Recent Trends in Cardiovascular Disease and Risk Factors in the Seven Countries Study: Japan
Rapid socioeconomic developments in Japan since the beginning of the Seven Countries Study in 1958 have brought remarkable changes in lifestyles and dietary patterns. Time trends in nutrient intake, risk factors, and cardiovascular disease (CVD) mortality and morbidity have been monitored in men aged 40–64 in a Japanese cohort of the Seven Countries Study, in Tanushimaru, a typical farming town on Kyushu Island.
The total daily calorie intake decreased from 2837 Kcal in 1958 to 2228 Kcal in 1968, and remained stable thereafter. The carbohydrate intake in percentage of total daily calories decreased markedly, from 78.1% in 1958 to 60.6% in 1989, in contrast to large increases during this period in protein intake (from 10.9% to 15.6%) and fat intake (from 5.3% to 21.6%).
The mean serum cholesterol level was 150 ± 41 mg/dl in 1958 (Keys method), and rapidly increased to 161 ± 32 in 1977 and to 188 ± 37 mg/dl in 1989 (enzymatic method). The frequency of overweight (body mass index exceeding 26) was 8% in 1958, and gradually increased to 11% in 1977 and to 18% in 1989. The frequency of diastolic hypertension (>95 mmHg) gradually increased from 8% in 1958 to 20% in 1982, and then declined to 13% in 1989. The frequency of isolated systolic hypertension also decreased steadily to 1989. The percentage of smokers decreased from 69% in 1958 to 55% in 1989.
The 15-year mortality and incidence rates for stroke and myocardial infarction were compared between two separate cohorts in Tanushimaru, the first sampled in 1958 and the second in 1977. Age-adjusted death rate from all causes declined from 17.6 to 7.4/1000 per year. Stroke mortality declined dramatically from 4.6 to 0.8/1000 per year, while no appreciable change occurred in the death rate from myocardial infarction (0.3 to 0.5/1000 per year) or sudden deaths (0.4 to 0.6/1000 per year). Stroke incidence declined from 6.7 to 4.4/1000 per year, but no appreciable trend was observed in the incidence of myocardial infarction (0.9 to 1.2/1000 per year).
The large changes in dietary patterns and lifestyles in Tanushimaru since 1958 have been associated with a remarkable reduction in stroke, but no increase in myocardial infarction. It is suggested that dietary changes in Tanushimaru in the last 30 years have contributed to the prevention of cardiovascular diseases. Continuation of the rapid increase in dietary fat calories could, however, change this favorable picture.
Key wordsNutrient intake Food consumption Risk factors Mortality and morbidity trends Stroke Myocardial infarction
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