Italy World's Healthiest Country

The Italian economy may not be in great shape, but Italians certainly are, according to a ranking of the world’s healthiest nations.

The Bloomberg Global Health Index ranks Italy top of 163 countries, followed by Iceland, Switzerland, Singapore and Australia.

While Italian babies can expect to live into their eighties, at the other end of the scale in Sierra Leone, life expectancy is just 52.

The index gave countries a ‘health score’ based on metrics such as life expectancy and causes of death, and then took into account ‘health risk penalties’. These included high blood pressure, blood glucose and cholesterol, as well as the prevalence of obesity, alcoholism, smoking and childhood malnutrition. It also considered environmental factors such as carbon emissions and access to drinking water.

The US, which has one of the highest obesity rates in the world, is in 34th place, with a health grade of 73.05 out of 100.

The key to Italy’s good health?

Despite a struggling economy with low growth and high unemployment, especially among young people, Italians are in far finer fettle than Americans, Canadians and Brits, who have higher blood pressure and cholesterol and poorer mental health.

Could the Mediterranean diet be a critical factor? Bloomberg notes that Italians enjoy a diet rich in fresh vegetables, fish, lean meats and olive oil, and that there’s an “excess of doctors” in the country.

When it comes to living a very long, active life, scientists believe one place in Italy may hold the secret. The Cilento peninsula, south of Naples and the Amalfi Coast, has an unusually high number of sprightly centenarians.

Researchers found that residents of one village, Acciaroli, where more than one in 10 of the population is over 100 years old, had remarkably good blood circulation. Though an exact reason has yet to be determined, scientists believe it could be a combination of the residents’ healthy diet based on vegetables, herbs and fish, being physically active and genetic factors that have developed over centuries.

Rosamond Hutt. "Italy may have a struggling economy but its people are the healthiest in the world". World Economic Forum, 18 Apr 2017.

Italians Aren't Lactose Intolerant

In studies on lactose intolerance and its frequency in different populations, you'll often see numbers like 20-70% or 18-85% for Italy, with the highest percentages being in the south. The sources are usually old studies from the 80s or before, but there's a problem with the way testing was done back then. There are also the problems of incorrect self-diagnoses and confusion with different, less severe conditions like lactose maldigestion and irritable bowel syndrome.

According to Dr. Steve Hertzler of Iowa State University:

First, it is very important that people do not "self-diagnose". In addition, even when an individual goes to a physician for a diagnosis, the physician often uses an incorrect approach. The classic example of this is to put the patient on a lactose-free diet and see if the symptoms go away. The potential for "placebo" effect in this type of diagnosis is enormous. From double-blind studies our laboratory group conducted at the University of Minnesota, 1 out of 3 people who "self-diagnosed" themselves as severely lactose intolerant were actually able to digest 15 g lactose (just over 1 cup of milk). It is important to have objective evidence of lactose maldigestion. It is also important to realize that lactose maldigestion among varying individuals is more of a continuum than an "either-or" phenomenon. For example, traditional lactose tolerance tests done by physicians used 50 g of lactose in water after an overnight fast. This is equivalent to drinking a quart of milk on an empty stomach! This is not very physiological or realistic. Just because a person can not tolerate 50 g does not mean that he/she won't tolerate the 12 g in a cup of milk. In our double-blind studies, the symptom response to 12 g lactose was about 25% of subjects, which was not statistically different from a lactose-free placebo. Dose of lactose is a very important factor.

How should lactose intolerance be diagnosed? First, there is a difference between lactose maldigestion and lactose intolerance. The former term means that a person is unable to digest lactose to a certain degree. On average, lactose maldigesters malabsorbed about half of the lactose in 1 cup of milk (some more, some less). However, not everyone experiences symptoms from lactose maldigestion. I once did breath hydrogen testing on a dietitian who worked for the National Dairy Council. She turned out to be a lactose maldigester, but she had no symptoms from drinking milk. Lactose intolerance is when lactose maldigestion is coupled with gastrointestinal symptoms such as diarrhea, flatulence (most common), and stomach discomfort. A person who is experiencing GI symptoms that he/she suspects might be related to lactose maldigestion needs to have confirmation by an objective test. This is important to rule out other potential bowel conditions. Irritable bowel can often masquerade as lactose intolerance.

A later study on Sicilians (who are supposedly one of the most lactose intolerant groups in Europe) took all these facts into account and found a much lower frequency of the condition in a representative sample:

The present study is the first to attempt to clarify the dimensions of the problem of self-reported milk-intolerance, the real correspondence between self-reported milk-intolerance and gastrointestinal symptoms following the breath hydrogen test, and the impact of this self-diagnosis on dietary intake of total calories, proteins and calcium, using data from the general population and not from a pre-selected sample.

In a wide randomized sample representative of a rural community, we observed that 36% of the population were lactose-maldigesters, but only 4% of the whole study group (13% of the maldigesters) showed lactose intolerance after an oral load of 25 g lactose. Although many previous studies have reported a much higher frequency of gastrointestinal symptoms after lactose load in subjects with maldigestion, it has been underlined how field investigations indicate a greater average tolerance to milk than studies on patients referred to hospitals because of aspecific abdominal complaints.

[...]

After the cases of self-reported milk intolerants were selected, the analysis of the results is more interesting. The percentage of subjects who believe that they cannot tolerate milk and accordingly reduce milk consumption is considerable: 15% of the examined population. The results of the breath test after lactose challenge were, however, surprising: a) more than 1/3 of these subjects were actually lactose digesters and tolerants (normal H2 breath test and no symptoms following lactose load); b) only 10% of the self-reported lactose-intolerants were really intolerants and showed symptoms after a 25 g lactose load. These results, obtained in a non-selected group of healthy subjects representative of the general population, are in agreement with those recently reported by Suarez et al who showed that 9/30 self-reported lactose intolerants had a normal lactose digestion capacity and that in the remaining 21/30 the gastrointestinal symptoms did not worsen during administration of lactose-containing milk. It is therefore likely that in order to explain the gastrointestinal symptoms of many lactose-maldigesters, the possibility of a diagnosis of irritable bowel syndrome or of non-ulcer dyspepsia should be investigated. Our study also clarifies the impact of self-reported milk intolerance on dietary habits. These subjects did not consume milk, or consumed very low quantities of milk and their daily calcium intake was significantly lower. It must be underlined that in the population we studied daily calcium intake was generally much lower than the recommended level (500 mg vs. 800–1000 mg/day), and an unnecessary self-limitation of the consumption of a food rich in calcium, as milk is, seems to be a particularly serious risk factor for osteoporosis. In particular, recent prospective studies have suggested that reduced calcium intake during the adolescence and early adulthood may have a great impact on bone mineral density measurements; this result must induce physicians to pay particular attention to dietary calcium intake.

In conclusion, we affirm that in a representative sample of the general population, with an approximately 40% prevalence of lactase insufficiency, there was: a) a low frequency of lactose intolerance (4%); b) an incongruous overestimation of the frequency of milk intolerance: 15% of the general population; c) a low dietary calcium intake, which is even less satisfactory (300 mg/day) in subjects who limit milk consumption due to self-reported milk intolerance. Lactose digestion capacity should therefore be carefully investigated in all self-reported milk intolerant subjects.

Carroccio et al. "Lactose intolerance and self-reported milk intolerance: relationship with lactose maldigestion and nutrient intake". J Am Coll Nutr, 1998.

Height Gains in a Global Context

Even though Italians are seeing more height gains than Northern Europeans due to improved nutrition, they're still on the shorter side in a European context, but they're relatively tall compared to the rest of the world and moving steadily up the ladder.

According to a new study that analyzed measurements of people born between 1896 and 1996 in 200 countries, including large samples from all over Italy, a hundred years ago Italian men were the 57th tallest in the world (women 55th), but today they're the 29th tallest (women 32nd). The men grew by about 13cm (5in) from 165cm (5'5") to 178cm (5'10"), and the women by 11cm (4in) from 154cm (5'1") to 165cm (5'5").

Adult height for the 1896 and 1996 birth cohorts for men:

Adult height for the 1896 and 1996 birth cohorts for women:

Change in adult height between the 1896 and 1996 birth cohorts:

NCD Risk Factor Collaboration (NCD-RisC). "A century of trends in adult human height". eLife, 2016.

Italians Aren't That Emotional

Italians are often stereotyped as overly emotional (always yelling, sobbing or singing), but a recent Gallup poll that surveyed people around the world about their emotions found that Italian levels are about average and don't stand out as unusual. An article in the Washington Post added a color-coded map to better visualize the results (click here for the original data).

Gallup measures daily emotions in more than 150 countries and areas by asking residents whether they experienced five positive and five negative emotions a lot the previous day. Negative experiences include anger, stress, sadness, physical pain, and worry. Positive emotions include feeling well-rested, being treated with respect, enjoyment, smiling and laughing a lot, and learning or doing something interesting.

To measure the presence or absence of emotions, Gallup averaged together the percentage of residents in each country who said they experienced each of the 10 positive and negative emotions.

[...]

Results are based on telephone and face-to-face interviews with approximately 1,000 adults, aged 15 and older, in each country each year between 2009 and 2011.

Some Perspective on Italian IQ

A new paper tries to evaluate the evidence in the recent debate about Italian IQ. The author has a little too much faith in Richard Lynn and the validity of his data, but still challenges his simplistic genetic explanations for north-south disparities, and urges caution when interpreting correlations between IQ and other variables.

The present study was intended to provide perspective, albeit less than unequivocal, on the research of Lynn (2010) who reported higher IQs in the northern than southern Italian regions. He attributes this to northern Italians having a greater genetic similarity to middle Europeans and southern Italians to Mediterranean people. Higher regional IQ was associated with biological variables more characteristic of middle European than Mediterranean populations (cephalic index, eye color, hair color, multiple sclerosis rates, schizophrenia rates). It was maintained, however, that very confident and definitive inferences regarding genetic regional differences in IQ are not warranted. Social conceptualized variables also correlated significantly with IQ so as to suggest the importance of nutrition and economic developmental status more generally.

[...]

One should also bear in mind that the correlations are ecological correlations and have the limitations associated with such. Prince (1998) succinctly described three problems with ecological correlations. One problem, the "ecological fallacy," is that people who are high or low in one variable are not necessarily the same people who are high or low on the other variable. In the present study the people in a region who are high in cephalic index are not necessarily the same people who are high in IQ. The second problem is that a third variable may be responsible for the correlation between the other two. In the present study, temperature, precipitation, constituents of drinking water, constituents of soil, health, genetic predisposition to medical disorder, nutrition, and medical care are some of the variables that could conceivably influence the correlation of IQ with schizophrenia and multiple sclerosis. The third problem is that cause and effect cannot be determined.

4. Discussion

It is apparent that regions that have at least some biological characteristics more common in middle European than Mediterranean populations (higher cephalic index, lighter eye color and hair, and higher rates of multiple sclerosis and schizophrenia) tend to have higher IQs. This could be viewed consistent with Lynn's (2010) assertion of a genetically based explanation of north-south IQ differences. Great caution, however, is urged regarding such inferences. Since these are ecological correlations, the persons high or low in these biological variables may not be the same persons in that region high or low in IQ. Because some characteristics are different does not mean that all characteristics are different. East Asians have different facial features than Europeans and Africans. These differences, however, may be only remotely related or not related at all to IQ differences. Also, there are notable exceptions to generalizations about IQ and coloration. Most East Asians and Jewish persons are darker than Scandinavians and yet have higher mean IQs. Furthermore, social variables could account, at least in part, for the north-south IQ differences. Nevertheless, examination and discussion of the biological variable findings are warranted.

[...]

The social correlations with IQ and latitude were also substantial and could be viewed as indicating social explanations of the north-south IQ differences. As reasoned above, the massive illiteracy of the south (and even in the north to a lesser extent) could not be explained mainly by genetically determined intelligence. The positive correlation between IQ and literacy suggests that the lower developmental stature of the southern region contributes to the lower IQ. Such an interpretation is also suggested by, as hypothesized, the negative correlation between IQ and percentage increase in stature and negative correlation between income and latitude. This correlation also shows that those regions with the greatest history of malnutrition have lower IQs. As pointed out by Lynn (1990), the secular increase in IQ and stature parallel each other and both seem to be a function of improved nutrition.

Donald I. Templer. "Biological correlates of northern-southern Italy differences in IQ". Intelligence, 2012.

Italians Are Getting Taller

Height is increasing throughout Europe because of improved living standards, but this is happening at a faster rate in the south (including Italy) where poverty and poor health were much worse, and people were shorter as a result.

This paper presents new evidence on the evolution of adult height in 10 European countries for cohorts born between 1950 and 1980 using the European Community Household Panel (ECHP), which collects height data from Austria, Belgium, Denmark, Finland, Greece, Ireland, Italy, Portugal, Spain and Sweden. Our findings show a gradual increase in adult height across all countries. However, countries from Southern Europe (Greece, Italy, Portugal, and Spain) experienced greater gains in stature than those located in Northern Europe (Austria, Belgium, Denmark, Finland, Ireland, and Sweden).

[...]

Three main features of these data stand out. First, we find that heights in all countries increased during this period. Second, the average stature in the Northern European countries is higher than in the Southern ones for all the cohorts and for both males and females. Third, the intensity of such a growth is heterogeneous: Northern versus Southern differences are visible. For instance, looking at Table 1, we see that Finnish men born in the first half of the 50’s were 177.8 cm tall, while those born in the late 70’s achieved 178.7 cm. The less than 1 cm increase by Finnish males contrasts sharply with the growth experienced by Spanish males: from 171.3 cm to 176.1 cm, almost 5 cm. In Table 2, we note that there are also huge differences between the growth experienced by Italian and Spanish women, more than 5 cm, in comparison to that of Danish women, only 1.4 cm.

This pattern of higher growth rates for both males and females in the Southern European countries becomes more evident when considering Table 3, where annual growth rates between the 1950-55 and the 1976-80 cohorts are reported (0.10% for Southern countries, 0.05% for Northern countries, and the total mean growth is 0.07%). Also we can point out that height growth rates are almost equal for males and females according to this geographical classification. There does not seem to be a clear pattern in terms of gender across countries. Some countries have experienced higher absolute gains for women (Belgium, Finland, Italy, Spain and Sweden) whereas some others have experienced greater gains for men (Austria, Denmark, Greece, Ireland and Portugal).

Considering the evolution of heights separately for the Northern and Southern European countries (Figures 1 - 4) some generalizations are evident. First, for the Northern countries, the cohorts of Danish males are always the tallest: 180.3 cm at the beginning and 183.7 cm at the end of the period. Second, the reverse situation is shown by the Irish males, who are the shortest in the Northern Europe sample during the whole period, 174.9 cm for those born in 1950-1955 and 177.4 cm in 1976-1980. Similar qualitative results are found for females.

From the evidence in Figure 3 and Figure 4 we can conclude for the Southern European countries that Greeks are the tallest for both males and females and Portuguese are the shortest ones in both cases. Both countries show a similar evolution profile in the period under consideration. At contrast, Spanish males and females for the last cohorts are growing more significantly than those in the other Southern European countries.

[...]

Trying to measure wellbeing in a society using only one measure is a challenging task, if not an impossible one. Usually, economists consider Gross Domestic Product (GDP) per capita or Gross National Product (GNP) per capita as conventional measures of living standards. Consumption per capita is also used. However, the use of these indicators is not without its shortcomings. [...] Stature is a measure that can help us to circumvent these caveats, but even more important, stature is interesting in its own right: it is a useful summary measure of biological wellbeing, as emphasized by Komlos and Baur (2004). First, stature is a measure that incorporates or adjusts for individual nutritional needs (Steckel, 1995). Second, it also meets satisfactorily the criteria set forth by Morris (1979) for an international standard of physical quality of life. Third, stature is a welfare measure that satisfies the approach to the standard of living suggested by Sen (1987): functionings and capabilities should be balanced. Fourth, it generally correlates positively with many health outcomes throughout the life course, and in particular, it correlates negatively with mortality (Waaler, 1984; Barker et al. 1990). Hence, physical stature can be used as a proxy for health, which as any inherently multidimensional concept is difficult to measure.

Garcia and Quintana-Domeque. "The Evolution of Adult Height in Europe: A Brief Note". Econ Hum Biol, 2007.

Related: Height Gains in a Global Context

Rates of Obesity Relatively Low

Europeans have gotten heavier over the last decade, but within that context, Italy has among the lowest rates of overweight and obese people, especially the latter and especially women.

Among the 19 [European Union] Member States for which data are available, the proportion of overweight and obese people in the adult population varied in 2008/09 between 36.9 % and 56.7 % for women and between 51 % and 69.3 % for men.

For both women and men aged 18 years and over, the lowest shares of obesity in 2008/09 were observed in Romania (8.0 % for women and 7.6 % for men), Italy (9.3 % and 11.3 %), Bulgaria (11.3 % and 11.6 %) and France (12.7 % and 11.7 %). The highest proportions of obese women were recorded in the United Kingdom (23.9 %), Malta (21.1 %), Latvia (20.9 %) and Estonia (20.5 % in 2006), and of men in Malta (24.7 %), the United Kingdom (22.1 %), Hungary (21.4 %) and the Czech Republic (18.4 %).

Overweight and Obesity — BMI Statistics. Eurostat — Statistics Explained, 2012.

No Such Thing as "Mediterranean Cuisine"

What nutritionists call the "Mediterranean diet" just consists of healthy ingredients commonly found around the Mediterranean, but doesn't represent a single, unified regional cuisine because the Mediterranean isn't a single, unified region. And its many divisions are reflected in its culinary diversity.

To speak of 'Mediterranean cuisine' — to use such a catch-all classification for the wines and herbs of southern France, the intricate and bold spices of Morocco, the octopus salad of Greece, the cool yoghurt soup of Syria and the hearty fish stew of Italy's Liguria — is a fool's errand, writes Corinne Vella.

The geographical area that comprises the Mediterranean consists of three continents and more than fifteen countries. It is a region so divided socially, politically, religiously and economically, that the notion of a single cuisine being the unifying factor is a heart-warming but wildly inaccurate idea. There is no such thing as Mediterranean cuisine. It is more accurate to speak of several types of cuisine within this region.

Commonalities do exist among the richly diverse range of culinary traditions found around the Mediterranean. The cuisines of the region can be roughly clustered into three groups: North African, eastern Mediterranean and southern European. But though there are some similarities within and between each group, they remain distinct, born as they are of differing cultures.

The misconception of a common culinary identity is possibly rooted in the idea that Mediterranean countries do share some things: their climate and terrain and much of their history of imperial colonisation and trade relations. Large swathes of the area have been variously influenced by the Phoenicians, the Romans, the Arabs, the Turks and the Venetians, all of whom have left traces of their presence and the lingering impression of a shared regional identity.

Marry that lingering impression to the contemporary concept of a "Mediterranean diet" and you have the basis for a myth, the idea of the existence of a cuisine that persists in the face of evidence to the contrary.

A food could be considered normal in one culture but have shock value in another. No eyebrows are raised when wine is drunk with meals anywhere from Spain to Greece, for example, but no self-respecting Muslim community, of which there are several in the Mediterranean, would count wine as part of its cuisine. Tuscany gorges on pork products, something not done anywhere from Morocco to Turkey. Lamb, chicken and fish are typical there. Prosciutto crudo is not.

Many traditional dishes are centred on religious holidays and the practices associated with them. Certain foods, such as meat and dairy products, are prohibited at significant points in the religious calendars, giving the various cuisines at least some of their individual characteristics. Though that much seems obvious, the belief remains that there is such a thing as a Mediterranean cuisine that could be alternatively referred to as "the Mediterranean diet".

"Mediterranean diet" is not the gastronomic flipside of "Mediterranean cuisine", nor is the difference between the two terms merely semantic. The "Mediterranean diet" is a model of healthy eating, rather than a truly localised diet born of tradition. Its supposed widespread presence in Mediterranean countries is itself becoming a myth of sorts, given the inroads made by global fast food brands. Even if it were not, the "Mediterranean diet" could not be related to any cuisine in the anthropological sense.

A cuisine is not invented overnight, nor is it established in the space of a couple of generations, as the "Mediterranean diet" has been. Rather, it is the distillation of generations-worth of experience of making the most of, or making do with, whatever nature provided. Many traditional dishes from mountain villages, in Crete for example, are based on survival tactics and the art of foraging for food in the wild. The predominance of lamb, goat meat and poultry in Arab cuisine has more to do with the portability of the animals in question, and their ability to survive on meagre rations — an important factor among nomadic tribes — than it has to do with partiality of taste.

Seen altogether, Mediterranean cuisines are a colourful mix, vaguely connected when taken at face value, but, when viewed historically, as fractured and deeply divided as the region itself. It is in that sense alone, perhaps, that there can be said to be the merest shadow of a unified cuisine that is truly Mediterranean.

Corinne Vella. "The Myth of the Mediterranean Diet". Taste, November 2004.