title: Dietary patterns and cardiovascular disease mortality in Japan: a prospective cohort study.
abstract: BACKGROUND
  Although ecological observations suggest that the Japanese diet may reduce the risk of cardiovascular disease (CVD), the impact of a Japanese dietary pattern upon mortality due to CVD is unclear.
  
  
  METHODS
  We prospectively assessed the association between dietary patterns among the Japanese and CVD mortality. Dietary information was collected from 40 547 Japanese men and women aged 40-79 years without a history of diabetes, stroke, myocardial infarction or cancer at the baseline in 1994.
  
  
  RESULTS
  During 7 years of follow-up, 801 participants died of CVD. Factor analysis (principal component) based on a validated food frequency questionnaire identified three dietary patterns: (i) a Japanese dietary pattern highly correlated with soybean products, fish, seaweeds, vegetables, fruits and green tea, (ii) an 'animal food' dietary pattern and (iii) a high-dairy, high-fruit-and-vegetable, low-alcohol (DFA) dietary pattern. The Japanese dietary pattern was related to high sodium intake and high prevalence of hypertension. After adjustment for potential confounders, the Japanese dietary pattern score was associated with a lower risk of CVD mortality (hazard ratio of the highest quartile vs the lowest, 0.73; 95% confidence interval: 0.59-0.90; P for trend = 0.003). The 'animal food' dietary pattern was associated with an increased risk of CVD, but the DFA dietary pattern was not.
  
  
  CONCLUSIONS
  The Japanese dietary pattern was associated with a decreased risk of CVD mortality, despite its relation to sodium intake and hypertension.
authors.affiliation: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan. tshimazu-thk@umin.ac.jp
authors.forename: Taichi
authors.initials: T
authors.lastname: Shimazu
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kuriyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: Kaori
authors.initials: K
authors.lastname: Ohmori
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sato
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakaya
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Nishino
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Tsubono
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control; D004032:Diet / Q000706:statistics & numerical data; D015930:Diet Records; D004812:Epidemiologic Methods; D005247:Feeding Behavior / Q000208:ethnology*; D005260:Female; D005518:Food Preferences / Q000208:ethnology; D015438:Health Behavior / Q000208:ethnology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology