DIET AND NUTRITION.

The European diet in the early twentieth century can be divided into four main regional types—northern, central, eastern, and southern—each based on a distinctive pattern of agricultural production and trade. Northern and southern Europe represent the extremes, the former distinguished by a high average consumption per head of animal foods, fats, and sugar and the latter by a heavy dependence on plant foods—cereals, fruits, vegetables, and olive oil—with small usage of meat and dairy products. The four regional patterns are differentiated in Table 1.

THE CHRONOLOGY OF CHANGE

European diets in the twentieth century have been shaped by environmental factors but also, increasingly, by socioeconomic factors. Although

traditional foods continue to be important, food patterns have become increasingly more diverse while at the same time tending to converge regionally and across income groups. The key determinants of dietary change have been, first and foremost, rising real income associated with a demand for quality, variety, convenience, and built-in services. Food availability per head has grown in line with rising agricultural production and trade, and with increased output of processed and preserved foods. Dietary change is closely correlated with social change (urbanization, smaller families, and more working women); with heightened consumer awareness of the relationship between food and health; with the demand for food services; with changes in food retailing; and with the globalization of the food industries. Kitchen routines have been revolutionized by technical change in the form of cast iron stoves (from the later nineteenth century), refrigerators and freezers (after World War II), and more recently the microwave oven.

Since 1914 European food patterns have undergone a succession of changes, beginning in the northern industrialized countries and spreading after World War II to the less developed regions. The period between the wars was one of marked contrasts. Diets in northern Europe became more varied, with fewer cereals and more animal foods, imported tropical and Mediterranean produce, and processed foods. Most households in eastern and southern Europe, meanwhile, were increasing their consumption of starchy foods. Many suffered severe shortages in the 1930s, when upward of one-quarter of the peasant population of east and southeast Europe is estimated to have been seriously undernourished. In many Romanian homes, the typical diet consisted almost entirely of corn polenta, with very little bread, meat, or milk, and as a result vitamin-related diseases, such as pellagra, were prevalent. As late as the 1950s, many peasants in central Greece and the Greek islands struggled to fill the "hungry gap" that came after their stocks of grain had been exhausted in early spring and before the threshing out of the next harvest at midsummer.

With the end of rationing in the early 1950s, food supplies soon recovered to prewar levels and in most countries, except in the laggard Eastern Bloc, by the end of the decade had comfortably exceeded them. Driven by rising incomes, new food products, and the vigorous promotional campaigns of food manufacturers, traditional consumption patterns began to break down. Changes within food categories were often more socially and dietetically significant than changes between categories. Cereal consumption per head was declining at the same time as wheat was displacing corn (maize) and rye as the principle bread grains in central and eastern Europe and in parts of the Mediterranean, and ready-to eat cereals were replacing cooked meats and bread as breakfast foods in the northern countries. In Britain, consumers increasingly preferred wholegrain and multigrain breads, which they had given up in the eighteenth century, to white bread. Bread and potatoes were giving ground to rice and pasta. Important shifts occurred also within the animal foods category, from beef and sheep meat to pork and poultry, and in dairy products from whole milk and butter to low-fat milk, flavored milks, chilled desserts, and cheese. The American milk bar (soda fountain), after a promising debut in Britain in the 1930s, made little progress in the postwar period.

By the beginning of the twenty-first century, total calorie consumption was generally higher than in the prewar period, the most impressive advances having been made in southern and eastern Europe, where it approached or exceeded the European Union (EU) 15-member country average of 3,500 calories. In northern Europe it had leveled off. Per capita cereal consumption continued to decline but in the Mediterranean remained

significantly above the EU average of 1,085 calories. Consumption of animal foods grew rapidly up to the 1970s, after which its growth began to slow or in some places decline. Eastern Europe registered a sharp downturn in animal protein intake in the early 1990s in the aftermath of the collapse of the former Communist regimes. Most Mediterranean countries saw gains of 80 percent to 100 percent or more between 1962 and 2002. The consumption of milk products has moved erratically but in most countries far exceeds prewar levels. Fruit and vegetable consumption has risen but is still substantially lower in northern and eastern than in southern Europe. In the north, exotic fruits such as bananas, citrus fruit, and peaches are increasingly preferred to indigenous fruits. The southern hemisphere supplies large quantities of fresh fruits and vegetables during the winter. Table 2 shows the main dietary trends in selected countries across the northern, southern, and eastern regions.

IMPACT OF FACTORY FOODS

Arguably, the outstanding feature of the postwar diet has been a huge increase in the consumption and variety of proprietary branded foods. Indeed, the overwhelming majority of food items on sale in the large modern supermarkets of the early twenty-first century did not exist in 1914. An estimated ten thousand new grocery items, packaged and branded, are introduced each year in Britain, of which 90 percent are withdrawn within two years. These include growing numbers of so-called socially engineered or niche foods, designed to meet the specific needs of groups of consumers identified by market research. In the early postwar years, the pace was set first by canned foods, then by fast frozen foods, and since 1990 chilled, ready-to-eat meals. Although slow to take hold in southern and eastern Europe, sales of processed foods are accelerating there due to growing affluence and the spread of supermarket. At the turn of the twenty-first century large sections of the European food industry are controlled by North American multinational firms, which, since World War II, have been a seminal force in the reshaping of European eating habits.

Since 1970 a rising share of food budgets has been expended on catered meals and takeaway foods, including fast foods. The first McDonalds restaurant in West Germany opened in 1973, in Britain in 1973, and in the former East Germany in 1990. McDonalds had four hundred outlets in Germany in 1992 and one thousand in 2003; in the same period, Russia went from fewer than ten McDonalds to more than eighty. McDonalds, Pizza Hut, Kentucky Fried Chicken, and Burger King, all American owned, are the largest restaurant chains. Starbucks, the first of the new-style coffee shops, opened branches in central Europe in 2002. Since the 1970s, foreign foods—of North and Central American, Mediterranean, and Far Eastern origin—modified to suit local tastes, have come to occupy an established position in European diets and now seriously challenge native cuisines. Chicken tikka masala, an Indian-style dish specially tailored for the British market, has replaced the traditional roast or steak and chips as the nation's favorite food.

Diversification and convergence are dominant themes in modern food history. Although under threat, customary foods and food habits still form the basis of most culinary regimes. Thus meals are social events in Spain, Italy, and Portugal; Portugal and Greece prefer light meals, but Sweden, Belgium, and Germany prefer heavy. Attitudes toward fast foods vary, with France and particularly Italy fighting vigorous rearguard actions in defense of traditional cooking. Research confirms, however, a growing similarity in consumption patterns across Europe, especially among younger consumers.

FOOD AND HEALTH

Although Europeans may be eating enough to satisfy their physiological requirements, it is an open question whether the right foods in the correct quantities are being eaten. Since the 1950s, evidence has been steadily mounting of a causal link between diseases such as diabetes, cancer, and cardiovascular problems and foods such as refined carbohydrates and unsaturated fats. Highly processed foods, together with fast foods, are believed to constitute a particular risk.

In 1950 coronary heart disease was primarily a disease of men in the affluent classes; in the early twenty-first century it affects all classes, including the younger age groups and particularly low-income groups. Western degenerative diseases are shown to be closely correlated with high levels of blood cholesterol, a deficiency of essential fatty acids, and excessive sodium. Refined sugars, highly refined white flour, hydrogenated vegetable oils, and synthetic food additives are also identified as potential risks. Low-fiber diets are believed to be a causative factor in the development of colon cancer, diabetes, and peptic ulcers and are believed to inhibit the absorption of proteins and fats.

The three basic classes of nutrient—carbohydrates, proteins, and fats—and their role in building and repairing the body and as sources of dietary energy were discovered by German physiologists in the mid-nineteenth century. After 1900 it was recognized that they were necessary but not sufficient to maintain bodily health. Between 1915 and 1925, British and American scientists identified many of the key vitamins but not as yet their precise functions or methods of action. By the 1930s, dairy products, eggs, cod liver oil, and seeds had been identified as rich sources of vitamin A, which was essential for the growth of children, and fresh vegetables had been identified as accessible sources of vitamin C. White flour was understood to be deficient in vitamin B and because vitamin C was destroyed by heating it was understood to be absent from most dried and canned foods. Research revealed important differences in the biological value of plant and animal protein, depending on the presence of certain classes of amino acids.

By 1939 the relationship of food and health to income could be explored scientifically. The two world wars were a perfect laboratory for nutritionists, allowing them to observe the effects of food shortages and rationing schemes on the general population. In World War I, for example, Denmark responded to the Allied blockade with a prescribed diet of vegetables, wholegrain bread, and milk products, with little or no meat or spirits, which is claimed to have resulted in a dramatic fall in death rates. World War II saw scientific research applied in the construction of national feeding programs. Britain, it was said, was never so well fed, nutritionally speaking, as during rationing.

The search for the perfect diet—one that would meet philosophical and religious as well as nutritional needs—predated the discovery of vitamins. Aversion to animal foods, especially meat, spawned a clutch of vegetarian and cereal-based diets, along with "nature cures," such as that designed by Dr. Max Bircher-Brenner at Zurich soon after 1900, which consisted of raw fruit and vegetables. Slimming diets and slimming foods, such as rye biscuits, were first formulated in the 1920s. In the same decade, organically grown foodstuffs were promoted as healthy and spiritually uplifting alternatives to foodstuffs grown by modern scientific methods. In the 1930s, health food shops selling herbal remedies and dietary supplements could be found in most major towns and cities across Europe. By this stage, scientific eating, in the form of patent preparations such as breakfast cereals, "natural" foods such as salad and nuts, and the "milk and greenstuffs" diet promoted by the American biochemist and discoverer of vitamin A Elmer McCollum had an enthusiastic following among a section of the educated middle classes. Spinach was for a time much acclaimed as an energy food on the spurious grounds that it was up to ten times richer in iron than any other green vegetable. By the 1950s, most countries were providing school-children with free or subsidized milk, and specific regimens and supplements were prescribed for expectant and nursing mothers and the aged.

The postwar period saw the formulation of countless dietary regimes addressing a wide range of medical conditions, including eating disorders and behavioral problems. Of these, the most celebrated was the so-called Mediterranean diet, which was high in fruit, vegetables, nuts, seeds, grains, and olive oil and relatively low in meat, dairy products, and animal fats. This became famous as a result of the Seven Nations Study published in 1970 by Ancel Keys. A long-term study of eleven countries, it confirmed that elderly people who followed it and who kept active and didn't smoke lived longer than those who did not. The high-protein Atkins diet, designed for weight watchers, continued to provoke controversy in the early twenty-first century. Low carbohydrate–high protein diets date from the 1950s but were criticized as deficient in vitamin B and liable to cause acidity. The marketplace became increasingly congested with proprietary dietary programs supported by a plethora of confusing scientific advice. Health concerns have been a factor in the falling consumption of sugar, saturated fats (especially lard and butter), and some refined carbohydrates and in the growing popularity of low-fat dairy products, high-fiber foods, complex carbohydrates, wine (promoted as a potent source of anti-oxidants), and specialized "functional" foods fortified with specific nutrients and trace elements, claiming to deliver health benefits above and beyond those normally supplied.

Whereas in the early postwar years the World Health Organization was concerned mainly with undernourishment, by the turn of the new century it had identified obesity as a serious late-twentieth-century disorder, affecting particularly the developed countries, where in many cases more than half the population is classified as overweight and up to one-quarter as clinically obese. The highest levels occur in northwest and central Europe, with the largest proportion of obese children in the seven-to-eleven age group being found in Spain, Italy, and Greece, where diets have moved dramatically away from the traditional Mediterranean model since 1980. By 2030 an estimated thirty million Europeans will require treatment for diabetes and other weight-related diseases. Better diets, the World Health Organization contends, could prevent 30 percent to 40 percent of cancer cases in Europe.

FOOD SAFETY

Deteriorating standards of food safety have also been a matter of growing concern. After almost a century of steady improvement, by 1960 most foodstuffs on sale were pure and unadulterated within the terms of the regulatory guidelines, bovine tuberculosis had been largely eliminated, and microbial food-borne diseases, although an ever-present threat, seemed to be under control. Subsequently, a sharp rise occurred in reported incidents of salmonella and campylobacter (the most common infections, found mainly in animal products, especially poultry), listeriosis (associated with uncooked meat, raw milk, and soft cheeses), and on a small scale clostridium botulinum. A new disease, variant Creutzfeldt-Jakob disease (CJD), linked to Bovine Spongiform Encephalopathy (BSE) in cattle, was first reported in Britain in 1996. By mid-2001, ninety-nine cases had been confirmed in Britain, three in France, and one in Ireland. Other food safety concerns include pesticide residues, food irradiation, chemical additives, and genetically modified foods.

The growth in reported food-linked infections is attributed to the extreme length and complexity of the modern food chain and to catered meals and industrially processed foods, especially meat and milk products. Poor culinary hygiene in handling frozen and reheated foods is a particular problem in low-income households that may be unable to afford hygienic aids, may lack clean hot water, and may have limited knowledge of food risks.

See alsoAgriculture; Alcohol; Consumption; Public Health; Rationing.

BIBLIOGRAPHY

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Ted Collins