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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te (
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0,0
00
)
Stroke (M)Stroke (W)ICH (M)ICH (W)CI (M)CI (W)
(Year)
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20
40
60
80
100
120
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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.
Click for larger picture Click for larger picture
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
160
170
180
190
200
210
220
230
240
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
240
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
8
10
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.