Full Report - Food, Nutrition, and the Prevention of Cancer

CHAPTER 4 • FOODS AND DRINKS
to that seen in low-income countries. Intakes are highest in
some parts of Africa, the Middle East, southern Europe, and
Oceania, and lowest in other parts of Africa and Asia. Fruit
consumption also tends to be low in north-eastern Europe.
Intakes range from as much as 20 per cent of daily energy
in parts of Africa to as little as 0.5 per cent in parts of Asia.
The availability of fruit has increased globally in recent
decades, although there was a slight decrease in the 1990s.
Most countries have national recommendations for the
daily amount of vegetables and fruits that need to be eaten
to maintain optimal health (Chapter 10). These vary, but
they tend to recommend three or more servings per day of
vegetables and two or more servings per day of fruits; a serving
is about 80 g (or half a US cup). In most high-income
countries for which data were available, daily consumption
of vegetables fell short of this target, although this is not due
to lack of availability; indeed, availability is high due to the
wide use of refrigeration. Fruit consumption tended to be
closer to national targets. Seasonal availability influences
overall availability, although less so in high-income countries
where vegetables and fruits are more likely to be imported.
Pulses (legumes)
Globally, pulses supply 2 per cent of total energy intake
(based on availability) and 3.5 per cent of daily protein
intake. 17 The highest availability is in parts of Africa, South
America, Asia, and the Middle East. In these areas, pulses
are a dietary staple, and can account for as much as 20 per
cent of daily energy intake and 50 per cent of protein intake.
In societies with high intakes of meat and other foods of animal
origin, pulses are less important in diets, and are usually
consumed infrequently or in small amounts. Peanuts and
soya beans account for most of the legume products eaten
around the world.
Soya bean availability per person represents 0.5 per cent
of daily energy intake globally, but it is notably high in parts
of Asia, and higher than average in parts of Africa and
Central America. In parts of Asia, soya beans account for up
to 4.9 per cent of daily energy availability and 15 per cent
of protein.
Pulses are eaten in a variety of ways around the world; for
instance, Japanese and Chinese bean curd (tofu), Chinese
mung bean sprouts, Mexican chilli and refried beans, Indian
dahl, Middle Eastern falafel and hummus, Indonesian cultured
soya bean cakes (tempeh), Cuban black beans and rice,
Boston baked beans, French cassoulet, Brazilian feijoada,
Swedish pea soup, and US peanut butter. Soya beans are particularly
versatile and their products are a common feature
in manufactured foods, although they are not commonly
eaten whole. Soya foods include soya drinks and flour, tofu,
tempeh, textured vegetable protein, and the many products
that can be prepared from these foods. Fermented soya beans
produce soy sauce and miso. Soya bean oil is also used widely
(see chapter 4.5.3).
Nuts and seeds
Nuts and seeds were an important part of human diets before
the advent of agriculture and they remain locally important
in a few areas. Globally, tree nuts supply 0.4 per cent of daily
energy availability. The highest availability is in the Middle
East and parts of Europe, and the lowest is in South America
and parts of Africa; intakes range from 3 per cent of total
energy in parts of the Middle East to virtually zero in many
low-income countries.
Coconuts represent 0.5 per cent of daily energy availability
globally, although coconuts can be locally important in
tropical islands, for instance in parts of Oceania, Asia (Sri
Lanka and Indonesia), the Caribbean, and in the African
islands. In parts of Oceania, for example, coconuts provide
as much as 20 per cent of energy in the diet.
Sunflower, rape, mustard, and sesame seeds together supply
0.2 per cent of daily energy intake globally. There are
fewer data available for seeds than for many other foods,
although sesame seed intake is relatively high in parts of
Africa and Asia, providing a maximum of 3.9 per cent of
energy in parts of central Africa. Oils from seed crops are
widely used (see chapter 4.5.3).
Herbs, spices, and condiments
Although spices are consumed in small amounts to flavour
food, they are such a regular feature of some diets that they
account for a measurable quantity of daily energy intake.
Worldwide, spices provide 0.3 per cent of available dietary
energy and in parts of Asia they constitute as much as 1.8
per cent. Herbs and spices tend to be part of the traditional
diet in the areas from which they originate, and many traditional
cuisines are characterised by the use of herbs, spices,
and condiments. Most are now available worldwide,
although their use still varies greatly in different parts of the
world. Many herbs and spices are believed to have medicinal
or tonic value and have been used in this way at least
since the times of the earliest medical records. Many modern
pharmaceuticals are derived from herbs and other plants.
Many herbs and some spices are biologically very potent:
the modern pharmacopoeia lists drugs, many of which have
been isolated from herbs, sometimes known as ‘plants with
healing powers’. There are some in vivo experimental data
for potentially beneficial effects in the cases of turmeric, saffron,
ginger, pepper, garam masala (a herb and spice mix),
and also eugenol and myristin, constituents of a number of
herbs and spices.
Conversely, it is at least theoretically possible that some
condiments have adverse effects. Two examples are hot chilli
juices and harissa, a fiery condiment; both are consumed in
substantial quantities in Mexico and the Mahgreb countries
of North Africa, respectively, and both irritate the mouth and
throat.
4.2.4 Interpretation of the evidence
4.2.4.1 General
For general considerations that may affect interpretation of
the evidence, see chapter 3.3 and 3.5, and boxes 3.1, 3.2,
3.6 and 3.7.
‘Relative risk’ (RR) is used in this Report to denote ratio
measures of effect, including ‘risk ratios’, ‘rate ratios’, ‘hazard
ratios’, and ‘odds ratios’.
81