Salt intake and age‐adjusted death rate from cerebral infarction
Salt intake and age‐adjusted death rate from cerebral infarction
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DOI：
10.1111/j.1447-0594.2007.00397.x
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发表时间：
2007-06
影响因子：
3.3
通讯作者：
Y. Fukuoka;Aiko Hatakeyama;A. Satoh;Reiko Hatakeyama;Hisashi Kudo;R. Mita;Hidetada Sasaki
中科院分区：
文献类型：
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作者：
Y. Fukuoka;Aiko Hatakeyama;A. Satoh;Reiko Hatakeyama;Hisashi Kudo;R. Mita;Hidetada Sasaki
20世纪60年代以后，中风死亡率在世界范围内呈下降趋势。这种下降在日本尤为明显，因为中风是日本人死亡的主要原因。中风死亡率的迅速下降归因于高血压治疗和控制的改善。中风死亡率的加速下降是由于在普通社区中增加使用抗高血压药物治疗的结果，这种观点当然是合理的。尽管有这些有利的趋势，中风仍然是日本第三大死亡原因，死亡率是一个重要的公共卫生问题。日本的营养变化也被证实是中风死亡率下降的一个重要因素。与高盐、低脂肪和低蛋白质的传统日本饮食的背离与中风发病率的降低有关。慢性盐摄入过量是原发性高血压的发病机制。据报道，20世纪60年代日本人高血压和中风的高发是由低脂肪和低蛋白质摄入以及过量盐摄入的营养状况造成的。研究表明，日本和美国的食物摄取量差异导致两国中风死亡率不同。与日本相比，美国人的低盐摄入量和高脂肪和蛋白质摄入量是由于美国的中风患病率较低。Yamori和Horie在日本岛根县引入低盐高蛋白饮食改善后的10年里，中风的发病率急剧下降。尽管饮食中脂肪和蛋白质的含量有所增加，盐的含量有所减少，但日本的中风死亡率可能自1990年以来一直处于平稳状态。众所周知，日本中风死亡率存在地区差异，20世纪60年代，日本东北部的中风死亡率较高，而日本西南部的中风死亡率较低。据报道，食物摄入量的区域差异与日本中风死亡率相对应。例如，20世纪60年代，广岛的平均盐摄入量为每天14克，秋田的平均盐摄入量为每天26克。在本研究中，我们想知道即使在今天，是否仍然存在食物摄入量和中风死亡率的地区差异，这可能会影响近年来中风死亡率的下降。我们研究了日本12个地区的膳食摄入量和中风死亡率。如果高盐摄入和低脂肪和蛋白质摄入与中风死亡率的地区差异有关，我们可能会建议改善饮食摄入以降低这些地区的中风死亡率。我们分析了日本厚生劳动省公布的流行病学数据，以及日本生命统计数据中脑梗死和脑出血的年龄调整死亡率，以及日本国家营养调查中所消耗的食物。日本的食物消费记录为12个街区；北海道、东北、北陆、关东一、关东二、东海、近畿一、近畿二、中国、四国、北九州、南九州。我们在一年内对大约12000人进行了随机抽样，并对1998-2000年的数据进行了平均。由于年龄调整死亡率每5年公布一次，因此从2000年起，脑梗死和脑出血的年龄调整死亡率按照所消耗食物的方式分为12个组，并在每个组内取平均值。在日本，每10万男性中，经年龄调整后的脑梗死平均死亡率最高，为44例，脑出血占20例，蛛网膜下腔出血占7例；而在女性中，脑梗死占25例，脑出血占10例，蛛网膜下腔出血占8例。我们分析了营养因素对脑梗死和脑出血的影响，忽略了蛛网膜下腔出血可能与先天性血管畸形有关。盐的摄入量从近畿I区的11.8克/天到2007年Tohoku Geriatr Gerontol区的14.1克/天不等；7: 202 - 204
Stroke mortality has been in a worldwide decline after the 1960s. This decline has been particularly striking in Japan where stroke was the leading cause of death. This rapid downturn of stroke mortality has been attributed to improved treatment and control of hypertension. The notion that the accelerated decline in stroke mortality has resulted from increased use of antihypertensive drug therapy in the general community is certainly plausible. Despite these favorable trends, stroke remains the third leading cause of death in Japan and mortality is an important public health problem. Nutritional change in Japan was also confirmed to be an important factor in the decline of stroke mortality. Departure from the traditional Japanese diet, which was very high in salt and low in fat and protein has been associated with a reduced incidence of stroke. Chronic excess salt consumption is empirically confirmed to be the pathogenesis of essential hypertension. The nutritional conditions of low fat and protein intake as well as excessive salt intake have been reported to be responsible for the high incidence of hypertension and stroke in the Japanese in the 1960s. The differences in food intake between Japan and the US have been suggested to cause a different death rate from stroke between the two. The low intake of salt and high intake of fat and protein in the US is attributed to the low prevalence of stroke in the US compared to that in Japan. Yamori and Horie demonstrated a steeper decline of stroke during 10 years after the introduction of a dietary improvement of low salt and high protein in Shimane prefecture, Japan. Despite an increase in fat and protein and a reduction in the amount of salt in the diet, stroke mortality rates may have reached a plateau since 1990 in Japan. It was well-known that there were regional differences in stroke mortality in Japan, the rates being higher in north-eastern Japan and lower in south-western Japan in the 1960s. It was reported that regional differences of food intake corresponded to the death rate of stroke in Japan. For example, the average salt intake in Hiroshima was 14 g per day and 26 g per day in Akita in the 1960s. In the present study, we wonder if there are still regional differences of food intake and death rate from stroke even in the present day, which might affect the decrease in stroke mortality in recent years. We studied the dietary intake and death rate from stroke in 12 regional districts of Japan. If there are regional differences in high salt consumption and low fat and protein related to regional differences in the death rate from stroke, we might recommend improving dietary intake to reduce the death rate from stroke in these regions. We analyzed epidemiological data published by the Ministry of Health, Labor and Welfare, Japan, with ageadjusted death rates from cerebral infarction and cerebral hemorrhage from the Vital Statistics of Japan and food consumed from the National Nutrition Survey in Japan. Foods consumed were documented in 12 blocks in Japan; Hokkaido, Tohoku, Hokuriku, Kanto I, Kanto II, Tokai, Kinki I, Kinki II, Chugoku, Shikoku, KitaKyushu, and Minami-Kyushu. Food consumed was determined by random sampling of approximately 12 000 people in 1 year and we averaged the data from 1998–2000. Because age-adjusted death rates are published every 5 years, age-adjusted death rates from cerebral infarction and cerebral hemorrhage from 2000 were divided into 12 blocks in the same way as food consumed and were averaged within each block. Average Japanese age-adjusted death rates from cerebral infarction per 100 000 men was the most frequent at 44, cerebral hemorrhage accounted for 20 and subarachnoid hemorrhage for seven, while, in women, cerebral infarction accounted for 25, cerebral hemorrhage for 10 and subarachnoid hemorrhage for eight. We analyzed nutritional factors for cerebral infarction and cerebral hemorrhage and omitted subarachnoid hemorrhage which may be predisposed with congenital vascular malformations. Salt intake varied from 11.8 g/ day in Kinki I district to 14.1 g/day in the Tohoku Geriatr Gerontol Int 2007; 7: 202–204