Skip to main content Accessibility help

Intake of starch and sugars and total and cause-specific mortality in a Japanese community: the Takayama Study

  • Chisato Nagata (a1), Keiko Wada (a1), Michiyo Yamakawa (a1), Kie Konishi (a1), Yuko Goto (a1), Sachi Koda (a1), Fumi Mizuta (a1) and Takahiro Uji (a1)...


Studies on the intake of different types of carbohydrates and long-term mortality are sparse. We examined the association of starch, total and each type of sugar and free sugars with the risk of total and cause-specific mortality in a cohort of the general population in Japan. Study subjects were 29 079 residents from the Takayama Study, Japan, who responded to a self-administered questionnaire in 1992. Diet was assessed by a validated FFQ at the baseline. Mortality was ascertained during 16 years of follow-up. We noted 2901 deaths (974 cancer related and 775 cardiovascular related) in men and 2438 death (646 cancer related and 903 cardiovascular related) in women. In men, intake of starch was inversely associated with total mortality after controlling for covariates (hazard ratio (HR) for the highest quartile v. lowest quartile: 0·71; 95 % CI 0·60, 0·84; Ptrend < 0·001). Intakes of total sugars, glucose, fructose, sucrose, maltose and free and naturally occurring sugars were significantly positively associated with total mortality in men (HR for the highest v. lowest quartile of total sugar: 1·27; 95 % CI 1·12, 1·45; Ptrend < 0·0001). Similar relations were observed for cardiovascular mortality and non-cancer, non-cardiovascular mortality in men. In women, there was no significant association between any type of carbohydrates and mortality except that intake of free sugars was significantly positively associated with total and non-cancer, non-cardiovascular mortality. Data suggest that the high intake of starch reduces mortality, whereas the high intake of sugars, including glucose, fructose and sucrose, increases mortality in Japanese men.


Corresponding author

*Corresponding author: C. Nagata, email


Hide All
1.Coutinho, M, Gerstein, HC, Wang, Y, et al. (1999) The relationship between glucose and incident cardiovascular event: a metaregression analysis of published data from 20 studies of 95783 individuals followed for 12.4 years. Diabetes Care 48, 937942.
2.Unwin, N, Shaw, J, Zimmet, P, et al. (2002) Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med 19, 708723.
3.Scappaticco, L, Maiorino, MI, Bellastella, G, et al. (2017) Insights into the relationships between diabetes, prediabetes, and cancer. Endocrine 56, 231239.
4.Te Morenga, L, Mallard, S & Mann, J (2012) Dietary sugars and body weight: systematic review and meta-analyses of randomized controlled trials and cohort studies. BMJ 346, e7492.
5.Siri, PW & Krauss, RM (2005) Influence of dietary carbohydrate and fat on LDLand HDL particle distributions. Curr Atheroscler Rep 7, 455459.
6.Klein, KV & Kiat, H (2015) The mechanisms underlying fructose-induced hypertension: a review. J Hypertens 33, 912920.
7.Dehghan, M, Mente, A, Zhang, X, et al. (2017) Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 390, 20502062.
8.Nagata, C, Wada, K, Tsuji, M, et al. (2014) Dietary glycemic index and glycemic load in relation to all-cause and cause-specific mortality in a Japanese community: the Takayama study. Br J Nutr 112, 20102017
9.Mela, DJ & Woolner, EM (2018) Perspective: total, added, or free? What kind of sugars should be talking about? Adv Nutr 9, 6369.
10.Kahn, TA & Sievenpiper, JL (2016) Controversies about sugars: results from systematic reviews and meta-analyses on obesity, cardiometabolic disease and diabetes. Eur J Nutr 55, Suppl. 2, S25S43.
11.Dekker, MJ, Su, Q, Baker, C, et al. (2010) Fructose: a highly lipogenic nutrient implicated in insulin resistance, hepatic steatosis, and the metabolic syndrome. Am J Physiol Endocrinol Metab 299, E685E694.
12.Malik, VS & Hu, FB (2015) Fructose and cardiometabolic health: what the evidence from sugar-sweetened beverages tells us. J Am Coll Cardiol 66, 16151624. Koning, L, Malik, VS, Rimm, EB, et al. (2011) Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes. Am J Clin Nutr 93, 13211327. Koning, L, Malik, VS, Rimm, EB, et al. (2012) Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men. Circulation 125, 17351741.
15.Fung, TT, Malik, V, Rexrode, KM, et al. (2009) Sweetened beverage and risk of coronary heart disease in women. Am J Clin Nutr 89, 10371042.
16.Rippe, JM & Angelopoulos, TJ (2013) Sucrose, high-fructose corn syrup, and fructose, their metabolism and potential health effects: what do we really know? Adv Nutr 4, 236245.
17.Tasevska, N, Park, Y, Jiao, L, et al. (2014) Sugars and risk of mortality in the NIH-AARP Diet and Health Study. Am J Clin Nutr 99, 10771088.
18.Liu, S, Willett, WC, Stampfer, MJ, et al. (2000) A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 71, 14551461.
19.Beulens, JW, de Bruijne, LM, Stolk, RP, et al. (2007) High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women. a population-based follow-up study: a population-based follow-up study. J Am Coll Cardiol 50, 1421.
20.Sieri, S, Brighenti, F, Agnoli, C, et al. (2013) Dietary glycemic load and glycemic index and risk of cerebrovascular disease in the EPICOR cohort. Plos One 8, e62625.
21.Sieri, S, Krogh, V, Berrino, F, et al. (2010) Dietary glycemic load and index and risk of coronary heart disease in a large Italian cohort. The EPICOR study. Arch Intern Med 170, 640647.
22.Rebella, SA, Koh, H, Chen, C, et al. (2014) Amount, type, and sources of carbohydrates in relation to ischemic heart disease mortality in a Chinese population: a prospective cohort study. Am J Clin Nutr 100, 5364.
23.Yasui, T (2015) Advances in food composition tables of Japan–amino acid, fatty acid and available carbohydrate tables. J Nutr Sci Vitaminol 61, S28S30.
24.Shimizu, H (1996) The Basic Report on Takayama Study. Gifu: Department of Public Health, Gifu University School of Medicine.
25.Shimizu, H, Ohwaki, A, Kurisu, Y, et al. (1999) Validity and reproducibility of a quantitative food frequency questionnaire for a cohort study in Japan. Jpn J Clin Oncol 29, 3844.
26.Office for Resources, Policy Division Science and Technology Policy Bureau (2015) Standard tables of food composition in Japan - 2015 - (seventh revised edition) – available carbohydrates, polyols and organic acids. (accessed September 2019).
27.Council for Science and Technology, Ministry of Education C, Sports, Science and Technology, Japan, ed. (2005) Standard Tables of Food Composition in Japan (5th revised and enlarged edition) (in Japanese). Tokyo: National Printing Bureau.
28.World Health Organization (2015) Guideline: Sugars Intake for Adults and Children. Geneva: WHO.
29.Karrtinen, NE, Simila, ME, Kanerva, N, et al. (2017) Naturally occurring and added sugar in relation to macronutrient intake and food consumption: results from a population-based study in adults. J Nutr Sci 6, e7.
30.Suzuki, I, Kawakami, N & Shimizu, H (1998) Reliability and validity of a questionnaire for physical activity in epidemiological studies. J Epidemiol 8, 152159 (supplementary comment: J Epidemiol 2002;12, 54).
31.Kipnis, V, Freedman, LS, Brown, CC, et al. (1993) Interpretation of energy adjustment models for nutritional epidemiology. Am J Epidemiol 137, 13761380.
32.Warfa, K, Drake, I, Wallström, P, et al. (2016) Association between sucrose intake and acute coronary event risk and effect modification by lifestyle factors: Malmö Diet and Cancer Cohort Study. Br J Nutr 116, 16111620.
33.Bahadoran, Z, Mirmiran, P, Tohidi, M, et al. (2017) Longitudinal associations of high-fructose diet with cardiovascular events and potential risk factors: Tehran Lipid and Glucose Study. Nutrients 9, 872.
34.Izadi, V & Azadbakht, L (2015) Is there any association between rice consumption and some of the cardiovascular diseases risk factors? A systemic review. ARYA Atheroscler 11, Suppl. 1, 109115.
35.Saneei, P, Larijani, B & Esmaillzadeh, A (2016) Rice consumption, incidence of chronic diseases and risk of mortality: meta-analysis of cohort studies. Public health Nutr 20, 233244.
36.Azais-Braesco, V, Sluik, D, Maillot, M, et al. (2017) A review of total & added sugar intakes and dietary sources in Europe. Nut J 16, 6.
37.Kim, K, Yun, SH, Choi, BY, et al. (2008) Cross-sectional relationship between dietary carbohydrate, glycaemic index, glycaemic load and risk of the metabolic syndrome in a Korean population. Br J Nutr 106, 576584.
38.Hare-Bruun, H, Nielsen, BM, Grau, K, et al. (2008) Should glycemic index and glycemic load be considered in dietary recommendations? Nutr Rev 66, 569590.
39.Yang, Q, Zhang, Z, Gregg, EW, et al. (2014) Added sugar intake and cardiovascular disease mortality among US adults. JAMA Intern Med 174, 516524.
40.Liu, ZM, Tse, LA, Chan, D, et al. (2018) Dietary sugar intake was associated with increased body fatness but decreased cardiovascular mortality in Chinese elderly: an 11-year prospective study of Mr and Ms OS of Hong Kong. Int J Obes 42, 808.


Type Description Title
Supplementary materials

Nagata et al. supplementary material
Nagata et al. supplementary material

 Word (44 KB)
44 KB

Intake of starch and sugars and total and cause-specific mortality in a Japanese community: the Takayama Study

  • Chisato Nagata (a1), Keiko Wada (a1), Michiyo Yamakawa (a1), Kie Konishi (a1), Yuko Goto (a1), Sachi Koda (a1), Fumi Mizuta (a1) and Takahiro Uji (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed