NUTRITION FOR THE JAPANESE ELDERLY H. SHIBATA, 1 H. NAGAI, 1 H. HAGA, 1 S. YASUMURA, 1 T. SUZUKI, 2 Y. SUYAMA1· 3 Department of Community Health, 1 Department of Epidemiology, 2 Tokyo Metropolitan Institute of Gerontology Physical Fitness Research Institute 3
ABSTRACT The present paper examines the relationship of nutritional status to further life expectancy and health status in the Japanese elderly based on 3 epidemiological studies. I. Nutrient intakes in 94 Japanese centenarians investigated between 1972 and 1973 showed a higher proportion of animal protein to total proteins than in contemporary average Japanese. 2. High intakes of milk and fats and oils had favorable effects on 10-year (1976-1986) survivorship in 422 urban residents aged 69-71. The survivors revealed a longitudinal increase in intakes of animal foods such as eggs, milk, fish and meat over the 10 years. 3. Nutrient intakes were compared, based on 24-hour dietary records, between a sample from Okinawa Prefecture where life expectancies at birth and 65 were the longest in Japan, and a sample from Akita Prefecture where the life expectancies were much shorter. Intakes of Ca, Fe, vitamins A, B~o B2 , C, and the proportion of energy from proteins and fats were significantly higher in the former than in the latter. Intakes of carbohydrates and NaCl were lower.
Key words: Longevity, centenarians, food intake, nutrient intake, food records, crosssectional study, longitudinal study, regional difference, period effect.
INTRODUCTION
Nutritional problems for the Japanese elderly are largely common to those found in other developed countries (Morley 1986). A number of age-related physiological and biological changes, and social, psychological, physical, and economic status are all associated with nutritional status, whether as Address for correspondence: Hiroshi Shibata, MD, Department of Community Health, Tokyo Metropolitan Institute of Gerontology, Sakaecho 35-2, ltabashiku, Tokyo 173, Japan. Phone. 813-3964-3241. ext. 3120 Fax. 813-3579-4776. 165
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cause or effect. On the other hand, there are nutritional problems peculiar to the Japanese elderly. Food intake patterns and nutritional status in Japan have drastically changed, and they are located intermediately between those of developed and developing countries. The present paper deals with Japanese nutritional problems from the standpoint of further life expectancies and health status of the elderly. It will simultaneously document the role of nutritional status for attaining longevity in Japan during the post Second World War period. METHODS
The present study consisted of 3 investigations carried out by the authors, dealing with the relationship of nutritional status to longevity or health status in the Japanese elderly. The subjects and methods were as follows: 1. Investigation of centenarians: The project team of Tokyo Metropolitan Institute of Gerontology investigated 117 centenarians (21 men, 96 women) from among all 405 centenarians from 1972 to the end of 1973 (Shibata, 1990). The investigation covered all the Japanese archipelagoes including Okinawa Prefecture immediately after it was returned to Japan by the USA. Medical, psychological, and sociologic;ll examinations were carried out. Life styles including food intakes were also investigated. A quantitative nutrition survey based on one-day 24-hour recall by the centenarians and their family members were administered by a nutritionist, excluding 23 centenarians in Kyushu Island. Valid data were obtained from 94 centenarians (20 men, 74 women). The nutritional status of the centenarians was compared with that of average Japanese according to the National Nutrition Survey of 1972. 2. In 1976, we undertook a longitudinal interdisciplinary study of aging in 422 subjects (197 men, 225 women) aged 69-71 years living at home in Koganei City, a suburb of Tokyo. The details of this study have been described elsewhere (Shibata et al., 1990, Haga et al., 1991), and only necessities are briefly mentioned here. The baseline survey consisted of medical, psychological, and sociological disciplines. Follow-up surveys have been carried out every 5 years using the same methods as in the baseline survey. A food frequency questionnaire was included in the study items. Over the 10-year period, 102 subjects died. The relationship of the pattern of food intake to 10-year survivorship was examined. Further, longitudinal changes of food intake pattern were observed at baseline, 5-years later, 10years later in survivors, excluding those admitted to hospitals or long-term care facilities, or emigrants from the city. Follow-up surveys were carried out by either mass-examination or door-to-door methods. Subjects were divided into two groups according to frequency of each food; a high-intake group and a low-intake group. High intake groups were defined as those
Downloaded from nah.sagepub.com at MCMASTER UNIV LIBRARY on January 7, 2015
167
who took rice 5 days a week or more, fruits or fats and oils 4 days a week or more, and bread, noodles, fish, meat 3 days or more. Those who ate vegetables every day, at least one egg a day, and at least 200ml milk a day were also defined as high-inake groups. The rest were defined as low intake groups. 3. We compared prevalence of diseases, health status, and dietary pattern between two typical rural areas: one was Ogimi Village as a sample of Okinawa Prefecture where life expectancies both at birth and 65 years were the longest in Japan, and another was Nangai Village as a sample of Akita Prefecture; a northern part, which was one of the regions with the shortest life expectancies. A survey for Ogimi Village was undertaken in 727 residents aged 65 years or over in 1987. The response rate was 89.2% for eligible persons. In 1988, a baseline survey for Nangai Village was undertaken in 720 residents of the same age group as Ogimi Village survey, when the response rate reached 95.7%. In August 1988, a quantitative dietary survey was carried out in 148 Ogimi and in 154 Nangai residents (randomly selected) ranging in age from 65 to 79. Dietary records for 24 hours were checked and confirmed by nutritionists using life-sized food models and photos. After that, nutrient intakes were calculated according to The 4th Edition Standard Tables of Food Consumption in Japan edited by the Science and Technology Agency.
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Figure 1. Comparison in proportion of energy from fats to total energy between the centenarians (1972-3) and the average Japanese (1972).
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RESULTS
1. the average daily intake of total energy of centenarians was 1073kcal in men and 939kcal in women. As shown in Figure 1, the proportion of energy from fats to total energy intake was a little lower than that of contemporary average Japanese according to the National Nutrition Survey in 1972. Figure 2 shows that the proportion of energy from proteins to total energy intake was a little higher than that of contemporary average Japanese. It was 100 Ul
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ABSTRACT The present paper examines the relationship of nutritional status to further life expectancy and health status in the Japanese elderly based on 3 epidemiological studies. I. Nutrient intakes in 94 Japanese centenarians investigated between 1972 and 1973 showed a higher proportion of animal protein to total proteins than in contemporary average Japanese. 2. High intakes of milk and fats and oils had favorable effects on 10-year (1976-1986) survivorship in 422 urban residents aged 69-71. The survivors revealed a longitudinal increase in intakes of animal foods such as eggs, milk, fish and meat over the 10 years. 3. Nutrient intakes were compared, based on 24-hour dietary records, between a sample from Okinawa Prefecture where life expectancies at birth and 65 were the longest in Japan, and a sample from Akita Prefecture where the life expectancies were much shorter. Intakes of Ca, Fe, vitamins A, B~o B2 , C, and the proportion of energy from proteins and fats were significantly higher in the former than in the latter. Intakes of carbohydrates and NaCl were lower.
Key words: Longevity, centenarians, food intake, nutrient intake, food records, crosssectional study, longitudinal study, regional difference, period effect.
INTRODUCTION
Nutritional problems for the Japanese elderly are largely common to those found in other developed countries (Morley 1986). A number of age-related physiological and biological changes, and social, psychological, physical, and economic status are all associated with nutritional status, whether as Address for correspondence: Hiroshi Shibata, MD, Department of Community Health, Tokyo Metropolitan Institute of Gerontology, Sakaecho 35-2, ltabashiku, Tokyo 173, Japan. Phone. 813-3964-3241. ext. 3120 Fax. 813-3579-4776. 165
Downloaded from nah.sagepub.com at MCMASTER UNIV LIBRARY on January 7, 2015
166
cause or effect. On the other hand, there are nutritional problems peculiar to the Japanese elderly. Food intake patterns and nutritional status in Japan have drastically changed, and they are located intermediately between those of developed and developing countries. The present paper deals with Japanese nutritional problems from the standpoint of further life expectancies and health status of the elderly. It will simultaneously document the role of nutritional status for attaining longevity in Japan during the post Second World War period. METHODS
The present study consisted of 3 investigations carried out by the authors, dealing with the relationship of nutritional status to longevity or health status in the Japanese elderly. The subjects and methods were as follows: 1. Investigation of centenarians: The project team of Tokyo Metropolitan Institute of Gerontology investigated 117 centenarians (21 men, 96 women) from among all 405 centenarians from 1972 to the end of 1973 (Shibata, 1990). The investigation covered all the Japanese archipelagoes including Okinawa Prefecture immediately after it was returned to Japan by the USA. Medical, psychological, and sociologic;ll examinations were carried out. Life styles including food intakes were also investigated. A quantitative nutrition survey based on one-day 24-hour recall by the centenarians and their family members were administered by a nutritionist, excluding 23 centenarians in Kyushu Island. Valid data were obtained from 94 centenarians (20 men, 74 women). The nutritional status of the centenarians was compared with that of average Japanese according to the National Nutrition Survey of 1972. 2. In 1976, we undertook a longitudinal interdisciplinary study of aging in 422 subjects (197 men, 225 women) aged 69-71 years living at home in Koganei City, a suburb of Tokyo. The details of this study have been described elsewhere (Shibata et al., 1990, Haga et al., 1991), and only necessities are briefly mentioned here. The baseline survey consisted of medical, psychological, and sociological disciplines. Follow-up surveys have been carried out every 5 years using the same methods as in the baseline survey. A food frequency questionnaire was included in the study items. Over the 10-year period, 102 subjects died. The relationship of the pattern of food intake to 10-year survivorship was examined. Further, longitudinal changes of food intake pattern were observed at baseline, 5-years later, 10years later in survivors, excluding those admitted to hospitals or long-term care facilities, or emigrants from the city. Follow-up surveys were carried out by either mass-examination or door-to-door methods. Subjects were divided into two groups according to frequency of each food; a high-intake group and a low-intake group. High intake groups were defined as those
Downloaded from nah.sagepub.com at MCMASTER UNIV LIBRARY on January 7, 2015
167
who took rice 5 days a week or more, fruits or fats and oils 4 days a week or more, and bread, noodles, fish, meat 3 days or more. Those who ate vegetables every day, at least one egg a day, and at least 200ml milk a day were also defined as high-inake groups. The rest were defined as low intake groups. 3. We compared prevalence of diseases, health status, and dietary pattern between two typical rural areas: one was Ogimi Village as a sample of Okinawa Prefecture where life expectancies both at birth and 65 years were the longest in Japan, and another was Nangai Village as a sample of Akita Prefecture; a northern part, which was one of the regions with the shortest life expectancies. A survey for Ogimi Village was undertaken in 727 residents aged 65 years or over in 1987. The response rate was 89.2% for eligible persons. In 1988, a baseline survey for Nangai Village was undertaken in 720 residents of the same age group as Ogimi Village survey, when the response rate reached 95.7%. In August 1988, a quantitative dietary survey was carried out in 148 Ogimi and in 154 Nangai residents (randomly selected) ranging in age from 65 to 79. Dietary records for 24 hours were checked and confirmed by nutritionists using life-sized food models and photos. After that, nutrient intakes were calculated according to The 4th Edition Standard Tables of Food Consumption in Japan edited by the Science and Technology Agency.
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Average Japanese
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Figure 1. Comparison in proportion of energy from fats to total energy between the centenarians (1972-3) and the average Japanese (1972).
Downloaded from nah.sagepub.com at MCMASTER UNIV LIBRARY on January 7, 2015
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Figure 2. Comparison in proportion of energy from proteins to total energy between the centenarians (1972-3) and the average Japanese (1972).
RESULTS
1. the average daily intake of total energy of centenarians was 1073kcal in men and 939kcal in women. As shown in Figure 1, the proportion of energy from fats to total energy intake was a little lower than that of contemporary average Japanese according to the National Nutrition Survey in 1972. Figure 2 shows that the proportion of energy from proteins to total energy intake was a little higher than that of contemporary average Japanese. It was 100 Ul
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