Abstract

INTRODUCTION

Studies of migrant populations mean the impact of environmental factors on the appearance of non-communicable chronic diseases can be assessed.⁴⁸48. Yamashita C, Damiao R, Chaim R, Harima HA, Kikuchi M, Franco LJ, et al. [Interethnic marriage of Japanese-Brazilians associated with less healthy food habits and worse cardiometabolic profile]. Arq Bras Endocrinol Metabol. 2009;53:485-96. DOI:10.1590/S0004-27302009000500002
https://doi.org/10.1590/S0004-2730200900... Individuals who move to live in different countries are at high risk of developing these types of disease due to the socio-cultural changes they experience.²⁶26. Massimino FC, Gimeno SG, Ferreira SR. All-cause mortality among Japanese-Brazilians according to nutritional characteristics. Cad Saude Publica. 2007;23:2145-56. DOI:10.1590/S0102-311X2007000900022
https://doi.org/10.1590/S0102-311X200700...

In this context, diet constitutes an important factor involved in the development of these pathologies.⁴⁵ Dietary acculturation, defined as adopting and maintaining dietary habits from other traditions,²²22. Kim MJ, Lee SJ, Ahn YH, Bowen P, Lee H. Dietary acculturation and diet quality of hypertensive Korean Americans. J Adv Nurs. 2007;58:436-45. DOI:10.1111/j.1365-2648.2007.04258.x
https://doi.org/10.1111/j.1365-2648.2007... is common in the majority of immigrants, irrespective of their country of origin.

The demographic proportion of Japanese immigration means that dietary acculturation is relevant to this population. According to the Associação Kaigai Nikkeijin Kyokai,^aa Associação Kaigai Nikkeijin Kyokai. Quem são os Nikkeis no Exterior? [cited 2012 Oct]. Available from: http://www.jadesas.or.jp/pt/aboutnikkei/index.html in 2004 there were around 2.6 million individuals of Japanese origin residing outside of Japan. Data from the Ministry of Foreign Affairs of Japan,^bb Ministry of Foreign Affairs of Japan. Japan - Brazil relations [cited 2012 Oct 6]. Available from: http://www.mofa.go.jp/region/latin/brazil/index.html from 2009, estimate that around 60 thousand Japanese and 1.5 million descendants of Japanese are living in Brazil. According to Hinata's¹⁷ (2010) Japanese dictionary, the term Nikkei refers to Japanese immigrants and their respective descendants.

Analyzing changes in dietary habits in Nikkeis is justified by the drastic increase in incidence of cancer and cardiovascular disease in this population⁴⁵ compared with in their native country. In Brazil, studies¹²12. Gimeno SG, Ferreira SR, Franco LJ, Iunes M. Comparison of glucose tolerance categories according to World Health Organization and American Diabetes Association diagnostic criteria in a population-based study in Brazil. The Japanese-Brazilian Diabetes Study Group. Diabetes Care. 1998;21:1889-92. DOI:10.2337/diacare.21.11.1889
https://doi.org/10.2337/diacare.21.11.18... ^{, 21}21. Iunes M, Franco LJ, Wakisaka K, Iochida LC, Osiro K, Hirai AT, et al. Self-reported prevalence of non-insulin-dependent diabetes mellitus in the 1st (Issei) and 2nd (Nisei) generation of Japanese-Brazilians over 40 years of age. Diabetes Res Clin Pract. 1994;24(Suppl):S53-7. indicate that the prevalence of type II diabetes among Japanese-Brazilians tripled between the 1980s and the 2000s. The main food in the traditional Japanese is rice, accompanied by vegetables, mushrooms, seaweed and soya and soya derivatives. On average, this diet contains 15% protein, 17% fat and 61% carbohydrates in relation to the total daily calorie value.²⁶ For Japanese living in Japan, high consumption of fish throughout their lives may be linked to lower levels of arteriosclerosis in this population, due to the anti-inflammatory effects from ω-3 fatty acid, which improves endothelial function, reducing oxidative stress and the risk of thrombosis.⁴¹ However, in the process of migrating to other countries, the Japanese population incorporated the habit of consuming bread, cereals, red meat, dairy products, snacks and soft drinks and reducing their fish consumption.²⁶26. Massimino FC, Gimeno SG, Ferreira SR. All-cause mortality among Japanese-Brazilians according to nutritional characteristics. Cad Saude Publica. 2007;23:2145-56. DOI:10.1590/S0102-311X2007000900022
https://doi.org/10.1590/S0102-311X200700...

Some studies show that American-Asian individuals born outside of the United States, after having lived a short period of time on American soil (less than five years), had a higher risk of being overweight and obese than those who had been living in the country for more than 15 years.²⁴24. Lauderdale DS, Rathouz PJ. Body mass index in a US national sample of Asian Americans: effects of nativity, years since immigration and socioeconomic status. Int J Obes Relat Metab Disord. 2000;24:1188-94. DOI:10.1038/sj.ijo.0802147
https://doi.org/10.1038/sj.ijo.0802147... Moreover, Japanese-Americans have a higher prevalence of diabetes compared to white Americans and native Japanese.³¹ However, Japanese-Americans who maintain a Japanese lifestyle (a relatively low fat diet, rich in complex carbohydrates and regular physical activity) seem to be less prone to developing diabetes than those who do not preserve these customs, especially with respect to the diet.³⁵35. Pierce BL, Austin MA, Crane PK, Retzlaff BM, Fish B, Hutter CM, et al. Measuring dietary acculturation in Japanese Americans with the use of confirmatory factor analysis of food-frequency data. Am J Clin Nutr. 2007;86:496-503.

In line with these findings, studies carried out with the population of Japanese origin in the municipality of Bauru, SP, Southeastern Brazil, also showed a high prevalence of glucose metabolism disorders and incidence of diabetes mellitus. Such results may reflect this population's strong genetic predisposition to these disorders associated with the Western lifestyle.¹¹ The aim of this article was to analyze food intake and the dietary factors involved in the health and disease process of the Nikkei population.

METHODS

A systematic revision of the literature on food intake of Japanese immigrants and their descendants was carried out. The Medline/PubMed, Lilacs and SciELO databases and selected articles from the period 1997 to 2012 were used, with the aim of including the latest on the topic. The terms used in the searches were: "issei",^cc Issei: Japanese grandfather (Japanese immigrant)19 "nisei",^dd Nisei: Japanese second generation descendant (son of immigrant)19 "sansei"^ee Sansei: Japanese third generation descendant (grandson of immigrant)19 "Nikkei", "Japanese-Brazilian", "Japanese-American" to characterize the subjects and "diet", "dietary habits", "dietary patterns", "food habits", "food intake" to identify the food intake of these individuals, either isolated or combined using "and" or "or".

Intervention studies or those which involved animal experimentation were excluded, as were those which only presented metabolite and vitamin plasma levels, revision studies and or reports of the results of various studies and articles which did not include the object of this review. Articles written in languages other than English, Spanish or Portuguese were also excluded.

Next, the complete test of the selected articles was analyzed, as well as the references cited, from which additional studies pertinent to the topic were selected. The total number of studies selected was then classified according to the criteria of Downs & Black⁶6. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377-84. (1998), adapted for observational studies, with the aim of evaluating their methodological quality. The adapted version consisted of 20 items from the original 32 point list. Thus, the adapted score had a total of 20 points. The cutoff point used to exclude articles using the Downs & Black⁶6. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377-84. assessment was 10, representing half the total possible score (20).

The initial search identified 137 articles. Of these, six were found in SciELO, 22 in Lilacs and 109 in Medline/PubMed. Only those articles published between 1/1/1997 and 3/10/2012 were considered for selection. Based on analysis of the titles and abstracts, 26 repeated articles, seven articles which were about intervention studies, six which only contained data on metabolite and vitamin plasma levels and 68 which did not meet the objectives of this study or were narrative or systematic revisions were identified and excluded. The total number of eligible studies found in the databases was 30. Later, eight more articles were found through bibliographical references cited in the eligible articles. Therefore, the full text of 38 articles was read and analyzed according to the adapted Downs & Black criteria and five with scores below 10 were excluded. Finally, the systematic revision consisted of 33 studies.

For the purposes of analysis, the studies were organized into 3 groups: 1. Studies of Japanese-Brazilians, 2. Studies of Japanese-Americans and 3. Carried out in Brazil and Japan or the United States and Japan. Multi-ethnic studies which analyzed and described Nikkei dietary habits were also included in the revision.

RESULTS

Of all the studies analyzed, 36% (n = 12) were conducted with the Japanese-Brazilian population; 42% (n = 14) with the Japanese-American population (which was often allocated in a group in multi-ethnic studies); and 22% (n = 7) were studies carried out in two countries, Japan and Brazil or Japan and the United States.

Studies with Japanese-Brazilians

The majority of studies with Japanese-Brazilians were carried out in the population of Japanese descendants living in the municipality of Bauru in the state of Sao Paulo. Of the 12 studies, only two²2. Cardoso MA, Hamada GS, de Souza JM, Tsugane S, Tokudome S. Dietary patterns in Japanese migrants to southeastern Brazil and their descendants. J Epidemiol. 1997;7:198-204. DOI:10.2188/jea.7.198
https://doi.org/10.2188/jea.7.198... ^{, 15}15. Hamada GS, Kowalski LP, Nishimoto IN, Rodrigues JJ, Iriya K, Sasazuki S, et al. Risk factors for stomach cancer in Brazil (II): a case-control study among Japanese Brazilians in Sao Paulo. Jpn J Clin Oncol. 2002;32:284-90. DOI:10.1093/jjco/hyf061
https://doi.org/10.1093/jjco/hyf061... had been carried out in other locations with high concentrations of Japanese descendants. Table 1 shows the list of the articles and the characteristics of each study.

With regards to language, eight articles⁷7. Ferreira SR, Lerario DD, Gimeno SG, Sanudo A, Franco LJ. Obesity and central adiposity in Japanese immigrants: role of the Western dietary pattern. J Epidemiol. 2002;12:431-8. DOI:10.2188/jea.12.431
https://doi.org/10.2188/jea.12.431...

8. Freire RD, Cardoso MA, Gimeno SG, Ferreira SR. Dietary fat is associated with metabolic syndrome in Japanese Brazilians. Diabetes Care. 2005;28:1779-85. DOI:10.2337/diacare.28.7.1779
https://doi.org/10.2337/diacare.28.7.177... ^{- 9}9. Freire RD, Cardoso MA, Shinzato AR, Ferreira SR. Nutritional status of Japanese-Brazilian subjects: comparison across gender and generation. Br J Nutr. 2003;89:705-13. DOI:10.1079/BJN2002824
https://doi.org/10.1079/BJN2002824... ^{, 15}15. Hamada GS, Kowalski LP, Nishimoto IN, Rodrigues JJ, Iriya K, Sasazuki S, et al. Risk factors for stomach cancer in Brazil (II): a case-control study among Japanese Brazilians in Sao Paulo. Jpn J Clin Oncol. 2002;32:284-90. DOI:10.1093/jjco/hyf061
https://doi.org/10.1093/jjco/hyf061... ^{, 26}26. Massimino FC, Gimeno SG, Ferreira SR. All-cause mortality among Japanese-Brazilians according to nutritional characteristics. Cad Saude Publica. 2007;23:2145-56. DOI:10.1590/S0102-311X2007000900022
https://doi.org/10.1590/S0102-311X200700... ^{, 32}32. Neuhouser ML, Thompson B, Coronado GD, Solomon CC. Higher fat intake and lower fruit and vegetables intakes are associated with greater acculturation among Mexicans living in Washington State. J Am Diet Assoc. 2004;104:51-7. DOI:10.1016/j.jada.2003.10.015
https://doi.org/10.1016/j.jada.2003.10.0...

33. Okuda N, Ueshima H, Okayama A, Saitoh S, Nakagawa H, Rodriguez BL, et al. Relation of long chain n-3 polyunsaturated fatty acid intake to serum high density lipoprotein cholesterol among Japanese men in Japan and Japanese-American men in Hawaii: the INTERLIPID study. Atherosclerosis. 2005;178:371-9. DOI:10.1016/j.atherosclerosis.2004.09.007
https://doi.org/10.1016/j.atherosclerosi... ^{- 34}34. Pan YL, Dixon Z, Himburg S, Huffman F. Asian students change their eating patterns after living in the United States. J Am Diet Assoc. 1999;99:54-7. DOI:10.1016/S0002-8223(99)00016-4
https://doi.org/10.1016/S0002-8223(99)00... were in English and four^1,5,37,48 in Portuguese. As for the study design used, two studies were cohort studies⁴4. Damiao R, Castro TG, Cardoso MA, Gimeno SG, Ferreira SR. Dietary intakes associated with metabolic syndrome in a cohort of Japanese ancestry. Br J Nutr. 2006;96:532-8. DOI:10.1079/BJN20061876
https://doi.org/10.1079/BJN20061876... ^{, 26}26. Massimino FC, Gimeno SG, Ferreira SR. All-cause mortality among Japanese-Brazilians according to nutritional characteristics. Cad Saude Publica. 2007;23:2145-56. DOI:10.1590/S0102-311X2007000900022
https://doi.org/10.1590/S0102-311X200700... and the others¹1. Bertolino CN, Castro TG, Sartorelli DS, Ferreira SR, Cardoso MA. [Dietary trans fatty acid intake and serum lipid profile in Japanese-Brazilians in Bauru, Sao Paulo, Brazil]. Cad Saude Publica. 2006;22:357-64 DOI:10.1590/S0102-311X2006000200013
https://doi.org/10.1590/S0102-311X200600...

2. Cardoso MA, Hamada GS, de Souza JM, Tsugane S, Tokudome S. Dietary patterns in Japanese migrants to southeastern Brazil and their descendants. J Epidemiol. 1997;7:198-204. DOI:10.2188/jea.7.198
https://doi.org/10.2188/jea.7.198... ^{- 3}3. Costa MB, Ferreira SR, Franco LJ, Gimeno SG, Iunes M. Dietary patterns in a high-risk population for glucose intolerance. Japanese-Brazilian Diabetes Study Group. J Epidemiol. 2000;10:111-7. DOI:10.2188/jea.10.111
https://doi.org/10.2188/jea.10.111... ^{, 5}5. De Castro TG, Bertolino CN, Gimeno SG, Cardoso MA. [Changes in dietary intake among Japanese-Brazilians in Bauru, Sao Paulo, Brazil, 1993-2000]. Cad Saude Publica. 2006;22:2433-40. DOI:10.1590/S0102-311X2006001100017
https://doi.org/10.1590/S0102-311X200600... ^{, 7}7. Ferreira SR, Lerario DD, Gimeno SG, Sanudo A, Franco LJ. Obesity and central adiposity in Japanese immigrants: role of the Western dietary pattern. J Epidemiol. 2002;12:431-8. DOI:10.2188/jea.12.431
https://doi.org/10.2188/jea.12.431...

8. Freire RD, Cardoso MA, Gimeno SG, Ferreira SR. Dietary fat is associated with metabolic syndrome in Japanese Brazilians. Diabetes Care. 2005;28:1779-85. DOI:10.2337/diacare.28.7.1779
https://doi.org/10.2337/diacare.28.7.177... ^{- 9}9. Freire RD, Cardoso MA, Shinzato AR, Ferreira SR. Nutritional status of Japanese-Brazilian subjects: comparison across gender and generation. Br J Nutr. 2003;89:705-13. DOI:10.1079/BJN2002824
https://doi.org/10.1079/BJN2002824... ^{, 15}15. Hamada GS, Kowalski LP, Nishimoto IN, Rodrigues JJ, Iriya K, Sasazuki S, et al. Risk factors for stomach cancer in Brazil (II): a case-control study among Japanese Brazilians in Sao Paulo. Jpn J Clin Oncol. 2002;32:284-90. DOI:10.1093/jjco/hyf061
https://doi.org/10.1093/jjco/hyf061... ^{, 37}37. Salvo VL, Cardoso MA, Barros Junior N, Ferreira SR, Gimeno SG. [Dietary intake and macrovascular disease in a Japanese-Brazilian population: a cross-sectional study]. Arq Bras Endocrinol Metabol. 2009;53:865-73. ^{, 48}48. Yamashita C, Damiao R, Chaim R, Harima HA, Kikuchi M, Franco LJ, et al. [Interethnic marriage of Japanese-Brazilians associated with less healthy food habits and worse cardiometabolic profile]. Arq Bras Endocrinol Metabol. 2009;53:485-96. DOI:10.1590/S0004-27302009000500002
https://doi.org/10.1590/S0004-2730200900... were cross-sectional studies, with three¹1. Bertolino CN, Castro TG, Sartorelli DS, Ferreira SR, Cardoso MA. [Dietary trans fatty acid intake and serum lipid profile in Japanese-Brazilians in Bauru, Sao Paulo, Brazil]. Cad Saude Publica. 2006;22:357-64 DOI:10.1590/S0102-311X2006000200013
https://doi.org/10.1590/S0102-311X200600... ^{, 2}2. Cardoso MA, Hamada GS, de Souza JM, Tsugane S, Tokudome S. Dietary patterns in Japanese migrants to southeastern Brazil and their descendants. J Epidemiol. 1997;7:198-204. DOI:10.2188/jea.7.198
https://doi.org/10.2188/jea.7.198... ^{, 5}5. De Castro TG, Bertolino CN, Gimeno SG, Cardoso MA. [Changes in dietary intake among Japanese-Brazilians in Bauru, Sao Paulo, Brazil, 1993-2000]. Cad Saude Publica. 2006;22:2433-40. DOI:10.1590/S0102-311X2006001100017
https://doi.org/10.1590/S0102-311X200600... being comparisons of transversal data.

With regards to the tools used to investigate food intake, all of the studies used food frequency questionnaires (FFQ) and only two articles²2. Cardoso MA, Hamada GS, de Souza JM, Tsugane S, Tokudome S. Dietary patterns in Japanese migrants to southeastern Brazil and their descendants. J Epidemiol. 1997;7:198-204. DOI:10.2188/jea.7.198
https://doi.org/10.2188/jea.7.198... reported using three-day-food-diaries, in the second stage of the research.

Of the 12 articles analyzed, eight¹1. Bertolino CN, Castro TG, Sartorelli DS, Ferreira SR, Cardoso MA. [Dietary trans fatty acid intake and serum lipid profile in Japanese-Brazilians in Bauru, Sao Paulo, Brazil]. Cad Saude Publica. 2006;22:357-64 DOI:10.1590/S0102-311X2006000200013
https://doi.org/10.1590/S0102-311X200600... ^{, 2}2. Cardoso MA, Hamada GS, de Souza JM, Tsugane S, Tokudome S. Dietary patterns in Japanese migrants to southeastern Brazil and their descendants. J Epidemiol. 1997;7:198-204. DOI:10.2188/jea.7.198
https://doi.org/10.2188/jea.7.198... ^{, 4}4. Damiao R, Castro TG, Cardoso MA, Gimeno SG, Ferreira SR. Dietary intakes associated with metabolic syndrome in a cohort of Japanese ancestry. Br J Nutr. 2006;96:532-8. DOI:10.1079/BJN20061876
https://doi.org/10.1079/BJN20061876... ^{, 5}5. De Castro TG, Bertolino CN, Gimeno SG, Cardoso MA. [Changes in dietary intake among Japanese-Brazilians in Bauru, Sao Paulo, Brazil, 1993-2000]. Cad Saude Publica. 2006;22:2433-40. DOI:10.1590/S0102-311X2006001100017
https://doi.org/10.1590/S0102-311X200600... ^{, 7}7. Ferreira SR, Lerario DD, Gimeno SG, Sanudo A, Franco LJ. Obesity and central adiposity in Japanese immigrants: role of the Western dietary pattern. J Epidemiol. 2002;12:431-8. DOI:10.2188/jea.12.431
https://doi.org/10.2188/jea.12.431...

8. Freire RD, Cardoso MA, Gimeno SG, Ferreira SR. Dietary fat is associated with metabolic syndrome in Japanese Brazilians. Diabetes Care. 2005;28:1779-85. DOI:10.2337/diacare.28.7.1779
https://doi.org/10.2337/diacare.28.7.177... ^{- 9}9. Freire RD, Cardoso MA, Shinzato AR, Ferreira SR. Nutritional status of Japanese-Brazilian subjects: comparison across gender and generation. Br J Nutr. 2003;89:705-13. DOI:10.1079/BJN2002824
https://doi.org/10.1079/BJN2002824... ^{, 48}48. Yamashita C, Damiao R, Chaim R, Harima HA, Kikuchi M, Franco LJ, et al. [Interethnic marriage of Japanese-Brazilians associated with less healthy food habits and worse cardiometabolic profile]. Arq Bras Endocrinol Metabol. 2009;53:485-96. DOI:10.1590/S0004-27302009000500002
https://doi.org/10.1590/S0004-2730200900... verified a high contribution of lipids in the total calorie intake of the subjects studied, to the detriment of carbohydrates and proteins. Salvo et al³⁷37. Salvo VL, Cardoso MA, Barros Junior N, Ferreira SR, Gimeno SG. [Dietary intake and macrovascular disease in a Japanese-Brazilian population: a cross-sectional study]. Arq Bras Endocrinol Metabol. 2009;53:865-73. (2009) stated that the Nikkei diet, irrespective of macrovascular disease, was composed by 54% carbohydrates, 14% proteins and 32% lipids in relation to their daily calorie intake. In another publication, referring to the same study,¹³13. Gimeno SG, Hirai AT, Harima HA, Kikuchi MY, Simony RF, de Barros N, Jr., et al. Fat and fiber consumption are associated with peripheral arterial disease in a cross-sectional study of a Japanese-Brazilian population. Circ J. 2008;72:44-50. DOI:10.1253/circj.72.44
https://doi.org/10.1253/circj.72.44... the authors verified that higher consumption of total fats was significantly linked to peripheral arterial disease. This link was corroborated by Freire et al⁸8. Freire RD, Cardoso MA, Gimeno SG, Ferreira SR. Dietary fat is associated with metabolic syndrome in Japanese Brazilians. Diabetes Care. 2005;28:1779-85. DOI:10.2337/diacare.28.7.1779
https://doi.org/10.2337/diacare.28.7.177... (2005), who verified significantly higher lipid intake in men with metabolic syndrome than in those without this disorder.

Also in this context, it was observed that individuals who were married to a non-Japanese spouse had higher mean values for calorie intake, carbohydrate, protein, lipid and saturated fat intake than those who were intra-ethnically married (2,183 kcal versus 1,990 kcal; 278.1 g versus 268.3 g; 71.2 g versus 68.9 g; 85.7 g versus 70.5 g; and 20.5 g versus 16.9 g, respectively).⁴⁸48. Yamashita C, Damiao R, Chaim R, Harima HA, Kikuchi M, Franco LJ, et al. [Interethnic marriage of Japanese-Brazilians associated with less healthy food habits and worse cardiometabolic profile]. Arq Bras Endocrinol Metabol. 2009;53:485-96. DOI:10.1590/S0004-27302009000500002
https://doi.org/10.1590/S0004-2730200900... Comparisons between generations also show relevant differences. Evidence indicates that consuming traditional Japanese food such as Miso soup (missoshiru), is declining among Nisseis compared with Isseis; on the other hand, there is higher reported lipid intake among the youngest. However, consuming traditional Japanese food, with soya derivatives, pickled vegetables and green tea was rare in both generations.⁹9. Freire RD, Cardoso MA, Shinzato AR, Ferreira SR. Nutritional status of Japanese-Brazilian subjects: comparison across gender and generation. Br J Nutr. 2003;89:705-13. DOI:10.1079/BJN2002824
https://doi.org/10.1079/BJN2002824...

With regards other dietary changes, De Castro et al⁵5. De Castro TG, Bertolino CN, Gimeno SG, Cardoso MA. [Changes in dietary intake among Japanese-Brazilians in Bauru, Sao Paulo, Brazil, 1993-2000]. Cad Saude Publica. 2006;22:2433-40. DOI:10.1590/S0102-311X2006001100017
https://doi.org/10.1590/S0102-311X200600... (2006) found that, between 1993 and 2000, Japanese-Brazilians, in the city of Bauru, SP, increased their consumption of dairy products, fruit and fruit juice. Damião et al⁴4. Damiao R, Castro TG, Cardoso MA, Gimeno SG, Ferreira SR. Dietary intakes associated with metabolic syndrome in a cohort of Japanese ancestry. Br J Nutr. 2006;96:532-8. DOI:10.1079/BJN20061876
https://doi.org/10.1079/BJN20061876... (2006), after following the same population for seven years, observed a decrease in the consumption of red meat and whole milk and an increase in consumption of skimmed milk.

Studies with Japanese-Americans

Of the 14 articles analyzed in this subgroup, 78.57% (n = 11) formed part of some multi-ethnic study, mainly carried out in Hawaii-California in the United States. All of the selected studies were published in English. Table 2 shows the list of the articles and their characteristics.

With regards to the studies' designs, ten were cohort studies,¹⁶16. Henderson SO, Haiman CA, Wilkens LR, Kolonel LN, Wan P, Pike MC. Established risk factors account for most of the racial differences in cardiovascular disease mortality. PLoS One. 2007;2:e377. DOI:10.1371/journal.pone.0000377
https://doi.org/10.1371/journal.pone.000... ^{, 18}18. Hopping BN, Erber E, Grandinetti A, Verheus M, Kolonel LN, Maskarinec G. Dietary fiber, magnesium, and glycemic load alter risk of type 2 diabetes in a multiethnic cohort in Hawaii. J Nutr. 2010;140:68-74. DOI:10.3945/jn.109.112441
https://doi.org/10.3945/jn.109.112441...

19. Howarth NC, Murphy SP, Wilkens LR, Hankin JH, Kolonel LN. Dietary energy density is associated with overweight status among 5 ethnic groups in the multiethnic cohort study. J Nutr. 2006;136:2243-8. ^{- 20}20. Hu Y, Block G, Sternfeld B, Sowers M. Dietary glycemic load, glycemic index, and associated factors in a multiethnic cohort of midlife women. J Am Coll Nutr. 2009;28:636-47. ^{, 23}23. Kolonel LN, Henderson BE, Hankin JH, Nomura AM, Wilkens LR, Pike MC, et al. A multiethnic cohort in Hawaii and Los Angeles: baseline characteristics. Am J Epidemiol. 2000;151:346-57. DOI:10.1111/j.1365-2648.2007.04258.x
https://doi.org/10.1111/j.1365-2648.2007... ^{, 25}25. Laurin D, Masaki KH, Foley DJ, White LR, Launer LJ. Midlife dietary intake of antioxidants and risk of late-life incident dementia: the Honolulu-Asia Aging Study. Am J Epidemiol. 2004;159:959-67. DOI:10.1039/aje/kwh124
https://doi.org/10.1039/aje/kwh124... ^{, 42}42. Sharma S, Wilkens LR, Shen L, Kolonel LN. Dietary sources of five nutrients in ethnic groups represented in the Multiethnic Cohort. Br J Nutr. 2013;109:1479-89. DOI:10.1017/S0007114512003388
https://doi.org/10.1017/S000711451200338...

43. Steinbrecher A, Erber E, Grandinetti A, Kolonel LN, Maskarinec G. Meat consumption and risk of type 2 diabetes: the Multiethnic Cohort. Public Health Nutr. 2011;14:568-74. DOI:10.1017/S1368980010002004
https://doi.org/10.1017/S136898001000200... ^{- 44}44. Stram DO, Hankin JH, Wilkens LR, Park S, Henderson BE, Nomura AM, et al. Prostate cancer incidence and intake of fruits, vegetables and related micronutrients: the multiethnic cohort study* (United States). Cancer Causes Control. 2006;17:1193-207. DOI:10.1007/s10552-006-0064-0
https://doi.org/10.1007/s10552-006-0064-... ^{, 46}46. Willcox BJ, Yano K, Chen R, Willcox DC, Rodriguez BL, Masaki KH, et al. How much should we eat? The association between energy intake and mortality in a 36-year follow-up study of Japanese-American men. J Gerontol A Biol Sci Med Sci. 2004;59:789-95. DOI:10.1093/gerona/59.8.B789
https://doi.org/10.1093/gerona/59.8.B789... one was of a case control,⁴⁷47. Wu AH, Wan P, Hankin J, Tseng CC, Yu MC, Pike MC. Adolescent and adult soy intake and risk of breast cancer in Asian-Americans. Carcinogenesis. 2002;23:1491-6. DOI:10.1093/carcin/23.9.1491
https://doi.org/10.1093/carcin/23.9.1491... and three¹⁴14. Gold EB, Block G, Crawford S, Lachance L, FitzGerald G, Miracle H, et al. Lifestyle and demographic factors in relation to vasomotor symptoms: baseline results from the Study of Women's Health Across the Nation. Am J Epidemiol. 2004;159:1189-99. DOI:10.1093/aje/kwh168
https://doi.org/10.1093/aje/kwh168... ^{, 35}35. Pierce BL, Austin MA, Crane PK, Retzlaff BM, Fish B, Hutter CM, et al. Measuring dietary acculturation in Japanese Americans with the use of confirmatory factor analysis of food-frequency data. Am J Clin Nutr. 2007;86:496-503. ^{- 36}36. Rice MM, LaCroix AZ, Lampe JW, van Belle G, Kestin M, Sumitani M, et al. Dietary soy isoflavone intake in older Japanese American women. Public Health Nutr. 2001;4:943-52. DOI:10.1079/PHN2001150
https://doi.org/10.1079/PHN2001150... were cross sectional.

In the Multiethnic Cohort Study (MEC), carried out in Hawaii and California, Japanese-Americans had the most energy-dense diets and the lowest body mass index compared with other ethnic groups.¹⁹19. Howarth NC, Murphy SP, Wilkens LR, Hankin JH, Kolonel LN. Dietary energy density is associated with overweight status among 5 ethnic groups in the multiethnic cohort study. J Nutr. 2006;136:2243-8. Moreover, Henderson et al¹⁶16. Henderson SO, Haiman CA, Wilkens LR, Kolonel LN, Wan P, Pike MC. Established risk factors account for most of the racial differences in cardiovascular disease mortality. PLoS One. 2007;2:e377. DOI:10.1371/journal.pone.0000377
https://doi.org/10.1371/journal.pone.000... (2007) found that higher consumption of saturated fat was related to higher mortality from cardiovascular disease, and that in Japanese-American men this consumption was significantly lower than in Afro-Americans, Latinos and Whites. Recently, Steinbrecher et al⁴³43. Steinbrecher A, Erber E, Grandinetti A, Kolonel LN, Maskarinec G. Meat consumption and risk of type 2 diabetes: the Multiethnic Cohort. Public Health Nutr. 2011;14:568-74. DOI:10.1017/S1368980010002004
https://doi.org/10.1017/S136898001000200... (2011) verified that red meat consumption, whether processed or not, was positively associated with risk of diabetes, with higher risk for Caucasian individuals than for Japanese-Americans Sharma et al⁴²42. Sharma S, Wilkens LR, Shen L, Kolonel LN. Dietary sources of five nutrients in ethnic groups represented in the Multiethnic Cohort. Br J Nutr. 2013;109:1479-89. DOI:10.1017/S0007114512003388
https://doi.org/10.1017/S000711451200338... (2013) highlighted that, in their cohort study, the main foods consumed by Americans of Japanese origin were: rice, bread, cereals, chicken, turkey, nuts, fish, salad dressing, butter, meat fried with vegetables, oranges, grape or pomelo juice, bananas, tropical fruit, soft drinks and fruit juice.

Concerning the intake of soya and soya derivatives, intake was highest in women of Chinese origin, medium in women of Japanese origin and lowest in those of Philipino descent.⁴⁷47. Wu AH, Wan P, Hankin J, Tseng CC, Yu MC, Pike MC. Adolescent and adult soy intake and risk of breast cancer in Asian-Americans. Carcinogenesis. 2002;23:1491-6. DOI:10.1093/carcin/23.9.1491
https://doi.org/10.1093/carcin/23.9.1491... Other studies found that the greatest indicator for isoflavone consumption was the language spoken in the interview (Japanese or English). Individuals who spoke Japanese consumed, on average, more isoflavone-rich foods. Birthplace also proved to be a strong indicator for intake of soya and soya derivatives. Consumption, over the preceding year, of isoflavone food sources were 7.8 mg/day, 6 mg/day and 22.5 mg/day in women born in the USA, Hawaii and in Japan, respectively.³⁶36. Rice MM, LaCroix AZ, Lampe JW, van Belle G, Kestin M, Sumitani M, et al. Dietary soy isoflavone intake in older Japanese American women. Public Health Nutr. 2001;4:943-52. DOI:10.1079/PHN2001150
https://doi.org/10.1079/PHN2001150...

Tofu, consumed in its natural state or as part of a dish, was the main source of soya among Chinese, Japanese and Philipino women, comprising around 60% of total daily calorie intake.⁴⁷47. Wu AH, Wan P, Hankin J, Tseng CC, Yu MC, Pike MC. Adolescent and adult soy intake and risk of breast cancer in Asian-Americans. Carcinogenesis. 2002;23:1491-6. DOI:10.1093/carcin/23.9.1491
https://doi.org/10.1093/carcin/23.9.1491... In a study by Rice et al³⁶36. Rice MM, LaCroix AZ, Lampe JW, van Belle G, Kestin M, Sumitani M, et al. Dietary soy isoflavone intake in older Japanese American women. Public Health Nutr. 2001;4:943-52. DOI:10.1079/PHN2001150
https://doi.org/10.1079/PHN2001150... (2001), isoflavone intake was positively linked to kamaboko (fish dumplings), manju and mochi (both Japanese desserts), skimmed milk and red and yellow vegetables. However, among women of Chinese and Japanese origin, genistein consumption (one of the soya isoflavones) showed a positive, although not significant, link with vasomotor menopausal symptoms.¹⁴14. Gold EB, Block G, Crawford S, Lachance L, FitzGerald G, Miracle H, et al. Lifestyle and demographic factors in relation to vasomotor symptoms: baseline results from the Study of Women's Health Across the Nation. Am J Epidemiol. 2004;159:1189-99. DOI:10.1093/aje/kwh168
https://doi.org/10.1093/aje/kwh168...

In the comparison between Japanese-Americans generations, the Nisseis, on average, consumed more Japanese food products, whereas the Sanseis had a more Westernized dietary profile.³⁵35. Pierce BL, Austin MA, Crane PK, Retzlaff BM, Fish B, Hutter CM, et al. Measuring dietary acculturation in Japanese Americans with the use of confirmatory factor analysis of food-frequency data. Am J Clin Nutr. 2007;86:496-503.

Mixed studies: Japan x Brazil and Japan x United States

Seven studies were carried out in two different countries and only one of them³⁹ was conducted in Brazil and Japan. Other six studies²⁷27. Miura K, Nakagawa H, Ueshima H, Okayama A, Saitoh S, Curb JD, et al. Dietary factors related to higher plasma fibrinogen levels of Japanese-americans in hawaii compared with Japanese in Japan. Arterioscler Thromb Vasc Biol. 2006;26:1674-9. DOI:10.1161/01.ATV.0000225701.20965.b9
https://doi.org/10.1161/01.ATV.000022570... ^{, 29}29. Nakamura Y, Ueshima H, Okuda N, Higashiyama A, Kita Y, Kadowaki T, et al. Relation of dietary and other lifestyle traits to difference in serum adiponectin concentration of Japanese in Japan and Hawaii: the INTERLIPID Study. Am J Clin Nutr. 2008;88:424-30.

30. Nakamura Y, Ueshima H, Okuda N, Miura K, Kita Y, Okamura T, et al. Relation of dietary and lifestyle traits to difference in serum leptin of Japanese in Japan and Hawaii: the INTERLIPID study. Nutr Metab Cardiovasc Dis. 2012;22:14-22. DOI:10.1016/j.numecd.2010.03.004
https://doi.org/10.1016/j.numecd.2010.03... ^{- 31}31. Nakanishi S, Okubo M, Yoneda M, Jitsuiki K, Yamane K, Kohno N. A comparison between Japanese-Americans living in Hawaii and Los Angeles and native Japanese: the impact of lifestyle westernization on diabetes mellitus. Biomed Pharmacother. 2004;58:571-7. DOI:10.1016/j.biopha.2004.10.001
https://doi.org/10.1016/j.biopha.2004.10... ^{, 33}33. Okuda N, Ueshima H, Okayama A, Saitoh S, Nakagawa H, Rodriguez BL, et al. Relation of long chain n-3 polyunsaturated fatty acid intake to serum high density lipoprotein cholesterol among Japanese men in Japan and Japanese-American men in Hawaii: the INTERLIPID study. Atherosclerosis. 2005;178:371-9. DOI:10.1016/j.atherosclerosis.2004.09.007
https://doi.org/10.1016/j.atherosclerosi... ^{, 45}45. Takata Y, Maskarinec G, Franke A, Nagata C, Shimizu H. A comparison of dietary habits among women in Japan and Hawaii. Public Health Nutr. 2004;7:319-26. DOI:10.1079/PHN2003531
https://doi.org/10.1079/PHN2003531... were carried out in the United States and Japan.

Different instruments were used to obtain data on the diets of the individuals in question. Four studies²⁷27. Miura K, Nakagawa H, Ueshima H, Okayama A, Saitoh S, Curb JD, et al. Dietary factors related to higher plasma fibrinogen levels of Japanese-americans in hawaii compared with Japanese in Japan. Arterioscler Thromb Vasc Biol. 2006;26:1674-9. DOI:10.1161/01.ATV.0000225701.20965.b9
https://doi.org/10.1161/01.ATV.000022570... ^{, 29}29. Nakamura Y, Ueshima H, Okuda N, Higashiyama A, Kita Y, Kadowaki T, et al. Relation of dietary and other lifestyle traits to difference in serum adiponectin concentration of Japanese in Japan and Hawaii: the INTERLIPID Study. Am J Clin Nutr. 2008;88:424-30. ^{, 30}30. Nakamura Y, Ueshima H, Okuda N, Miura K, Kita Y, Okamura T, et al. Relation of dietary and lifestyle traits to difference in serum leptin of Japanese in Japan and Hawaii: the INTERLIPID study. Nutr Metab Cardiovasc Dis. 2012;22:14-22. DOI:10.1016/j.numecd.2010.03.004
https://doi.org/10.1016/j.numecd.2010.03... ^{, 33}33. Okuda N, Ueshima H, Okayama A, Saitoh S, Nakagawa H, Rodriguez BL, et al. Relation of long chain n-3 polyunsaturated fatty acid intake to serum high density lipoprotein cholesterol among Japanese men in Japan and Japanese-American men in Hawaii: the INTERLIPID study. Atherosclerosis. 2005;178:371-9. DOI:10.1016/j.atherosclerosis.2004.09.007
https://doi.org/10.1016/j.atherosclerosi... used 24 hour food diaries and the other three^31,39,45 used food frequency questionnaires. All of the studies were published in English. Table 3 shows the list of the articles analyzed.

Schwingel et al³⁹39. Schwingel A, Nakata Y, Ito LS, Chodzko-Zajko WJ, Erb CT, Shigematsu R, et al. Central obesity and health-related factors among middle-aged men: a comparison among native Japanese and Japanese-Brazilians residing in Brazil and Japan. J Physiol Anthropol. 2007;26:339-47. DOI:10.2114/jpa2.26.339
https://doi.org/10.2114/jpa2.26.339... (2007) observed that Japanese-Brazilians living in Brazil or in Japan consumed significantly less fish, more red meat, more fatty foods and sweets that Japanese living in Japan. Following this same dietary pattern, Takata et al⁴⁵45. Takata Y, Maskarinec G, Franke A, Nagata C, Shimizu H. A comparison of dietary habits among women in Japan and Hawaii. Public Health Nutr. 2004;7:319-26. DOI:10.1079/PHN2003531
https://doi.org/10.1079/PHN2003531... (2003) showed that in the city of Gifu, Japan, consumption of fish, eggs, soya, vegetable and seaweed products was higher, and consumption of meat, dairy products and fruit lower than that verified in the diets of Japanese-Americans and Caucasians from Hawaii.

Regarding calorie consumption and macronutrients, Miura et al²⁷27. Miura K, Nakagawa H, Ueshima H, Okayama A, Saitoh S, Curb JD, et al. Dietary factors related to higher plasma fibrinogen levels of Japanese-americans in hawaii compared with Japanese in Japan. Arterioscler Thromb Vasc Biol. 2006;26:1674-9. DOI:10.1161/01.ATV.0000225701.20965.b9
https://doi.org/10.1161/01.ATV.000022570... (2006) found that, in men, calorie intake was higher in Hawaii (2,427 kcal sd = 613 kcal) than in Japan (2,280 kcal sd = 428 kcal). However, this difference was not found in women. As for macronutrient intake, there was a higher consumption of animal protein, total fats, saturated and trans fats for both sexes.

Okuda et al³³33. Okuda N, Ueshima H, Okayama A, Saitoh S, Nakagawa H, Rodriguez BL, et al. Relation of long chain n-3 polyunsaturated fatty acid intake to serum high density lipoprotein cholesterol among Japanese men in Japan and Japanese-American men in Hawaii: the INTERLIPID study. Atherosclerosis. 2005;178:371-9. DOI:10.1016/j.atherosclerosis.2004.09.007
https://doi.org/10.1016/j.atherosclerosi... (2005) reported that, in men, energy, protein and total fat intake was higher in Hawaii than in Japan. Women in Japan consumed fewer carbohydrates (56.2% kcal sd = 6.4 versus 50.9% kcal sd = 8.7) and less total fat (26.1% kcal sd = 4.9 versus 31.9% kcal sd = 7.7) than Hawaiian women (p < 0.001). Findings by Nakamura et al³⁰30. Nakamura Y, Ueshima H, Okuda N, Miura K, Kita Y, Okamura T, et al. Relation of dietary and lifestyle traits to difference in serum leptin of Japanese in Japan and Hawaii: the INTERLIPID study. Nutr Metab Cardiovasc Dis. 2012;22:14-22. DOI:10.1016/j.numecd.2010.03.004
https://doi.org/10.1016/j.numecd.2010.03... (2012) indicate that consumption of omega 3 fatty acids was greater in Japan than in Hawaii, for both men and women (p < 0.001).

On the other hand, Nakanishi et al³¹31. Nakanishi S, Okubo M, Yoneda M, Jitsuiki K, Yamane K, Kohno N. A comparison between Japanese-Americans living in Hawaii and Los Angeles and native Japanese: the impact of lifestyle westernization on diabetes mellitus. Biomed Pharmacother. 2004;58:571-7. DOI:10.1016/j.biopha.2004.10.001
https://doi.org/10.1016/j.biopha.2004.10... (2004) found no differences in total energy intake among Japanese-Americans and native Japanese. In contrast, total energy intake in women tended to be greater among the Japanese (1,925 kcal) compared with Japanese-American women (1,727 kcal). In the same context, Japanese women in Gifu reported the highest energy intake, followed by Japanese-American women and by Caucasians in Hawaii. The authors observed that, in Japanese women, the lowest percentage of calories came from fat and the greatest from carbohydrates.⁴⁵45. Takata Y, Maskarinec G, Franke A, Nagata C, Shimizu H. A comparison of dietary habits among women in Japan and Hawaii. Public Health Nutr. 2004;7:319-26. DOI:10.1079/PHN2003531
https://doi.org/10.1079/PHN2003531...

DISCUSSION

The results of the studies evaluated suggest that Japanese immigrants and their descendants, even when preserving many of their traditional dietary habits, at the same time, adopt a Western-style diet (rich in saturated fats, sodium and simple sugars and low in fiber).

In Brazil, over the years (1997 a 2012) various articles¹1. Bertolino CN, Castro TG, Sartorelli DS, Ferreira SR, Cardoso MA. [Dietary trans fatty acid intake and serum lipid profile in Japanese-Brazilians in Bauru, Sao Paulo, Brazil]. Cad Saude Publica. 2006;22:357-64 DOI:10.1590/S0102-311X2006000200013
https://doi.org/10.1590/S0102-311X200600... ^{, 2}2. Cardoso MA, Hamada GS, de Souza JM, Tsugane S, Tokudome S. Dietary patterns in Japanese migrants to southeastern Brazil and their descendants. J Epidemiol. 1997;7:198-204. DOI:10.2188/jea.7.198
https://doi.org/10.2188/jea.7.198... ^{, 4}4. Damiao R, Castro TG, Cardoso MA, Gimeno SG, Ferreira SR. Dietary intakes associated with metabolic syndrome in a cohort of Japanese ancestry. Br J Nutr. 2006;96:532-8. DOI:10.1079/BJN20061876
https://doi.org/10.1079/BJN20061876... ^{, 5}5. De Castro TG, Bertolino CN, Gimeno SG, Cardoso MA. [Changes in dietary intake among Japanese-Brazilians in Bauru, Sao Paulo, Brazil, 1993-2000]. Cad Saude Publica. 2006;22:2433-40. DOI:10.1590/S0102-311X2006001100017
https://doi.org/10.1590/S0102-311X200600... ^{, 8}8. Freire RD, Cardoso MA, Gimeno SG, Ferreira SR. Dietary fat is associated with metabolic syndrome in Japanese Brazilians. Diabetes Care. 2005;28:1779-85. DOI:10.2337/diacare.28.7.1779
https://doi.org/10.2337/diacare.28.7.177... ^{, 9}9. Freire RD, Cardoso MA, Shinzato AR, Ferreira SR. Nutritional status of Japanese-Brazilian subjects: comparison across gender and generation. Br J Nutr. 2003;89:705-13. DOI:10.1079/BJN2002824
https://doi.org/10.1079/BJN2002824... ^{, 37}37. Salvo VL, Cardoso MA, Barros Junior N, Ferreira SR, Gimeno SG. [Dietary intake and macrovascular disease in a Japanese-Brazilian population: a cross-sectional study]. Arq Bras Endocrinol Metabol. 2009;53:865-73. ^{, 45}45. Takata Y, Maskarinec G, Franke A, Nagata C, Shimizu H. A comparison of dietary habits among women in Japan and Hawaii. Public Health Nutr. 2004;7:319-26. DOI:10.1079/PHN2003531
https://doi.org/10.1079/PHN2003531... ^{, 48}48. Yamashita C, Damiao R, Chaim R, Harima HA, Kikuchi M, Franco LJ, et al. [Interethnic marriage of Japanese-Brazilians associated with less healthy food habits and worse cardiometabolic profile]. Arq Bras Endocrinol Metabol. 2009;53:485-96. DOI:10.1590/S0004-27302009000500002
https://doi.org/10.1590/S0004-2730200900... have reported the increased contribution of lipids to the diets of Japanese immigrants and their descendants. The same pattern of increased intake was observed in the studies by Okuda et al (2005)³³33. Okuda N, Ueshima H, Okayama A, Saitoh S, Nakagawa H, Rodriguez BL, et al. Relation of long chain n-3 polyunsaturated fatty acid intake to serum high density lipoprotein cholesterol among Japanese men in Japan and Japanese-American men in Hawaii: the INTERLIPID study. Atherosclerosis. 2005;178:371-9. DOI:10.1016/j.atherosclerosis.2004.09.007
https://doi.org/10.1016/j.atherosclerosi... and Schwingel et al³⁹39. Schwingel A, Nakata Y, Ito LS, Chodzko-Zajko WJ, Erb CT, Shigematsu R, et al. Central obesity and health-related factors among middle-aged men: a comparison among native Japanese and Japanese-Brazilians residing in Brazil and Japan. J Physiol Anthropol. 2007;26:339-47. DOI:10.2114/jpa2.26.339
https://doi.org/10.2114/jpa2.26.339... (2007). In these two studies, the authors report that the contribution of lipids in the diet was greater among individuals living in Brazil or the United States than those who were born and lived in Japan. However, in a multi-ethnic study comparing Japanese immigrants with those from other places, Henderson et al¹⁶16. Henderson SO, Haiman CA, Wilkens LR, Kolonel LN, Wan P, Pike MC. Established risk factors account for most of the racial differences in cardiovascular disease mortality. PLoS One. 2007;2:e377. DOI:10.1371/journal.pone.0000377
https://doi.org/10.1371/journal.pone.000... (2007) found that lipid intake in Japanese-Americans was significantly lower than that found in individuals of other, non-Asian, descent.

Following a diet rich in lipids appears to increase with the number of generations of Japanese immigrants born in the country. Freire et al⁹9. Freire RD, Cardoso MA, Shinzato AR, Ferreira SR. Nutritional status of Japanese-Brazilian subjects: comparison across gender and generation. Br J Nutr. 2003;89:705-13. DOI:10.1079/BJN2002824
https://doi.org/10.1079/BJN2002824... (2003) and Ferreira et al⁷7. Ferreira SR, Lerario DD, Gimeno SG, Sanudo A, Franco LJ. Obesity and central adiposity in Japanese immigrants: role of the Western dietary pattern. J Epidemiol. 2002;12:431-8. DOI:10.2188/jea.12.431
https://doi.org/10.2188/jea.12.431... (2002) verified that Nisseis consumed more total fat than Isseis. High levels of lipid intake may explain the increase in the number of deaths caused by cardiovascular disease in a population whose country of origin, Japan, has the lowest mortality rates from heart disease in the world.²⁸28. Moriguchi EH, Yamori Y, Mori M, Sagara M, Mori H, Sakuma T, et al. New Beverage for Cardiovascular Health, Proposal Based on Oriental and Occidental Food Culture from a World-Wide Epidemiological Study. Geriatrics & Gerontology International. 2008;8:S3-S7. DOI:10.1111/j.1447-0594.2007.00398.x
https://doi.org/10.1111/j.1447-0594.2007...

Sharma et al⁴²42. Sharma S, Wilkens LR, Shen L, Kolonel LN. Dietary sources of five nutrients in ethnic groups represented in the Multiethnic Cohort. Br J Nutr. 2013;109:1479-89. DOI:10.1017/S0007114512003388
https://doi.org/10.1017/S000711451200338... (2012) described how the foods which contributed the most to Japanese-Americans' energy consumption were rice and bread. The authors identified that soft drinks and artificial juices were the greatest source of added sugars in the population. These findings are relevant considering the elevated rates of type II diabetes (DM2) among Nikkeis and the link between this disease and excessive consumption of carbohydrates, added sugar and foods with a high glycemic index.¹⁸18. Hopping BN, Erber E, Grandinetti A, Verheus M, Kolonel LN, Maskarinec G. Dietary fiber, magnesium, and glycemic load alter risk of type 2 diabetes in a multiethnic cohort in Hawaii. J Nutr. 2010;140:68-74. DOI:10.3945/jn.109.112441
https://doi.org/10.3945/jn.109.112441...

Epidemiological studies¹⁰10. Fujimoto WY, Bergstrom RW, Leonetti DL, Newell-Morris LL, Shuman WP, Wahl PW. Metabolic and adipose risk factors for NIDDM and coronary disease in third-generation Japanese-American men and women with impaired glucose tolerance. Diabetologia. 1994;37:524-32. ^{, 38}38. Schulz LO, Bennett PH, Ravussin E, Kidd JR, Kidd KK, Esparza J, et al. Effects of traditional and western environments on prevalence of type 2 diabetes in Pima Indians in Mexico and the U.S. Diabetes Care. 2006;29:1866-71. DOI:10.2337/dc06-0138
https://doi.org/10.2337/dc06-0138... consistently show that migrant individuals rapidly incorporate the same patterns of chronic disease that exist in their destination. Japanese and Mexicans living in the United States have a higher prevalence of cardiovascular disease compared with those who live in the country of origin. One possible explanation for this would be dietetic acculturation and changes in patterns of physical activity. In addition to the Japanese, other ethnicities are affected by this process. In 2004, Neuhouser et al³² found that immigrants of Hispanic origin acculturated in North America reported higher lipid consumption in their diet. Kim et al²²22. Kim MJ, Lee SJ, Ahn YH, Bowen P, Lee H. Dietary acculturation and diet quality of hypertensive Korean Americans. J Adv Nurs. 2007;58:436-45. DOI:10.1111/j.1365-2648.2007.04258.x
https://doi.org/10.1111/j.1365-2648.2007... (2007), in a study of North American and native Koreans, reported that the former consumed fewer typically Korean foods (32.5%) and more fast food (42.5%), whereas in the native Koreans the predominance of Korean food was 100%, and no fast food consumption was reported. The classic example of acculturation are the Pimas Indians, descendants of the Hohokans who inhabited the Pimeria region of what used to be Mexico, today part of the state of Arizona, United States. The considerable reduction in physical activity and changes in eating habits were determinants in increased weight gain. Today, as well as obesity, this population has the highest recorded prevalence of DM2 in the world. There is, then, compelling evidence that lifestyle changes associated with Westernization play an important part in the global DM2 epidemic.³⁸38. Schulz LO, Bennett PH, Ravussin E, Kidd JR, Kidd KK, Esparza J, et al. Effects of traditional and western environments on prevalence of type 2 diabetes in Pima Indians in Mexico and the U.S. Diabetes Care. 2006;29:1866-71. DOI:10.2337/dc06-0138
https://doi.org/10.2337/dc06-0138...

Analysis of Japanese-American³⁵35. Pierce BL, Austin MA, Crane PK, Retzlaff BM, Fish B, Hutter CM, et al. Measuring dietary acculturation in Japanese Americans with the use of confirmatory factor analysis of food-frequency data. Am J Clin Nutr. 2007;86:496-503. ^{, 36}36. Rice MM, LaCroix AZ, Lampe JW, van Belle G, Kestin M, Sumitani M, et al. Dietary soy isoflavone intake in older Japanese American women. Public Health Nutr. 2001;4:943-52. DOI:10.1079/PHN2001150
https://doi.org/10.1079/PHN2001150... and Japanese-Brazilian⁷7. Ferreira SR, Lerario DD, Gimeno SG, Sanudo A, Franco LJ. Obesity and central adiposity in Japanese immigrants: role of the Western dietary pattern. J Epidemiol. 2002;12:431-8. DOI:10.2188/jea.12.431
https://doi.org/10.2188/jea.12.431... studies show that Nissei individuals had a higher intake of Japanese food products that Sanseis. However, in a study of young Asians who emigrated to the United States, Pan et al³⁴34. Pan YL, Dixon Z, Himburg S, Huffman F. Asian students change their eating patterns after living in the United States. J Am Diet Assoc. 1999;99:54-7. DOI:10.1016/S0002-8223(99)00016-4
https://doi.org/10.1016/S0002-8223(99)00... observed significant changes in eating habits, with increased consumption of sweets and fat, dairy products and fruit and lower intake of meat and vegetables. The main reasons reported for not consuming a similar diet to that of their home country were: lack of time to prepare food, ingredients being unavailable, poor quality food products, not knowing how to prepare traditional dishes and the higher prices of these products.

Intake of soya based foods, such as tofu, seems to be strongly linked to the individual's birthplace and their preferred language of communication. Thus, immigrants who were born in Japan and those Nikkeis who chose to be interviewed in Japanese were those who consumed the most soya derivatives.³⁶36. Rice MM, LaCroix AZ, Lampe JW, van Belle G, Kestin M, Sumitani M, et al. Dietary soy isoflavone intake in older Japanese American women. Public Health Nutr. 2001;4:943-52. DOI:10.1079/PHN2001150
https://doi.org/10.1079/PHN2001150... The study by Wu et al⁴⁷47. Wu AH, Wan P, Hankin J, Tseng CC, Yu MC, Pike MC. Adolescent and adult soy intake and risk of breast cancer in Asian-Americans. Carcinogenesis. 2002;23:1491-6. DOI:10.1093/carcin/23.9.1491
https://doi.org/10.1093/carcin/23.9.1491... (2002) shows that soya consumption, especially at a young age, may have a protective effect against breast cancer in later life. This cancer is the most prevalent among women in Brazil.⁴⁰40. Sclowitz ML, Menezes AM, Gigante DP, Tessaro S. [Breast cancer's secondary prevention and associated factors]. Rev Saude Publica. 2005;39:340-9. DOI:10.1590/S0034-89102005000300003
https://doi.org/10.1590/S0034-8910200500...

This study has some limitations which should be borne in mind. There may have been a selection bias due to other databases not being used, although the Medline/PubMed, Lilacs and SciELO databases, together, include the majority of publication in English, Spanish and Portuguese. Another limitation is related to the methodologies of the selected and analyzed studies. Various aspects of design used may produce limitations which affect the accuracy and validity of the estimates inferred. The most common were: using non-representative samples, short follow-up periods and follow-up losses. Moreover, variations in age groups in the samples studied make comparisons between the studies difficult. Other criteria used which may also have led to systematic errors were: data obtained using strategies of recall and based on subjective perceptions of the group evaluated, sample selection made through advertisements in the media such as newspapers and magazines, and use of instruments to measure food intake valid for the population in general and not specific to Japanese descendants.

Using scores to assess the methodological quality of the articles aimed to make their assessment less subjective. However, due to the heterogeneity of the studies, it was difficult for the score to be appropriate for all designs. Thus, using the adapted Downs & Black criteria for observational studies may have also been a limitation.

In spite of this, this study provides up-to-date information on food intake and dietary factors related to the health and disease processes in Japanese immigrants and their descendants, providing support in formulating projects to promote the health and prevent the development of disease of this population.

This revision shows that few studies with standardized methodologies enabling comparisons exist on the food intake of Nikkeis outside of Hawaii in the USA and Bauru (Sao Paulo state) in Brazil. These findings are important for public health, considering the large contingent of individuals of Japanese descent living in Brazil. In addition to public policies aimed at stimulating healthy eating, in regions with large concentrations of these immigrants there could also be incentives for them not to abandon the healthy eating habits characteristic of the Japanese population.

References

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History