American Journal of Clinical Nutrition, Vol 22, 1504-1520, Copyright © 1969 by The American Society for Clinical Nutrition, Inc.

Dietary Intake, Smoking History, Energy Balance, and "Stress" in Relation to Age, and to Coronary Heart Disease Risk in Hawaiian and Japanese Men in Hawaii

¹ From the Hawaii Cardiovascular Study, the Department of Medicine, the Queen's Medical Center; and the Hawaii State Department of Health, Honolulu, Hawaii

Certain ecologic factors, including diet, cigarette smoking, stress, and physical activity, have been examined in Japanese and Hawaiian men resident in Hawaii, to determine which of these factors are significantly related to age at time of examination, and to coronary heart disease-risk status. The analyses included comparison of nutrient intake of younger versus older men and of nutrient intake of control subjects at low versus those at high CHD-risk status; analysis of gradients in nutrient intake; and stepwise multiple regression analysis taking these ecologic factors as independent variables.

The principal ecologic factors involved, which by these analyses appear related to CHD in these men are: saturated fat (higher intake in younger than in older Japanese men); linoleic acid (acting here as in other reports, in a protective or reciprocal relationship, i.e., higher intake in Hawaiian controls in the low CHD-risk category); degree of current cigarette smoking (increased use by Japanese controls in the high risk category); dietary cholesterol (higher intake in Hawaiian high risk as compared with low risk controls); number of cups of tea (higher intake in Japanese high risk as compared with low risk controls); alcohol (higher intake in younger than in older Japanese men). An accompanying report (6) has implicated saturated fat and stress (higher levels in Hawaiian than in Japanese controls).

The factors of saturated fat, linoleic acid (in a reciprocal sense), dietary cholesterol, and possibly alcohol intake, very likely exert their pathogenetic influence by producing hypercholesterolemia. It is noted that certain of the factors studied might appear as an indicator of some other (unmeasured) ecologic variable, which is more directly involved in pathogenesis (e.g., the factor of tea intake, in this study, could not be related to levels of caffeine intake). The mechanisms of action by which cigarette smoking, tea intake, and stress exert their effect in CHD pathogenesis remain to be determined.