Br Is the Chilean Diet a Mediterranean-type Diet?

Food intake in Chile has changed markedly in the last decades, showing an increase in fat consumption and presently a small fruit and vegetables intake. A parallel is made between the Chilean and Mediterranean diet (mainly the one from Spain, Italy, and Greece), both currently and from 50 years ago. The main differences and similarities are based on food availability. Although Chilean diet seems to be approaching the traditional Mediterranean diet of the 60's, there is concern about changes that are moving away from Chilean traditional diet and towards a western one. A new food pyramid for Chile is proposed based on the traditional Mediterranean-type diet.


INTRODUCTION
The last decades have witnessed a radical change in the way we feed ourselves.The access to food and its availability have markedly increased in this period of time and the establishment of large food outlets has made purchasing items very simple.This is true not only for the well-to-do but also for the poor population in many developing countries.
This pattern of change has also been present in Chile.In the last 5 decades malnutrition has practically disappeared, and infant mortality rate has decreased from 120/1000 live births to less than 7/1000 live births nowadays (1).Unfortunately, in the same period of time we have seen a dramatic increase in the prevalence of obesity, currently at levels comparable to those of developed countries (2).Nevertheless, health indicators, in general, have improved markedly in the country (1).
Recently the World Health Organization developed an indicator called HALE (Healthy Life Expectancy at Birth), which also takes into consideration the appearance of disease during the life of an individual (3).Table I shows the HALE indicator for some selected countries.The Chilean HALE is one of the highest in South America, and is very similar to the one in the US.Although in Chile, HALE is still lower than in European Mediterranean countries, this measurement suggests that the Chilean environment is more favorable than that of other countries in South America.Obviously diet plays an important role here, but there are other aspects worth establishing.Chilean health expenditures per capita (US$ 654) are lower than in the majority of the more developed countries in South America, with the exception of Cuba (US$ 303) and Costa Rica (US$ 450), and substantially lower than in the US and in the Mediterranean countries mentioned previously (4).The country also has a relatively low number of physicians / 100,000 inhabitants (140) compared to 530 in Cuba, 279 in the US, 303 in France, 424 in Spain, 554 in Italy, and 392 in Greece (3).
So what is so special about the Chilean environment that makes it favorable to the health of its population?Although there are many factors influencing the outcome, we will concentrate on the Chilean diet and its comparison with the one from Mediterranean countries, since their diet has been widely recognized as a healthy one (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).One of the problems that we encounter in analyzing the Chilean diet is the lack of national nutrition surveys.The first was done in 1960 (16) and the second (and last one) was performed in 1974 (17).Therefore, we have no idea of the composition of the Chilean diet at a national level.The information we do have comes from studies in relatively small samples obtained mainly from the large cities or that are non-representative.For this reason, we decided to analyze the  between 1993-1995.As we can see, Chileans consume a much higher proportion of cereals (mainly bread) and sugar than Spaniards.We also consume less tubers, legumes, fruits and vegetables, vegetable oil, and dairy products.
In order to expand this analysis we compared food availability in grams/day in Chile, Italy, Greece, and Spain, using the Spanish data as the unit (Fig 1).As observed in Figure 1, we do consume more cereals than Spain but less than Italy or Greece.Our meat consumption (which includes chicken, a main staple in Chilean diet) is lower than in the three Mediterranean countries.The same happens for dairy products, fruits and vegetables, vegetable oil, and legumes.Potato consumption in Chile is lower than in Spain and Greece but higher than in Italy.We consume more eggs than the Mediterranean countries and substantially less fish than Spain and Greece and more than Italy.
This information indicates that Chile shows a varied pattern of food availability compared to Mediterranean countries.
Nevertheless, several reports have shown that the diet of Mediterranean countries has undergone changes with time (19,20).We therefore decided to study, again using FAO data, which changes have taken place with time in the availability of food from 1961 to 1999 in Chile, Spain and Italy (18).
Table III shows the changes in total calories in the three countries.In all of them there has been an increase in availability, although the increase has been slower in Chile.What is interesting to point out is that calorie availability in Chile is now at the level of availability in Spain around 1970, and we are approaching the availability of Italy in 1961.A similar pattern was observed for the contribution of cereals, dairy products, and fruits to total calories (Table III).Contribution of vegetables to total calories has decreased in Spain and Chile and increased in Italy, while fish availability has increased in all of them (data not shown).Nevertheless, fish consumption in Italy and Chile is much lower than in Spain.In terms of availability of vegetable oil, Chile is now at the level of  So what can we conclude from these data?Table IV shows the proportion of calories contributed by different foods but this time comparing Spain in 1961 to Chile in 1993-95.As we see, the availability of cereals, fruits and vegetables (grouped together), dairy products, and fish are similar to the consumption of Spain at that time.However, Chileans consume relatively fewer legumes, tubers, vegetable oil, and more red meat and sugar than Spaniards did at that time.
The information showed here indicates that in all these countries there has been a change in the pattern of food availability (and therefore, in food consumption).Although Chile seems to be moving in a favorable way, we have observed an increase in the consumption of sugar and other sweeteners, an increase in the consumption of fats and of prepared meats, which are usually rich in fat and salt (21,22).Probably of great importance has been the decrease in the amount of exercise in the population (23,24).
The current guideline for food intake in Chile is the Food Pyramid (Fig 2) (25).This pyramid gives large importance to cereals, potatoes, and fresh vegetables.The first two already are highly consumed in Chile.The pyramid also gives guidelines based on portions consumed per day, which is confusing to the majority of the population.
Here we propose a new type of pyramid, stressing the Mediterranean-style of consumption (J.Rozowski, O. Castillo, I. Urquiaga and F. Leighton, unpublished).As shown in Figure 3, this pyramid stresses the consumption of whole-grain vegetables, and of prepared dishes that have always been an integral part of our diet.This guideline also recommends exercise, intake of milk and dairy products, and a moderate consumption of wine.We feel very strongly that wine intake in moderate amounts (up to 1 glass/day in women and 2 glasses/day in men) has already shown to provide health benefits specially when combined with a Mediterranean-style diet (26)(27)(28)(29)(30)(31).
The reason to recommend traditional food preparation is because the preservation
Italy in 1961, with all 3 countries showing an increase in the availability of this product.

TABLE I
Healthy life expectancy at birth (HALE) in selected countries.

TABLE II Calories
availability contributed by food items in Spain and Chile as percentage of total calories.

TABLE III Total
calories availibality and contribution of total cereals, dairy products, fruits and vegetable oil to total calories in Chile,Spain and Italy, 1961 and 1999

TABLE IV Calories
availability contributed by food items in Spain and Chile as a percentage of total calories.