which can protect us from getting the diseases over a long period of time
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Coronary artery disease (CAD), ischemic stroke, diabetes, and some specific cancers, which until recently were common only in high-income countries, are now becoming the dominant sources of morbidity and mortality worldwide (WHO 2002). In addition, rates of cancers and cardiovascular disease (CVD) among migrants from low-risk to high-risk countries almost always increase dramatically. In traditional African societies, for example, CAD is virtually nonexistent, but rates among African Americans are similar to those among Caucasian Americans. These striking changes in rates within countries over time and among migrating populations indicate that the primary determinants of these diseases are not genetic but environmental factors, including diet and lifestyle. Thus, considerable research has been aimed at identifying modifiable determinants of chronic diseases.
Prospective epidemiological studies, some randomized prevention trials, and many short-term studies of intermediate endpoints such as blood pressure and lipids have revealed a good deal about the specific dietary and lifestyle determinants of major chronic diseases. Most of these studies have been conducted in Western countries, in part because of the historical importance of these diseases in the West, but also because they have the most developed research infrastructure. A general conclusion is that reducing identified, modifiable dietary and lifestyle risk factors could prevent most cases of CAD, stroke, diabetes, and many cancers among high-income populations (Willett 2002). These findings are profoundly important, because they indicate that these diseases are not inevitable consequences of a modern society. Furthermore, low rates of these diseases can be attained without drugs or expensive medical facilities, an outcome that is not surprising, because their rates have historically been extremely low in developing countries with few medical facilities. However, preventing these diseases will require changes in behaviors related to smoking, physical activity, and diet; investments in education, food policies, and urban physical infrastructure are needed to support and encourage these changes (see box 44.1).