Recent trends in diet and serum lipids level in Japan

1. Recent trends in diet and serum lipids level in Japan Hirotsugu Ueshima MD Professor and Chairman Department of Health Science Shiga University of Medical Science, Otsu, Japan

2. 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

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5. 300 AUST SCOT USA NZ FIN 200 E&W USSR SING 100 CHN JPN CAN FRAN HK ITY 0

6. 750 FIN USA AUST SCOT NZ CAN 500 SING USSR 250 ITY SPN FRAN JPN HK CHN 0

7. 240 JPN USSR CHN SCOT 160 AUST FIN NZ USA ITY SPN NOR SING FRAN 80 HK CAN 0

8. 400 300 R KOREA USSR CHN 200 FIN SCOT AUST SPN NZ E&W USA CAN 100 JPN 0

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11. Kodama Fukuda 5 Konishi Kitamura MRFIT NIPPON DATA80,14-year 4 NIPPON DATA80,Men NIPPON DAT 80 Women 3 Coronary Heart Dis. (Relative Risk) 2 NIPPON DATA 80 19-year follow-up Men & Women 1 0 0 1 0 0 150 20 0 30 0 2 50 3 50 Serum total cholesterol (mg/dl)

12. Slowing down of declining trend in mortality from ischemic heart disease in Tokyo and Osaka Click for larger picture Okayama A, et al. Am J Epidemiol, 2001.

13. Trends in Serum Total Cholesterol for Men Aged 40-59, Cohort Studies in Japan, 1966-1990 Urban Population Rural Population Measurement term Measurement term Okayama, Ueshima, et al.J Clin Epidemiol,1995

14. US 1960-62 US 1976-80 US 1988-91 Total Cholesterol (mg/dl) JPN 2000 JPN 1990 JPN 1980 Age

15. Changes in Energy Percent from Fat, Protein and Carbohydrate Intake per Capita National Nutrition Survey in Japan, 1975-97 70 57.4% 60 63.1% Carbohydrate 50 Percent 40 Fat 26.6% 22.3% 30 20 10 16.0% Protein 0 1975 1980 1985 1990 1995 1997

16. Fat Energy Percent per Capita per Day, Men, by Age Group in 1998, Japan, Excluding alcohol energy, National Nutrition Survey 15-19 20-29 30-39 40-49 50-59 60-69 70-

17. 50-59

18. Relationship Between Serum Total Cholesterol and 1.35(2S-P) Serum total cholesterol Other SCS Japan, SCS Japan, 1970s,1985 Intersalt II,Japan S:Saturated fatty acids P:Polyunsaturated fatty acids

19. 20-49Years, 3116Men and Women National Nutrition Survey, 1994 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. Change in BMI of Men, National Nutrition Survey in Japan

21. Reduction of serum total cholesterol by lifestyle modification 197 hypercholesterolemia, Randomized controlled study 6 Mon. later 8mg/dl diff. P<0.05 Ueshima H, Okayama A. Education for cholesterol lowering, Hoken Dojin

22. Change in Daily Salt Consumption per Capita in Japan, National Nutrition Survey, 1975-1997

23. Trend in Alcohol Consumption per Adult per Year in Japan National Report on Alcohol Tax Statistics 1963-1995 (L/year)

24. INTERLIPID Objective 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

25. Summary (1) • Fat intake increased in Japan and the proportion of fat in the diet in young generation became 30 %. • Serum total cholesterol level increased during 1980-90 but did not change in the past 10 years. This is explained by slowdown of the increase in fat intake. • The difference in serum total cholesterol level between the USA and Japan became 5-10mg/dl in age 30-40 years. In contrast, there was still large difference in that of the elderly people.

26. Summary (2) • The large difference in coronary heart disease between Japan and the USA is explained in part by the difference in serum total cholesterol level. • 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.