Asia Pac J Clin Nutr. 2002 ; 11 Suppl 3(): S569-75.

Morbidity mortality paradox of 1st generation Greek Australians.

Kouris-Blazos A.

Asia Pacific Health and Nutrition Centre, Monash Asia Institute, Monash University, Clayton, Australia. [email protected]

There is evidence in Australia that 1st generation Greek Australians (GA), despite their high prevalence of cardiovascular disease (CVD) risk factors (e.g. obesity, diabetes, hyperlipidaemia, smoking, hypertension, sedentary lifestyles) continue to display more than 35% lower mortality from CVD and overall mortality compared with the Australian-born after at least 30 years in Australia. This has been called a 'morbidity mortality paradox' or 'Greek-migrant paradox'. Retrospective data from elderly Greek migrants participating in the International Union of Nutrition Sciences Food Habits in Later Life (FHILL) study suggests that diets changed on migration due to the: (i) lack of familiar foods in the new environment; (ii) abundant and cheap animal foods (iii) memories of hunger before migration; and (iv) status ascribed to energy dense foods (animal foods, white bread and sweets) and 'plumpness' as a sign of affluence and plant foods (legumes, vegetable dishes, grainy bread) and 'thinness' as a sign of poverty. This apparently resulted in traditional foods (e.g. olive oil) being replaced with 'new' foods (e.g. butter), 'traditional' plant dishes being made more energy dense, larger serves of animal foods, sweets and fats being consumed, and increased frequency of celebratory feasts. This shift in food pattern contributed to significant weight gain in GA. Despite these potentially adverse changes, data from Greece in the 1960s (seven countries study) and from Australia in the 1990s (FHILL study) has shown that Greek migrants have continued to eat large serves of putatively protective foods (leafy vegetables, onions, garlic, tomatoes, capsicum, lemon juice, herbs, legumes, fish) prepared according to Greek cuisine (e.g. vegetables stewed in oil). Furthermore, GA were found to return to the traditional Greek food pattern with advancing years. We suspect that these factors may explain why GA have recently been found to have over double the circulating concentrations of antioxidant carotenoids, especially lutein, compared with Australians of Anglo-Celtic ancestry. This in turn may have helped to make the CVD risk factors 'benign' and reduce the risk of death. This raises the question whether specific dietary guidelines need to be developed for recent migrants to Australia, encouraging them to retain the best of their traditional cultures and include the best of the mainstream culture.