After the French paradox comes the Italian enigmaBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7474.1064-c (Published 04 November 2004) Cite this as: BMJ 2004;329:1064
Frequent consumers of Italian pizza had less than half the risk of an acute myocardial infarction compared with those eating pizza only occasionally, says a research article in the European Journal of Clinical Nutrition (2004:58;1543-6). Even those who ate fewer than four portions a month seemed to gain some protection.
The hospital based, case-control study in Milan was based on 507 cases aged 25 to 79 with a first episode of non-fatal acute myocardial infarction and 478 controls admitted for conditions unrelated to heart attack. All those taking part were questioned about their lifestyle, including how much pizza they ate. Pizza eaters were classed as occasional (one to three 200 g portions a month), regular (more than one a week), and frequent (two or more a week).
The results show that the greater the consumption of pizza, the lower the risk of heart attack (odds ratio 0.78, occasional eaters; 0.62 regular; and 0.44 frequent).
Just how pizza could be protective is not clear. The authors took into account a wide range of potential confounders, but these did not explain the link.
The authors say the finding may be a marker for the Italian diet, which has been linked to cardiovascular benefits. Yet when they allowed for the Mediterranean diet in the calculations, the odds ratios did not materially change. Pizza may also be an indicator of a diverse diet, but after adjusting for variety, the odds ratio for regular eaters of pizza did not change.
The authors point out that in Italy most pizza is usually consumed in traditional pizzerias and that consumption of “fast food” pizza is unusual. The average energy of a standard pizza in Italy is relatively low (2.09-3.34 MJ (500-800 kcal)), and 100 g of a traditional Italian pizza has about 50g of carbohydrates, 20 g of tomato sauce, 20 g of mozzarella cheese, 4 g of olive oil, and 2 g of yeast.
“Some of the ingredients of pizza have been shown to have a favourable influence on the risk of cardiovascular disease. However, there is no single explanation for the present findings,” say the authors.