summARY An examination was made of the statistical correlations between the main foodstuff and nutrient intakes and the chief causes of mortality in 20 different countries, comprising 17 in Europe, and Canada, USA, and Japan. Subsidiary examinations were made of the effects of including and excluding Japan, and of the effects of various statistical standardisation procedures. Complex food patterns were identified and related both to geographical latitude and to levels of affluence; these, in turn, were related to complex patterns of mortality. Criteria for drawing special attention to specific associations were identified, based partly on statistical significance tests and also on strength-of-association yardsticks supplied by diseases with known causes. Findings suggesting causal interpretations were: (a) alcohol intakes and cirrhosis of the liver, cancer of the mouth, and cancer of the larynx; (b) total fat intakes and multiple sclerosis, cancer of the large intestine, and cancer of the breast; and (c) beer and cancer of the rectum.International variations in the incidence of illness provide striking epidemiological characteristics of many diseases. Examples are: the relative rarity of anencephalus in France compared with England, the high incidence of carcinoma of the breast in North America compared with Japan, the temperate zone distribution of multiple sclerosis, the high incidence of ischaemic heart disease and of carcinoma of the large intestine in Europe compared with Africa.Transfers of complex living patterns from one country to another-for example, from Europe to the emerging middle classes of developing African and Asian countries-have been followed by the disease patterns of the donor country, and studies of migrants have in other cases demonstrated their progressive acquisition of the disease patterns of the new domicile. Studies have implicated environmental rather than (purely) racial and genetic factors and the dietary component of the changed culture reasonably excites suspicion.A wide range of geographical associations between specified food and nutrient intakes and disease incidences continue to be reported, but the complexities of both disease and dietary patterns, each with its own set of internal correlation, and each with a set of associations with non-dietary components of life-style, make critical interpretation a formidable task. Certainly, the arbitrary selection of any single food/disease pair, and its examination for a positive or negative association across a range of different countries or different times, can scarcely do justice to the complexity of the background from which the particular example was picked. It would seem necessary, at least, to examine a range of foodstuffs and a range of diseases besides the ones in question. This study is an investigation in this sense and is based upon the availability of two sets of international data from a common range of countries, which do not seem previously to have been associated in a systematic
