Lifestyle and risk factor trends, mortality trends, and public health perspectivesChanging patterns of coronary heart disease, stroke, and nutrient intake in Japan☆
Abstract
During the last 25 years a remarkable change has occurred in the ranking of the causes of death in Japan. In particular, stroke, the leading cause of death in Japan for a long period of time, has been declining from its peak in 1965. Although ischemic heart disease increased about fourfold, it is not yet as prominent as stroke. One reason for these changes may be that the average life span of Japanese men in 1975 was 71.8 years, 12 years longer than in 1950. This trend of mortality rate for stroke compelled attention to changes in dietary habits. This article deals in detail with these Japanese trends.
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Cited by (25)
Salt and health
2019, Reducing Salt in FoodsCardiovascular disease (CVD) is the leading cause of death and disability worldwide. The most important risk factor for cardiovascular disease is raised blood pressure. Salt intake is the major cause of raised blood pressure, as demonstrated by several different lines of evidence – epidemiological, migration, population-based intervention, treatment, animal, and genetic studies. Independently and additive to its effects on blood pressure, the current high-salt intake (9–12 g per day in most countries of the world) also has a direct effect on stroke, left ventricular hypertrophy, renal disease, stomach cancer, and bone demineralization. Reducing our salt intake to the recommended 5–6 g per day will result in major public health gains; a further reduction to 3 g per day would have a much greater impact and should become the long-term target for population salt intake worldwide. As 75%–80% of the salt intake in developed countries comes from processed foods, the most effective strategy is for the food industry to reduce the amount of salt added to their products in a gradual and sustained manner. Several developed countries (e.g. Finland, the United Kingdom) have successfully reduced their population salt intake, and this was accompanied by significant falls in population blood pressure and CVD mortality. A major challenge now is to expand this to developing countries, where over 80% of the global salt-related disease burden occurs. A reduction in salt intake worldwide, even in small amounts, will result in enormous public health gains and cost savings.
Stratified Age-Period-Cohort Analysis of Stroke Mortality in Japan, 1960 to 2000
2007, Journal of Stroke and Cerebrovascular DiseasesBackground: Although stroke mortality has been decreasing in Japan, in 2000 it was still the third leading cause of death among Japanese of either sex. Elucidation of stroke mortality trends among age, calendar year, and birth cohorts should improve stroke prevention efforts. The objective of this study was to clarify the age, period, and cohort effects on stroke mortality in Japan from 1960 to 2000 by using stratified age-period-cohort models with improved goodness of fit. Methods: Death and population from the Vital Statistics of Japan and the National Statistics Bureau, respectively, were tabulated among 12 age groups (30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and 85-89) and 9 quinquennials (1960, 1965, 1970, 1975, 1980, 1985, 1990, 1995, and 2000), which yielded 20 birth cohorts (midyears of 1873, 1878, 1883, 1888, 1893, 1898, 1903, 1908, 1913, 1918, 1923, 1928, 1933, 1938, 1943, 1948, 1953, 1958, 1963, and 1968). A stratified model (age-periods-cohort model) with 7 age classes (30-44, 45-54, 55-64, 65-69, 70-74, 75-79, and 80-89 years) was applied under the assumption that the number of deaths has an extra-Poisson variation. Results: The stratified model showed that: (1) middle-aged groups (40-64 years in men and 40-59 years in women) had higher mortality than their linear age trends; (2) young (30-44 years) and middle-aged (45-64 years) groups showed different patterns than those of the elderly (65-89 years) age groups: the two younger groups had higher nonlinear period effects than their linear trends between 1970 and 1990, and the trend of decreasing began later (in 1975 in men and 1980 in women, respectively) than it did for the elderly (1970); and (3) the nonlinear cohort effects indicated 4 patterns in each sex, and the effects increased in post-1948 cohort in men and in post-1958 cohort in women. Conclusion: Young and middle age (30-59 years) boosted the mortality, suggesting that this age range should be targeted for increased stroke prevention efforts.
Dietary salt, high blood pressure and other harmful effects on health
2007, Reducing Salt in Foods: Practical StrategiesSalt (sodium chloride) is the primary cause of raised blood pressure and is largely responsible for the rise in blood pressure that occurs in almost all adults as they grow older. Salt intake is important in blood pressure regulation and a reduction in salt intake would lead to a reduction in population blood pressure, a reduction in the rise in blood pressure with age and a reduction in blood pressure in those with high blood pressure whether on or off anti-hypertensive treatment. A reduction in salt intake is, therefore, one of the most important strategies for improving public health and preventing people dying or suffering unnecessarily from strokes, heart attacks and heart failure. There is also increasing evidence that the current high salt intake has other harmful effects on health, which may be independent of and additive to the effect of salt on blood pressure, for example, a direct effect on stroke, left ventricular hypertrophy, progression of renal disease and albuminuria, stomach cancer and bone demineralization. This chapter reviews the evidence that relates salt to raised blood pressure as well as the possible mechanisms whereby salt increases blood pressure. It also briefly discusses other harmful effects of salt on health.
Intake of fruit and vegetables and the risk of ischemic stroke in a cohort of Danish men and women
2003, American Journal of Clinical NutritionPrevious studies have suggested that a high dietary intake of fruit and vegetables is associated with a reduced risk of ischemic stroke. The magnitude of the effect is uncertain, and only one study reported data on the intake of specific fruit and vegetables and the risk of stroke.
We examined whether the intake of fruit and vegetables is associated with a reduced risk of ischemic stroke, with particular attention paid to specific fruit and vegetables and subtypes of ischemic stroke.
In a prospective cohort study of 54 506 men and women who were included in the Danish Diet, Cancer, and Health study from 1993 to 1997, estimated total intakes of fruit and vegetables (in g/d) were extracted from a semiquantitative food-frequency questionnaire completed at baseline. Data about subjects hospitalized with ischemic stroke were obtained from the Danish National Registry of Patients and were verified later by record reviews. The follow-up for ischemic stroke ended on the date of a first hospital admission for stroke or transient ischemic attack, the date of death or emigration, or the end of the study, whichever came first.
We identified 266 cases of ischemic stroke involving hospitalization during 168 388 person-years of follow-up (median follow-up: 3.09 y; range: 0.02–5.10 y). After adjustment for potential confounders, persons in the top quintile of fruit and vegetable intake (median: 673 g/d) had a risk ratio of ischemic stroke of 0.72 (95% CI: 0.47, 1.12) relative to persons in the bottom quintile of intake (median: 147 g/d) (P for trend = 0.04). When comparing the top quintile with the bottom quintile, an inverse association was most evident for fruit intake (risk ratio: 0.60; 95% CI: 0.38, 0.95; P for trend = 0.02). Similar risk estimates were seen for most types of fruit and vegetables, although the risks were significant only for citrus fruit.
An increased intake of fruit may reduce the risk of ischemic stroke.
Diet quality index: Capturing a multidimensional behavior
1994, Journal of the American Dietetic AssociationObjective Data for 5,484 adults (aged 21 years and older) who participated in the 1987–1988 Nationwide Food Consumption Survey (NFCS) were used to develop an index of overall dietary intake that related to the major, diet-related, chronic diseases in the United States. The low response rate of the 1987–1988 NFCS has raised concerns about potential bias, but this large data set is useful for methodologic studies and research that does not attempt to generalize the results to the US population.
Analyses Dietary recommendations from the 1989 National Academy of Sciences publication Diet and Health were stratified into three levels of intake for scoring. Individuals who met a dietary goal were given a score of zero. Those who did not meet a goal, but had a fair diet, were given one point, and those who had a poor diet were give two points. These points were summed across eight diet variables to score the index from zero (excellent diet) to 16 (ppor diet).
Results Lower index scores were positively associated with high intakes of other important measures of diet quality (eg, fiber, vitamin C). We found that single nutrients (such as dietary fat) were not necessarily associated with other measures of diet quality.
Conclusion We concluded that this inex ranking of overall dietary patterns were reflective of total diet quality, though substantial misclassification can result from using single nutrients or foods as indicators of diet quality.
The decline in stroke mortality An epidemiologic perspective
1993, Annals of EpidemiologyThe evidence that treatment of hypertension prevents stroke is incontrovertible. Several observations, however, suggest that improvements in the prevalence of antihypertensive treatment cannot explain all of the recent decline in stroke mortality. Changes in nutritional patterns may explain some of the observed decline. Prospective studies have demonstrated conclusively an independent, increasing risk of hemorrhagic, but not thrombotic, stroke at higher levels of alcohol use. Stroke mortality is associated inversely with fat and protein intake. Dietary sodium has been linked to stroke in ecologic studies but not in prospective studies. Ecologic studies have suggested that foods high in vitamin C and potassium protect against stroke; an inverse association of potassium intake with fatal stroke has been demonstrated in cohort studies. Two studies in humans also suggest a protective effect of serum selenium against subsequent stroke. Determination of the influence of nutrients on stroke incidence offers tantalizing opportunities for future research and possibly, intervention.
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Presented at the International Symposium on Epidemiology and Prevention of Atherosclerotic Disease, June 24–26, 1981, Anacapri, Italy.