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 ScienceMedical 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

3. (Year)

5. 300 200 100 0 JP N HK USSR NZ SCOT FRA N SING CHN USA AUS T E&W ITY CA N FI N

6. JP N NZ FRAN SP N USSR CHN SING HKHK US A AUS T CAN FI N ITY SCOT 75 0 50 0 25 0 0

7. JPN USSR SP N FRAN CHN CAN NOR SIN G HKHK NZ SCOT ITY FI N AUS T USA 240 160 80 0

8. E&W USSR R KOREA CHN SP N JPN NZ SCOT FI N CA N AUST US A 400 300 200 100 0

9. Click for larger picture

11. 5 4 3 2 1 0 0 150200 250 300 350 Serum total cholesterol (mg/dl) Konishi NIPPON DATA80,14-year Kodama Kitamura Fukuda Coronary Heart Dis. (Relative Risk) MRFIT 100 NIPPON DATA80,Men NIPPON DAT 80 Women NIPPON DATA 80 19-year follow-up Men & Women

12. 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

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

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

15. 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 197519801985199019951997 Percent Carbohydrate Protein Fat 22.3% 26.6% 57.4% 16.0% 63.1%

16. Fat Energy Percent per Capita per Day, Men, by Age Group in 1998, Japan, Excluding alcohol energy, National Nutrition Survey 15-1920-2930-3940-4950-5960-6970-

17. 50-59

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

19. T-Cho BMI Diet.Fiber Keys Score (mg/dl) (kg/m 2 ) (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 Women National Nutrition Survey, 1994

20. Change in BMI of Men, National Nutrition Survey in Japan

21. P<0.05 6 Mon. later 8mg/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

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) 1.Fat intake increased in Japan and the proportion of fat in the diet in young generation became 30 %. 2.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. 3.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) 4.The large difference in coronary heart disease between Japan and the USA is explained in part by the difference in serum total cholesterol level. 5.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.