Secular changes in diet and disease incidence

The first type of evidence comes from studying changes in disease incidence and diet (but also other factors) over time. Table 7.1 shows the changes in diet in rural southwest Wales between 1870 and 1970. This was a century during which there was a marked decrease in hunger-related diseases and a marked increase in premature death from coronary heart disease — to the extent that in 1970 this region had one of the highest rates of coronary heart disease in Europe.

The major changes over this period were an increase in the proportion of energy derived from fat and an increase in the proportion of dietary fat that was saturated (section At the same time there was a considerable increase in cholesterol consumption as a result of increased consumption of animal (saturated) fats and a significant decrease in the proportion of energy derived from starch, although sugar consumption increased considerably. Intake of cereal fibre also decreased. This suggests that increased intakes of fat (and especially saturated fat), cholesterol and sugar and reduced intakes of starch and cereal fibre may be factors in the development of coronary heart disease.

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