Caloric Restriction, the Traditional Okinawan Diet, and Healthy Aging: The Diet of the World's Longest‐Lived People and Its Potential Impact on Morbidity and Life Span
Open accessAbstract
Long-term caloric restriction (CR) is a robust means of reducing age-related diseases and extending life span in multiple species, but the effects in humans are unknown. The low caloric intake, long life expectancy, and the high prevalence of centenarians in Okinawa have been used as an argument to support the CR hypothesis in humans. However, no long-term, epidemiologic analysis has been conducted on traditional dietary patterns, energy balance, and potential CR phenotypes for the specific cohort of Okinawans who are purported to have had a calorically restricted diet. Nor has this cohort's subsequent mortality experience been rigorously studied. Therefore, we investigated six decades of archived population data on the elderly cohort of Okinawans (aged 65-plus) for evidence of CR. Analyses included traditional diet composition, energy intake, energy expenditure, anthropometry, plasma DHEA, mortality from age-related diseases, and current survival patterns. Findings include low caloric intake and negative energy balance at younger ages, little weight gain with age, life-long low BMI, relatively high plasma DHEA levels at older ages, low risk for mortality from age-related diseases, and survival patterns consistent with extended mean and maximum life span. This study lends epidemiologic support for phenotypic benefits of CR in humans and is consistent with the well-known literature on animals with regard to CR phenotypes and healthy aging.
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The Okinawan diet is plant-based, low in calories, and characterized by substantial consumption of vegetables, legumes, and sweet potatoes.
“The Okinawans’ diet, characterized by a substantial consumption of vegetables, legumes, and sweet potatoes, is inherently plant-based and low in calories [7,156,157,158,159,160,161].”
From The Power of Environment: A Comprehensive Review of the Exposome's Role in Healthy Aging, Longevity, and Preventive Medicine-Lessons from Blue Zones and Cilento (2025) · cites this paper as [157]
The Results (Table 1) show that the traditional Okinawan diet in 1949 was low in calories and dominated by sweet potatoes, with substantial legumes and other vegetables. The Discussion says the diet changed after the 1960s, so the source does not support describing Okinawans’ diet this way without a historical qualifier. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOkinawa until recently experienced among the lowest rates of CHD in the world.
“Japanese diets have been of considerable interest, particularly from Okinawa, which until recently experienced among the lowest rates of CHD in the world.111”
From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [111]
Appropriate energy balance and little age-related weight gain are important features of the Okinawan diet pattern.
“Appropriate energy balance and little age-related weight gain are also important features of the Okinawan diet pattern.111”
From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [111]
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- Authors
- WILLCOX, B. J., WILLCOX, D. C., TODORIKI, H., FUJIYOSHI, A., YANO, K., HE, Q., CURB, J. D., & SUZUKI, M.
- Affiliations
- University of Hawaiʻi at Mānoa (US)
- Okinawa Prefectural College of Nursing (JP)
- University of the Ryukyus (JP)
- Pacific Health Research and Education Institute (US)
- Corresponding author
- WILLCOX, BRADLEY J.
- WILLCOX, D. CRAIG
- Venue
- Annals of the New York Academy of Sciences
- Publisher
- Wiley
- Published
- 2007-10
- Volume
- 1114
- Issue
- 1
- Pages
- 434-455
- ISSN
- 0077-8923 (ISSN-L)
- 1749-6632
- OpenAlex
- W2165781101
- Cited by
- 370
- References
- 61
- Citations by year
- 2026: 22 · 2025: 20 · 2024: 23 · 2023: 22 · 2022: 24 · 2021: 24 · 2020: 20 · 2019: 23 · 2018: 19 · 2017: 15 · 2016: 20 · 2015: 12 · 2014: 25 · 2013: 26 · 2012: 17
- FWCI
- 2.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annals of the New York Academy of Sciences (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1r03ag021293-01)
- National Institute on Aging (K08AG022788, R03AG021293-01, K08 AG22788-02, R01AG027060)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Aging › Genetics, Aging, and Longevity in Model Organisms
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- caloric restriction, Okinawan diet, healthy aging, centenarians, energy balance, lifespan extension, energy intake, energy expenditure, body mass index, survival patterns
- MeSH terms
- Aged, Aged, 80 and over, Aging, Animals, Haplorhini, Diet, Female, Humans, Japan, Life Expectancy, Male, Middle Aged, Morbidity, United States, Caloric Restriction
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