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Redefining target omega-3 index levels: The Japan Public Health Center Study

      According to international data compiled by the American Heart Association, the rate of death (per 100,000 people) from coronary heart disease (CHD) in 2011 in Japan was 47 and in the US, 132 [
      • Mozaffarian D.
      • Benjamin E.J.
      • Go A.S.
      • et al.
      Heart disease and stroke Statistics—2015 update: a report from the american heart association.
      ]. This marked difference was shown many years ago to not have a genetic basis [
      • Robertson T.L.
      • Kato H.
      • Rhoads G.G.
      • et al.
      Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California. Incidence of myocardial infarction and death from coronary heart disease.
      ], and thus can only be attributable to environmental factors. Smoking rates are higher in Japan than the US [
      • Ng M.
      • Freeman M.K.
      • Fleming T.D.
      • et al.
      Smoking prevalence and cigarette consumption in 187 countries, 1980-2012.
      ], and hypertension is more prevalent [
      • Collaboration, NCDRF
      Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants.
      ], so these two risk factors clearly cannot explain lower CHD rates in Japan vs. the US. Diet is an obvious possibility, but which component(s)? Total calorie intakes are much lower in Japan than in the US, and, as a percent of calories, so is the fat intake; but carbohydrate intake is higher [
      • Zhang R.
      • Wang Z.
      • Fei Y.
      • et al.
      The difference in nutrient intakes between Chinese and mediterranean, Japanese and american diets.
      ]. Another major difference between US and Japanese diets is the much greater intake in Japan of the long-chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) compared with the US (approximately 900 mg/d [
      • Iso H.
      • Kobayashi M.
      • Ishihara J.
      • et al.
      Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based (JPHC) Study Cohort I.
      ] vs 100 mg/day [
      • Papanikolaou Y.
      • Brooks J.
      • Reider C.
      • et al.
      U.S. adults are not meeting recommended levels for fish and omega-3 fatty acid intake: results of an analysis using observational data from NHANES 2003-2008.
      ]). Given the known cardioprotective effects of these FAs [
      • Endo J.
      • Arita M.
      Cardioprotective mechanism of omega-3 polyunsaturated fatty acids.
      ,
      • Khawaja O.A.
      • Gaziano J.M.
      • Djousse L.
      N-3 fatty acids for prevention of cardiovascular disease.
      ], many studies have examined the associations between the intake of omega-3 FAs and risk for CHD in Japan, but few have used circulating FA biomarkers as their exposure variable. In that light, the report by Hamazaki et al. in this issue of Atherosclerosis is illuminating [
      • Hamazaki K.
      • Iso H.
      • Eshak E.S.
      • et al.
      Plasma levels of n-3 fatty acids and risk of coronary heart disease among Japanese: The Japan Public Health Center-based (JPHC) study.
      ].

      Keywords

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