**2. Incidence of formal diet consultation in Japan**

In Japan, formal professional dietary intervention is not so common. Generally, registered dietitians provide recommendations for meals according to the patients' disease conditions from medical, nutritional, and hygienic aspects. Statistical data from the two university hospitals in Tokyo indicate that the number of dietary referrals from physicians for patients with dyslipidemia is less than 5% of total cases, which is in sharp contrast to those with diabetes at more than 50% [4, 5]. There are several reasons to explain the fewer consultations, including scanty data in diet intervention trials in Japanese population, weak recognition of effectiveness of diet therapy for dyslipidemia among physicians, and most importantly, patients find it easier to take statins than follow diet therapy. Compared with LDL cholesterol reduction by diet therapy, statins are more powerful, with up to 50% reduction in LDL cholesterol. Results in the PREDIMED study have clearly shown that a Mediterranean diet enriched with extra-virgin olive oil or nuts reduced CV events by 30% [6]. This magnitude of CV event reduction was compatible with those of statin trials, and importantly, it was achieved with small changes in LDL cholesterol, blood pressure, and blood glucose. The data in the PREDIMED study have clearly shed light on distinctive features of the power of diet therapy, which affects many aspects of not only classical risk factors but also other unknown biological processes modulating the pathophysiology of diseases.
