The complex relationship between diet, quality of life and life expectancy: a narrative review of potential determinants based on data from Italy
- 93 Downloads
The increasing life expectancy at birth and the improvement of general health observed worldwide over the previous years are likely due to many factors. In this regard, the Organisation for Economic Cooperation and Development (OECD) has highlighted the favourable situation of the Italian population, which is amongst the most privileged in the world. In Italy, the national healthcare system is easily accessible to the whole population without direct costs, and alcohol abuse and cigarette smoke are less widespread compared to neighbouring countries. Moreover, the population still largely follows a dietary pattern characterised by the consumption of foods rich in protective compounds (plant foods and their components, such as fibre, polyphenols and polyunsaturated fatty acids). According to recent data, a significant consumption of these foods, which are key components of the Mediterranean model, is likely to play a more important role compared to the limited consumption of nutrients considered less favourable (essentially, saturated fat and sugar). Based on these assumptions, it can be inferred that the adoption of coercive legislative interventions—which have been introduced in other western countries to improve diet quality—may not be an optimal strategy in a country like Italy. Such an intervention would contend with psychological and social aspects (namely with the belief that participating in decision-making is an essential right) and with broader indications emerging in the research within this field (the effectiveness of a nudge approach as opposed to constraining interventions). These factors may limit any expected positive impact on health within this context.
Level of evidence
Level V, narrative review.
KeywordsLife expectancy Mediterranean diet Dietary pattern Nutrient taxation Italy
The authors wish to thank Bianca Barbi for language editing.
The preparation of this paper has been made possible by an educational unrestricted grant from Soremartec Italia s.r.l. The sponsor had no role in the preparation of the manuscript or in the decision to publish the document.
Compliance with ethical standards
Conflict of interest
All the authors have signed a conflict of interest declaration. AP and FM are, respectively, president and head of research of NFI, a nonprofit organisation partially supported by 18 food companies. CA declares speaking fees from Soremartec Italia s.r.l.
This article does not contain any studies with human participants performed by any of the authors.
For this type of study, formal informed consent is not required.
- 1.United Nations Department of Economic and Social Affairs/Population Division (2017) World population prospects: the 2017 revision, key findings and advance tables, ESA/P/WP/248. https://esa.un.org/unpd/wpp/publications/Files/WPP2017_KeyFindings.pdf. Accessed 18 Jun 2018
- 2.OECD and the European Observatory on Health Systems and Policies (2017) State of Health in the EU—Italy. Healthcare profile 2017. http://www.euro.who.int/__data/assets/pdf_file/0008/355985/Health-Profile-Italy-Eng.pdf?ua=1. Accessed 30 July 2018
- 5.World Health Organization—Noncommunicable Diseases (NCD) Country Profiles (2014) Italy. http://www.who.int/nmh/countries/ita_en.pdf?ua=1. Accessed 30 Jul 2018
- 6.Bloomberg (2017) Bloomberg 2017 Healthiest Country Index. https://www.bloomberg.com. Accessed 18 Apr 2018
- 8.Van Horn L, Carson JAS, Appel LJ et al (2016) Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: a scientific statement from the american heart association. Circulation 134:e505–e529. https://doi.org/10.1161/CIR.0000000000000462 CrossRefPubMedGoogle Scholar
- 11.de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, Uleryk E, Budylowski P, Schünemann H, Beyene J, Anand SS (2015) Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 351:h3978. https://doi.org/10.1136/bmj.h3978 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Dehghan M, Mente A, Zhang X, Prospective Urban Rural Epidemiology (PURE) study investigators, et al (2017) Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 390:2050–2062. https://doi.org/10.1016/S0140-6736(17)32252-3 CrossRefPubMedGoogle Scholar
- 13.Guasch-Ferré M, Babio N, Martínez-González MA, Corella D, Ros E, Martín-Peláez S, Estruch R, Arós F, Gómez-Gracia E, Fiol M, Santos-Lozano JM, Serra-Majem L, Bulló M, Toledo E, Barragán R, Fitó M, Gea A, Salas-Salvadó J, PREDIMED Study Investigators (2015) Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. Am J Clin Nutr 102:1157–1563. https://doi.org/10.3945/ajcn.115.116046 CrossRefGoogle Scholar
- 14.Praagman J, Beulens JWJ, Alssema M, Zock PL, Wanders AJ, Sluijs I, van der Schouw YT (2016) The association between dietary saturated fatty acids and ischemic heart disease depends on the type and source of fatty acid in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. Am J Clin Nutr 103:356–365. https://doi.org/10.3945/ajcn.115.122671 CrossRefPubMedGoogle Scholar
- 16.Public Health England (2016) Government dietary recommendations. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/618167/government_dietary_recommendations.pdf. Accessed 30 Jul 2018
- 17.EFSA Panel on Dietetic Products Nutrition and Allergies (NDA) (2010) Scientific opinion on dietary reference values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA J 8:1461. https://doi.org/10.2903/j.efsa.2010.1461 CrossRefGoogle Scholar
- 23.Marangoni F, Brignoli O, Cricelli C, Poli A (2017) Lifestyle and specific dietary habits in the Italian population: focus on sugar intake and association with anthropometric parameters—the LIZ (Liquidi e Zuccheri nella popolazione Italiana) study. Eur J Nutr 56:1685–1691. https://doi.org/10.1007/s00394-016-1215-z CrossRefPubMedGoogle Scholar
- 24.Sette S, Le Donne C, Piccinelli R, Mistura L, Ferrari M, Leclercq C, INRAN-SCAI 2005–06 Study Group (2013) The third national food consumption survey, INRAN-SCAI 2005–06: major dietary sources of nutrients in Italy. Int J Food Sci Nutr 64:1014–1021. https://doi.org/10.3109/09637486.2013.816937 CrossRefPubMedGoogle Scholar
- 25.Euromonitor (2018) Soft drinks in Italy. http://www.euromonitor.com/soft-drinks-in-italy/report. Accessed 30 Jul 2018
- 26.National Center for Health Statistics (2017) Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. https://www.ncbi.nlm.nih.gov/books/NBK453378/pdf/Bookshelf_NBK453378.pdf. Accessed 24 Sept 2018
- 29.United States Department of Agriculture (2015) Scientific report of the 2015 dietary guidelines advisory committeeGoogle Scholar
- 32.Tresserra-Rimbau A, Rimm EB, Medina-Remón A, Martínez-González MA, López-Sabater MC, Covas MI, Corella D, Salas-Salvadó J, Gómez-Gracia E, Lapetra J, Arós F, Fiol M, Ros E, Serra-Majem L, Pintó X, Muñoz MA, Gea A, Ruiz-Gutiérrez V, Estruch R, Lamuela-Raventós RM, PREDIMED Study Investigators (2014) Polyphenol intake and mortality risk: a re-analysis of the PREDIMED trial. BMC Med 12:77. https://doi.org/10.1186/1741-7015-12-77 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Wu JH, Lemaitre RN, King IB, Song X, Psaty BM, Siscovick DS, Mozaffarian D (2014) Circulating omega-6 polyunsaturated fatty acids and total and cause-specific mortality: the cardiovascular health study. Circulation 130:1245–1253. https://doi.org/10.1161/CIRCULATIONAHA.114.011590 CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ (2015) Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J Acad Nutr Diet 115:1447–1463. https://doi.org/10.1016/j.jand.2015.02.031 CrossRefPubMedGoogle Scholar
- 41.Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA, PREDIMED Study Investigators (2018) Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 378:e34. https://doi.org/10.1056/NEJMoa1800389 CrossRefPubMedGoogle Scholar
- 42.Stewart RAH, Wallentin L, Benatar J, Danchin N, Hagström E, Held C, Husted S, Lonn E, Stebbins A, Chiswell K, Vedin O, Watson D, White HD, STABILITY Investigators (2016) Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease. Eur Heart J 37:1993–2001. https://doi.org/10.1093/eurheartj/ehw125 CrossRefPubMedPubMedCentralGoogle Scholar
- 44.Magni P, Bier DM, Pecorelli S, Agostoni C, Astrup A, Brighenti F, Cook R, Folco E, Fontana L, Gibson RA, Guerra R, Guyatt GH, Ioannidis JP, Jackson AS, Klurfeld DM, Makrides M, Mathioudakis B, Monaco A, Patel CJ, Racagni G, Schünemann HJ, Shamir R, Zmora N, Peracino A (2017) Perspective: improving nutritional guidelines for sustainable health policies: current status and perspectives. Adv Nutr 8:532–545. https://doi.org/10.3945/an.116.014738 CrossRefPubMedPubMedCentralGoogle Scholar
- 46.World Health Organization (2013) Italy—WHO Country profile. http://www.euro.who.int/__data/assets/pdf_file/0018/243306/Italy-WHO-Country-Profile.pdf. Accessed 30 Jul 2018
- 47.Bonaccio M, Di Castelnuovo A, Bonanni A et al (2013) Adherence to a Mediterranean diet is associated with a better health-related quality of life: A possible role of high dietary antioxidant content. BMJ Open 3:e003003. https://doi.org/10.1136/bmjopen-2013-003003 CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Jacka FN, Cherbuin N, Anstey KJ, Butterworth P (2014) Dietary patterns and depressive symptoms over time: examining the relationships with socioeconomic position, health behaviours and cardiovascular risk. PLoS One 9:e87657. https://doi.org/10.1371/journal.pone.0087657 CrossRefPubMedPubMedCentralGoogle Scholar
- 51.Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE, European Union Working Group on Socioeconomic Inequalities in Health (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358:2468–2481. https://doi.org/10.1056/NEJMsa0707519 CrossRefPubMedGoogle Scholar
- 52.Victora CG, Bahl R, Barros AJD, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC, Lancet Breastfeeding Series Group (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 387:475–490. https://doi.org/10.1016/S0140-6736(15)01024-7 CrossRefPubMedPubMedCentralGoogle Scholar
- 53.Dernini S, Berry EM, Serra-Majem L, La Vecchia C, Capone R, Medina FX, Aranceta-Bartrina J, Belahsen R, Burlingame B, Calabrese G, Corella D, Donini LM, Lairon D, Meybeck A, Pekcan AG, Piscopo S, Yngve A, Trichopoulou A (2017) Med diet 4.0: the Mediterranean diet with four sustainable benefits. Public Health Nutr 20:1322–1330. https://doi.org/10.1017/S1368980016003177 CrossRefPubMedGoogle Scholar
- 55.UNESCO (2010) Representative List of the Intangible Cultural Heritage of Humanity. Paris. http://www.unesco.org/culture/ich/RL/00884. Accessed 30 Jul 2018
- 56.Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, Medina FX, Battino M, Belahsen R, Miranda G, Serra-Majem L, Mediterranean Diet Foundation Expert Group (2011) Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr 14:2274–2284. https://doi.org/10.1017/S1368980011002515 CrossRefPubMedGoogle Scholar
- 57.OECD (2017) Health at a glance 2017: OECD indicators. OECD Publishing, ParisGoogle Scholar
- 58.Meybeck A, Redfern S (2016) Sustainable value chains for sustainable food systems. In: Joint FAO/UNEP Workshop on Sustainable Value Chains for Sustainable Food Systems. FAO/UNEP, Rome (Italy) 8–9 Jun 2016. http://www.fao.org/3/a-i6511e.pdf. Accessed 18 Jun 2018
- 59.Renzella J, Townsend N, Jewell J, Breda J, Roberts N, Rayner M, Wickramasinghe K (2018) What national and subnational interventions and policies based on Mediterranean and Nordic diets are recommended or implemented in the WHO European Region, and is there evidence of effectiveness in reducing noncommunicable diseases? Health Evidence Network synthesis report 58 Copenhagen. http://www.euro.who.int/en/publications/abstracts/what-national-and-subnational-interventions-and-policies-based-on-mediterranean-and-nordic-diets-are-recommended-or-implemented-in-the-who-european-region,-and-is-there-evidence-of-effectiveness-in-reducing-noncommunicable-diseases-2018. Accessed 18 Jun 2018
- 63.Luomala HT, Laaksonen P, Leipamaa H (2004) How do consumers solve value conflicts in food choices? An empirical description and points for theory-building. In: Barbara E, Kahn and Mary Frances L (ed) NA—Advances in Consumer Research, 2004 Valdosta, GA: Association for Consumer Research, pp 564–570. http://www.acrwebsite.org/volumes/v31/acr_vol31_163.pdf. Accessed 18 Jun 2018
- 68.Sijtsma FP, Soedamah-Muthu SS, de Goede J, Oude Griep LM, Geleijnse JM, Giltay EJ, de Boer MJ, Jacobs DR Jr, Kromhout D (2015) Healthy eating and lower mortality risk in a large cohort of cardiac patients who received state-of-the-art drug treatment. Am J Clin Nutr 102(6):1527–1533. https://doi.org/10.3945/ajcn.115.112276 CrossRefPubMedPubMedCentralGoogle Scholar
- 69.Mytton OT, Scarborough P, Lentjes M, Luben R, Rayner M, Khaw KT, Wareham NJ, Monsivais P (2018) Association between intake of less-healthy foods defined by the United Kingdom’s nutrient profile model and cardiovascular disease: a population-based cohort study. PLoS Med 15:e1002484. https://doi.org/10.1371/journal.pmed.1002484 CrossRefPubMedPubMedCentralGoogle Scholar
- 70.Kaiser KA, Shikany JM, Keating KD, Allison DB (2013) Will reducing sugar-sweetened beverage consumption reduce obesity? Evidence supporting conjecture is strong, but evidence when testing effect is weak. Obes Rev 14:620–633. https://doi.org/10.1111/obr.12048 CrossRefPubMedPubMedCentralGoogle Scholar
- 71.Caro JC, Corvalán C, Reyes M, Silva A, Popkin B, Taillie LS (2018) Chile’s 2014 sugar-sweetened beverage tax and changes in prices and purchases of sugar-sweetened beverages: an observational study in an urban environment. PLoS Med 15(7):e1002597. https://doi.org/10.1371/journal.pmed.1002597 CrossRefPubMedPubMedCentralGoogle Scholar
- 72.Ministry of Health (2018) Shared objectives for improving the nutritional characteristics of food products, with a particular focus on children (3–12 years). http://www.salute.gov.it/imgs/C_17_pubblicazioni_2426_ulterioriallegati_ulterioreallegato_0_alleg.pdf. Accessed 30 Jul 2018
- 73.Strazzullo P, Cairella G, Campanozzi A, Carcea M, Galeone D, Galletti F, Giampaoli S, Iacoviello L, Scalfi L, GIRCSI Working Group (2012) Population based strategy for dietary salt intake reduction: Italian initiatives in the European framework. Nutr Metab Cardiovasc Dis 22:161–166. https://doi.org/10.1016/j.numecd.2011.10.004 CrossRefPubMedGoogle Scholar
- 76.Thaler RH, Sunstein CR (1999) Nudge: improving decisions about health, wealth, and happiness. CT Yales University Press, New HavenGoogle Scholar
- 77.Bucher T, Collins C, Rollo ME, McCaffrey TA, De Vlieger N, Van der Bend D, Truby H, Perez-Cueto FJ (2016) Nudging consumers towards healthier choices: a systematic review of positional influences on food choice. Br J Nutr 115:2252–2263. https://doi.org/10.1017/S0007114516001653 CrossRefPubMedGoogle Scholar
- 78.Oullier O, Cialdini R, Thaler RH, Mullainathan S (2010) Improving public health prevention with a nudge. Econ Perspect 6:117–136Google Scholar