Date Published: April 26, 2017
Publisher: Public Library of Science
Author(s): Akiko Nanri, Tetsuya Mizoue, Taichi Shimazu, Junko Ishihara, Ribeka Takachi, Mitsuhiko Noda, Hiroyasu Iso, Shizuka Sasazuki, Norie Sawada, Shoichiro Tsugane, Hajo Zeeb.
A meta-analysis showed an inverse association of a prudent/healthy dietary pattern with all-cause mortality and no association of a western/unhealthy dietary pattern. However, the association of distinctive dietary patterns of Japanese population with mortality remains unclear. We prospectively investigated the association between dietary patterns and all-cause, cancer, and cardiovascular disease mortality among Japanese adults.
Participants were 36,737 men and 44,983 women aged 45–74 years who participated in the second survey of the Japan Public Health Center-based Prospective Study (1995–1998) and who had no history of serious disease. Dietary patterns were derived from principal component analysis of the consumption of 134 food and beverage items ascertained by a food frequency questionnaire. Hazard ratios of death from the second survey to December 2012 were estimated using cox proportional hazard regression analysis.
A prudent dietary pattern, which was characterized by high intake of vegetables, fruit, soy products, potatoes, seaweed, mushrooms, and fish, was significantly associated with decreased risk of all-cause and cardiovascular disease mortality. The multivariable-adjusted hazard ratios (95% confidence intervals) of all-cause and cardiovascular disease mortality for the highest versus lowest quartile of the prudent dietary pattern score were 0.82 (0.77 to 0.86) and 0.72 (0.64 to 0.79), respectively (P for trend <0.001 in both). A Westernized dietary pattern, characterized by high intake of meat, processed meat, bread, and dairy products, was also inversely associated with risk of all-cause, cancer, and cardiovascular disease mortality. A traditional Japanese dietary pattern was not associated with these risks. The prudent and Westernized dietary patterns were associated with a decreased risk of all-cause and cardiovascular disease mortality in Japanese adults.
Japanese life expectancy began to increase rapidly in the 1950s and has now become among the highest in the world . Socioeconomic status, cultural background, and the Japanese diet might have contributed to Japanese population health . Japanese food has a balanced nutritional profile, and the diet of the Japanese population has changed with economic development. For example, consumption of total fat (especially animal fat), animal protein, and calcium has increased with accompanying increases in consumption of meat and poultry and milk and dairy products . The increase in the intake of these foods and nutrients after war achieved a peak in the 1970s . The modern Japanese diet, which is somewhat westernized while maintaining aspects of the traditional diet, including regular consumption of fish and soy products, may have a beneficial effect on health.
Characteristics of subjects according to quartile of dietary pattern score are shown in Table 1. The percentage of women was 55.0% in all diet categories because participants were divided into quartiles of dietary pattern score based on the separate distributions for men and women. Participants with higher score of the prudent dietary pattern were older, more likely to report histories of hypertension and diabetes, and less likely to be smokers than those with lower scores. Participants with higher score of the Westernized dietary pattern were younger and more likely to report lower levels of total physical activity. BMI was positively associated with the Westernized dietary pattern, whereas it was inversely associated with the traditional Japanese dietary pattern.
In this large-scale, population-based, prospective study among Japanese men and women, the prudent dietary pattern, which was characterized by a high intake of vegetables, fruits, soy products, potatoes, seaweed, mushrooms, and fish, albeit a high intake of salt, was significantly associated with a decreased risk of all-cause, CVD, heart disease, and cerebrovascular disease mortality. The Westernized dietary pattern, which was characterized by a high intake of meat, processed meat, bread, dairy products, coffee, black tea, soft drink, dressing, sauce, and mayonnaise but a low intake of salt, was also inversely associated with the risk of all or cause-specific mortality. The traditional Japanese dietary pattern was not associated with the risk of any type of mortality. To our knowledge, this is first study to inclusively examine the association between dietary pattern and all-cause and major cause-specific mortality in Japanese adults.