Coronary Heart Disease in Hawaii: Dietary Intake, Depot Fat, "Stress," Smoking, and Energy Balance in Hawaiian and Japanese Men

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Abstract
Dietary intake has been studied in 42 Hawaiian and 68 Japanese men who had recovered from acute myocardial infarction, and in 84 Hawaiian and 136 Japanese age-matched control subjects. The principal dietary differences that might give rise to the high risk factors observed in the Hawaiians, thereby accounting for the higher CHD mortality in Hawaiians are: 1) a history of sporadic heavy calorie intake in Hawaiians, either from total nutrients, or, on occasion, from alcohol; 2) a greater day-to-day variation in calorie intake (modified feast-or-famine type of eating pattern) in the Hawaiians; 3) higher saturated fat and total fat intakes in the Hawaiians, which, if pathogenetic, appear to operate through other than a hypercholesterolemic effect. This study has encountered the problems inherent in appraising total energy intake and total energy output, and suggests that abnormalities in energy balance, rather than differences in specific nutrient intake, appear to account for the differences in coronary heart disease frequency when Hawaiians are compared with Japanese men resident in Hawaii.