Albanian paradox, another example of protective effect of Mediterranean lifestyle?

Low mortality in Mediterranean populations has stimulated much interest, a possible explanation being diet. We have analysed data from Albania, the poorest country in Europe, to see if they corroborate findings from elsewhere in the region.

Data on mortality routinely collected in Albania, corrected for incompleteness, were analysed. Demographic and food consumption data from United Nations agency sources were used to identify potential explanations for the mortality pattern.

Consistent with its economic situation, Albania has one of the highest infant mortality rates in Europe (45.4 per 1000 live births for males and 38.0 for females in 1990). By contrast, adult mortality, including mortality from cardiovascular diseases, is similar to that in other Mediterranean countries. For example, age-standardised mortality for coronary heart disease in males aged 0-64 was 41 per 100,000 in Albania in 1990, less than half the rate in the UK but similar to that in Italy. Analysis of the geographical distribution of mortality within Albania (1978) showed that mortality was lowest in the southwest where most of the olive oil, fruits, and vegetables are produced and consumed.

This paradox of high adult life expectancy in very-low-income country can be most plausibly explained by diet--namely, low consumption of total energy, meat, and milk products but high consumption of fruit, vegetables, and carbohydrates. If this hypothesis is confirmed by future research, Albanian experience can contribute to formulation of preventive policy in high mortality countries.