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How Much Should We Eat? The Association Between Energy Intake and Mortality in a 36-Year Follow-Up Study of Japanese-American Men

¹ Pacific Health Research Institute, Honolulu, Hawaii.
² Honolulu Heart Program, Kuakini Medical Center, Hawaii.
³ Department of Geriatric Medicine and Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu.
⁴ College of Nursing, Okinawa Prefectural University, Japan.
⁵ Cancer Research Center of Hawaii, University of Hawaii, Honolulu.

Address correspondence to Bradley Willcox, MD, Pacific Health Research Institute, 846 South Hotel St., Suite 301, Honolulu, HI 96813. E-mail: bjwillcox{at}phrihawaii.org

Energy restriction extends life span and lowers mortality from age-related diseases in many species, but the effects in humans are unknown. We prospectively examined this relationship in a large epidemiological study of Japanese-American men. We followed 1915 healthy nonsmokers, aged 45–68 years at study onset, for 36 years. Twenty-four-hour recall of diet was recorded at baseline, and follow-up was for all-cause mortality. After adjustment for age and other confounders, there was a trend toward lower mortality in the second quintile of energy intake, suggesting that men who consumed 15% below the group mean were at the lowest risk for all-cause mortality. Increased mortality was seen with intakes below 50% of group mean. Thus, we observed trends between low energy intake and reduced risk for all-cause mortality in humans until energy intake fell to less than half the group mean, consistent with previous findings in other species.