LESSONS FROM SERUM CHOLESTEROL STUDIES IN JAPAN, HAWAII AND LOS ANGELES

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Abstract
Studies on the diet, the serum cholesterol and the frequency of atherosclerosis and coronary heart disease were made in Japanese in Japan, where coronary heart disease is rare; in Hawaii, where it is fairly common but less so than among local Caucasians; and in California, where the local Japanese are similar to the local Caucasians in regard to the frequency of the disease. In middle age, coronary heart disease is at least 10 times as common in the United States as in Japan. In 475 Japanese, the serum cholesterol concentration showed a linear relationship to the percentage of calories provided by fats in the diet from a low among farmers at Koga, and a slightly higher average among miners at Shime, Japan, to a high among Nisei in Los Angeles, who were not significantly different from local Caucasians in this respect. These differences (averaging 96 mg/100 ml comparing 40 to 49 year old Koga farmers, eating less than 10% fat calories, with Los Angeles Nisei of the same age, eating 39% fat calories) were accounted for by beta lipoprotein cholesterol, the alpha fraction showing no significant variation. These differences are not accounted for by differences in climate, relative obesity, physical activity, the use of alcohol and tobacco, the concentration of protein in the diet or the intake of "essential" fatty acids. The findings are consistent with the theory that an important factor in producing differences in the frequency of coronary heart disease in populations is the proportion of calories in the diet provided by fats, particularly the common saturated fats.

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