A Clinical Trial of the Effects of the

Traditional Okinawa Diet on Blood

Pressure and other Health Indicators:
Can DASH-like Results be Achieved?
Todoriki H., Katsumata Y., Ohya Y., Willcox D.C.,
Zheng K., Sasaki S
Department of Environmental and Preventive Medicine,
Department of Cardiovascular Medicine, Nephrology and Neurology,
Okinawa, Japan,
Department of Human Welfare, Okinawa International University, Okinawa,
Japan,
School of Public Health, the University of Tokyo, Department of Social and
Preventive Epidemiology, Tokyo, Japan

The 22nd Scientific Meeting of the International Society of Hypertension

June 14-19 2008 (Berlin)
Okinawa, an isolated island
prefecture of Japan, has
among the world's longest
average life expectancy and
the highest prevalence of
exceptionally long-lived
individuals.

Geographic
Location of
Okinawa

The Okinawans centenarians have the highest prevalence in Japan.

 Objectives
• The Okinawa Diet, a naturally occurring dietary
pattern similar to the DASH diet in food groups
and nutrient composition, is often cited as the
main reason.
• Unlike the DASH diet, a few dietary intervention
studies have been carried out. Therefore we
explored the effects of the traditional Okinawa
diet on blood pressure and other health
indicators through a clinical trial.
 Traditional Okinawan Diet

• High rich intake of

Green-Yellow Vegetables,
Sweet potatoes,
Soy beans products( ex. Tofu)
Bonito-flakes and kelp
• Low intake of Salty products , Dairy
products
• High-fiber diet, low caloric diet.
Todoirki H, Okinawan J.Amer Studies 1, 52-61, 2004
 • The Okinawa Diet, a naturally occurring dietary pattern
similar to the DASH diet in food groups and nutrient
composition.
• The Okinawa diet offers a new, Asian dietary approach to
preventing and treating hypertension.

The ratio of food groups by several diets mg/day Mineral amounts in several diets
100% 6000
90% Potassium(mg/day)
5000
80% Nuts,seeds Magnesium(mg/day)
70% Meat(incl. poultry) 4000
Calcium(mg/day)
60% Dairy
50% 3000 Sodium(mg/day)
Fruit
40% Vegetables 2000
30% Grains
20% 1000
10%
0
0%
DAS tradi mod J Ame
Hd iet tiona ern O pn. die t( rican
l Okin kin a 2001 diet(
awan w a d ie ) 1997
die t(1 t(199 )
972) 3 )

Appel, L. J. et al.; DASH Collaborative Research Group: A Clinical trial of the Effects of Dietary Patterns on
Blood Pressure. N Engl J Med, 336: 1117-1124, 1997
 Methods of the Chample Study
• Subjects :American residents in Okinawa aged
40 to 69 years (n=138; 50.0±7.2 years old, 51
men and 87 women). White: 85%, African
American:10%, Others:5%.
90% of subjects completed in the trial.
• Study design: Randomized cross-over design.
• Diets: Single-portion takeout meals common in
Japanese cuisine (bento) were provided. A four-
day supply of lunch and dinner bento was
delivered once a week. For two weeks, the
subjects were fed a typical Western style diet
then randomly assigned to receive four weeks of
traditional Okinawa diet, which is rich in green
leafy and yellow root vegetables, and low in
sodium, saturated, trans, and total fat.
 Chample Study 3 Method: Randomized Controlled Clinical Trial
Blood Sampling・24hUrine collection・Nutrition
Survey（DHQ), PWV
Blood Sampling・24hUrine collection・Nutrition Blood Sampling・24hUrine collection・Nutrition
Survey（DHQ), PWV Survey（DHQ), PWV

Western
0wk food intake 2wk B.P.
6wk
B.P.
10wk
B.P.
(1wk) DHQ) (1wk) DHQ)
(1wk) DHQ)

A Okinawan diet(75 subjects*) Western diet(75 subjects*)

Randomized Okinawan vegetable BENTO will be delivered to
the homes of the intervention group by an express
home parcel delivery service.
allocation
B Western diet(75 subjects*) Okinawan diet(75 subjects*)

Okinawan vegetable BENTO will be delivered to

the homes of the intervention group by an
express home parcel delivery service.

The members of the control group will be asked to avoid

Okinawan vegetables as much as possible. **

* The study will employ 150 healthy Americans aged 40 to 69 years

living in Okinawa.
** The dietary intervention group will be provided with instructions on how
to cook the Okinawan diet ( “The Okinawan Diet Plan” by Drs. Willcox).
Nutrients design of the Chample Study 3

Each meal contains ( on average):

• Energy 700kcal(this includes rice)
• Salt 2.5-2.7 g
• Vegetables 250g (Okinawa:Others=2:1)
• Potassium 1500mg
• Vitamin C 100mg
• Bonito flakes 1.5 g
*Nutrient component based on traditional
Okinawan diet in the nutritional survey in
1949.
 Examples of Okinawan Vegetables
in BENTO
Goya Green
(Momordica papaya
charantia) (Carica
papaya)

Sakuna
Handama
(Gynura
bicolor)

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Bento for Americans ( Chample Study 3)

• A four-day supply of lunch and dinner bento once a

week. traditional Okinawa diet, which is rich in green
leafy and yellow root vegetables, and low in sodium,
saturated, trans, and total fat.
• A two-day supply of Goya juice(480ml per day) once a
week .
• Subjects intake the average of 80% amount of the
delivered meals .
(Willcox ‘The Okinawa Diet Plan’)
 Results
• Among Okinawa diet subjects, systolic and diastolic
BP decreased 2.6 mmHg (95% CI -4.3,-1.1), and
2.1mmHg (95%CI -3.1 -1.0), respectively. Among
control group, systolic and diastolic BP decreased
0.2 mmHg (95% CI -1.6, 1.1), and 0.3mmHg
(95%CI -2.1 0.6), respectively. All BP values were
measured at home.
• 24h-urinary of sodium and body weight decreased
more in the intervention group than in controls
(significance of between-group differences ranged
from p=0.004 to 0.0008). Serum vitamin C level
increased in the intervention group than in controls
(significance of between-group differences
p=0.003).
• Post-intervention group indicated the similar results.
 Intervention changes in blood pressure
3.0
Change of Blood Pressure(mmHg) 2.0
A group B group

0.6 0.8
1.0

0.0
Mean±95%CI

-0.2 -0.3
-1.0

-2.0
-2.1 -1.9
-3.0 -2.6
P=0.013 -3.3 P<0.0001
-4.0
P=0.0221 P<0.0001
-5.0
SBP DBP SBP DBP
A group
120.5/75.5mmHg A group
intervention
B group
117.2/75.1mmHg B group
0 month 1 month intervention 2 month
 Pre-intervention changes in variables
Intervention group
Control group
10.0 12.0 80.0
9.0 11.0 79.0
10.0
24h‐Urinary Salt (g/day)

8.0 78.0
9.0
Serum VitC(μ/mL)

Body Weigth (kg)
7.0 8.0 77.0
6.0 7.0 76.0
P=0.003
5.0 6.0 75.0
4.0 5.0 74.0 P=0.0008
P=0.004 4.0 73.0
3.0
3.0
2.0 72.0
2.0
1.0 1.0 71.0
0.0 0.0 70.0
Before After Before After Before After
 Chample Study Scheme
( RCT design)
Project Inreve Character of Number Intervention Method Outcome
Location ntion Subjects of
Year Term Subjects
Part1 2 Female(18-38 39 Home-percel delivery Blood/Urinary
Okinawa weeks yrs) of Okinawan Nutrients
2005 vegetables
Part2 1 Middle-aged 229 Delivery of Okinawan B.P. , Blood/Urinary
Okinawa month Okinawan vegetables +GOYA Nutrients
Arteriosclerosis
2006 couples(40- Juice
Index(PWV/AI)
69 yrs)
Part3 1 Americans 138 Delivery of Okinawan B.P. , Blood/Urinary
Okinawa month Volunteers(40 Bento +GOYA Juice Nutrients,
Arteriosclerosis
Cross-over -69 yrs)
Index(PWV /AI)
2007
Part4 1 Middle-aged 282 Delivery of Okinawan B.P. , Blood/ Urinary
Yokohama month Main-land Bento +GOYA Juice Nutrients,
Arteriosclerosis
Cross-over + 1yr residents
Index(PWV /AI)
2008 follow couples(40-
Behavioral
up 69 yrs) modification,
 Macronutrient profile of popular diet and Chample Study Diet
High Carbo Chample Study Diet Low Carbo
Low Fat Dash Diet High Fat
Moderate Protein High Protein
100%

90%
80%

70%
60%
Energy(%)

50%
40%
Fat
30% C ar bo h ydr at e
Pr o t e i n
20%

10%
0% Me dit e
O mn i- Ch ampl NHANE Sou th
O r n ish DA S H r r an e a Zo n e A t kin s
Car b e S III B e ac h
n
Fat 7 30 28 23 33 46 27 40 62
Car bo h ydr at e 75 54 53 62 52 38 37 33 9
P r o t e in 18 16 20 15 15 16 35 26 29

Diet

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Source: The data except the Chample Study Diet came from de Souza RJ et al. Am J Clin Nutr 2008;88:1-11.
 Conclusion
• The traditional Okinawa diet, although
unique in culinary approach, has similar
composition of nutrients and food groups
to the DASH diet and seems to achieve
similar results. Americans subjects have a
good reputation of Okinawan Bento
diet( 71% of subjects would like to
purchase the delivered BENTO).
• The Okinawa diet offers a new, Asian
dietary approach to preventing and
treating hypertension.
 Thank you !
Nihe de biru!
Gokurou sama
deshita!

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