Recent trends in diet and serum lipids level in Japan

Hirotsugu Ueshima MDProfessor and Chairman

Department of Health Science Shiga University of

Medical Science, Otsu, Japan

Learning objectives

To learn the uniqueness of the trends in mortality from cardiovascular disease in Japan

To learn the trends in fat intake and levels of serum cholesterol in Japan

To learn some unique features of diet style in Japan

0

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Stroke (M)Stroke (W)ICH (M)ICH (W)CI (M)CI (W)

(Year)

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180ra

te (

/100

,000

) HD(M)

HD(W)

AMI(M)

AMI(W)

HF(M)

HF(W)

(Year)

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200

100

0

JPN 

HK

USSR

NZSCOT

FRAN

SING

CHN

USAAUST

E&W

ITY

CAN

FIN

JPN

NZ

FRANSPN

USSR

CHN

SING

HK

USAAUST

CAN

FIN

ITY

SCOT

750

500

250

0

JPN

USSR

SPNFRAN

CHN

CAN

NOR SING

HK

NZ

SCOT

ITY

FINAUST

USA

240

160

80

0

E&W

USSR R KOREACHN

SPN

JPN

NZSCOTFIN

CAN

AUST

USA

400

300

200

100

0

MEN

0 50 100 150 200 250 300

ITA-FRl

GER-RHN

GER-RDM

SWE-GOT

POL-WAR

GER-HAC

GER-KMS

DEN-GLO

RUS-MOl

J PN-SHIGA

RUS-MOC

SWE-NSW

CHN-BEl

YUG-NOS

FIN-TUL

LTU-KAU

RUS-NOI

FIN-NKA

FIN-KUO

Incidence per 100,000 population.

WOMEN

0 50 100 150 200 250 300

GER-RHN

GER-RDM

ITA-FRl

POL-WAR

SWE-GOT

GER-HAC

DEN-GLO

RUS-MOl

GER-KMS

J PN-SHIGA

RUS-MOC

FIN-TUL

YUG-NOS

SWE-NSW

FIN-NKA

CHN-BEl

LTU-KAU

FIN-KUO

RUS-NOI

Incidence per 100,000 population.

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MEN

0 200 400 600 800 1000

J PN-SHIGACHN-BEI

SPA-CATSWI-VAFITA-FRIFRA-LILSWI-TIC

GER-EGEBEL-GHEAUS-PERYUG-NOSRUS-MOINEZ-AUCLTU-KAUCZE-CZEUSA-STADEN-GLO

ICE-ICEPOL-WARSWE-NSWCAN-HALUNK-BELFIN-KUO

Incidence per 100,000 population.

WOMEN

0 200 400 600 800 1000

J PN-SHIGASPA-CATCHN-BEIITA-FRIFRA-LIL

GER-EGEBEL-GHEYUG-NOSLTU-KAUCZE-CZE

SWE-GOTICE-ICE

AUS-PERRUS-MOI

SWE-NSWNEZ-AUCFIN-KUOCAN-HALUSA-STADEN-GLOPOL-WARUNK-BEL

Incidence per 100,000 population.

Click for larger picture Click for larger picture

5

4

3

2

1

00 150 200 250 300 350

Serum total cholesterol (mg/dl)

Konishi

NIPPON DATA80,14-year

Kodama

Kitamura

FukudaC

oro

nary

Heart

Dis

. (R

ela

tive R

isk)

MRFIT

100

NIPPON DATA80,Men NIPPON DAT 80 Women

NIPPON DATA 8019-year follow-upMen & Women

Slowing down of declining trend in mortality from ischemic heart disease in Tokyo and Osaka

Okayama A, et al. Am J Epidemiol, 2001.

Click for larger picture

3

3.5

4

4.5

5

5.5

6

1 2 3 4

3

3.5

4

4.5

5

5.5

6

1 2 3 4

Trends in Serum Total Cholesterol for Men Aged 40-59, Cohort Studies in Japan, 1966-1990

Urban Population Rural Population

Measurement term Measurement termOkayama, Ueshima, et al.J Clin Epidemiol,1995

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20 30 40 50 60 70 80

US 1960-62

US 1976-80

US 1988-91

JPN 1980

JPN 1990JPN 2000

Age

Tot

al C

hole

s ter

ol (

mg/

dl)

Changes in Energy Percent from Fat,Protein and Carbohydrate Intake per Capita

National Nutrition Survey in Japan, 1975-97

0

10

20

30

40

50

60

70

1975 1980 1985 1990 1995 1997

Per

cent

Carbohydrate

Protein

Fat22.3% 26.6%

57.4%

16.0%

63.1%

Fat Energy Percent per Capita per Day, Men, by Age Group in 1998, Japan, Excluding alcohol

energy, National Nutrition Survey

0

5

10

15

20

25

30

35

??? ??? ??? ??? ??? ??? ???

age

Ene

rgy

from

Fat

(%

)

15-19 20-29 30-39 40-49 50-59 60-69 70-

0

40

80

120

160

15-19 20-29 30-39 40-49 50-50 60-69 70-

Age

g/da

y/C

apita

Milk and Dairy Products

MeatsFish and Shellfish

50-59

Relationship Between Serum Total Cholesterol and 1.35(2S-P)

S:Saturated fatty acids P:Polyunsaturated fatty acids

Other SCSJapan, SCSJapan, 1970s,1985Intersalt II,JapanS

eru

m t

otal

ch

oles

tero

l

T-Cho BMI Diet.Fiber Keys Score (mg/dl) (kg/m2) (g)

Men 199.2 23.3 19.8 15.2

Women 192.6 22.0 20.5 14.9

Total 194.9 22.5 20.3 15.0

20-49Years, 3116Men and WomenNational Nutrition Survey, 1994

Change in BMI of Men, National Nutrition Survey in Japan

21

22

23

24

30-30 40-49 50-59 60-69 70-

Bod

y M

ass

Inde

x

198019902000

210

220

230

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250

Start 2 Mon. 4 Mon. 6 Mon.

Ser

um

tot

al c

hol

este

rol (

mg/

dl)

Lifestylemodi.

Control

P<0.056 Mon. later8mg/dl diff.

Reduction of serum total cholesterol by lifestyle modification 197 hypercholesterolemia, Randomized controlled study

Ueshima H, Okayama A. Education for cholesterol lowering, Hoken Dojin

Change in Daily Salt Consumption per Capita

in Japan, National Nutrition Survey, 1975-1997

11.0

11.5

12.0

12.5

13.0

13.5

14.0

1975 1980 1985 1990 1995 1997

(g)

Trend in Alcohol Consumption per Adult per Year in Japan

National Report on Alcohol Tax Statistics 1963-1995

0

2

4

6

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1963 1965 1970 1975 1980 1985 1990 1995

5.6 8.3

(L/year)

INTERLIPIDObjective

To explore differences in lipid levels and other cardiovascular risk factors between Japanese individuals Living in Japan and in the United States

Presented by Curb D, Ueshima H, et al. in 5th ICPC, Osaka 2001

Summary (1)

3. Fat intake increased in Japan and the proportion of

fat in the diet in young generation became 30 %.

4. Serum total cholesterol level increased during 1980-

90 but did not change in the past 10 years. This is e

xplained by slowdown of the increase in fat intake.

5. The difference in serum total cholesterol level betwe

en the USA and Japan became 5-10mg/dl in age 30-

40 years. In contrast, there was still large differenc

e in that of the elderly people.

Summary (2)

5. The large difference in coronary heart disease

between Japan and the USA is explained in

part by the difference in serum total

cholesterol level.

6. Other risk factors including HDL-cholesterol,

fibrinogen, and alcohol and fish intake may

also contribute to the difference in coronary

heart disease between the USA and Japan.