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Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: The INTERMAP Study

Journal of Human Hypertension volume 17, pages 623–630 (2003)Cite this article

Abstract

The purpose of the study was to compare nutrient intakes among Chinese, Japanese, UK, and US INTERMAP samples, and assess possible relationships of dietary patterns to differential patterns of cardiovascular diseases between East Asian and Western countries. Based on a common Protocol and Manuals of Operations, high-quality dietary data were collected by four standardized 24-h dietary recalls and two 24-h urine collections from 17 population samples in China (three samples), Japan (four samples), UK (two samples), and USA (eight samples). There were about 260 men and women aged 40–59 years per sample—total N=4680. Quality of dietary interview and data entry were monitored and enhanced by extensive systematic ongoing quality control procedures at local, country, and international level. Four databases on nutrient composition of foods from the four countries were updated and enhanced (76 nutrients for all four countries) by the Nutrition Coordinating Center, University of Minnesota, in cooperation with Country Nutritionists. The mean body mass index was much higher for Western than East Asian samples. Macronutrient intakes differed markedly across these samples, with Western diet higher in total fat, saturated and trans fatty acids, and Keys dietary lipid score, lower in total carbohydrate and starch, higher in sugars. Based on extensive published data, it is a reasonable inference that this pattern relates to higher average levels of serum total cholesterol and higher mortality from coronary heart disease in Western than East Asian populations. The rural Chinese diet was lower in protein, especially animal protein, in calcium, phosphorus, selenium, and vitamin A. Dietary sodium was higher, potassium lower, hence Na/K ratio was higher in the Asian diet, especially for Chinese samples. This pattern is known to relate to risks of adverse blood pressure level and stroke. At the end of the 20th century, East Asian and Western diets remain significantly different in macro- and micronutrient composition. Both dietary patterns have aspects that can be regarded, respectively, as adverse and protective in relation to the major adult cardiovascular diseases. In both Asian and Western countries, public efforts should be targeted at overcoming adverse aspects and maintaining protective patterns for prevention and control of cardiovascular diseases.

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Acknowledgements

This research was supported by Grant 2-RO1-HL50490-06 from the US National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; by the Chicago Health Research Foundation; and by national agencies in China, Japan (the Ministry of Education, Science, Sports, and Culture, Grant-in-Aid for Scientific Research [A], No. 090357003), and the UK.

It is a pleasure to express appreciation to all INTERMAP staff at local, national, and international centres for their invaluable efforts; a partial listing of these colleagues is given in Stamler et al.1

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Authors and Affiliations

  1. Department of Epidemiology, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, People's Republic of China

    BF Zhou & L Zhao

  2. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    J Stamler & A Moag-Stahlberg

  3. Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    B Dennis

  4. Department of Health Science, Shiga University of Medical Science, Otsu, Japan

    N Okuda

  5. Department of Epidemiology and Public Health, Faculty of Medicine, St Mary's Campus, Imperial College, London, UK

    C Robertson, Q Chan & P Elliott

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  1. BF Zhou
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  2. J Stamler
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  7. L Zhao
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Zhou, B., Stamler, J., Dennis, B. et al. Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: The INTERMAP Study. J Hum Hypertens 17, 623–630 (2003). https://doi.org/10.1038/sj.jhh.1001605

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Keywords

  • dietary patterns
  • macronutrients
  • micronutrients
  • international population study

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