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Evidence is limited regarding the association between low-carbohydrate diet (LCD) score and mortality among Asians, a population that consumes a large amount of carbohydrates.The present study examined the association between low-carbohydrate diet (LCD) score (based on percentage of energy as carbohydrate, fat, and protein) and the risk of total and cause-specific mortality among Asians.This study was a prospective cohort study in Japan with follow-up for a median of 16.9 years involving 43008 men and 50646 women aged 45-75 years. Association of LCD score, LCD score based on animal sources of protein and fat, and LCD score based on plant sources of protein and fat with risk of mortality was assessed using Cox proportional hazards model.A U-shaped association was observed between LCD score and total mortality: the multivariable-adjusted hazard ratios (HRs) (95% CI) of total mortality for lowest through highest scores were 1.00, 0.95 (0.91, 1.01), 0.93 (0.88, 0.98), 0.93 (0.88, 0.98), and 1.01 (0.95, 1.07) (P-non-linearity0.01). A similar association was found for mortality from cardiovascular disease (CVD) and heart disease. LCD score based on carbohydrate, animal protein, and animal fat also showed a U-shaped association for total mortality (P-non-linearity0.01). In contrast, LCD score based on carbohydrate, plant protein, and plant fat was linearly associated with lower total (HR, 0.89; 95% CI: 0.83, 0.94 for highest versus lowest quintile), CVD [0.82 (0.73, 0.92)], heart disease [0.83 (0.71, 0.98)], and cerebrovascular disease [0.75 (0.62, 0.91) mortality.Both LCD with high animal protein and fat and high-carbohydrate diet with low animal protein and fat were associated with higher risk of mortality. Meanwhile, LCD high in plant-based sources of protein and fat was associated with a lower risk of total and CVD mortality.

Epstein-Barr virus (EBV) is one of the risk factors of nasopharyngeal carcinoma (NPC), and understanding the modifiable risk factors of EBV activation is crucial in the prevention of NPC. In this study, we aimed to investigate the association between solid fuel use and EBV seropositivity in a high-risk area of NPC. Our study was based on the baseline findings from an ongoing population-based prospective cohort in Sihui county in Southern China. We explored the association between current use of solid fuel in cooking and EBV seropositivity, and NPC-related EBV activation, using logistic regression models. Stratification analyses were further conducted to assess potential effect modifiers. We also examined the impact of frequency and duration of solid fuel use, and switch in fuel types, on EBV seropositivity among ever users. Of the 12,579 participants included in our analysis, 4088 (32.5%) were EBV seropositive and 421 (3.3%) were high risk for NPC-related EBV activation. Solid fuel use was associated with a higher risk of EBV seropositivity and NPC-related EBV activation, with odds ratios (ORs) of 1.33 (95%CI: 1.01, 1.76) and 1.81 (95%CI: 1.03, 3.18), respectively. Higher risk of EBV seropositivity was observed for those who did not use ventilation apparatus and those who consumed salted food. Among ever users, OR was highest for participants with more than 40 years of solid fuel exposure (1.17, 95%CI: 1.00-1.37) and who have been constantly using solid fuel (1.30, 95%CI: 0.96-1.75). We did not find a statistically significant impact of cooking frequency on EBV seropositivity. The identification of solid fuel as a risk factor for EBV activation is of great value for understanding the etiology of NPC. Our findings also have important public health implications given the fact that a third of the global population still lack access to clean cooking, especially in low resource settings.

Background: Randomized controlled studies have investigated the short-term effect of soy product intake on blood pressure (BP) in normotensive people. To our knowledge, no prospective studies exist on the effect of habitual intake of fermented soy products, separate from total soy products, on BP in the general population.Objective: We examined the association between the habitual intake of soy products, including fermented soy products, and the development of high BP during a 5-y period among participants in a population-based prospective cohort study in Japan.Methods: The study included normotensive participants aged 40-69 y at baseline (926 men and 3239 women) who completed 2 questionnaires and whose BP was measured at the baseline survey between 1993 and 1994 and the 5-y follow-up in the Japan Public Health Center-Based Prospective Study Cohort II. The intake of soy products was assessed with a food-frequency questionnaire. High BP was defined as systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥85 mm Hg, or antihypertensive medication use. ORs and 95% CIs of high BP by frequency of soy products (miso, natto, and tofu) consumption, intake of total and fermented soy products, and intake of isoflavones from total and fermented soy products were estimated with the use of multiple logistic regression analysis.Results: Multivariable-adjusted ORs of high BP for the highest compared with the lowest tertile of total and fermented soy product intake were 1.03 (95% CI: 0.84, 1.25; P-trend = 0.786) and 0.72 (95% CI: 0.56, 0.92; P-trend = 0.009), respectively. The frequency of nonfermented soy product (tofu) intake was not associated with the development of high BP (P-trend = 0.597).Conclusions: The intake of fermented soy products, but not total or nonfermented soy products, was inversely associated with developing high BP in men and women with normal BP.

Introduction We recently developed a risk prediction model for gastric cancer which showed good performance in terms of discrimination. However, lack of external validation hampers the generalizability of our results. Methods The study population consisted of 1292 individuals from JPHC cohort I (Omonogawa town, Akita prefecture). The previously developed model was used to predict survival for each individual at 10 years of follow-up. Results Thirty-three cases of gastric cancer occurred during 17,246 person-years of follow-up (27 cases occurred during the first 10 years). The c-index was estimated at 0.798 at 10 years of follow-up. In terms of calibration, the Nam-d’Agostino test was non significant (p-value = 0.23). Discussion Our previously developed risk prediction model for gastric cancer showed good performance on an external population. This suggests it might be used for risk discrimination in the general Japanese population.

Background The aim of the study was to investigate trends in cancer prognosis by examining the relationship between period of diagnosis and probability of death from cancer in a population-based cohort. Methods Within a cohort of Japanese men and women aged 40–69 years and free of prior diagnosis of cancer and cardiovascular disease at baseline, data from 4403 patients diagnosed with cancer between 1990 and 2006 and followed up until 2012 were analyzed using survival regression models to assess the presence of an effect of the period of diagnosis (before 1998 versus after 1998) on the risk of dying from cancer. Results We noted a significant decrease in risk of dying from cancer among individuals diagnosed after 1998 with lung cancer (hazard ratio [HR] = 0.676 [0.571–0.800]) or colorectal cancer (HR = 0.801 [0.661–0.970]). A decrease in the estimated five-year probability of death from cancer was also noted between the first (before 1998) and the second (after 1998) period of diagnosis for lung and colorectal cancers (e.g., 85.4% vs. 73.3% for lung cancer and 44.6% vs. 37.7% for colorectal cancer, respectively, for stage III in men aged 60 at diagnosis). Conclusions This study presented the first scientific evidence of improvement in prognosis for lung and colorectal cancer patients in a population-based cohort in Japan. Our results suggest that recent advances in cancer treatment could have influenced cancer survival differently among lung, colorectal and gastric cancers.

Purpose Cross-sectional studies have shown an association between different coping styles and suicidal behavior. It is unknown whether there is any prospective association between coping behaviors and suicide in the general population. Methods The study population consisted of participants of the Japanese Public Health Center-based Prospective Study. In the 10-year follow-up questionnaire, subjects aged 50–79 years were asked how they handle daily problems. Coping behaviors were used to determine two coping strategies (approach coping and avoidance coping). Of 99,439 subjects that returned the 10-year follow-up questionnaire, 70,213 subjects provided complete answers on coping and were included in our analyses. Cox regression models, adjusted for confounders, were used to determine the risk of committing suicide according to coping style. Mean follow-up time was 8.8 years. Results Two coping behaviors were significantly associated with suicide over time: planning (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.41–0.98) and self-blame (HR, 2.20; 95% CI, 1.29–3.76). Of the coping strategies, only the avoidance coping strategy was significantly associated with suicide (HR, 2.45; 95% CI, 1.24–4.85). Conclusions For the first time, two coping behaviors and one coping strategy have been shown to have a significant prospective association with suicide in a general population.

Introduction/Background After stroke, standing balance is usually described as a predictor of functional recovery. Regarding literature, various type of physical therapy (PT) is used to improve balance. The aim of this meta-analysis is to evaluate the effects of PT directly focused on balance training (DFBT) and theses of PT indirectly focused on balance training (IFBT) on balance after stroke. Material and method Randomised controlled trials (RCT), without language restriction, until October 2015, assessing the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke, the posturographic parameters in static condition and measures of independence in activities of daily living were included. Two independent authors (AH and JDM) led this selection following the Cochrane recommendations (Hugues et al., 2017). Results One hundred and ninety-three parallel and crossover RCT from 9337 records were included, involving 8018 subjects [study sample: mean 41.5 (SD 49.7) subjects, age: pooled mean 61.7 (pooled SD 12.78) years]. A significant difference in favor of PT compared to no treatment was immediately found after the intervention for the BBS (DFBT: 7 studies, mean difference [MD] 1.38; 95% confidence interval [CI] [0.71; 2.05]. IFBT: 18 studies, MD 1.88; 95% CI [1.31; 2.45]). Only IFBT PT is more effective than sham treatment or usual care immediately after the intervention for the BBS (DFBT: 1 study, MD 5.33; 95% CI [−4.68; 15.34]. IFBT: 26 studies, MD 1.85; 95% CI [0.67; 3.03]). Conclusion These results show immediately after the intervention: –that balance can be improved by PT aiming directly or indirectly at the recovery of balance compared to no treatment; –an improvement of balance by PT indirectly focused on the recovery of balance compared to sham treatment or usual care.

Objective Elaborate and test a method to extrapolate the population attributable fraction (benefit of an intervention to reduce the exposure of a given population to a given risk factor) to another population allowing for effects of synergistic factors. Study Design and Setting Using data from the Systolic Hypertension in the Elderly Program, the present study investigated the impact of a reduction of blood pressure on the occurrence of stroke accounting for the age of the targeted population. Results A reduction of blood pressure in populations differing by their age distributions showed that the preventable proportion of strokes increased with age. A 20-mm Hg reduction of blood pressure in a population with mean age 60 years was associated with a 14% reduction of strokes and 18% in a population with mean age 70 years. The difference between these two proportions can be interpreted as the proportion of cases due to the synergistic actions of age and high blood pressure on the occurrence of stroke. Conclusion The presented example illustrates how the method may be used by public health practitioners to transpose the potential benefits of interventions estimated in a study population to other populations with different exposures to synergistic risk factors.

Introduction The impact of risk factors on cancer development largely depends on time. In addition to the level of exposure, the time spent exposed or the cumulative exposure might provide a better measure of the cancer risk given a risk factor. In a large cohort of women, we assess the relationship between different patterns of overweight and obesity during adulthood and the incidence of three types of cancer that previously have been found to be associated with BMI; postmenopausal breast, colorectal and endometrial cancer. Methods The study population consisted of 90,299 women who attended organized nationwide screening for cancer of the cervix and breast in Iceland from between 1979 and 1989, corresponding to about 70% of the national adult female population. Data on reproductive factors and anthropometry were available at more than 300,000 occasions and information on cancer incidence was obtained through record linkage with the population-based Icelandic Cancer Registry. Repeated measurements of height and weight during follow-up were used in a growth curve model to predict individual-specific trajectories of body mass index (BMI) and to compute cumulative measures of overweight and obesity. The cumulative time spent above a given BMI value (e.g., 25 for the time spent with overweight and 30 for obesity) and cumulative overweight/obesity-years, taking into account the time spent as well as the degree of overweight/obesity, between ages 20–50 (between early adulthood and menopause), were calculated. To investigate the impact of these time-mediated and cumulative measures of overweight and obesity on the occurrence of postmenopausal breast, endometrial and colorectal cancer, Cox regression models were fitted, adjusting for important confounders. Results The mean BMI at 20 years was 21.9 and BMI was found to increase on average by 0.15 kg/m2 by year. Out of all women included, 64,015 reached age 50 during follow-up and among those, 2886 developed postmenopausal breast cancer. In addition, 891 colorectal and 404 endometrial cancers were observed in this subset of women. Taking into account the effects of relevant confounding factors, overweight and obesity before age 50 were associated with an increased risk of developing postmenopausal endometrial cancer (HR = 1.42, 95% CI: 1.04–1.94 and HR = 1.87, 95% CI: 1.13–3.10, respectively), with a 3% increase in risk for every additional year spent with obesity. The risk of colorectal cancer associated with obesity was HR = 1.34 and increased by 1% for every additional year spent with obesity. In contrast, there was no evidence for any statistically significant effect of mean BMI, overweight duration and cumulative exposure to overweight and obesity during adulthood on the risk of developing postmenopausal breast cancer. Conclusions The role of overweight duration in the aetiology of cancer differed between the three types of cancers. The results indicate that weight control is relevant at all ages. Furthermore, exploring time-dependent and cumulative effects of overweight and obesity increases our understanding of time-varying exposures and their association with disease occurrence. This knowledge is vital for the development of effective and targeted cancer prevention strategies in different stages of the life course.

Introduction/Background Several studies highlight that the physical therapy (PT) timing is important in rehabilitation process from physical disability after stroke. The purpose of this meta-analysis was to investigate the effect of all PT on balance after stroke and to evaluate whether changes are related to stroke stage of recovering [acute and subacute (ASS) or chronic stage (CS)]. Material and method Randomised controlled trials (RCT), without language restriction, until October 2015, assessing the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke, the posturographic parameters in static condition and measures of independence in activities of daily living were included. Two independent authors (AH and JDM) led this selection following the Cochrane recommendations (Hugues et al., 2017). Results One hundred and ninety-three parallel and crossover RCT from 9337 records were included, involving 8018 subjects [study sample: mean 41.5 (SD 49.7) subjects, age: pooled mean 61.7 (pooled SD 12.78) years]. A significant difference in favor of PT compared to no treatment was immediately found after the intervention for the BBS at ASS and CS (ASS: 11 studies, mean difference (MD) 3.14; 95% confidence interval (CI) [2.21; 4.06]. CS: 12 studies, MD 1.31; 95% CI [0.79; 1.82]. Mixed: 2 studies, MD 0.89; 95% CI [−0.63; 2.40]). Only at CS, PT is more effective than sham treatment or usual care immediately after the intervention for the BBS (ASS: 12 studies, MD 2.21; 95% CI [−0.37; 4.78]. CS: 13 studies, MD 2.50; 95% CI [1.00; 3.99]. Mixed: 2 studies, MD −1.17; 95% CI [−2.94; 0.60]). Conclusion These results show immediately after the intervention: –that balance can be improved by PT compared to no treatment whatever the stage of stroke; –an improvement of balance by PT compared to sham treatment or usual care at chronic stage.