## Dietary Fiber

Many articles have been reported about the relation between insufficient intake of dietary fiber and lifestyle disease, i.e. myocardial infarction, ischemic stroke, cardiovascular disease, diabetes, breast cancer and gastric cancer. Then the target amount has been set. But the reports about the relation between the intake of dietary fiber and colorectal cancer do not match. It’s unclear that which the intake of dietary fiber in daily life has relation with constipation or not.

In the meta-analysis with trial study, negative correlation has been suggested between the intake amount of dietary fiber and blood pressure, LDL cholesterol and fasting plasma glucose.

In 2015 edition, in order to calculate the dietary reference intakes of dietary fiber, they have compromised of ideal value and reality. Based on the National Health and Nutrition Examination Survey in 2010 and 2011, the median is 13.7 g/d. On the other hand, ideal value besed on the pooled analysis is 24 g/d. The intermediate of them is 18.9 g/d. They have extrapolated body surface area from the ratio of reference weight in each the gender and age groups to reference weight in adult and have set the target amount for each gender and age groups. They have not set the additional amount for pregnant and lactation and they have not set the target amount for child between 1 and 5 years old because it’s difficult to quantify the intake. They don’t ensure the effect of dietary fiber by supplements.

$\displaystyle 18.9\ \mathrm{(g/d)}\times [\mathrm{Reference\ Weight\ (kg)}/57.8\ \mathrm{(kg)}]^{0.75}$
The Dietary Reference Intakes of Dietary Fiber (g/d) (2015 edition)
Gender Male Female
Age Target Amount Target Amount
0-5 M
6-11 M
1-2
3-5
6-7 ≥ 11 ≥ 10
8-9 ≥ 12 ≥ 12
10-11 ≥ 13 ≥ 13
12-14 ≥ 17 ≥ 16
15-17 ≥ 19 ≥ 17
18-29 ≥ 20 ≥ 18
30-49 ≥ 20 ≥ 18
50-69 ≥ 20 ≥ 18
70- ≥ 19 ≥ 17
Pregnant
Lactation

The Dietary reference Intakes of dietary fiber in 2010 edition is based on the article, Dietary Fiber and Risk of Coronary Heart Disease, in which the reduction of the mortality has been suggested in more than 24 g/d intake group and the increase of mortality has been suggested in less than 12 g/d group. They had set the intermediate value, 18 g/d, as reference. In the National Health and Nutrition Examination Survey in 2005 and 2006, the median intake is 12.3-16.3 g/d in adult male and 11.8-16.1 g/d in adult female, respectively. Then it seems to be determined that the ideal value 24 g/d is not practical for most Japanese.

The Dietary Reference Intakes of Dietary Fiber (g/d) (2010 edition)
Gender Male Female
Age Target Amount Target Amount
0-5 M
6-11 M
1-2
3-5
6-7
8-9
10-11
12-14
15-17
18-29 ≥ 19 ≥ 17
30-49 ≥ 19 ≥ 17
50-69 ≥ 19 ≥ 17
70- ≥ 19 ≥ 17
Pregnant
Lactation

## Saturated Fatty Acid

In many intervention trial in America and Europe, decreasing saturated fatty acid intakes have been recognized to decrease coronary heart disease morbidity, atherosclerosis and LDL cholesterol. In JPHC trial for Japanese, positive correlation has been observed between saturated fatty acid and the onset of myocardial infarction. However, it is not clear whether the decrease of saturated fatty acid intake causes the increase of cerebral hemorrhage.

It is considered that excessive intake of saturated fatty acids is the risk of atherosclerosis, especially myocardial infarction. In order to prevent of the onset and the aggravation, it’s important not only to limit the intake of saturated fatty acids but also to increase of intake of unsaturated fatty acids. In each country, saturated fatty acids intake in adult has been recommended less than 10 %E. American Heart Association and American Diabetes Association have been recommended less than 7 %E. In National Health and Nutrition Survey in 2011, saturated fatty acids intake of 20 years old or older Japanese was 6.9 %E. Therefore, the target amount of saturated fatty acids in adults has been set to less than 7 %E.

### Child

Although it is considered that saturated fatty acid s intake should be less than 7 %E because the excessive intake of saturated fatty acids in child may cause coronary heart disease and obesity in middle age, research and related epidemiological studies and intervention trials were not enough to set the target amount of saturated fatty acids in child.

The Dietary Reference Intakes of saturated fatty acids 2015 edition and 2010 edition are following tables. They have not been set in infant, child, pregnant and lactation.

The Dietary Reference Intakes of saturated fatty acids (% energy) (2015 edition)
Gender Male Female
Age Target Amount Target Amount
0-5 M
6-11 M
1-2
3-5
6-7
8-9
10-11
12-14
15-17
18-29 ≤7 ≤7
30-49 ≤7 ≤7
50-69 ≤7 ≤7
70- ≤7 ≤7
The Dietary Reference Intakes of saturated fatty acids (% energy) (2010 edition)
Gender Male Female
Age Target Amount (range) Target Amount (range)
0-5 M
6-11 M
1-2
3-5
6-7
8-9
10-11
12-14
15-17
18-29 4.5≤<7 4.5≤<7
30-49 4.5≤<7 4.5≤<7
50-69 4.5≤<7 4.5≤<7
70- 4.5≤<7 4.5≤<7

## Mediterranean-style diet and risk of ischemic stroke, myocardial infarction, and vascular death: the Northern Manhattan Study

This article has described about the relation between the Mediterranean-style diet score (MeDi score) and risk of ischemic stroke, myocardial infarction, and vascular death on blacks and Hispanics in the United States. Although there is no relation between Mediterranean-style diet and stroke because population was too small, this is the first study that is multiethnic, population based, prospective cohort study in the United States.

# Mediterranean-style diet and risk of ischemic stroke, myocardial infarction, and vascular death: the Northern Manhattan Study

Hannah Gardener, Clinton B Wright, Yian Gu, Ryan T Demmer, Bernadette Boden-Albala, Mitchell SV Elkind, Ralph L Sacco, and Nikolaos Scarmeas

Am J Clin Nutr 2011; 94: 1458-64.

## Abstract

### Background:

A dietary pattern common in regions near the Mediterranean appears to reduce risk of all-cause mortality and ischemic heart disease. Data on blacks and Hispanics in the United States are lacking, and to our knowledge only one study has examined a Mediterranean-style diet (MeDi) in relation to stroke.

### Objective:

In this study, we examined an MeDi in relation to vascular events.

### Design:

The Northern Manhattan Study is a population-based cohort to determine stroke incidence and risk factors (mean ± SD age of participants: 69 ± 10 y; 64% women; 55% Hispanic, 21% white, and 24% black). Diet was assessed at baseline by using a food-frequency questionnaire in 2568 participants. A higher score on a 0–9 scale represented increased adherence to an MeDi. The relation between the MeDi score and risk of ischemic stroke, myocardial infarction (MI), and vascular death was assessed with Cox models, with control for sociodemographic and vascular risk factors.

### Results:

The MeDi-score distribution was as follows: 0–2 (14%), 3 (17%), 4 (22%), 5 (22%), and 6–9 (25%). Over a mean follow-up of 9 y, 518 vascular events accrued (171 ischemic strokes, 133 MIs, and 314 vascular deaths). The MeDi score was inversely associated with risk of the composite outcome of ischemic stroke, MI, or vascular death (P-trend = 0.04) and with vascular death specifically (P-trend = 0.02). Moderate and high MeDi scores were marginally associated with decreased risk of MI. There was no association with ischemic stroke.

### Conclusions:

Higher consumption of an MeDi was associated with decreased risk of vascular events. Results support the role of a diet rich in fruit, vegetables, whole grains, fish, and olive oil in the promotion of ideal cardiovascular health.