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Friday, May 28, 1999 Published at 08:11 GMT 09:11 UK


French health mystery

Fewer people die of heart disease in France

History is to thank for the French suffering less heart disease than the British - but doctors are unsure as to whether the last 30 or 130 years are behind the phenomenon.

Higher consumption of red wine had been thought by some to be the reason, but researchers said on Friday that this theory has long since been disproven.

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They suggest instead that it is because the French have traditionally eaten less animal fat but, because consumption in France has matched that in the UK for about 15 years, the future will see the two countries affected to a similar degree.

However, another article suggests that the truth may lie in France's reaction to defeat in the 1871 Franco-Prussian war.

Humiliated, the state took a protective approach to women, children and infants, and took the radical step of introducing school dinners.

As there is a well-established link between maternal nutrition and an infant's risk of developing heart disease in later life, this better nutrition could have safeguarded generations.

Heart conundrum

The papers appeared in the British Medical Journal as (BMJ) part of an attempt to resolve the so-called French paradox.

Heart disease accounts for only a quarter the number of deaths in France as it does in the UK - even though the French appear to be at just as high a risk as the British.

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Dr Malcolm Law and Professor Nicholas Wald, of the Wolfson Institute of Preventive Medicine in London, suggested difference in consumption of animal fats was to blame.

They say that instead of comparing the diets of today, doctors must compare the diets of the past because heart disease takes a long time to develop.

"If you relate what people were eating 20 to 30 years ago, there is no paradox," Dr Law told BBC News Online.

"It's easiest to understand if you compare it with smoking in Greece,"

"In Greece they smoke a lot but they don't get a lot of lung cancer, there's more lung cancer in Britain.

"It's because they haven't been smoking for very long in Greece, and it takes a good length of time for these diseases to show up."

History catches up

In the past the French have eaten less animal fat, but history will catch up with them because they are now consuming as much as the British.

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For the time being, the number of deaths from heart disease is only a quarter of that in the UK while the French benefit from a time-lag effect.

But in the next 10 to 15 years deaths from heart disease in France will be as high as those in the UK, Dr Law said.

He stressed that cutting down on animal fats had immediate health benefits, while increasing intake had a cumulative ill-effect on health.

And he said higher consumption of red wine had nothing to do with the paradox, and that that had been known for some time.

BBC News' John Andrew: Red wine not significant factor
"All alcohol has a protective effect in small amounts," he said. "Drinking more does not increase the benefits."

"Dr Law and Professor Wald conclude that, for the population of France, retribution has merely been postponed, and an epidemic of coronary heart disease is now approaching," Professor David Barker said.

Professor Barker, director of the Medical Research Councils' Environmental Epidemiology Unit, wrote a commentary on the study in the BMJ and doubts that France will be hit by such an epidemic.

Looking further back in time

He recently published research suggesting that a person's chances of developing heart disease can be influenced by their weight at birth.

The research suggested that smaller babies needed to eat more to reach a "normal weight", and that this was bad for the health of their hearts.

[ image:  ]
He suggests in the BMJ that the real solution to the French paradox may lie further back in history, in France's unique approach to defeat in the Franco-Prussian war.

Malnutrition was widespread in 19th Century Europe, and the French became concerned that it was affecting their strength as a nation.

So radical measures - including the routine feeding of school children - were instituted, focusing on nutrition for babies, children and mothers.

Professor Barker told BBC News Online this could have had a protective effect on generations of French people that was not seen elsewhere.

This is because the health of a mother, including her health as an infant, affects a child's risk of developing heart disease later in life.

"When nutrition improves in a community, the first beneficiaries are not usually girls and women, but boys because they will be the next generation of manual workers.

"But what France did 130 years ago was novel."

International lessons

Developing countries could learn a lot from this theory, he said.

He pointed to Rwanda - where nutrition today is similar to that in France in the18th Century - and India - similar to England at the same time.

Heart disease is at epidemic levels in India and rapidly becoming the most common cause of death, he said.

"There is a centrally important message in all this," he said.

"As nutrition improves, make sure it gets to girls and young women before and after pregnancy. A moment's reflection will tell you that is not what is happening."

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