Journal of Clinical & Experimental Orthopaedics

The Standard of World Meal Intake for Fat and Carbohydrate has Changed Hiroshi Bando

Нe standard nutrition has been changed in several decades. From mid-20th century, it has been believed that abstinence of lipids would prevent arteriosclerosis. One of the source would be from classical Seven Countries study. At that time, fatal diseases were OassLfied such as all causes, all causes less infective and parasitic diseases and violence, diseases of the circulatory system and degenerative heart disease Нere was a correlation between mortality rate from degenerative heart disease and fat intake ratio as percent of total . It was sLJnLficant linear correlation: 1) highest country is USA with 7.0 in deaths at 1000 and 40% in fat intake ratio 2) lowest country is Japan with 0.6 in death/1000 and 7% in fat intake 3) Canada, Australia, England and Italy were linearly situated between USA and Japan. In the 1970s, exceptionally high mortality rates of cardiovascular disease (CVD) was observed in Finland, and they started the health program. It concentrated heavily on changing the population’s diet, especially with respect to the quality of the fat consumed: a reduction in saturated and an increase in unsaturated fat intake . It showed both the feasibility and great potential of CVD prevention and heart health promotion through general dietary changes in the population. $Ñ?er that, there have been lots of nutritional research worldwide concerning the ratio of three major nutrients, Lnfluence to cardiovascular disease, saturated and unsaturated fatty acid. High saturated fatty acid diet was supposed to be related to Lnfluence the development of cardiovascular disease. Recently, it has been reported that saturated fatty acids and lipids does not a Ù´ Ù?ect the mortality rate or cardiovascular disease incidence rate, as well as the converse reports that the risk decreases Нere is no sLJnLficant evidence for concluding that dietary saturated fat is associated with an increased risk of CVD or coronary heart disease (CHD) with 5-23 year follow-up of 347,747 subjects, 11,006 developed CHD or stroke. However, further data would be necessary for the rejecting the saturated fat hypothesis . Нere has been a large-scale epidemiological study, which is called ͦНe Prospective Urban Rural Epidemiology (PURE) study” . It plans to recruit approximately 140,000 individuals residing in >600 communities in 17 low-, middle-, and high-income countries around the world . As one of PURE study, the consumption of fruit and vegetables was investigated . Consumption is rather low worldwide, particularly in lowincome countries, and this is associated with low Ù´ a Ù?ordabLOLt\ Policies worldwide should enhance the availability and a Ù´ Ù?ordabLOLt\ of fruits and vegetables. In 2017, another PURE study was reported . Нe\ studied 125 287 participants from 18 countries in North America, South America, Europe, Africa, and Asia, and reported that replacement of saturated fatty acids with carbohydrates was associated with the most adverse effects on lipids, whereas replacement of saturated fatty acids with unsaturated fats improved some risk markers . Furthermore, associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries were reported . It showed that higher carbohydrate intake was associated with an increased risk of total mortality (HR 1.28). On contrast, it showed that higher total fat was associated with lower total mortality (HR 0.77) and higher saturated fat intake was associated with lower risk of stroke (HR 0.79). Total fat and saturated and unsaturated fats were not significant associated with risk of myocardial infarction or cardiovascular disease mortality. According to these data, lower intake of carbohydrate about 50-55% and higher intake of fat about 35% were recommended. However, enough amount of protein would be necessary. Нen we suggest that less carbohydrate would be better for healthier life with adequate balance of 3 nutrients. In many countries and districts, the ratio of carbohydrate intake has seems to be around 50 – 70%. According to the data , the ratio less than 50% and more than 70% is shown in the following district: China, 5.5%, 42.6%; South Asia, 7.7%, 33.2%; Africa, 12.3%, 28.9%; South America, 25.5%, 14.5%; Middle East, 29.3%, 0.9%; Europe and north America, 39.7%, 1.5%, respectively . Furthermore, higher economic state tends to indicate higher fat intake, lower carbohydrate intake and better medical circumstance, which would be the limitation of various research. Consequently, we have to consider multiple axes in discussing the ideal or adequate ratio of fat and carbohydrate in various situations worldwide. Taking several data with cultural, historical and economic situation into consideration, it is rather dLÙ¹cuOt to propose the ideal proportion of three main nutrients. However, we expect the accumulation of sLJnLficant nutritional reports about better meal components in the world, leading to less metabolic syndrome and arteriosclerosis. In relation to these comment mentioned above, recent clinical and research concerning low carbohydrate diet (LCD) must be considered. Atkins and Bernstein started LCD with successful weight reduction in Europe and North American. Нere was Dietary Intervention Randomized Controlled Trial (DIRECT) study, in which weight reduction was investigated in low fat, Mediterranean and LCD for 2 years Нe mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. НLs is the milestone of the beneficLaO e Ù´ Ù?ects for LCD . On succession, the eÙ¹cac\ of LCD for 6 years in DIRECT study was reported. Нere have been various reports and discussion concerning the comparison between calorie restriction (CR) and LCD. Furthermore, the Lnfluences of LCD for arteriosclerosis and cardiovascular disease were investigated . As for Japan, authors and colleagues have started LCD and reported clinical studies including 2699 Journal of Clinical & Experimental Orthopedics ISSN 2471-8416 cases of LCD with remarkable weight reduction . We also cOarLfied that diabetic pregnant women can be treated successfully with LCD, and that remarkable elevated ketone bodies were observed in the axes of fetus, placenta, newborn and mother, suggesting that ketone bodies would generate necessary energy in the axes . In the clinical practice, the remarkable beneficial for LCD would be 1) successful weight reduction. 2) elevated ketone bodies with various beneficLaO e Ù´ Ù?ects to human organs, 3) three Ù´ dL Ù?erent LCD meals which are petit LCD, standard LCD and super LCD with carbohydrate ratio in 40%, 26%, 12%, respectively 4) decrease of triglyceride level , 5) rapid decrease of daily profiOe of blood glucose which can be calculated as Morbus (M) value indicating average and fluctuatLon of glucose in a day . НLs editorial was on the topics of the ratio for fat, carbohydrate, LCD in various meal and nutritional treatment. Нese speculations would be useful for the urgent problem worldwide, which is increasing metabolic syndrome (Met-S) such as obesity and diabetes. International Diabetes Federation (IDF) summarized the current situation and problems in the world. Diabetic prevalence will increase from 8.8% in 2015 to 10.4% in 2040. IDF summarized Standards of Medical Care in Diabetes in 2015.Нe important points were that 1) Monitoring carbohydrate intake, whether by carbohydrate counting or experience-based estimation, remains critical in achieving glycemic control in eating patterns and macronutrient distribution, and 2) the amount of dietary saturated fat, cholesterol, and trans fat recommended for people with diabetes is the same as that recommended for the general population in dietary fat. In summary, to prevent and treat arteriosclerosis and Met-S worldwide, we can apply adequate nutritional management such as less carbohydrate and enough fat with good quality

Hiroshi Bando