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© 2005 The American Society for Nutritional Sciences J. Nutr. 135:1451-1455, June 2005

Nutrient Requirements

Cholesterol Intake Is Associated with Lecithin Intake in Japanese People1,2

Masataka Ishinaga3, Aiko Ueda, Teruyo Mochizuki*, Sumi Sugiyama{dagger} and Toshio Kobayashi**

Department of Health Sciences, Hiroshima Prefectural Women’s University, Hiroshima, 734-8558 Japan; * Graduate School of Education, Hiroshima University, Higashi-Hiroshima, 739-8524 Japan; {dagger} Hiroshima Bunkyo Women’s University, Asakita-ku, Hiroshima 731-0295 Japan; and ** Graduate School of Health Sciences, Hiroshima University, Hiroshima, 734-8551 Japan

3To whom correspondence should be addressed. E-mail: isinaga{at}pu-hiroshima.ac.jp.


   ABSTRACT
TOP
 ABSTRACT
METHODS
 RESULTS
 DISCUSSION
 LITERATURE CITED
 
Many dietary recommendations for the prevention of heart disease and hyperlipidemia include restriction of cholesterol intake. However, limiting cholesterol intake might also affect the intake of other nutrients. The daily intakes of cholesterol, lecithin, total fatty acids, and SFAs by 388 Japanese subjects (ages 6–59 y) were analyzed directly using the duplicate portion sampling technique. Intakes were 266.1 ± 146.5 mg/d, 1.6 ± 0.9 g/d, 39.3 ± 16.8 g/d, and 12.8 ± 6.9 g/d, respectively. There was a strong positive correlation between cholesterol and lecithin intakes (r = 0.864, P < 0.001), and when food intake was adjusted to 1 kg/d, the correlation remained high (r = 0.881, P < 0.001). In contrast, the correlation between total fatty acid and lecithin intakes was lower (r = 0.423, P < 0.001), and when food intake was adjusted to 1 kg/d, the correlation coefficient remained stable (r = 0.448, P < 0.001). These results strongly indicate that limiting cholesterol intake decreases lecithin intake. Lecithin intake can be estimated from the following regression equation: lecithin intake (g/d) = 0.005 x cholesterol intake (mg/d) + 0.16 (R2 = 0.747, P < 0.001). Furthermore, the intake of choline derived from lecithin can be estimated by the following equation: choline (mg/d) = 0.724 x cholesterol (mg/d) + 21.5.

KEY WORDS: • cholesterol • lecithin • choline • daily Intake • dietary recommendation

The National Cholesterol Education Program recommends a daily cholesterol intake of <300 mg/d for the general population and <200 mg/d for individuals with elevated serum LDL cholesterol, diabetes, and/or cardiovascular disease (1). The dietary guidelines or nutritional recommendations of the American Heart Association (AHA)4 (2) and the American Academy of Pediatrics (3) are consistent with these recommendations. The AHA guidelines on limiting cholesterol intake were stricter in the 1970s than at present. However, recent recommendations are more specific regarding the intake of cholesterol-rich foods (2). In Japan, the Ministry of Health, Labor, and Welfare recommends a daily intake of <300 mg/d for individuals with elevated serum cholesterol levels (4). These recommendations have become dogma, as McNamara points out (5), and nonpatients as well as patients now limit their intake of cholesterol-rich foods such as eggs and meat (6,7). Cholesterol intake decreased from 318 mg/d in 1978 to 265 mg/d in 2000 in the United States and from 363 mg/d in 1989 to 338 mg/d in 2002 in Japan (8–11).

Canty and Zeisel (7) state that after North Americans began avoiding egg and meat products, their intake of lecithin decreased considerably. Dietary lecithin is a major source of choline. The human body can synthesize some choline, but not enough to meet its needs. Therefore, choline must be obtained from the diet (7,12). The U.S. Food and Nutrition Board (FNB) recommended that choline be considered an essential nutrient and designated adequate intake (AI) levels in 1998 (13).

In the present study, based on the chemical analysis of diets using the duplicate portion sampling technique, we demonstrated that limiting cholesterol intake decreases lecithin intake.


   METHODS
TOP
 ABSTRACT
 METHODS
RESULTS
 DISCUSSION
 LITERATURE CITED
 
    Participants. This study examined a total of 126 Japanese women (ages 20–59 y), 100 Japanese men (ages 30–59 y), and 162 Japanese schoolchildren (ages 6–12 y). Previously published data for 100 men, 72 women, and 100 children were analyzed (14–16), along with dietary samples gathered from 54 women and 62 children in 2001 to 2003. Participants were asked to prepare duplicate samples of all foods consumed over a 24-h period, including snacks and fluids, as accurately as possible (14). Documents describing the meal menus were not required. The participants (or the mothers of participating children) were informed about the procedures involved in the duplicate portion sampling technique.

    Lipid analysis. Each sample was initially grossly homogenized using a 1-L foodcutter (National) or a 4-L blender (Hamilton Beach). Then, a portion (300–400 g) was finely homogenized with a high-speed homogenizer (Polytron, Kinematica), and the crude lipids were extracted from 40 g (10 g x 4 50-mL tubes) of the homogenate using the method of Bligh and Dyer (17). The extraction was performed 3 times. The crude lipids were washed with 5% NaCl and water, dissolved in 10 mL of chloroform, and stored at –83°C until analysis. The organic solvents contained 0.001% butylhydroxyltoluene.

An aliquot of the crude lipids containing tripentadecanoin (Nu Chek Prep) as an internal standard was methylated using BF3/CH3OH (Pierce) and CH3ONa/CH3OH (Supelco) as described previously (14). A portion of the crude lipids containing 5{alpha}-cholestane as an internal standard was saponified. Unsaponified lipids were extracted with ethyl ether and trimethylsilylated for cholesterol analysis. Methyl esters were assayed by GLC (Shimadzu GC 9A) in a wide-bore capillary column (G-300, Chemicals Inspection and Testing Institute) with an He flow rate of 20 mL/min and a temperature program of 160 to 200°C. Trimethylsilylated cholesterol was also assayed by GLC in a column packed with 5% OV-17 (3.5 x 2000 mm) with an N2 flow rate of 35 mL/min at 290°C (14).

Phospholipids were fractionated from crude lipids by passage through a silica Sep Pak cartridge (Waters), and phospholipids were separated by TLC with chloroform:methanol:acetic acid:water (180:150:30:10, by vol.). The phosphorus content of the lecithin (not containing sphingomyelin and lysolecithin) was assayed using the methods of Bartlett (18) and Keenan et al. (19). Lecithin intake was calculated from the lecithin-phosphorus content using an estimated molecular weight for lecithin of 760.

All analyses were performed 2 or 3 times for each sample.

    Statistical analysis. Results were expressed as means ± SD. After logarithmic conversion, there was homogeneity of variance. Differences among the groups were determined by one-way ANOVA (P < 0.05). Individual differences between groups were determined using a Tukey-Kramer test. Pearson correlation coefficients between lecithin and cholesterol, lecithin and total fatty acids, and cholesterol and SFAs were determined. Values of P < 0.05 were considered significant. Statistical analyses were performed using StatView 5.0 for Windows (SAS Institute).


   RESULTS
TOP
 ABSTRACT
 METHODS
 RESULTS
DISCUSSION
 LITERATURE CITED
 
    Intakes of various lipids. Cholesterol intake was lower in schoolchildren than in men (P < 0.05) (Table 1). Lecithin intake did not differ among the groups. Total fatty acid intake differed among the 3 groups (P < 0.05) and was higher in men than in schoolchildren and women. SFA intake was lower in women than in schoolchildren and men (P < 0.05). One reason for this low value in women may be that one third of the women were students in their 20s. Japanese women ages 20 to 29 y generally have lower daily intakes of animal-derived foods than women of other ages. For example, the National Nutrition Survey of Japan in 2002 found that daily intake of animal-derived foods was 326.3 g/d in women in the 20- to 29-y age group, compared to 481.2 g/d in the 7- to 14-y age group, 356.9 g/d in the 30- to 39-y age group, and 366.7 g/d in the 40- to 49-y age group (8).


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  		TABLE 1 Daily intakes of cholesterol, lecithin, total fatty acids, and SFAs in different groups of Japanese subjects1

 
    Correlations among dietary lipids. Daily intake of cholesterol correlated with daily intake of lecithin (Fig. 1A; r = 0.864, P < 0.001). Because there was wide variation in the age of the subjects (6–59 y) and both males and females were included in this study, we expected wide variation in food intake. The correlation between daily intakes of lecithin and cholesterol may reflect only the quantitative difference in food intake (Fig. 1A). Therefore, the intakes of lecithin and cholesterol per kg of food were also compared (Fig. 1B). Intakes of lecithin and cholesterol correlated strongly when the data were adjusted for food intake (r = 0.881, P < 0.001).



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  		FIGURE 1 Correlations between daily lecithin and cholesterol intakes in all subjects, without (panel A) and with (panel B) adjustment of food intake to 1 kg/d. Regression equation in Fig. 1A: Lecithin intake (g/d) = 0.005 x cholesterol intake (mg/d) + 0.16 (R2 = 0.747, P < 0.001).

 
Lecithin intake correlated with total fatty acid intake (r = 0.423, P < 0.001; Fig. 2A). After adjusting food intake to 1 kg/d (Fig. 2B), the correlation coefficient between lecithin intake and total fatty acid intake was 0.448 (P < 0.001).



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  		FIGURE 2 Correlations between daily lecithin and total fatty acid intakes in all subjects, without (panel A) and with (panel B) adjustment of food intake to 1 kg/d.

 
These results indicate that lecithin intake is associated with cholesterol intake rather than with fatty acid intake.

The correlation coefficient between cholesterol intake and SFA intake was 0.363 (P < 0.001; Fig. 3A). After adjustment (Fig. 3B), the correlation coefficient between cholesterol intake and SFA intake was 0.383 (P < 0.001).



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  		FIGURE 3 Correlations between daily cholesterol and SFA intakes in all subjects, without (panel A) and with (panel B) adjustment of food intake to 1 kg/d.

 

   DISCUSSION
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
LITERATURE CITED
 
    Intake of lecithin and cholesterol. The 2002 National Nutrition Survey of Japan reported cholesterol intakes of 315.2–383.3 mg in schoolchildren (ages 6–14 y), 314.4–341.0 mg in women (ages 18–69 y), and 368–377 mg in men (ages 30–69 y) (8), all markedly higher than the values we obtained (Table 1). This disparity may be explained by differences between measured values and calculated values, because there are both quantitative and qualitative changes in cholesterol and fatty acids in some foods during cooking (20,21).

The National Nutrition Survey also reported a decrease in cholesterol intake in Japan, from 363 mg/d in 1989 (9) to 338 mg/d in 2002 (8). Although meat intake in Japan did not decrease over this period, intakes of both eggs and fish decreased continuously (8), and may account for the decrease in cholesterol intake. In the United States, the National Health and Nutrition Examination Survey also reported a decrease in cholesterol intake, from 318 mg/d in 1978 (10) to 265 mg/d in 2000 (11). This was attributed to decreases in consumption of eggs (from 271.5 eggs/y in 1978 to 243.8 eggs/y in 1998) (6) and of meat.

The present study was the first to measure lecithin intake in the Japanese population. We found equivalent lecithin intakes in children and adults (1.5–1.7 g/d; Table 1). Although children consume less food, they may be consuming foods that are richer in lecithin, compared with adults (8). The National Nutrition Survey reported that egg intake decreased from 41.5 g/d in 1975 to 36.5 g/d in 2002 (8), and that intakes of seafood and processed soy products containing high levels of lecithin also decreased over this period (8). However, meat intake has steadily increased, and this may have balanced the decreased intakes of these other lecithin sources, so that lecithin intake in the Japanese population has changed only very slightly over this 30-y period. In contrast, although lecithin intake in U.S. adults was ~6 g/d in 1980 (6), Canty and Zeisel (7) estimated that this figure would decrease as the intakes of eggs and meat decreased.

    Correlation between cholesterol and lecithin intakes. The correlation between lecithin and cholesterol intakes was markedly higher than that between lecithin and total fatty acid intakes (Figs. 1and 2). Furthermore, the coefficient of determination between lecithin and cholesterol intakes (R2 = 0.747) differed from that between lecithin and total fatty acid intakes (R2 = 0.179). These results indicate that lecithin intake is strongly associated with cholesterol intake.

In general, animal-derived foods are richer sources of lecithin (>100 mg/100 g food) than plant-derived foods (<50 mg/100 g food), with the exception of seeds and legumes, which may contain 200 to 900 mg lecithin/100 g food (22,23). Lecithin may be added to some processed foods, but it is still not present in large quantities. In contrast, cholesterol is primarily found in animal-derived foods. Therefore, the strong correlation between cholesterol and lecithin intakes that we found is likely related to the intake of animal-derived foods. Cholesterol intake is easily estimated from the intake of cholesterol-containing foods, but lecithin intake cannot be easily estimated this way. However, lecithin intake can be readily estimated from cholesterol intake using the following regression equation (Fig. 1A):

Humans also obtain fatty acids from animal-derived foods, plant-derived foods, and edible fats and oils. Recent data show that ~40% of total fat and oil intake in Japan is from animal fats that are high in SFAs, and ~20 to 25% of lipid intake is from dietary fats and oils (8). Therefore, the correlation between lecithin and fatty acid intakes may be lower than that between lecithin and cholesterol intakes.

Hu et al. report that saturated fat intake is positively correlated with cholesterol intake (24), consistent with the present results (r = 0.363, P < 0.001). This correlation may rise in the future as fish intake decreases and meat and poultry intakes increase in Japan (8).

    Choline intake. Lecithin is the main source of choline and appears to provide a more bioavailable supply than free choline (12,25). Choline plays an important role in methyl group metabolism and cell signaling and is also a precursor of the neurotransmitter acetylcholine (7,12,26). Human studies show that choline deficiency results in liver damage (27). In 1998, the FNB recommended that choline be considered an essential nutrient and designated AI levels (13). However, in Japan, choline is not on the list of recommended dietary allowances (4), and the reason for this is unclear.

In the present study, we estimated the daily intake of choline derived from lecithin to be 214.1 mg/d (13.5 mg choline/100 mg lecithin). Although it is unclear whether the choline AI levels recommended in the United States are applicable to the Japanese population, current intakes in Japan are 40 to 60% of the FNB AI levels. However, because Japanese also consume a high proportion of foods that contain sphingomyelin, free choline, phosphocholine, and betaine, all sources of choline (23), we predict that the total choline intake will prove to be higher than that estimated from lecithin intake alone.

Lecithin-derived choline intake can be estimated from cholesterol intake using the following regression equation (Fig. 1A):

Taken together, these results suggest that limiting the intake of cholesterol-rich foods might decrease choline intake. A recent meta-analysis indicated that when daily intake of cholesterol increased to 100 mg/d, serum LDL cholesterol rose by 0.049 mmol/L (28). Jones and Papamandjaris (29) showed that dietary cholesterol is not a very potent regulator of serum cholesterol concentration. Therefore, people who have no clinical indication for limiting cholesterol intake need not vigorously avoid eating eggs and meat. Those who must limit their intake of cholesterol-rich foods should be encouraged to increase their intake of other foods rich in choline and betaine (30).


   FOOTNOTES
 
1 Presented at the 13th Conference of the Japan Society for Lipid Nutrition, September 3–4, 2004, Sakata City, Japan [Ishinaga, M. (2004) Limiting cholesterol intake decreases in the lecithin intake (Japanese)]. Back

2 Supported by KIEIKAI Research Foundation and a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology. Back

4 Abbreviations used: AHA, American Heart Association; AI, adequate intake; FNB, Food and Nutrition Board. Back

Manuscript received 16 December 2004. Initial review completed 12 January 2005. Revision accepted 21 March 2005.


   LITERATURE CITED
TOP
 ABSTRACT
 METHODS
 RESULTS
 DISCUSSION
 LITERATURE CITED
 

1. National Heart, Lung, and Blood Institute (2001) Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) [Online]. National Institutes of Health National Cholesterol Education Program. http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf [accessed Nov. 17, 2004].

2. Krauss, R. M., Eckel, R. H., Howard, B., Appel, L J., Daniels, S. R., Deckelbaum, R. J., Edrman, J. W., Kris-Etherton, P. & Goldberg, I. J., et al (2000) AHA Dietary Guidelines. Revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Stroke 31:2751-2766.[Free Full Text]

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6. Frazao, E. eds. America’s Eating Habits: Changes and Consequences, appendix table 1 [Online]. USDA Economic Research Service, Agriculture Information Bulletin no. 750 1999 http://www.ers.usda.gov/publications/aib750/aib750app.pdf [accessed Nov. 17, 2004].

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