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A Comparison of Health and Fitness–Related Variables in a Small Sample of Children of Japanese Descent on 2 Continents
Arlette C. Perry, PhD;
Tomoki Okuyama, MS;
Kijoji Tanaka, PhD;
Joseph Signorile, PhD;
Ted A. Kaplan, MD;
Xuewen Wang, BS
Arch Pediatr Adolesc Med. 2002;156:362-368.
ABSTRACT
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Objective To compare physical characteristics, health and fitness–related
variables, and nutrient intake between children of Japanese ancestry living
in the United States and Japan.
Design Cross-sectional study.
Setting Miami, Fla, and Tsukuba, Japan.
Subjects Fourteen children of Japanese descent living in the United States and
14 sex- and age-matched children living in Japan.
Main Outcome Measures US and Japanese resident groups were compared on physical characteristics,
health and fitness–related variables, and nutrient intake using the t test for paired samples. To assess differences between groups in
variables not statistically significant, effect sizes were calculated using
the Cohen d test of standardized differences.
Results The following significant differences were found between US and Japanese
resident groups, respectively: body mass index, 19.3 and 16.9, P =
.02; percentage of body fat, 22.0% and 14.3%, P = .002; diastolic
blood pressure, 65.8 and 58.9 mm Hg, P = .01; total cholesterol,
169.8 and 138.7 mg/dL (4.39 and 3.59 mmol/L, P = .001); low-density
lipoprotein cholesterol, 108.2 and 88.0 mg/dL (2.80 and 2.28 mmol/L, P = .01); triglycerides, 92.5 and 59.0 mg/dL (1.04 and 0.67 mmol/L,
P = .02); percentage of fat intake, 26.1% and 20.3%, P =
.001; percentage of saturated fat intake, 7.9% and 6.1%, P<.002;
percentage of carbohydrate intake, 57.9% and 63.9% (P = .004); vertical jump,
28.9 and 34.4 cm, P = .02; and flexibility, 58.2 and 42.6 cm, P = .002.
Using the Cohen d test, US residents showed a
moderately greater systolic blood pressure (107.5 vs 101.9 mm Hg, P = .10) and leg strength (81.5 vs 55.8 kg, P = .11) than
did Japanese residents.
Conclusions A small sample (n = 14) of children of Japanese descent living in Florida
showed more adverse health-related characteristics than did a comparable group
of their peers living in Japan. The results are probably related to differences
in their diets. It remains to be seen whether the differences in diets are
related to where the children live.
INTRODUCTION
AMONG industrialized nations, cardiovascular disease is the number one
cause of adult deaths.1-3
Interestingly, Japan has one of the lowest mortality rates from heart disease
among industrialized nations.4 According to
the American Heart Association,5 mortality
rates from cardiovascular disease total 561 per 100 000 adults in the
United States vs less than half, 271 per 100 000 adults, living in Japan.
Although the levels of cardiovascular disease in Japan remain low, adult
Japanese men who have relocated to the United States, and have adopted the
habits and lifestyles common to Western civilization, show a significantly
higher risk for developing cardiovascular disease compared with their peers
living in Japan. Research6-8
has indicated a 3-fold increase in the incidence of myocardial infarction
in adult men of Japanese descent residing in California compared with their
counterparts living in Japan. Given the elevated rates of cardiovascular disease
observed in adult Japanese men in California, it may be relevant to examine
variables related to health and fitness in children of a similar cultural
background.
Past research9-10 has shown
that risk factors for cardiovascular disease do not suddenly appear in adulthood
but rather progress on a continuum of unfavorable lifelong habits and experiences
that may begin as early as childhood. Poor nutrient profiles, reduced aerobic
fitness, and obesity in children have all been postulated to contribute to
the cardiovascular disease process.11 Furthermore,
an unhealthy diet and sedentariness may influence obesity, and those who are
obese in childhood stand a greater than 50% chance of becoming obese adults.12
Thus, this study examines the physical characteristics, health and fitness–related
variables, and nutrient intake in children of Japanese descent residing in
the United States (AR) compared with age- and sex-matched children living
in Japan (JR).
SUBJECTS AND METHODS
SUBJECTS
Volunteer subjects were recruited via flyers, newspaper advertisements,
and telephone calls in Miami, Fla, and Tsukuba, Japan. Accordingly, identical
flyers were put up in those markets in closest proximity to the University
of Miami and the University of Tsukuba. An identical advertisement was put
in the school newspaper in both locations, and telephone calls were taken
by the project coordinator (T.O.), who was fluent in Japanese, in both locations.
The flyers and advertisements appealed to participants who were interested
in learning more about their fitness levels, cholesterol levels, dietary intake,
and overall health. There were no monetary inducements to participate in the
study. The advertisement also explained that participants should be "apparently
healthy," free from taking any medications regularly, and permissive of a
physician's review of their medical history. No children were excluded from
the study for medical reasons. In attempting to maintain uniform recruiting
and testing, 2 weeks were allotted for the testing of children in
both locations.
In both locations, several parents failed to commit to the study after
learning more about the data collection. Several children (1 in the United
States and 2 in Japan) were excluded from participating because they were
not yet aged 8 years or had turned 13 years during testing. Investigators
used the information collected on participants in Miami to recruit the first
14 children who could be age and sex matched in Tsukuba. All adults were screened
about their children by telephone, when the subjects' age, significant medical
history, availability, and testing requirements were reviewed.
Fourteen children, aged 8 to 12 years (7 boys and 7 girls), from Miami
and 14 age- and sex-matched children from Tsukuba agreed to participate and
undergo all testing. Bilingual written informed consent forms were obtained
from children and parents in accordance with the guidelines stated by the
University of Miami Office of Research Standards for the Protection of Human
Subjects.
Nine children from Miami were born in the United States and were US
citizens. One child had continuous residence in the United States for 10 years,
2 had continuous residence for 5 years, and 2 had continuous residence for
2 years. All children living in Japan were born there, had continuous
residence in Japan, and had never been to the United States. All children
had parents of Japanese descent.
METHODS
Data collection initially occurred at the Human Performance Laboratory,
University of Miami, followed by collection at Higashitoride Hospital Fitness
Laboratory, near the University of Tsukuba. At each location, children were
required to rotate through 5 stations appropriately designed so that all variables,
with the exception of aerobic fitness, could be measured. On a second visit
and within 1 week of the initial testing, children were required to perform
a graded exercise test to determine maximum oxygen consumption ( O2max). With the exception of the metabolic cart and electrocardiograph,
those instruments used in Miami were transported to and used in Japan according
to the same procedures followed in the United States.
PHYSICAL CHARACTERISTICS
Height was obtained in children without their shoes using a wall-mounted
stadiometer and measured according to standard procedures, recorded to the
nearest 0.1 cm. Weight was measured on a balance beam scale, with calibration
procedures performed before data collection and reported to the nearest 0.1
kg. Body mass index (BMI) was calculated as weight in kilograms divided by
the square of height in meters. Resting heart rate (measured in beats per
minute) was recorded manually. Blood pressure (BP) was taken by a trained
investigator (T.O.) using standard procedures.13
All measurements were recorded by the same investigator and taken to the nearest
2 mm Hg.
Body composition was measured according to standardized procedures using
bioelectrical impedance (Quantum NIA-101Q; RJL Systems, Inc, Clinton Township,
Michigan).14-15 Bioimpedance uses
the resistance of bodily tissues to an electric current to determine the amount
of lean (fat-free) tissue. Values were then entered into a weight- and height-adjusted
formula developed for children by Houtkooper et al16
to determine body density, fat mass, percentage of body fat, and fat-free
mass.
SERUM LIPID AND LIPOPROTEIN MEASUREMENTS
Serum lipid and lipoprotein measurements were obtained by venipuncture
following an overnight fast. Blood was then placed in 10-mL silica-coated
self-separating tubes, centrifuged immediately, and analyzed 24 hours later
in accordance with standard procedures.17-19
The concentrations of total cholesterol (T-Chol), high-density lipoprotein
cholesterol, and triglycerides (TG) were measured via lightabsorbency in serum
samples using a photometer (Premiere Filter Photometer; Stanbio Laboratory,
San Antonio, Tex). The very low-density lipoprotein cholesterol (LDL-C) level
was calculated by dividing TG by 5, and the LDL-C level was estimated by subtracting
the high-density lipoprotein cholesterol and very LDL-C levels from the T-Chol
level.20 These measurements have been validated
against a large range of low, normal, and high lipid levels and have been
used elsewhere to estimate serum lipoprotein levels in children.21-22
PHYSICAL FITNESS MEASURES
Grip strength was assessed using a standard grip dynamometer. Each subject's
forearm was placed on a flat table while in a seated position, and each subject
was asked to squeeze as hard as possible. The best of 3 trials was recorded
to the nearest 0.1 kg.
Assessment of leg strength was made using a standard dynamometer. By
attaching a grip bar to a chain that is connected in series with a dynamometer,
isometric leg strength was measured in kilograms. The highest maximum voluntary
isometric contraction recorded in 3 trials was used to indicate leg strength.
The Vertec (Questek Corp, Northridge, Calif), an apparatus used to measure
vertical jump height, was also used to calculate peak leg power. Each child
was required to perform 3 vertical jumps to their maximum height while extending
one arm as high as possible to indicate a vertical jump mark. The greatest
distance between the baseline and the vertical jump mark constituted the vertical
jump distance. Peak leg power was calculated using vertical jump distance
and body weight in a formula reported by Fox and Mathews.23
A sit-and-reach test was used to measure hamstring and lower back flexibility.
The baseline was set at 15 cm from the vertical surface of the box, and the
examiner (A.C.P.) instructed children to place the right hand over the left
and reach as far forward as possible. The best of 3 trials was recorded.
Within 1 week of the initial testing, the children completed a graded
exercise test to maximum on a motor-driven treadmill to determine O2max as a measure of aerobic fitness. Using a modified protocol from
Gutin et al,24 each child walked at 3.5 mph
and 0% grade for 3 minutes, after which time the child's speed was increased
to a comfortable run (4-5 mph) at 0% grade. Thereafter, the speed remained
constant and the grade was increased 2.5% every other minute until O2max was reached. Metabolic measurements were continuously recorded
(2900 Metabolic Cart; SensorMedics, Yorba Linda, Calif). The criterion for
achieving O2max included a plateau in levels of oxygen consumption
per minute, a respiratory exchange ratio above 1.1, and/or the child's communication
of being unable to continue further.25 During
recovery, each child walked at a comfortable speed at 0% grade until the child's
heart rate returned to the warm-up level.
NUTRIENT ANALYSIS
A sample of food items, liquid and solid measurement utensils, and cups
and plates were used to familiarize the children and their parents with portion
sizes and adequate food descriptions. Children were told to select 2 weekdays
and 1 weekend (nonschool) day that were representative of typical eating habits,
and an interviewer (T.O.) reviewed records of children with their parents
to ensure that appropriate information was recorded. A software package (Nutritionist
IV; First Data Bank, San Bruno, Calif) was used to analyze food records. Other
studies26-27 have shown that 3-day
food records can be used to assess nutrient intake in children when assisted
by their parents.
Japanese Food Nutrient Charts (The Science and Technology Agency and
Ishiyaku Shuppan Corporation, both in Tokyo, Japan) were used for manual data
entry of Japanese foods into the software system (Nutritionist IV). This manual
data entry method was used to ensure that nontraditional and unlisted Japanese
foods consumed were also entered into the database.
STATISTICAL ANALYSIS
All results are presented as mean ± SD. All other statistical
analyses were completed using the Statistical Package for the Social Sciences,
version 10.0.28 Univariate statistics using
a t test for paired samples were used to compare
children residing in both locations on all measured variables. For variables
not showing equal variances, the Welch t was used
to determine significant differences between groups. This was done for TG,
T-Chol–high-density lipoprotein cholesterol ratio, flexibility, total
calorie (energy) intake, and calcium intake. P .05
was considered significant. A Cohen29 d test was used to indicate standardized differences between
groups for each variable. A medium effect size, d  0.5,
was used to determine moderate to medium differences between groups. A Pearson
product moment correlation was performed to examine relationships among all
measured variables.
RESULTS
An examination of physical characteristics showed that body weight and
BMI (Table 1) were significantly
greater in AR. Children in the United States were, on average, 7.6 kg heavier
than JR, and their BMI was greater by 2.4. In accordance with greater weight
and BMI, AR had a greater percentage body fat, which was higher by 7.7%, and
a higher diastolic BP, which was higher by 6.9 mm Hg, compared with JR (Table 1). Although the systolic BP did
not show a statistically significant difference between groups, the Cohen d was 0.65, which indicated a moderately greater systolic
BP for AR.
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AR Compared With JR for Physical Characteristics, Serum Lipid and Lipoprotein
Levels, Physical Fitness Variables, and Nutrient Intake*
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Analysis of serum lipid and lipoprotein levels showed significantly
higher T-Chol, LDL-C, and TG levels for AR compared with JR (Table 1). In fact, AR had TG values more than 1.5 times greater,
T-Chol values 31.1 mg/dL (0.80 mmol/L) greater, and LDL-C values 20.2 mg/dL
(0.52 mmol/L) greater than JR.
Results of the physical fitness variables showed that AR were more flexible
but failed to jump as high as JR (Table
1). Interestingly, JR could outjump AR by 5.5 cm, yet were less
flexible by almost the same margin. Children of Japanese descent residing
in the United States could generate 25.7 kg greater leg strength, which, although
not statistically significant, indicated a substantial difference (d = 0.62) in leg strength between the 2 groups. There were no other
statistical and effect size differences observed between groups for any other
fitness variables. All children were strongly encouraged to obtain their O2max during testing. Only one girl residing in Japan could not be pushed
during the graded exercise test and could not continue to perform and meet
the necessary criteria for obtaining O2max. Therefore,
her data were excluded from statistical analysis. All children achieved a
maximum heart rate above 200 beats/min during the graded exercise test.
Children of Japanese descent residing in the United States consumed
a greater percentage of calories as carbohydrates, total fat, and saturated
fat, as calculated by the t test (Table 1). The same significant differences were observed whether
nutrient intake was expressed as an absolute amount or as a percentage of
total calories consumed. Although AR consumed 6% less calories as carbohydrate,
they also consumed 5.8% more total fat and 1.8% more saturated fat than did
JR. There were no other statistically significant differences and no other
moderate to medium effect size differences observed between groups for any
other nutrient measured.
COMMENT
In the present study, several physical characteristics were similar
between children living in the United States and Japan. The AR group, however,
showed a higher body weight, BMI, and diastolic BP than the JR group. They
also showed a higher percentage of body fat, which, along with BMI, may have
accounted for their higher diastolic BP when compared with their peers in
Japan.30-33
A moderately higher systolic BP was also noted for AR. In fact, the mean systolic
BP of 107 mm Hg was close to the 75th percentile (109 mm Hg) observed for
US children.34
Although both groups of children showed serum lipid profiles that would
not be considered clinically elevated (80th percentile) and not requiring
dietary or pharmacological treatment,35 AR
displayed values associated with greater cardiovascular disease risk. For
LDL-C, AR had values exceeding 108 mg/dL (2.79 mmol/L), which is just at the
75th percentile for US boys.36 In contrast,
JR had a mean LDL-C level of 88 mg/dL (2.28 mmol/L), which was significantly
lower than their US peers and below the US average of 97 mg/dL (2.51 mmol/L).
Similarly, the TG level of AR, 92.5 mg/dL (1.04 mmol/L), exceeded the 75th
percentile for TG in boys and girls (73.5 and 78.0 mg/dL [0.83 and 0.88 mmol/L],
respectively).36 In contrast, JR showed a mean
TG level of 59.0 mg/dL (0.67 mmol/L), which was slightly below the national
average of 60.1 mg/dL (0.68 mmol/L) observed for US children.35
Interestingly, TG levels were also higher in adult Japanese men living in
California and were clinically relevant, corresponding to (along with other
lipoprotein levels) their higher mortality rates from heart disease compared
with their peers living in Japan.37
Although aerobic fitness levels, as indicated by O2max,
were similar between groups, AR had lower vertical jump scores than did JR.
Their greater percentage of body fat may have accounted for their lower vertical
jump height because our study showed a significant inverse relationship between
the 2 (r = -0.50, P
= .006). The greater BMI and body weight may have contributed to the substantially
greater leg strength of AR. It is unknown why AR showed better flexibility.
In general, there were no clear differences observed between groups in physical
fitness variables. Interestingly, both groups of children displayed physical
fitness values at or above the national averages reported for their respective
countries.38-40
The higher BMI, higher percentage of body fat, and elevated serum lipoprotein
levels observed in AR may be explained, in part, by their diet. Children of
Japanese descent living in the United States, however, showed a trend toward
a more Westernized diet, including a higher intake of total and saturated
fat and a lower amount of carbohydrates when compared with JR. Nutrient intake
values of AR, however, fell within the recommended daily allowance.41 In fact, results of this study mirrored the results
of the study of adult men of Japanese descent living in California; they,
too, showed a higher total and saturated fat intake and a lower carbohydrate
intake compared with their adult peers in Japan.6-7
These findings may be due to the greater variety and availability of food
products higher in fat and lower in nutritional value in the United States
and a greater preference for those foods in the United States.42
Interestingly, total fat intake in the present study was significantly
related to percentage of body fat (r = 0.54, P = .003) and T-Chol level (r
= 0.49, P = .008) in children. The same results were
demonstrated when saturated fat was substituted for total fat. An examination
of individual food logs revealed that JR consumed a large amount of rice,
which may have accounted for their higher carbohydrate consumption. The large
consumption of shellfish by JR may have accounted for their cholesterol intake,
exceeding 300 mg/d, which is above recommended levels.35, 43
Analysis of school lunches may explain some of the dietary differences
observed between groups. According to the School Nutrition Dietary Assessment
Study, US children consume an average of 753 calories for lunch,44
with approximately 36% of the calories as fat, 13% as saturated fat, 44.5%
as carbohydrates, and 19% as protein.45-46
In contrast, the Japanese school lunch contains a total of 690 calories, with
less than 30% of the calories as fat and less than 15% as protein.47 Thus, school lunches represent 2 different nutrient
profiles for schoolchildren living in the United States and Japan.
One limitation of this study was that research was performed on a small
sample size. While tremendous effort was made to ensure uniform testing procedures
and instrumentation, the small number of subjects reduced the power of our
statistical analysis and increased the likelihood of committing a type II
error. Despite this limitation, statistically significant differences were
found for several variables. Effect sizes were also calculated so that moderate,
but nonsignificant, differences between groups could be noted.48-49
A more relevant limitation was that the sample may not have been representative
of children of Japanese descent living in the United States and/or Japan.
Although recruitment procedures were virtually identical in both locations,
the possibility exists that the more sedentary, unfit, and overweight children
may have volunteered in one location and not the other. On further evaluation,
it was found that the average BMI observed for Asian children living in the
United States ranged from 14.9 to 19.2 depending on the age and sex of the
child.50 These results, however, may be confounded
by the inclusion of children of various Asian backgrounds. Evidence in adults
has suggested that those of Japanese descent tend to be more overweight and
have a greater BMI than those of different Asian ancestry.51
Furthermore, regional variations suggest a somewhat higher mean BMI for Asian
adolescents residing in the South compared with those in the North.52-53 In either case, our AR displayed
mean BMI values lower than those reported for either white, black, or Hispanic
adolescents in the United States,52-53
which is consistent with what is observed in adults.54
Average BMI levels reported for children living in Japan ranged from 15.7
to 18.9, and seemed to be reflective of values observed for JR.55-56
National data examining O2max in the United States
and Japan showed that children in both continents had values similar to those
of their country of residence.38, 57-58
Although our data suggest that volunteers were representative of children
in both countries, it is possible that our sample was not reflective of children
of Japanese ancestry living in either location. Furthermore, parental education
and income were not assessed, and research has shown an inverse association
between socioeconomic status and obesity levels.51
This may have influenced variables in this study independent of place of residence.
The data presented document a diet higher in fat, lower in carbohydrate,
and higher in total calories for children residing in the United States compared
with the group living in Japan. Not surprisingly, AR were considerably heavier,
possessing higher BMI, diastolic BP, and lipid levels in the serum; they were
also more obese. Although health-related variables observed in AR were not
clinically relevant, requiring neither dietary nor pharmacological intervention,
this may become problematic as these trends continue. Studies of US-born adults
of Japanese ancestry show they possess greater rates of overweight and obesity
compared with their native-born peers, and these prevalence rates tend to
rise with increasing duration in the United States.51
Clearly, nutrient intake reflective of a more Westernized diet may be
responsible for the more adverse health-related characteristics observed in
AR compared with JR. One cannot conclude, however, that these differences
in nutrient intake are related to place of residence. As mentioned previously,
socioeconomic status was not measured and the sample size was small. Although
it is uncertain whether both groups of volunteers were strictly comparable,
our results are in accordance with previous studies conducted in adults6-8,51 and
with what is known about the influence of total and saturated fat in the diet.35, 43, 46
| What This Study Adds
Past research has shown that adult Japanese men who have relocated to
the United States demonstrate a 3-fold increase in the incidence of myocardial
infarction compared with their peers living in Japan. This may be related,
in part, to the adoption of unhealthy habits and lifestyles common to Western
civilization. It is unknown whether AR show similar differences in health-related
variables when compared with their age- and sex-matched peers living in Japan.
This article indicates that as early as childhood, more adverse health-related
characteristics are observed in a sample of AR compared with a sample of JR.
These results are in accordance with previous studies conducted in adults
and seem to be related to differences in the children's diets. It is unknown
whether differences in diet are related to place of residence.
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AUTHOR INFORMATION
Accepted for publication November 8, 2001.
We thank Jennifer Puhl, Maurice Qualls, and the graduate students in
the Exercise Physiology Department and the staff at the University of Tsukuba,
Tsukuba, for their valuable assistance, time commitment, and superb effort
in facilitating completion of all tests and measurements in our study.
Corresponding author and reprints: Arlette C. Perry, PhD, 5202 University
Dr, School of Education, University of Miami, Coral Gables, FL 33146 (e-mail: aperry{at}miami.edu).
From the Exercise and Sport Sciences Department, School of Education
(Drs Perry and Signorile and Messrs Okuyama and Wang), and the Department
of Pediatrics, School of Medicine (Dr Kaplan), University of Miami, Miami,
Fla; and the Institute of Health and Sports, University of Tsukuba, Tsukuba,
Japan (Dr Tanaka).
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