
2,99
0,0028
2283,5
234,50
1770,0
380,000
Animal products (%)
8
2,47
0,0136
30,2
5,61
22,1
6,440
Grain-vegetables (%)
4
-2,89
0,0039
45,7
11,17
65,5
8,340
Fruit drinks (%)
23
0,89
0,3720
11,9
1,55
10,6
3,900
Alcoholic beverages (%)
1
3,20
0,0014
8,8
5,15
1,0
0,895
Macro nutrients
Nutrients Animal products
Energy %
7
2,57
0,0101
26,5
6,50
10,5
6,500
?rotein %
1
3,20
0,0014
54,5
10,00
26,5
12,500
Fat %
11
2,15
0,0313
44,5
14,00
31,0
7,500
Percentage composition of Energy
Carboh %
5
-2,78
0,0054
50,5
8,00
63,0
11,500
Proteins %
16
1,68
0,0929
13,0
1,00
11,0
0,500
Fats %
4
2,89
0,0039
37,0
7,00
26,0
10,500
T?tal Energy 100%
Energy (kcal/person/day)2003-05
12
2,10
0,0357
3565,0
385,00
3175,0
250,000
Proteins (g/person/day) 2003-05
8
2,47
0,0136
114,50
12,00
89,00
9,000
Fats (g/person/day) 2003-05
3
2,99
0,0028
146,0
33,00
90,0
35,000
Proteins/Fats 2003-05 %
9
-2,42
0,0157
75,5
11,00
106,0
51,000
Micro nutrients
animal origin2003-05
2
3,10
0,0019
4,4
1,20
1,7
0,800
vit. ? 2003-05
24
0,79
0,4309
6,0
1,00
5,5
2,000
vegetal origin2003-05
32
0,00
10,000
12,9
5,80
13,3
2,400
Diversification of nutrition
Energy% 2003-05
-
3,31
0,0009
67,0
7,50
48,5
16,000
Proteins% 2003-05
1
3,20
0,0014
68,5
8,50
44,5
16,000
Fats% 2003-05 Fats%
5
2,78
0,0054
97,0
2,00
92,5
6,500
Table 2 pf 2:
In Euro2 countries with high per capita incomes, overall morbidity was lower (p=0.001), life expectancy (p=0.002), Happiness Index, Eco-efficiency Index and Health Care Index (p=0.02) were higher.
Cancer incidence: In Euro2 countries with a high per capita income, the incidence of 12 cancer types out of 24 (Brain, Breast, Colorect, Corpus ut, Kidney, Leukaemia, Lip oral, Melanoma, Ovary, Pancreas, Prostate, Testis) was 2-5 times higher than (p=0.01). The incidence of the other 12 cancer types out of 24 again did not differ between countries (Blader, Cervix, Gollblad, Hodgkin L, Kaposi s, Laryngx, Liver, Lung, Nasophar, Oesophar, Stomach, Thyroid) (p=0.5) .
In countries with a high per capita income, there were 1.1 times more men with a BMI> 25 (p=0.04), 1.5 times more men and women with cholesterol level> 5.0 (p=0.001), 1.3 times more men with high blood pressure> 140/90mmHg (p=0.02).
The nutrition structure: The nutrition structure of Euro2 countries contained 30.2% and 22.1% of animal products compared to the Med2 countries (p=0.01); 45.7% and 65.5% of grain and vegetables (p=0.003); 8.8% and 1.0% (p=0.001) of alcoholic beverages; 11.9% and 10,6% (p=0.4) of fruit and drinks. In Euro2 countries, the food consumption level was 1.5 times higher (p=0.002). In Euro2 countries, the level of Energy was 1.05 times higher than in Med2 (p=0.03), Proteins and Fats were 1.8 times higher in Euro2 than in the Med2 countries (p=0.01). The level of macronutrients of animal products (Energy, Proteins and Fats) was 2 times higher in Euro2 countries than in Med2 countries (p=0.01). Diversification of nutrition in Euro2 countries was 1.5 times higher than in Med2 countries (p=0.005).
Thus, in Euro2 countries with 4 times higher per capita income than in Med2 countries, the incidence of the same 12 cancer types out of 24 was higher than in Med2 countries. The incidence of the remaining 12 cancer types did not differ between countries. To find out the reasons for the increase in incidence only for certain cancer types in response to the increase of per capita income, we undertook one more study. We have chosen 8 European countries, in which a per capita income was 6 times higher than in Med2 countries.
Analysis of the nutrition structure and cancer incidence in European and Mediterranean countries with 6 times difference in per capita income
For the analysis, 8 European countries with a per capita income of $41 and 8 Mediterranean countries with a per capita income of $7 (p=0.001) were selected (Table 3). Euro3 countries are located in higher latitudes (52°) compared to Med3 countries (36°) (p=0.001). Social characteristics in Euro3 countries were 3-10 times higher than in Med3 countries (p=0.001).
Indicator
U n-8/8
Z
p-value
Median 1
Quartile 1
Median 2
Quartile 2
Totalmorbidity
Male - general morbidity (DALY - person/100 thousand) standardized by age
-
-3,31
0,0009
11167,2
1487,77
17689,7
2159,54
Female - general morbidity (DALY - person/100 thousand) standardized by age
-
-3,31
0,0009
9512,7
707,08
16217,2
2762,78
Human development index
-
3,31
0,0009
0,962
0,007
0,762
0,08
Health Rating
-
-3,31
0,0009
7,0
10,50
69,0
21,00
Happiness Index 2016
-
3,31
0,0009
7,315
0,491
5,087
0,76
Ecological efficiency index
-
3,31
0,0009
78,1
3,47
54,6
5,93
Average life expectancy
Male life expectancy
-
3,31
0,0009
76
2
71
3,60
Female life expectancy
1,0
3,20
0,0014
82
2
75
2,55
Economic and geographical factors
Of GDP ($)2008 - per capita income
-
3,31
0,0009
41,1
13,05
6,8
4,35
lat° - geographical latitude
-
3,31
0,0009
52,0
9,10
35,9
5,00
Frequency of cancer diseases - person/100 thousand age-standardized population
Blader
19,0
1,31
0,1893
18,1
8,70
15,6
10,20
Brain
8,5
2,42
0,0157
6,6
1,30
3,7
2,45
Breast
-
3,31
0,0009
85,9
12,40
33,4
14,30
Cervix
20,5
1,16
0,2480
7,6
4,25
5,3
5,85
Colorect
-
3,31
0,0009
41,1
9,70
10,9
5,15
Corpusut
-
3,31
0,0009
12,6
2,00
3,2
3,05
Gollblad
28,5
0,32
0,7527
1,5
0,30
1,2
1,25
Hodgkin l
27,0
0,47
0,6365
2,5
0,55
2,1
1,25
Kaposi s
32,0
-0,05
0,9581
0,0
0,00
0,0
0,00
Kidney
7,0
2,57
0,0101
9,250
1,75
2,600
1,75
Laryngx
11,0
-2,15
0,0313
4,0
1,65
5,7
1,65
Leukaemia
5,0
2,78
0,0054
8,7
1,25
5,0
2,25
Liporal
7,0
2,57
0,0101
5,6
0,95
2,8
2,10
Liver
21,0
1,10
0,2701
3,7
5,75
2,3
3,35
Lung
17,5
1,47
0,1415
38,2
8,35
26,5
24,10
Melanoma
-
3,31
0,0009
14,3
5,10
0,5
1,35
Nasophar
-
-3,31
0,0009
0,4
0,20
1,6
3,00
Oesophar
3,5
2,94
0,0033
6,1
3,45
1,3
2,00
Ovary
1,5
3,15
0,0016
10,2
2,95
5,0
2,50
Pancreas
8,0
2,47
0,0136
7,7
2,20
2,7
1,75
Prostate
-
3,31
0,0009
87,2
40,80
10,7
10,80
Stomach
19,0
1,31
0,1893
8,1
2,10
5,9
9,50
Testis
-
3,31
0,0009
8,5
2,70
0,7
1,70
Thyroid
11,0
2,15
0,0313
1,8
1,60
1,2
0,55
Table 3: Analysis of the nutrition structure and cancer incidence in European and Mediterranean countries with 6 times difference in per capita income (Mann-Whitney U-test).
Allcancer
-
3,31
0,0009
321,2
35,90
130,7
75,95
Metabolic Syndrome
Male BMI>25 (kg/m2) - body mass index
21,0
1,10
0,2701
60,2
7,00
59,2
17,20
Female BMI>25 (kg/m2) - body mass index
8,5
-2,42
0,0157
48,6
6,50
60,1
12,10
Male ch> 5.0 (mmol/L) - blood cholesterol level
-
3,31
0,0009
64,8
5,45
36,7
3,45
Female ch>5.0 (mmol/L) - blood cholesterol level
-
3,31
0,0009
62,3
4,15
41,4
5,65
Male glu>7.0 (mmol/L) - blood glucose level
30,5
-0,11
0,9164
10,0
2,40
10,2
2,40
Female glu>7.0 (mmol/L) - blood glucose level
7,5
-2,52
0,0117
7,2
1,90
9,7
1,95
Male AD>140/90 (mmHg) - level of arterial blood pressure
6,5
2,63
0,0087
46,5
2,85
38,7
6,25
Female AD>140/90 (mmHg) - level of arterial blood pressure
22,5
0,95
0,3446
37,7
5,25
36,6
6,15
Male insact<60 minutes/day walking - low physical activity
14,0
-0,09
0,9247
45,1
16,20
39,5
19,85
Female insact<60 minutes/day walking - low physical activity
11,0
-0,47
0,6366
44,3
10,80
44,8
13,85
Dietary patterns
The general level of consumption (g/person/day)
7,0
2,57
0,0101
2228,0
416,00
1770,0
380,00
Animal products (%)
7,0
2,57
0,0101
36,6
7,33
22,1
6,44
Grain-vegetables (%)
-
-3,31
0,0009
34,5
4,86
65,5
8,34
Fruit drinks (%)
6,0
2,68
0,0074
15,9
2,70
10,6
3,90
Alcoholic beverages (%)
-
3,31
0,0009
14,4
7,00
1,0
0,90
Macro nutrients
Nutrients Animal products
Energy %
-
3,31
0,0009
33,0
5,00
10,5
6,50
?rotein %
-
3,31
0,0009
64,0
4,50
26,5
12,50
Fat %
7,0
2,57
0,0101
60,5
3,00
31,0
7,50
Percentage composition of Energy
Carboh %
-
-3,31
0,0009
51,0
1,50
63,0
11,50
Proteins %
13,0
1,94
0,0520
12,5
1,0
11,0
0,50
Fats %
-
3,31
0,0009
37,0
3,00
26,0
10,50
T?tal Energy 100%
Energy (kcal/person/day)2003-05
8,5
2,42
0,0157
3420,0
370,00
3175,0
250,00
Proteins (g/person/day) 2003-05
3,0
2,99
0,0028
107,0
8,00
89,0
9,00
Fats (g/person/day) 2003-05
-
3,31
0,0009
139,5
23,00
90,0
35,00
Proteins/Fats 2003-05 %
8,5
-2,42
0,0157
78,5
12,50
106,0
51,00
Micro nutrients
animal origin2003-05
-
3,31
0,0009
3,8
1,30
1,7
0,80
vit. ? 2003-05
16,0
1,63
0,1036
6,5
1,00
5,5
2,00
vegetal origin2003-05
14,0
-1,84
0,0661
10,3
2,90
13,3
2,40
Diversification of nutrition
Energy% 2003-05
-
3,31
0,0009
72,0
5,50
48,5
16,00
Proteins% 2003-05
-
3,31
0,0009
74,0
4,50
44,5
16,00
Fats% 2003-05 Fats%
1,5
3,15
0,0016
98,0
1,00
92,5
6,50
Table 3 of 1:
Indicators
U n-8/8
Z
p-value
Median 1
Quartile1
Median2
Quartile2
Totalmorbidity
M DALY
-
-3,31
0,0009
11167,2
1487,77
17689,7
2,159,544
M Death
-
-3,31
0,0009
591,1
94,86
951,0
119,126
F DALY
-
-3,31
0,0009
9512,7
707,08
16217,2
2,762,776
F Death
-
-3,31
0,0009
379,6
55,41
704,2
95,837
Health Rating
-
-3,31
0,0009
7,0
10,50
69,0
21,000
Access to improved medicine1990
4,0
2,72
0,0065
100,0
0,00
86,0
12,000
Access to clean water 1990
-
3,18
0,0015
100,0
0,00
79,0
13,000
air pollution Short-circuit protection of children under 5 years of age 2004
-
-3,31
0,0009
0,0
0,00
38,5
40,500
Ecological efficiency index
-
3,31
0,0009
78,1
3,47
54,6
5,930
????? 2016
-
-3,31
0,0009
8,5
12,50
95,5
30,500
Happiness Index 2016
-
3,31
0,0009
7,315
0,491
5,087
0,762
Human development index
-
3,31
0,0009
0,962
0,007
0,762
0,082
Average life expectancy
Male life expectancy
-
3,31
0,0009
76
2
71
4
Female life expectancy
1,0
3,20
0,0014
82
2
75
3
Economic and geographical factors
6
4
Of GDP ($)2008
-
3,31
0,0009
41,1
13,05
6,8
4,350
Of GDP ($) 2016
-
3,31
0,0009
147,4
71,13
11,0
14,548
lat°
-
3,31
0,0009
52,0
9,10
35,9
5,000
UV rad J/m2 2004
-
-3,31
0,0009
1674,5
241,50
3257,5
596,000
lon°
15,0
-1,73
0,0831
7,8
7,17
25,2
24,925
Frequency of diseases-person/100 thousand age-standardized population
Bladerinc
19,0
1,31
0,1893
18,1
8,70
15,6
10,200
Braininc
8,5
2,42
0,0157
6,6
1,30
3,7
2,450
Breastinc
-
3,31
0,0009
85,9
12,40
33,4
14,300
Cervixinc
20,5
1,16
0,2480
7,6
4,25
5,3
5,850
Table 3a: Analysis of the nutrition structure and cancer incidence in European and Mediterranean countries with 6 times difference in per capita income (Mann-Whitney U-test) (chronic infectious diseases and levels of consumption).
FEMALES Alcohol use disorders
-
3,31
0,0009
190,2
140,20
3,5
43,093
Epilepsdaly rates
4,0
-2,89
0,0039
61,5
8,00
82,0
49,500
Osteoarth Daly
17,0
1,52
0,1278
275,5
18,50
185,0
149,500
MAL Diabetes m
13,0
-1,94
0,0520
192,2
55,07
314,6
174,608
FEM Diabetes m
11,0
-2,15
0,0313
184,4
37,47
417,7
259,324
Endocrine dis Daly
29,0
0,26
0,7929
169,5
65,50
161,0
148,000
Cirrhosis of the liver Daly
27,0
0,47
0,6365
100,4
164,80
112,6
145,975
Poisonings Daly
28,0
-0,37
0,7132
39,5
74,11
45,1
26,719
Falls Daly
14,0
-1,84
0,0661
145,3
48,66
211,8
85,984
Respiratory infections
-
-3,31
0,0009
107,1
68,76
538,3
389,370
Drag daly rates
26,0
0,58
0,5635
157,0
105,65
112,5
145,149
Suiside death rates
-
3,31
0,0009
14,0
4,23
3,4
2,844
Suiside daly rates
1,0
3,20
0,0014
261,9
56,05
80,9
83,748
Metabolic Syndrome
Male BMI? 25 crude
21,0
1,10
0,2701
60,2
7,00
59,2
17,200
Female BMI ? 25 crude
8,5
-2,42
0,0157
48,6
6,50
60,1
12,100
Male ch ? 5.0 crude
-
3,31
0,0009
64,8
5,45
36,7
3,450
Female ch ? 5.0 crude
-
3,31
0,0009
62,3
4,15
41,4
5,650
Male glu ? 7.0 crude
30,5
-0,11
0,9164
10,0
2,40
10,2
2,400
Female glu ? 7.0 crude
7,5
-2,52
0,0117
7,2
1,90
9,7
1,950
Male AD 2 crude
6,5
2,63
0,0087
46,5
2,85
38,7
6,250
Female AD 2 crude
22,5
0,95
0,3446
37,7
5,25
36,6
6,150