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Curr Nutr Rep (2015) 4:111113

DOI 10.1007/s13668-015-0120-z

INVITED COMMENTARY

Over-intake, not White Rice per se, is to Blame in Type-2 Diabetes


Shigeru Yamamoto 1 & Saiko Shikanai 1

Published online: 9 April 2015


# Springer Science+Business Media New York 2015

Abstract In this article, we would like to offer some argu- that rice itself is not. This is true for all foods, perhaps with
ments that white rice (WR) per se is the cause neither of no exceptions. There are many reports that obesity is an
diabetes mellitus (DM) nor of obesity. Japanese eat rice as important factor for DM and that a high carbohydrate diet
their staple food. Although their per capita intake a day has may cause obesity. In this article, we would like to offer
been dropping from about 330 g in the mid-1960s to about some arguments that WR per se is the cause neither of
165 g in 2010, DM in Japan has been increasing from about 10 DM nor of obesity.
% in 2006 to about 13 % in 2013. The prevalence of adult The main reason for the claim that WR is a cause of DM is
obesity (BMI >30) in the last 40 years has increased in the its high glycemic index [4]. However, the glycemic index is a
USA from 15 to 33 %, in England from 7 to 25 %, but in Japan rating of individual food items but in daily life people seldom
from 2 to 3.5 %. From this and other evidence, we concluded eat a single food. The quantity of WR consumed also should
that WR can be a cause of DM but only when intake is very be considered, as we can see in the reports on glycemic load
high and perhaps with small amount of other foods. published by the Harvard University group [5, 6]. The glyce-
mic load of a food is calculated by multiplying the glycemic
Keywords White rice . Type 2 diabetes mellitus . Obesity . index by the amount of carbohydrate in grams provided
Japanese . Vietnamese by a food and dividing the total by 100. Dietary glycemic
load is the sum of the glycemic loads for all foods con-
We have to distinguish man-made problems and problems sumed in the diet.
inherent to a food itself. There are quite a number of publica- Japanese eat rice as their staple food. Rice, mainly WR,
tions that claim white rice (WR) is the cause of type 2 diabetes intake has been drastically decreasing in Japan. Per capita
mellitus (DM) [13]. However, rice is the staple food for most intake a day was about 330 g in the mid-1960s; since then,
of the population of Asia, and Asia has a number of notable intake has been dropping and was about 165 g in 2010 [7]. In
food cultures. These food cultures are based on WR. The contrast, DM, defined as HbA1c over 6.5 %, has been increas-
significance of WR for these cultures is profoundly different ing from male 12.3 % and female 8.2 % in 2006 to male
from cultures where rice is not the staple. In nutrition educa- 16.2 % and female 9.2 % in 2013 [8]. These facts suggest that
tion for Asians, especially for ordinary people, we should be the claim that WR is a major factor for DM cannot be correct.
careful to say only that rice may be a cause of DM. People The age-adjusted prevalence of DM removes the differ-
should clearly understand that over-intake is a problem but ences in age profiles between countries, and therefore, it is
more appropriate for purposes of comparison. In 2010,
of the 223 countries in the world, the rankings for certain
countries were as follows (percentage of population with DM
in parentheses): Saudi Arabia, 3rd (16.8 %), USA, 29th
* Shigeru Yamamoto (10.3 %), Japan, 161st (5.0 %), and Vietnam, 204th (3.5 %)
shigeruy@jumonji-u.ac.jp [9]. From this report, it is clear that the prevalence of DM in
Japan and Vietnam, in both of which people eat WR as the
1
Asian Nutrition and Food Culture Center, Jumonji University, staple food, is much lower than in the USA or other countries
2-1-28 Sugasawa, Niiza-City, Saitama 352-8510, Japan where rice is not a staple.
112 Curr Nutr Rep (2015) 4:111113

Foods with a high glycemic index are reported to be a cause with Vietnamese, people with DM had a BMI that is consid-
of obesity, and obesity is the major cause of DM. OECD ered normal, around 23 [19]. We think the reason for this is
Health Data in 2010 showed that prevalence of adult obesity over-intake of WR; Vietnamese take about 70 % of their en-
(BMI30) in the last 40 years has increased in USA from 15 ergy from carbohydrate, mainly from WR [20]. We made 30
to 33 % and in England from 7 to 25 % [10]. pairs of pre-diabetic Vietnamese women, with each pair close-
In Japan, it has also increased from about 2 to 3.5 %, but the ly matched for factors such as height/weight/age, and for
increase has been small. In January 2013, the Washington post 4 months gave one member in each pair either WR or pre-
reported success in obesity control in Japan and that this is due germinated brown rice (PGBR) as her staple food [21]. PGBR
to the school lunch program [11]. School lunch with WR as is made by soaking brown rice in water for about 24 h [22]. It
the staple food is served more than 3.5 times a week (5 days) is slightly germinated and therefore soft and tasty and some
[12] to more than 98 % of elementary schools (612 years old, nutrients increase, e.g., -amino butylic acid increases about
20,920 schools), 78 % of junior high schools (1315 years three times of brown rice and is about ten times of WR [22].
old, 9083 schools), about 89 % of child welfare facilities At the end of the study, not only blood glucose levels but also
(934 schools), and 80 % of evening high schools (482 blood lipids were improved in the PGBR group [21]. In an-
schools) [13]. other study, we compared post-prandial blood glucose from a
The definition of overweight in Japan is a weight higher diet with ordinary high WR with high vegetable and low lipid
than 120 % of standard body weight for a given height [14]. content (control diet), a diet with low rice, moderate oil, or low
For example, the percentage of 11-year-old boys who were vegetable content in Vietnamese women in their 20s, 40s, and
overweight was about 7 % in 1977 and had increased to about 60s [23]. The study suggests that moderate vegetable and oil
12 % by 2006 but since then it has decreased to about 10 % in high WR diet can control blood glucose concentration well.
[15]. The tendency is the same for the girls, about 6 % in 1977, Lastly, we would like to add that traditional Japanese cui-
10 % in 2006, and 8 % in 2014. On the other hand, in the sine, in which WR is the staple food, was recognized as a
USA, child obesity has increased from about 5 % in the 1960s UNESCO Intangible Culture Heritage in 2013. The fact is that
to 16 % in 2000s (definition of obesity95th percentile for life-expectancy for Japanese at birth is long; since the 1980s
BMI by age and sex based on NHANES I reference data) [16]. that of women has been the longest in the world and that of
This also suggests that we cannot simply blame WR as the men one of the longest [24] might help account for the success
cause of obesity. of the registration and also may indicate that WR is not harm-
In a recent paper of meta-analysis and systematic review of ful for health.
the effect of WR consumption on the risk for DM, the authors In conclusion, WR can be a cause of DM but only when
concluded that higher consumption of WR is associated with a intake is very high and is perhaps not accompanied by other
significantly increased risk of DM in Asian (Chinese and Jap- foods; however, for people who take less than 250 g a day
anese) populations [3]. There are some contradictory points in (890 kcal) WR is not a problem, especially when they eat the
the data. In Japan, such a tendency was observed only in rice together with vegetables and oils.
women but not in men [17]. The energy of WR is 3.56 kcal/
g according to the Japanese food composition table [2]. In Acknowledgments The authors would like to thank for the support
women, the highest energy intake was 2291 kcal and from from the US-Japan Medical Science Program. The authors also would
rice 2164 kcal (3.56 kcal608 g). This result seems to suggest like to thank Andrew R. Durkin, Professor Emeritus of Indiana Univer-
that the highest group ate only rice. The same can be seen in sity, Bloomington, USA, for his careful editing of the English for this
article.
Japanese men; the highest energy intake was 2730 kcal and
from rice 2710 kcal. Furthermore, the study did not include Compliance with Ethics Guidelines
sugar intakes, which are usually an important factor for
DM [18]. A study from China concluded that high intake Conflict of Interest Shigeru Yamamoto and Saiko Shikanai declare
of foods with a high glycemic index and glycemic load, that they have no conflict of interest.
especially rice, the main carbohydrate-contributing food in
Human and Animal Rights and Informed Consent This article does
DM patients was observed only in those with a rice intake
not contain any studies with human or animal subjects performed by any
of more than 250 g (890 kcal) a day but not in the groups of the authors.
with an intake less than 249 g. These results suggest that
the adverse effect of WR is only when its intake is high,
maybe more than 250 g (890 kcal) a day. References
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