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Purpose Elbow fractures are common in children and occur during daily activities. The aim of this study is to evaluate the epidemiology of paediatric elbow fractures over a two-year period in Okinawa, a southern subtropical island in Japan. Methods This was a retrospective study of 488 elbow fractures in children younger than 15 years old treated at 11 hospitals in Okinawa. Data included age, gender, calendar month, type of fracture, operation rate, mechanism of injury, and aetiology. Results The most frequent age was 6 years old, with 47.5% of all elbow fractures occurring in an age range from 6 to 10 years old. The fracture rate for boys was 1.6 times higher than that for girls. The incidence was the highest in May (56 fractures) and the lowest in August (25 fractures). Supracondylar fractures were the most common type (44%), followed by lateral condyle fractures (22%); 45% of all fractures were treated operatively. Medial epicondyle fractures had the highest rate of operative treatment (91%). In the 6 to 10-year-old group, 19% of all fractures occurred while skateboarding or caster-boarding, the most frequent aetiology. Conclusions Supracondylar fractures are the most common fracture type in 4 to 7-year-old boys. In the 6 to 10-year-old group, skateboarding and caster-boarding are the most frequent and increasing cause of elbow fractures. Therefore, some preventive measures are needed. [ABSTRACT FROM AUTHOR]

Objective To examine the relationship between the intake of dairy products and calcium and the prevalence of depressive symptoms during pregnancy. Design Cross-sectional study. Setting Kyushu Okinawa Maternal and Child Health Study (KOMCHS). Sample A cohort of 1745 pregnant Japanese women. Methods Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. Scores of 16 or higher on the Center for Epidemiologic Studies Depression Scale denoted depressive symptoms. Adjustment was made for age, gestation, region of residence, number of children, family structure, history of depression, family history of depression, smoking, secondhand smoke exposure at home and at work, job type, household income, education, and body mass index. In our analyses regarding dairy products in general, adjustment was also made for fish intake; in our analysis regarding calcium, adjustment was also made for the intake of saturated fatty acids, eicosapentaenoic acid plus docosahexaenoic acid, and vitamin D. Main outcome measures Depressive symptoms during pregnancy. Results Higher intake levels of yogurt and calcium were independently related to a lower prevalence of depressive symptoms during pregnancy: the adjusted odds ratios between extreme quartiles were 0.69 (95% CI 0.48-0.99, P for trend = 0.03) and 0.59 (95% CI 0.40-0.88, P for trend = 0.006), respectively. No relationships were observed between the intake of all dairy products, milk, or cheese and depressive symptoms during pregnancy. Conclusions The current results suggest that a higher intake of yogurt and calcium may be associated with a lower prevalence of depressive symptoms during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Nearly all epidemiologic studies examining the association between the risk of Parkinson's disease (PD) and diet have focused on single foods and specific nutrients. However, epidemiologic evidence for the association of dietary pattern with PD, namely the measurement of overall diet by considering the cumulative effects of nutrients is extremely limited. We conducted a hospital-based case-control study in Japan to examine the relationship between dietary patterns and the risk of PD. Methods: Patients with PD diagnosed using the UK PD Society Brain Bank criteria ( n = 249) and controls without neurodegenerative diseases ( n = 368) were recruited. At the time of recruitment, dietary intake during the preceding 1 month was assessed using a validated, self-administered diet history questionnaire. Dietary patterns from 33 predefined food groups (energy-adjusted food g/day) were extracted by factor analysis. Results: Three dietary patterns were identified: 'Healthy', 'Western' and 'Light meal' patterns. After adjustment for potential non-dietary confounding factors, the Healthy pattern, characterized by a high intake of vegetables, seaweed, pulses, mushrooms, fruits and fish, was inversely associated with the risk of PD with a border-line significance ( P for trend = 0.06). Multivariate Odds ratio (95% confidence intervals) for PD in the highest quartile of the Healthy pattern was 0.54 (0.32-0.92) compared with the lowest quartile. No associations with PD were detected for the other two dietary patterns. Conclusion: In this case-control study in Japan, a dietary pattern consisting of high intakes of vegetables, fruits and fish may be associated with a decreased risk of PD. [ABSTRACT FROM AUTHOR]

Objective:To measure total energy expenditure (TEE) for normal healthy Japanese by the doubly labelled water (DLW), and to compare the physical activity level (PAL) among categories classified by the categories used in daily reference intake (DRI), Japan and the International Physical Activity Questionnaire (IPAQ).Subjects and methods:A total of 150 healthy Japanese men and women aged 20- to 59-year-old living in four districts of Japan. TEE was measured by the DLW method, and the PAL was calculated from TEE divided by basal metabolic rate. Simultaneously with TEE measurement, the PAL was assessed employing the categories used in DRI, Japan and IPAQ.Results:The average TEE and PAL were 10.78±1.67 MJ/day and 1.72±0.22 for males and 8.37±1.30 MJ/day and 1.72±0.27 for females, respectively. The subjects in the highly active categories assessed by both DRI and IPAQ showed significantly higher PAL compared with less active categories. However, PALs among light and moderate categories by DRI, and insufficient and sufficiently active by IPAQ were not significantly different.Conclusions:In developed countries, highly active subjects could be assessed by a simple questionnaire. However, the questionnaire should be improved to clarify the sedentary to moderately active subjects by assessing carefully very light to moderate physical activity.European Journal of Clinical Nutrition (2008) 62, 885–891; doi:10.1038/sj.ejcn.1602805; published online 23 May 2007 [ABSTRACT FROM AUTHOR]

Objective:To examine associations between dietary patterns and obesity.Design:Cross-sectional study.Subjects:A total of 3760 Japanese female dietetic course students aged 18–20 years from 53 institutions in Japan.Measurements:Diet was assessed over a 1-month period with a validated self-administered diet history questionnaire with 148 food items, from which 30 food groups were created and entered into a factor analysis. Body mass index (BMI) was calculated from self-reported body height and weight.Results:Mean BMI (±s.d.) was 20.9±2.8 kg m−2. Four dietary patterns were identified. After adjustment for several confounding factors and total energy intake, the ‘Healthy’ pattern, characterized by high intakes of vegetables, mushrooms, seaweeds, potatoes, fish and shellfish, soy products, processed fish, fruit and salted vegetables, was significantly associated with a lower risk of BMI25 (odds ratio of the highest quintile vs lowest, 0.57; 95% confidence interval: 0.37–0.87; P for trend <0.05). In contrast, the ‘Japanese traditional’ pattern, characterized by high intakes of rice, miso soup and soy products, and the ‘Western’ pattern, characterized by high intakes of meats, fats and oils, seasonings, processed meats and eggs, were both significantly associated with an increased risk of BMI25 (OR: 1.77; 95% CI: 1.17–2.67; P for trend <0.01 and OR: 1.56; 95% CI: 1.01–2.40; P for trend=0.04, respectively).Conclusion:Three major dietary patterns, Healthy, Japanese traditional and Western, were all independently and significantly related to the risk of obesity even among a relatively lean young Japanese female population.International Journal of Obesity (2008) 32, 541–549; doi:10.1038/sj.ijo.0803737; published online 25 September 2007 [ABSTRACT FROM AUTHOR]

Objective:Most research on constipation has focused on dietary fiber intake. Here, we examined the intake of water and magnesium, nutrients possibly associated with constipation, as well as that of dietary fiber in relation to constipation.Design:Cross-sectional study.Subjects:A total of 3835 female Japanese dietetic students aged 18–20 years from 53 institutions in Japan.Methods:Dietary intake was estimated with a validated, self-administered diet history questionnaire. Functional constipation was defined using the Rome I criteria.Results:The prevalence of functional constipation was 26.2%. Neither dietary fiber intake (mean=6.4 g/4186 kJ) nor intakes of total water and water from fluids were associated with constipation. Conversely, low intake of water from foods was associated with an increasing prevalence of constipation. In comparison with women in the first (lowest) quintile, the multivariate adjusted odds ratio (OR) (95% confidence interval (CI)) for women in the second, third, fourth, and fifth quintiles were 0.72 (0.57, 0.90), 0.78 (0.62, 0.98), 0.71 (0.56, 0.89), and 0.77 (0.61, 0.97), respectively (P for trend=0.04). Additionally, low magnesium intake was associated with increasing prevalence of constipation. Compared with women in the first quintile, the multivariate adjusted OR (95% CI) for women in the second, third, fourth and fifth quintiles were 0.70 (0.56, 0.88), 0.75 (0.60, 0.95), 0.73 (0.58, 0.92) and 0.79 (0.63, 0.996), respectively (P for trend=0.09).Conclusions:Low intakes of water from foods and magnesium are independently associated with an increasing prevalence of functional constipation among a population whose dietary fiber intake is relatively low.European Journal of Clinical Nutrition (2007) 61, 616–622. doi:10.1038/sj.ejcn.1602573; published online 6 December 2006 [ABSTRACT FROM AUTHOR]

Background: Little is known about the relationship of healthy diets, which are widely recommended to prevent diseases in general populations, with the risk of hypertensive disorders of pregnancy (HDP), particular among non-Western populations with different dietary habits. We aimed to investigate the association between periconceptional diet quality and the risk of HDP among pregnant Japanese women., Methods and Results: Dietary intake over 1 year before the first trimester of pregnancy was assessed using a validated, self-administered food frequency questionnaire among 81 113 pregnant Japanese women who participated in a prospective cohort of the Japan Environment and Children's Study. Overall diet quality was assessed by the Balanced Diet Score (BDS) based on adherence to the country-specific dietary guidelines and the Dietary Approaches to Stop Hypertension (DASH) score. Cases of HDP were identified by medical record transcription. The association between diet quality and HDP risk was examined using Bayesian logistic regression models with monotonic effects. We identified 2383 (2.9%) cases of HDP. A higher BDS was associated with a lower risk of HDP. When comparing the highest with the lowest quintile of the BDS, the adjusted odds ratio (aOR) of HDP was 0.83 (95% credible interval [CrI], 0.73-0.94). The DASH score and HDP risk were inversely associated in a monotonic dose-response manner (aOR per 1-quintile increase in the DASH score, 0.92 [95% CrI, 0.89-0.95])., Conclusions: A high-quality diet, which is recommended for disease prevention in general populations, before conception may also reduce the risk of HDP among pregnant Japanese women.

The current prebirth cohort study investigated the association between maternal intake of specific types of fatty acids during pregnancy and adolescent depressive symptoms based on the Center for Epidemiologic Studies Depression Scale. Subjects were 873 mother-child pairs. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. The risk of depressive symptoms was 23.3% among the 873 adolescents at 13 years of age. Higher maternal saturated fatty acid intake during pregnancy was independently associated with a reduced risk of depressive symptoms in adolescents. Maternal intake of total fat, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, α-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid, n-6 polyunsaturated fatty acids, linoleic acid, arachidonic acid and cholesterol during pregnancy was not significantly related to depressive symptoms in adolescents. Higher maternal intake of saturated fatty acids during pregnancy may be inversely associated with adolescent depressive symptoms.

Purpose: Individuals with impaired masticatory function tend to prefer soft foods, which results in decreased masticatory muscle activity. This study examined the association between the oral condition (number of teeth, occlusal force, and occlusal contact area) and dietary hardness using a daily dietary questionnaire., Methods: This cross-sectional study evaluated 1841 participants aged 69-71 and 79-81 years. Registered dentists examined the number of teeth, occlusal force, and occlusal contact area. Dietary hardness was defined as the estimated masticatory muscle activity required for a habitual diet. Habitual diet during the preceding month was assessed using a brief self-administered diet history questionnaire. Confounding factors, such as age, sex, socioeconomic status, smoking habits, history of chronic diseases (hypertension, hyperlipidemia, and diabetes), and cognitive function were also evaluated. Multivariate linear regression analyses were performed to assess the association between dietary hardness and each oral condition., Results: Occlusal force (standardized regression coefficients [β]=0.08, P < 0.01) and occlusal contact area (β=0.06, P < 0.01) were significantly associated with dietary hardness after adjusting for the confounding factors. Number of teeth was not significantly associated with dietary hardness. In addition, the associations between dietary hardness, sex, and a history of diabetes were stronger than those between dietary hardness and oral factors., Conclusions: Occlusal force and contact area were significantly associated with dietary hardness as estimated from the masticatory muscle activity using a daily diet questionnaire.

Objectives: Nuts are nutrient-dense foods rich in unsaturated fatty acids, protein, dietary fiber, vitamins, and minerals. The present prebirth cohort study examined the association between maternal nut intake during pregnancy and the risk of childhood behavioral problems in 5-year-old Japanese children., Methods: Study subjects were 1199 mother-child pairs. Dietary intake was assessed using a diet history questionnaire. Emotional problems, conduct problems, hyperactivity problems, peer problems, and low prosocial behavior were assessed using the parent-reported version of the Strengths and Difficulties Questionnaire. Adjustments were made for a priori-selected nondietary confounders and potentially related dietary factors., Results: Compared with mothers who had not eaten nuts during pregnancy, mothers who had eaten nuts had a significantly reduced risk of peer problems in children; the adjusted odds ratio was 0.64 (95% confidence interval: 0.42-0.97). There were no measurable associations between maternal consumption of nuts during pregnancy and the risk of childhood emotional problems, conduct problems, hyperactivity problems, and low prosocial behavior., Conclusions: Maternal consumption of nuts during pregnancy may be associated with a decreased risk of peer problems in 5-year-old children., (© 2024 The Authors. Journal of Pediatric Gastroenterology and Nutrition published by Wiley Periodicals LLC on behalf of European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Background and Aim: Although diet is one of the potential environmental factors affecting ulcerative colitis (UC), evidence is not sufficient to draw definitive conclusions. This Japanese case-control study examined the association between the consumption of coffee, other caffeine-containing beverages and food, and total caffeine and the risk of UC., Methods: The study involved 384 UC cases and 665 control subjects. Intake of coffee, decaffeinated coffee, black tea, green tea, oolong tea, carbonated soft drinks, and chocolate snacks was measured with a semiquantitative food-frequency questionnaire. Adjustments were made for sex, age, pack-years of smoking, alcohol consumption, history of appendicitis, family history of UC, education level, body mass index, and intake of vitamin C, retinol, and total energy., Results: Higher consumption of coffee and carbonated soft drinks was associated with a reduced risk of UC with a significant dose-response relationship (P for trend for coffee and carbonated soft drinks were <0.0001 and 0.01, respectively), whereas higher consumption of chocolate snacks was significantly associated with an increased risk of UC. No association was observed between consumption of decaffeinated coffee, black tea, green tea, or oolong tea and the risk of UC. Total caffeine intake was inversely associated with the risk of UC; the adjusted odds ratio between extreme quartiles was 0.44 (95% confidence interval: 0.29-0.67; P for trend <0.0001)., Conclusions: We confirmed that intake of coffee and caffeine is also associated with a reduced risk of UC in Japan where people consume relatively low quantities of coffee compared with Western countries., (© 2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: The role of prenatal diet on childhood wheezing and subsequent risk of asthma is inconclusive, which may be partly due to the heterogeneity in wheezing phenotypes. We aimed to identify wheeze trajectories in early childhood and to examine their associations with periconceptional maternal diet quality., Methods: Data from 70,530 mother-child pairs of liveborn singletons from the Japan Environment and Children's Study were analysed. Wheezing was reported by caregivers using a modified International Study of Asthma and Allergies in Childhood questionnaire yearly from 1 to 4 years of age, from which trajectories were derived using group-based trajectory modelling. Maternal diet in the year preceding the first trimester of pregnancy was assessed using a validated food frequency questionnaire; overall diet quality was determined using the balanced diet score based on the Japanese Food Guide Spinning Top. Bayesian inference of multinomial logistic regression models was performed to examine the association between maternal diet quality and wheeze trajectory in early childhood., Results: We identified four wheeze trajectories: 'never/infrequent' (69.1%; reference group), 'early-childhood onset' (6.2%), 'transient early' (16.5%) and 'persistent' (8.2%). After adjustment for confounders, a higher quartile of maternal balanced diet score was associated with a lower risk of belonging to the 'transient early' and 'persistent' wheeze trajectories compared with the 'never/infrequent' wheeze trajectory by 10% of both. Maternal balanced diet score was not associated with belonging to the 'early-childhood onset' wheeze trajectory., Conclusion: Improving maternal diet quality prior to conception may reduce certain wheeze phenotypes in early childhood., (© 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Background: While research has explored the risk of periodontal disease in various eye conditions, the link between dry eye and periodontal disease remains underexplored, especially in Japanese adults. This study aims to investigate the association between dry eye and periodontal disease in community-dwelling Japanese adults., Methods: This study is a subset of the Uonuma cohort study, which includes Japanese adults aged 40 years and older residing in the Uonuma area of Niigata Prefecture, Japan. Participants completed a self-administered, paper-based questionnaire. Statistical analyses, including the chi-square test, independent t test, ANOVA test, and logistic regressions, were employed to assess the association of periodontal disease with independent variables., Results: Among 36,488 participants (average age 63.3 years, 47.4% men), 39.3% had a history of periodontal disease, and gender differences were statistically significant (p < 0.001). Significant associations were found between periodontal disease and dry eye diagnosis or symptoms. Univariable logistic regression revealed links between periodontal disease and age, gender, living status, alcohol consumption, remaining teeth, bite molar availability, and history of dry eye disease or symptoms. Multiple-adjusted regression found that doctor-diagnosed dry eye was associated with a higher likelihood of periodontal disease (odds ratio, 1.12; 95% confidence interval, 1.03-1.22). Participants who never experienced dryness or foreign body sensation had lower ORs of periodontal disease than those who always experienced such symptoms across all models., Conclusion: A significant correlation was found between dry eye and periodontal disease in Japanese adults. Regular check-ups, early detection, and effective management of both conditions are strongly recommended., (© 2023. The Author(s).)

Background: Diets contain toxic chemical contaminants as well as essential nutrients, both of which influence the intrauterine environment for foetal growth. However, whether a high-quality diet that is nutritionally healthy also results in lower exposure to chemical contaminants is unknown., Objective: We examined associations between periconceptional maternal diet quality and circulating concentrations of heavy metals during pregnancy., Design: Dietary intake over the year prior to the first trimester of pregnancy was assessed using a validated, self-administered food frequency questionnaire among 81,104 pregnant Japanese women who participated in the Japan Environment and Children's Study. Overall diet quality was determined using the Balanced Diet Score (BDS) based on the Japanese Food Guide Spinning Top, the Healthy Eating Index-2015 (HEI-2015), the Dietary Approaches to Stop Hypertension (DASH) score and the Mediterranean diet score (MDS). We measured whole-blood concentrations of mercury (Hg), lead (Pb) and cadmium (Cd) during the second or third trimester of pregnancy., Results: After controlling for confounders, all diet quality scores were positively associated with blood Hg concentrations. By contrast, higher BDS, HEI-2015 and DASH scores were associated with lower concentrations of Pb and Cd. Although the MDS was positively associated with concentrations of Pb and Cd, when dairy products were classified as a beneficial (rather than detrimental) food component, these associations were attenuated., Conclusion: A high-quality diet may reduce exposure to Pb and Cd but not Hg. Further studies are required to determine the optimal balance between mercury exposure risk and nutritional benefits of high-quality diets prior to pregnancy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: mRNA vaccination is an effective, safe, and widespread strategy for protecting pregnant women against infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, information on factors such as perinatal outcomes, safety, and coverage of mRNA vaccinations among pregnant women is limited in Japan. Therefore, this study aimed to investigate the perinatal outcomes, coverage, adverse effects, and short-term safety of mRNA vaccination as well as vaccine hesitancy among pregnant women., Methods: We conducted a multicenter online survey of postpartum women who delivered their offspring at 15 institutions around Tokyo from October 2021 to March 2022. Postpartum women were divided into vaccinated and unvaccinated groups. Perinatal outcomes, COVID-19 prevalence, and disease severity were compared between the two groups. Adverse reactions in the vaccinated group and the reasons for being unvaccinated were also investigated retrospectively., Results: A total of 1,051 eligible postpartum women were included. Of these, 834 (79.4%) had received an mRNA vaccine, while 217 (20.6%) had not, mainly due to concerns about the effect of vaccination on the fetus. Vaccination did not increase the incidence of adverse perinatal outcomes, including fetal morphological abnormalities. The vaccinated group demonstrated low COVID-19 morbidity and severity. In the vaccinated group, the preterm birth rate, cesarean section rate, and COVID-19 incidence were 7.2%, 33.2%, and 3.3%, respectively, compared with the 13.7%, 42.2%, and 7.8% in the unvaccinated group, respectively. Almost no serious adverse reactions were associated with vaccination., Conclusions: mRNA vaccines did not demonstrate any adverse effects pertaining to short-term perinatal outcomes and might have prevented SARS-CoV-2 infection or reduced COVID-19 severity. Concerns regarding the safety of the vaccine in relation to the fetus and the mother were the main reasons that prevented pregnant women from being vaccinated. To resolve concerns, it is necessary to conduct further research to confirm not only the short-term safety but also the long-term safety of mRNA vaccines., (© 2023. The Author(s).)

Background: Both poor maternal nutrition and toxic heavy metal exposure influence foetal growth and development. However, whether consumption of a variety of healthy foods modifies the association between prenatal heavy metal exposure and foetal growth is unknown., Objective: We examined whether long-term maternal diet quality in periconception modifies the associations between maternal circulating concentrations of heavy metals and foetal growth., Design: Data of 72,317 Japanese women who delivered singleton infants was extracted from the Japan Environment and Children's Study. Maternal diet over a 1-year before the first trimester of pregnancy was assessed using a validated food frequency questionnaire, and overall diet quality was determined using the balanced diet score based on the Japanese Food Guide Spinning Top. Maternal whole-blood concentrations of mercury (Hg), lead (Pb) and cadmium (Cd) were measured during the second/third trimester of pregnancy. Bayesian inference of multiple linear regression analysis was performed to evaluate the relationships between maternal diet quality and the blood concentrations of heavy metals; Bayesian logistic regression was used to analyse the risk of low birth weight (LBW; <2,500 g)., Results: After controlling for confounders, a high maternal balanced diet score was associated with low concentrations of blood Pb and Cd and high Hg. While all heavy metals assessed were positively associated with LBW risk, a higher maternal balanced diet score was negatively associated with LBW risk. A high-quality maternal diet attenuated the effect of Pb on LBW, an effect that was more marked at high blood Pb concentrations., Conclusion: A high-quality, 'well-balanced' diet prior to conception may reduce exposure to some heavy metals and mitigate the elevated risk of LBW associated with prenatal Pb exposure in Japanese mother-child pairs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

(1) Background: The aim of this study is to review the benefits of the 8020 Campaign since its inception. (2) Methods: We followed the PRISMA guideline and collected information regarding the 8020 Campaign through online database searches. (3) Results: Twenty-five studies met the inclusion criteria and were eligible for analysis. The main outcomes of the 25 included studies were reviewed. The quality evaluation demonstrated a range of studies showing a credible relationship between masticatory function, number of teeth, salivary secretion, frequent dental check-ups, and general health concerns. Due to the risk of bias, publication bias, and indirectness, 22 studies were considered that only had "fair" quality. (4) Conclusions: The 8020 Foundation funded several of the studies, and other research papers noted the 8020 Campaign in their papers, however there were no clear explanations for any direct relationship between their findings and the 8020 Campaign. As a result, evidence for the direct effectiveness and benefits assessment of the 8020 Campaign positive outcomes were compromised by confounding social and economic variables over the 30-year period. To fully elucidate how improvement in Japan's oral health was directly related to the 8020 Campaign, a more informed and systematic explanation of the campaign's structure and activities is required., Competing Interests: The authors declare no conflict of interest.

In April 2011, the International Commission on Radiological Protection recommended reducing the occupational equivalent dose limit for the lens. Such a new occupational lens dose limit has thus far been implemented in many countries, and there are extensive discussions toward its regulatory implementation in other countries. In Japan, discussions in the Japan Health Physics Society (JHPS) began in April 2013 and in Radiation Council in July 2017, and the new occupational lens dose limit was implemented into regulation in April 2021. To share our experience, we have published a series of papers summarizing situations in Japan: the first paper based on information available by early 2017, and the second paper by early 2019. This paper (our third paper of this series) aims to review updated information available by mid-2022, such as regarding regulatory implementation of the new occupational lens dose limit, recent discussions by relevant ministries based on the opinion from the council, establishment process of safety and health management systems, the JHPS guidelines on lens dose monitoring and radiation safety, voluntary countermeasures of the licensees, development of lens dose calibration method, and recent studies on exposure of the lens in nuclear workers and biological effect on the lens.

Objective: Tryptophan is an essential amino acid wholly derived from diet. While the majority of tryptophan is degraded through the kynurenine pathway into neuroactive metabolites like quinolinic acid and kynurenic acid, a small proportion of ingested tryptophan is metabolized into the neurotransmitter serotonin. The current cross-sectional study in Japan examined the association between tryptophan intake and depressive symptoms during pregnancy., Methods: Study subjects were 1744 pregnant women. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. Depressive symptoms were defined as a score ≥ 16 on the Center for Epidemiologic Studies Depression Scale. Adjustment was made for age, gestation, region of residence, number of children, family structure, history of depression, family history of depression, smoking, secondhand smoke exposure at home and at work, employment, household income, education, body mass index, and intake of saturated fatty acids, eicosapentaenoic acid plus docosahexaenoic acid, calcium, vitamin D, and isoflavones., Results: The prevalence of depressive symptoms during pregnancy was 19.2%. After adjustment for confounding factors, higher tryptophan intake was independently inversely associated with the prevalence of depressive symptoms during pregnancy: the adjusted prevalence ratios (95% confidence intervals) for depressive symptoms during pregnancy in the first, second, third, and fourth quartiles of tryptophan intake were 1 (reference), 0.99 (0.76-1.28), 0.94 (0.71-1.25), and 0.64 (0.44-0.93), respectively (p for trend = 0.04)., Conclusions: Higher estimated tryptophan intake was cross-sectionally independently associated with a lower prevalence of depressive symptoms during pregnancy in Japanese women., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objectives: Lower maternal metal intake during pregnancy might affect childhood development. The current prebirth cohort study investigated the relationship between maternal intake of zinc, magnesium, iron, copper, and manganese during pregnancy and behavioral problems in Japanese children aged five years., Methods: Subjects were 1199 mother-child pairs. Dietary intake during the preceding month was assessed using a diet history questionnaire. Emotional, conduct, hyperactivity, and peer problems and low prosocial behavior were assessed using the Strengths and Difficulties Questionnaire. Maternal age, gestation at baseline, region of residence, number of children, maternal and paternal education, household income, maternal depressive symptoms during pregnancy, maternal alcohol intake during pregnancy, maternal smoking during pregnancy, child's birth weight, child's sex, breastfeeding duration, smoking in the household during the first year of life, and some dietary confounders that were associated with outcomes under study in this population were adjusted for., Results: Compared with maternal magnesium intake during pregnancy in the first quartile, magnesium intake in the second, third, and fourth quartiles was independently inversely related to childhood hyperactivity problems, but not to emotional, conduct, or peer problems or low prosocial behavior: the adjusted odds ratio between extreme quartiles was 0.48 (95% confidence interval: 0.23-0.99, P for trend = 0.04). No evident associations were observed between maternal intake of zinc, iron, copper, or manganese during pregnancy and childhood emotional, conduct, hyperactivity, or peer problems or low prosocial behavior., Conclusions: The present study suggests that higher maternal magnesium intake during pregnancy is inversely associated with hyperactivity problems in Japanese children.

It is uncertain whether the effects of prenatal exposure to isoflavones on childhood behaviour are beneficial or detrimental. This prebirth cohort study investigated the associations between maternal consumption of soy products and isoflavones during pregnancy and behavioural problems in Japanese children aged 5 years. Subjects were 1199 mother-child pairs. Emotional problems, conduct problems, hyperactivity problems, peer problems and low prosocial behaviour were assessed using the Strengths and Difficulties Questionnaire. Maternal total soy product consumption during pregnancy was independently inversely associated with childhood hyperactivity and peer problems. Maternal fermented soybean consumption during pregnancy was independently inversely associated with childhood hyperactivity problems. Maternal isoflavone consumption during pregnancy was independently inversely related to childhood hyperactivity problems. Maternal consumption of total soy products, fermented soybean and isoflavones during pregnancy may be protective against hyperactivity problems in Japanese children. Also, maternal total soy product consumption during pregnancy may be preventive against childhood peer problems.

Background: Recently, more attention has been paid to behavioral problems in children. However, for the most part, risk factors for these problems have yet to be determined. Objective: The current prebirth cohort study investigated the relationship between maternal calcium consumption during pregnancy and behavioral problems in five-year-old Japanese children. Methods: Subjects were 1199 mother-child pairs. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. Emotional problems, conduct problems, hyperactivity problems, and peer problems were assessed using the Strengths and Difficulties Questionnaire. Logistic regression analysis was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Compared with the lowest quartile of maternal calcium intake, the highest was significantly associated with decreased risk of childhood emotional problems: the adjusted OR (95% CIs) was 0.46 (0.27-0.79, P for trend = 0.01). Higher maternal calcium intake during pregnancy was also independently associated with decreased risk of childhood hyperactivity problems; the adjusted ORs (95% CIs) in the first, second, third, and fourth quartiles of maternal calcium intake during pregnancy were 1 (reference), 0.52 (0.31-0.84), 0.58 (0.35-0.93), and 0.60 (0.37-0.97), respectively ( P for trend = 0.046). No such inverse associations were observed for childhood conduct problems or peer problems; the adjusted ORs (95% CIs) in the highest quartile of maternal calcium intake were 0.97 (0.64-1.47) for conduct problems and 1.11 (0.61-2.01) for peer problems. Conclusions: Maternal calcium intake during pregnancy may decrease the risk of childhood emotional and hyperactivity problems.

Aim: To examine the association between maternal caffeine intake during pregnancy and the development of food allergy in young Japanese children up to 3 years of age., Methods: The study involved 1522 mother-child pairs. Data on maternal caffeine intake during pregnancy were assessed with a validated diet history questionnaire. Food allergy was defined by a self-reported claim of having a physicians' diagnosis of food allergy or of having an acute reaction to a food., Results: Compared with the lowest tertile of maternal caffeine intake during pregnancy, the second tertile, but not the highest tertile, was significantly associated with an increased risk of food allergy. Further adjustment on suspicion or diagnosis of atopic eczema at around 4 months postpartum in a follow-up survey did not substantially change the association between maternal caffeine intake during pregnancy and the risk of food allergy in children: further adjusted hazard ratios (95% confidence intervals) for the second (T2), the highest tertiles (T3) and the second and the highest tertiles combined (T2 + T3) were 1.46 (1.10-1.96), 1.16 (0.85-1.56) and 1.31 (1.01-1.70), respectively., Conclusions: Our findings suggest that maternal caffeine intake during pregnancy may be positively associated with the risk of food allergy in children., (© 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Coronavirus disease 2019 (COVID-19) is a severe infectious disease of the respiratory tract caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2, and has a high mortality rate. The disease emerged from Wuhan, China, in late 2019, and spread to Japan, including Hokkaido, in January 2020. In February 2020, 3 children were diagnosed with COVID-19 in Furano, Hokkaido, Japan. During this period, influenza and human metapneumovirus infections were prevalent among children in the Furano region. Two of the 3 patients experienced co-infection with other respiratory viruses, including influenza virus A or human metapneumovirus. To the authors' knowledge, the cases described in the present report were the first pediatric patients with COVID-19 in Japan. In children with COVID-19, the possibility of co-infection with other respiratory pathogens should be considered.

Objectives: The current prebirth cohort study investigated the relationship between maternal B vitamin intake during pregnancy and behavioral problems in Japanese children aged 5 years. Methods: Subjects were 1199 mother-child pairs. Dietary intake was assessed using a diet history questionnaire. Emotional problems, conduct problems, hyperactivity problems, peer problems, and low prosocial behavior were examined using the Japanese parent-report version of the Strengths and Difficulties Questionnaire. Adjustment was made for maternal age, gestation at baseline, region of residence, number of children, maternal and paternal education, household income, maternal depressive symptoms, alcohol intake, vitamin B complex supplement use, smoking during pregnancy, child's birth weight, child's sex, breastfeeding duration, and smoking in the household during the first year of life. Results: Maternal folate intake during pregnancy was independently inversely associated with childhood low prosocial behavior: the adjusted odds ratio (OR) (95% confidence interval [CI], P for trend) between extreme quartiles was 0.55 (0.37-0.80, 0.0002). Maternal vitamin B 6 intake during pregnancy was independently inversely related to childhood hyperactivity problems and low prosocial behavior: the adjusted ORs (95% CIs, P for trend) between extreme quartiles were 0.57 (0.34-0.94, 0.01) and 0.58 (0.40-0.85, 0.0009), respectively. Maternal vitamin B 2 intake during pregnancy was independently inversely associated with childhood emotional problems: the adjusted OR (95% CI, P for trend) between extreme quartiles was 0.58 (0.33-0.99, 0.11). Conclusions: Maternal intake of folate, vitamin B 6 , and vitamin B 2 during pregnancy may be protective against childhood low prosocial behavior, hyperactivity problems and low prosocial behavior, and emotional problems, respectively.

Background and Aim: The presence of cirrhosis is an important factor for the management of patients with hepatitis C virus (HCV) infection and it determines the duration of treatment for HCV with the direct-acting antiviral (DAA) regimen of glecaprevir (GLE) and pibrentasvir (PIB), that is, 8 or 12 weeks, if patients do not have a history of DAA failure. However, in real-world settings, determination of cirrhosis depends on the discretion of the attending hepatologists, and it is unclear whether compensated cirrhosis was homogenously diagnosed or not. In this study, we investigated the real-world diagnosis of cirrhosis by characterizing DAA-naïve patients who underwent a 12-week GLE/PIB regimen in whom cirrhosis was diagnosed, comparing their characteristics with those of patients who underwent an 8-week regimen in whom cirrhosis was absent., Methods: In a large, multicenter cohort study, we compared background characteristics and treatment outcomes among DAA-naïve patients who underwent an 8-week versus a 12-week GLE/PIB regimen., Results: Among 977 patients enrolled, 296 (30.3%) were determined to have cirrhosis and underwent a 12-week regimen. Some patient characteristics largely overlapped between the two groups, including liver fibrosis indices. Sustained viral response rates were similar between groups after adjusting liver fibrosis index with propensity score matching., Conclusion: Although adequately diagnosed, the determination of cirrhosis varied widely among institutions or by hepatologists in real-world settings, and the severity of liver fibrosis overlapped significantly between patients in whom compensated cirrhosis was determined to be present and patients in whom cirrhosis was absent. Virologic efficacy was similar after adjusting for the degree of liver fibrosis., (© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: In clinical trials, a pangenotype direct-acting antiviral (DAA) regimen consisting of glecaprevir (GLE) and pibrentasvir (PIB) exhibited high virologic efficacy and tolerability in patients with hepatitis C virus (HCV) infection. This study sought to confirm these findings in real-world settings, focusing on patients with cirrhosis, history of DAA failure, or HCV genotype 3 who were treated with a 12-week regimen in a large multicenter study from Japan., Methods: In a nationwide multicenter prospective cohort study, we analyzed background characteristics, tolerability, and treatment outcome of patients who underwent a 12-week GLE/PIB regimen., Results: Of 1190 patients, 509 (42.8%) underwent the 12-week regimen, and the remaining patients underwent an 8-week regimen. The rate of sustained virologic response (SVR) of patients treated with the 12-week regimen was 99.0%, comparable with that of patients treated with the 8-week regimen. The adverse events were observed in 29.1% of patients. The main adverse event was pruritus, which was observed in 14.7%. Ten patients (2.0%) discontinued therapy during treatment period., Conclusion: The 12-week GLE/PIB regimen was well-tolerated with high virologic efficacy in patients with cirrhosis, experience of DAA, or HCV genotype 3; tolerability and SVR rate were comparable with those of DAA-naïve, non-cirrhotic, non-genotype 3 patients who underwent 8-week regimen., (© 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: Direct-acting anti-virals (DAAs) have markedly improved the effectiveness of anti-viral therapy for chronic hepatitis C (CHC) patients. In a phase III trial in Japan, treatment with the NS3/4A protease inhibitor glecaprevir and the NS5A inhibitor pibrentasvir (G/P) resulted in a small number of patients with refractory factors. We aimed to evaluate the effectiveness and safety of G/P, especially among patients with these refractory factors, and the influence of these factors on treatment., Methods: In a prospective, multicenter study involving 33 medical institutions, 1439 patients were treated with G/P, and their efficacy, safety, and most frequent adverse effects (AEs) were analyzed., Results: Overall SVR12 rates were 99.1% (1397/1410) in the per-protocol-analysis, and genotype sustained virologic response SVR12 rates were: genotype 1, 99.4% (707/711); genotype 2, 99.4% (670/674); genotype 3, 80.0% (16/20). DAA-naïve patients (p = 0.008) with HCV genotype except 3 (genotype 1 vs. 3, p = 2.68 × 10 -5 ; genotype 2 vs. 3, p = 3.28 × 10 -5 ) had significantly higher SVR12 rates. No significant difference was observed between CKD stage 1-3 (99.1% [1209/1220]) and chronic kidney disease (CKD) stage 4-5 (98.9% [188/190]) patients, or between cirrhotic (99.0% [398/402]) and non-cirrhotic (99.1% [999/1008]) patients. Multiple logistic regression analysis revealed that genotype 3 [OR 33.404, 95% CI (7.512-148.550), p value (p = 4.06 × 10 -5 )] and past experience of IFN-free DAAs [OR 3.977, 95% CI (1.153-13.725), p value (p = 0.029)] were both significantly independent predictors of non-SVR12. AEs were reported in 28.2% of patients, and 1.6% discontinued treatment owing to drug-related AEs. AEs were significantly higher in CKD stage 4-5 (41.6% [79/190]) than CKD stage 1-3 (26.1% [319/1220]) patients (p = 2.00 × 10 -5 ). AEs were also significantly higher in cirrhotic (38.6% [155/402]) than in non-cirrhotic (24.1% [243/1008]) (p = 2.91 × 10 -18 ) patients., Conclusions: G/P regimen is highly effective and safe to treat CHC patients even with refractory factors such as CKD and advanced liver fibrosis. However, patients with past experience of IFN-free DAA treatment and genotype 3, CKD stage 4 or 5, and advanced liver fibrosis should be more closely observed.

Background: The National Nutrition Survey on Preschool Children, Japan (NNSPC) provides fundamental information for policy making for child nutrition. However, the response rate and background characteristics of subjects are unclear. Here, we examined response rate and sociodemographic factors related with response to the survey and evaluated the magnitude of bias due to selective response in the survey estimates of the NNSPC., Methods: This study was based on two national surveys conducted in 2015: the NNSPC and the Comprehensive Survey of Living Conditions (CSLC). Because potential survey participants of the NNSPC were children aged <6 years and their households that answered the CSLC, we examined response rates and respondent characteristics by linking the data of the NNSPC and CSLC. Multiple logistic regression analysis was used to identify sociodemographic factors associated with response. Potential bias caused by non-response in the survey estimates was examined after considering missingness through multiple imputation., Results: Among the 5,343 children who participated in the CSLC, 3,426 children responded to the NNSPC (response rate = 64.1%). Variables associated with response were living in a smaller city, a large number of children, three-generation family structure, older maternal age, and a non-working mother. The prevalence of overweight was underestimated by 20%, but the bias for almost all variables examined was small., Conclusions: Response to the survey varied by sociodemographic characteristics. Some biases, mostly small, were seen in survey estimates of the 2015 NNSPC. Further insight into the effect of selective response is important to assess associations between variables more precisely.

Objective: The aim of this pre-birth cohort study was to examine the associations between maternal intake of vegetables, fruit, and antioxidants during pregnancy and behavioral problems in Japanese children 5 y of age., Methods: Participants were 1199 mother-child pairs. Dietary intake was assessed using a diet history questionnaire. Emotional, conduct, hyperactivity, and peer problems, as well as low prosocial behavior were assessed using the parent version of the Strengths and Difficulties Questionnaire. Adjustment was made for maternal age, gestation at baseline, region of residence, number of children, maternal and paternal education, household income, maternal depressive symptoms during pregnancy, maternal alcohol intake during pregnancy, maternal smoking during pregnancy, child's birth weight, child's sex, breastfeeding duration, and smoking in the household during the child's first year of life., Results: Maternal intake of total vegetables and green and yellow vegetables during pregnancy was independently inversely associated with childhood low prosocial behavior. Maternal intake of other vegetables during pregnancy was independently inversely related to childhood hyperactivity problems and low prosocial behavior. Maternal intake of fruit and apples during pregnancy was independently inversely related to childhood hyperactivity problems. Maternal intake of citrus fruits during pregnancy was independently inversely related to childhood emotional, conduct, and hyperactivity problems. Maternal vitamin C intake during pregnancy was independently inversely associated with childhood conduct and hyperactivity problems and low prosocial behavior., Conclusions: Maternal intake of vegetables, fruit, and vitamin C during pregnancy may be preventive against any of the behavioral problems assessed here except for peer problems in Japanese children 5 y of age., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: The present prebirth cohort study examined the association between maternal caffeine consumption during pregnancy and behavioral problems in Japanese children aged 5 years. Methods: Subjects were 1199 mother-child pairs. Dietary intake was assessed using a diet history questionnaire. Emotional problems, conduct problems, hyperactivity problems, and peer problems were assessed using the Japanese parent-report version of the Strengths and Difficulties Questionnaire. Adjustment was made for maternal age, gestation at baseline, region of residence at baseline, number of children at baseline, maternal and paternal education, household income, maternal depressive symptoms during pregnancy, maternal alcohol intake during pregnancy, maternal smoking during pregnancy, child's birth weight, child's sex, breastfeeding duration, and smoking in the household during the first year of life. Results: The contributors of caffeine in the diet during pregnancy were Japanese and Chinese tea (74.8%), coffee (13.0%), black tea (4.4%), confectionaries (4.0%), and soft drinks (3.7%). Higher maternal caffeine consumption during pregnancy was independently associated with a reduced risk of peer problems in the children: the adjusted odds ratios (95% confidence intervals) in the first, second, third, and fourth quartiles of maternal caffeine consumption during pregnancy were 1 (reference), 0.61 (0.35-1.06), 0.52 (0.29-0.91), and 0.51 (0.28-0.91), respectively ( P for trend = 0.01). Maternal caffeine intake during pregnancy was not evidently related to the risk of emotional problems, conduct problems, or hyperactivity problems in the children. Conclusions: Maternal caffeine consumption, mainly from Japanese and Chinese tea, during pregnancy may be preventive against peer problems in Japanese children.

Based on high efficacy and safety demonstrated in clinical trials, treatment with glecaprevir/pibrentasvir (G/P) for 8 weeks is recommended for hepatitis C virus (HCV)-infected patients who are direct-acting antiviral (DAA) naïve, genotype 1 or 2, and noncirrhotic. The aim of this study was to validate real-world experience with 8-week G/P treatment in Japan. We conducted a prospective observational cohort study in 554 patients who underwent 8-week treatment from among 1,022 patients who initiated G/P therapy. The majority (54.5%) were male, with a median age of 66 years, and HCV genotype distribution was genotype 1, 43.8%; genotype 2, 55.3%; and mixed subtype, 0.9%. Overall, the sustained virologic response rate at 12 weeks (SVR12) was 92.8% (530/571) in the intention-to-treat population and 99.3% (526/530) in the per-protocol population. The SVR12 rates by subgroups were as follows: subtype 1a, 100% (6/6); 1b, 100% (189/189); 2a, 99.3% (150/151); 2b, 99.0% (103/104); and mixed subtype, 50% (2/4). Among four patients with virologic failure following 8-week treatment with G/P, none had baseline polymorphisms or treatment-emergent amino acid substitutions in NS3. However, 2 of 4 patients with virologic failure had treatment-emergent amino acid substitutions in NS5A. Adverse events (AEs) were reported in 21.5% of patients and 1.2% of patients discontinued due to drug-related AEs. In conclusion, G/P treatment for 8 weeks was safe and effective for DAA-naïve noncirrhotic genotype 1 or 2 patients in a real-world clinical setting in Japan., (© 2019 John Wiley & Sons Ltd.)

Background: The virological efficacy and safety of the direct-acting antiviral (DAA) regimen consisting of daclatasvir, asunaprevir, and beclabuvir (DCV/ASV/BCV) for patients chronically infected with hepatitis C virus (HCV) genotype 1 have not been previously evaluated in Japanese real-world settings., Methods: In a Japanese nationwide multicenter study, the rate of sustained virologic response (SVR) and safety were analyzed in 91 patients who started the DCV/ASV/BCV regimen between November 2016 and July 2017. SVR rates were compared based on baseline patient characteristics., Results: More than 60% of patients had a history of failure to achieve SVR with interferon (IFN)-free DAA therapy. Overall, 50 of 91 patients (54.9%) achieved SVR. Multivariate analysis identified a history of failure with IFN-free DAA therapy and pretreatment HCV RNA levels as factors significantly associated with treatment failure. Whereas the SVR rate in patients without a history of IFN-free DAA therapy was 91.7% (33 of 36 patients), it was only 30.9% (17 of 55 patients) among patients with a history of IFN-free DAA therapy. The rate of discontinuation due to an adverse event was 4.4%., Conclusions: Many patients treated with the DCV/ASV/BCV regimen have a history of a failure to achieve SVR with previous IFN-free DAA therapy. SVR rate was not as high as that in pre-approval clinical trial of this regimen in IFN-free DAA-naïve patients. In addition, most patients with a history of failure with IFN-free DAA therapy, particularly the DCV/ASV regimen, showed resistance to this regimen.

Background: There is increasing evidence of causal links between poor mastication and cognitive impairment, but possible effects of dietary hardness, which clearly affects mastication, on cognitive function are unknown., Objective: We investigated the hypothesis that hardness of the habitual diet would be associated with cognitive function among older Japanese adults., Methods: The subjects of this cross-sectional study were 635 Japanese community-dwelling people aged 69-71 years. The masticatory muscle activity required for the habitual diet was used to determine dietary hardness. Consumption of 38 foods was assessed by a validated, brief-type, self-administered diet history questionnaire. A published database was then used to estimate the masticatory muscle activity involved in the ingestion of these foods. The Japanese version of the Montreal Cognitive Assessment (MoCA-J) was used for the measurement of cognitive function., Results: The principal contributors to dietary hardness were cooked rice (28.0%), green leafy vegetables (5.1%), dried fish (4.9%), and pork and beef (4.6%). There was a positive association between dietary hardness and MoCA-J score that was robust to adjustment for potential confounders (MoCA-J score per 100-unit increase in dietary hardness: β = 0.83 [95% CI: 0.08, 1.59], P = 0.03). These results did not change materially even after exclusion of subjects who reported substantial changes in their diet for any reason (β = 0.94 [95% CI: 0.02, 1.86], P = 0.04)., Conclusion: This preliminary cross-sectional study suggests that dietary hardness might have a beneficial effect on cognitive function in older Japanese people. Further prospective studies with more accurate measurements are needed to confirm this finding., (© 2018 John Wiley & Sons Ltd.)

Background: Cigarette smoking is consistently more common among schizophrenia patients than the general population worldwide; however, the findings of studies in Japan are inconsistent. Recently, the smoking rate has gradually decreased among the general population., Methods: We performed a meta-analysis of smoking status in a large Japanese cohort of (1) 1845 schizophrenia patients and 196845 general population and (2) 842 schizophrenia patients and 766 psychiatrically healthy controls from 12 studies over a 25-year period, including 301 patients and 131 controls from our study., Results: In our case-control sample, schizophrenia patients had a significantly higher smoking rate than healthy controls (P=.031). The proportion of heavy smokers (P=.027) and the number of cigarettes smoked per day (P=8.20×10-3) were significantly higher among schizophrenia patients than healthy controls. For the smokers in the schizophrenia group, atypical antipsychotics dosage was positively correlated with cigarettes per day (P=1.00×10-3). A meta-analysis found that schizophrenia patients had a higher smoking rate than the general population for both men (OR=1.53, P=.035; schizophrenia patients, 52.9%; general population, 40.1%) and women (OR=2.40, P=1.08×10-5; schizophrenia patients, 24.4%; general population, 11.8%). In addition, male schizophrenia patients had a higher smoking rate than male healthy controls (OR=2.84, P=9.48×10-3; schizophrenia patients, 53.6%; healthy controls, 32.9%), but the difference was not significant for women (OR=1.36, P=.53; schizophrenia patients, 17.0%; healthy controls,14.1%). Among both males and females, schizophrenia patients had a higher smoking rate than both the general population (OR=1.88, P=2.60×10-5) and healthy controls (OR=2.05, P=.018). These rates were not affected by the patients' recruitment year (P>.05). The cigarettes per day values of schizophrenia patients and the general population were 22.0 and 18.8, respectively., Conclusions: Schizophrenia patients are approximately 2 times more likely to smoke than the general population and healthy controls based on data collected over a decade in Japan.

There is growing recognition that eating slowly is associated with a lower risk of obesity, and chewing well might be an effective way to reduce the eating rate. However, little is known about these relationships among children. We therefore investigated the associations of eating rate and chewing degree with weight status among 4451 Japanese children aged 5⁻6 years. Information on eating rate (slow, medium, or fast), degree of chewing (not well, medium, or well), and nutrient intake of children were collected from guardians using a diet history questionnaire. Weight status was defined using the International Obesity Task Force cut-offs based on BMI calculated from guardian-reported height and weight. The prevalence of overweight and thinness was 10.4% and 14.3%, respectively. A higher eating rate and a lower degree of chewing were associated with being overweight (both p < 0.001). Eating slowly was associated with being thin ( p < 0.001), but no association was observed between chewing degree and thinness. These associations were still evident after controlling for potential confounders including parental educational attainment, weight status, and the child's nutrient intake. In conclusion, this cross-sectional study suggested that chewing well, rather than eating slowly, might be a more effective way for healthy weight management among Japanese preschool children.

Background: The real-world virological efficacy and safety of an interferon (IFN)-free direct-acting antiviral (DAA) therapy with elbasvir (EBR) and grazoprevir (GZR) were evaluated in Japanese patients chronically infected with hepatitis C virus (HCV) genotype 1., Methods: The rate of sustained virologic response (SVR) and safety were analyzed in patients who started the EBR/GZR regimen between November 2016 and July 2017. SVR rates were compared based on patient baseline characteristics., Results: Overall, 371 of 381 patients (97.4%) achieved SVR. Multivariate analysis identified a history of failure to IFN-free DAA therapy and the presence of double resistance-associated substitutions (RASs) in HCV non-structural protein 5A (NS5A) as factors significantly associated with failure to EBR/GZR treatment. The SVR rates of patients with a history of IFN-free DAA therapy and those with double RASs were 55.6 and 63.6%, respectively. In all other subpopulations, the SVR rates were more than 90%. There were no severe adverse events associated with the treatment., Conclusions: The EBR/GZR regimen yielded high virological efficacy with acceptable safety. Patients with a history of failure to IFN-free DAA therapy or with double RASs in HCV-NS5A remained difficult to treat with this regimen.

We assessed the adequacy of nutrient intakes of Japanese children aged 3⁻5 years. Dietary information was collected using a 3-nonconsective-day weighed dietary record among 143 boys and 143 girls. Estimates of usual nutrient intakes from foods and beverages were obtained using the best-power method. The proportions of children with intakes below and above the Japanese Dietary Reference Intakes (DRIs) were estimated. The estimated usual intakes of boys and girls were adequate for most nutrients, given the low proportion (≤2%) of children consuming diets that fell below the Estimated Average Requirement (EAR) or the mean usual intakes higher than the Adequate Intake. However, a high percentage of boys and girls had usual intakes below the EAR for calcium (64% and 54%, respectively), vitamin A (20% and 11%, respectively), thiamin (15% and 41%, respectively), and iron (27% and 10%, respectively). Additionally, 62% of boys and 66% of girls had diets that exceeded the recommended range for total fat (20%⁻30% energy). Further, 92% for boys and 85% for girls consumed diets that exceeded the recommended limit for sodium (4.0 and 4.5 g NaCl equivalent/day, respectively). In conclusion, the estimated usual intakes were adequate for most nutrients in this sample of 3⁻5-year-old Japanese children.

Objective: The aim of this cohort study was to investigate the relationship between maternal fat consumption during pregnancy and behavioral problems in 1199 Japanese children at age 5 y., Methods: Dietary intake of mothers during pregnancy was assessed using a diet history questionnaire. Emotional, conduct, hyperactivity, and peer problems in children were assessed using the Strengths and Difficulties Questionnaire; the four scale scores were dichotomized, comparing children with borderline and abnormal scores to children with normal scores. Logistic regression analysis was applied to estimate adjusted odds ratios and 95% confidence intervals for each behavioral problem according to the quartile of dietary factors under study, adjusting for potential confounding factors., Results: Higher maternal intake of monounsaturated fatty acids, α-linolenic acid, ω-6 polyunsaturated fatty acids, and linoleic acid during pregnancy was independently associated with an increased risk for childhood emotional problems. The adjusted odds ratios between extreme quartiles (95% confidence intervals, P trend ) were 1.85 (1.11 - 3.17, 0.04), 1.60 (0.99 - 2.60, 0.03), 2.06 (1.24 - 3.46, 0.002), and 2.09 (1.26 - 3.51, 0.002), respectively. No such positive associations were observed for the other outcomes. No relationships were found between maternal intake of total fat, saturated fatty acids, ω-3 polyunsaturated fatty acids, eicosapentaenoic acid, docosahexaenoic acid, arachidonic acid, or cholesterol, or the ratio of ω-3 to ω-6 polyunsaturated fatty acid intake during pregnancy and any of the outcomes., Conclusions: Maternal consumption of monounsaturated fatty acids, α-linolenic acid, ω-6 polyunsaturated fatty acids, and linoleic acid during pregnancy may increase the risk for childhood emotional problems., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Several observational studies and trials examined the relationship between isoflavones or soybeans and depressive symptoms among peri- and postmenopausal women. We cross-sectionally evaluated the associations between intake of soy products and isoflavones and depressive symptoms during pregnancy in Japan., Methods: Study subjects were 1745 pregnant women. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. Depressive symptoms were defined by a score of 16 or over in the Center for Epidemiologic Studies Depression Scale., Results: Higher intake of total soy products, tofu, tofu products, fermented soybeans, boiled soybeans, miso soup, and isoflavones was independently related to a lower prevalence of depressive symptoms during pregnancy: The adjusted prevalence ratios (95 % confidence intervals, P for trend) between extreme quartiles were 0.63 (0.47-0.85, 0.002), 0.72 (0.54-0.96, 0.007), 0.74 (0.56-0.98, 0.04), 0.57 (0.42-0.76, <0.0001), 0.73 (0.55-0.98, 0.03), 0.65 (0.49-0.87, 0.003), and 0.63 (0.46-0.86, 0.002), respectively. A significant positive exposure-response relationship was found between miso intake and depressive symptoms during pregnancy. No material relationship was observed between soymilk intake and depressive symptoms during pregnancy., Conclusions: Our study is the first to show independent inverse relationships between intake of total soy products, tofu, tofu products, fermented soybeans, boiled soybeans, miso soup, and isoflavones and depressive symptoms during pregnancy.

Background and Objectives: Despite growing interest in the association between dietary amino acid intake and optimal health, validated dietary questionnaires that can estimate amino acid intake have been scarce. We examined the validity of amino acid intakes estimated using a self-administered diet history questionnaire (DHQ) comparing with 16-day semi-weighed dietary records (DR)., Methods and Study Design: A total of 184 Japanese men and women completed a four-day DR and a DHQ four times, once in each season. Dietary amino acid intakes were estimated as crude, energy-adjusted, and percentage of total protein intake (% protein) using an amino acid database of Japanese foods. The validity of dietary amino acid intake estimated by the first-time DHQ was examined using the mean of 16 days' DRs as reference., Results: Mean intakes of almost all amino acids estimated by DHQ were significantly lower than those estimated by the DR for energy-adjusted values in both sexes. Although mean amino acid intakes estimated by DHQ were significantly higher than those estimated by the DR for % protein value, the differences between the DR and DHQ were slight (-0.04 to 0.39% protein for men, -0.05 to 0.37% protein for women). Pearson correlation coefficients between DHQ and the DR showed reasonable ranking ability in % protein values for men (interquartile range (Q1-Q3): 0.31-0.47) and energy-adjusted values for women (interquartile range (Q1-Q3): 0.40-0.45)., Conclusion: DHQ showed acceptable ability to estimate mean amino acid intake and to rank individuals in a population according to their amino acid intake for using in large-scale epidemiological studies.

Background and Objectives: Information on a whole array of characteristics associated with dietary misreporting in a representative sample in each country is still limited. Using data from the 2012 National Health and Nutrition Survey, Japan, we investigated the prevalence and characteristics of under- and over-reporting of energy intake among 19,986 Japanese adults aged >=20 years., Methods and Study Design: Each individual's energy intake was calculated based on a 1-day semi-weighed dietary record. Under-, plausible, and over-reporters were identified based on the 95% confidence limits 1) for agreement between the ratio of energy intake to basal metabolic rate and a physical activity level for sedentary lifestyle (1.55), and 2) of the expected ratio of energy intake to estimated energy requirement of 1.0, assuming 'low active' level of physical activity., Results: Almost all subjects (>=92.8%) were classified as plausible reporters by any of the methods applied, with very low percentages of under- and over-reporters (<=6.3% and <=2.0%, respectively). Under-reporting was associated with younger age, overweight and obesity (compared with normal weight), current smoking (compared with never smoking), no alcohol drinking (compared with drinking everyday), and household consisting of a single person (compared with that consisting of two persons). Over-reporting was associated with gender (female), normal weight (compared with overweight), and household consisting of a single person., Conclusions: Overall mean energy intake obtained in this sample of Japanese adults appears to be plausible, but caution should be exercised when assessing the plausibility of energy intake in some subgroups.

Background: An increasing number of studies in Western countries have shown that healthy dietary patterns may have a protective effect against cognitive decline and dementia. However, information on this relationship among non-Western populations with different cultural settings is extremely limited. We aim to examine the relationship between dietary patterns and cognitive function among older Japanese people., Methods: This cross-sectional study included 635 community-dwelling people aged 69-71 years who participated in the prospective cohort study titled Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC). Diet was assessed over a one-month period with a validated, brief-type, self-administered diet history questionnaire. Dietary patterns from thirty-three predefined food groups [energy-adjusted food (g/d)] were extracted by factor analysis. Cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Multivariate regression analysis was performed to examine the relationship between dietary patterns and cognitive function., Results: Three dietary patterns were identified: the 'Plant foods and fish', 'Rice and miso soup', and 'Animal food' patterns. The 'Plant foods and fish' pattern, characterized by high intakes of green and other vegetables, soy products, seaweeds, mushrooms, potatoes, fruit, fish, and green tea, was significantly associated with a higher MoCA-J score [MoCA-J score per one-quartile increase in dietary pattern: β = 0.56 (95% CI: 0.33, 0.79), P for trend <0.001]. This association was still evident after adjustment for potential confounding factors [β = 0.41 (95% CI: 0.17, 0.65), P for trend <0.001]. In contrast, neither the 'Rice and miso soup' nor the 'Animal food' pattern was related to cognitive function. To confirm the possibility of reverse causation we also conducted a sensitivity analysis excluding 186 subjects who reported substantial changes in their diet for any reason, but the results did not change materially., Conclusion: This preliminary cross-sectional study suggests that a diet with high intakes of vegetables, soy products, fruit, and fish may have a beneficial effect on cognitive function in older Japanese people. Further prospective studies are needed to confirm this finding.

Epidemiologic evidence on the associations between dietary acid load and metabolic risk factors are limited and inconsistent. We investigated the hypothesis that dietary acid load is associated with adverse profiles of metabolic risk factors in Japanese adults. This cross-sectional study included 15 618 Japanese adults aged ≥20 years from the 2012 National Health and Nutrition Survey, Japan. Dietary acid load was characterized as potential renal acid load (PRAL) and net endogenous acid production (NEAP) based on information on nutrient intake, which was derived from a 1-day semi-weighed dietary record. After adjustment for potential confounding factors, both PRAL and NEAP were positively associated with body mass index (BMI) and waist circumference in both sexes (P for trend ≤.01). PRAL and NEAP also showed positive associations with systolic and diastolic blood pressure in men, independently of BMI (P for trend ≤.005), while they showed positive associations with systolic (but not diastolic) blood pressure in women (P for trend ≤.03). For other metabolic risk factors, there were positive associations between PRAL and NEAP and total and LDL-cholesterol concentrations only in men (P for trend ≤.04). After excluding participants taking medication for hypertension, dyslipidemia, and diabetes, similar associations were observed for adiposity measures and blood pressure (P for trend ≤.01), with there being positive associations between NEAP and HDL-cholesterol and between PRAL and NEAP and glycated hemoglobin in men (P for trend ≤.04). In conclusion, higher dietary acid load was significantly but weakly associated with higher adiposity measures and blood pressure in Japanese adults., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The associations of dietary energy density with dietary intake and obesity have been largely unexplored in non-Western populations. The present cross-sectional study examined the associations using data from the 2012 National Health and Nutrition Survey, Japan. Dietary intake was assessed using a 1-d semi-weighed dietary record in 15 618 Japanese adults aged ≥20 years. Mean dietary energy density (calculated on the basis of foods only) was 5·98 (sd 1·20) kJ/g in men and 5·72 (sd 1·16) kJ/g in women. Dietary energy density was positively associated with intakes of bread, noodles (only men), meat, fats and oils, and sugar and confectionery but inversely with intakes of white rice (only men), potatoes, pulses, vegetables, fruits, and fish and shellfish. For nutrient intake, dietary energy density was positively associated with total fat and SFA but inversely associated with all other nutrients examined such as protein, carbohydrate, alcohol (only women), dietary fibre, and several vitamins and minerals, including Na. After adjustment for potential confounding factors, dietary energy density was positively associated with abdominal obesity (waist circumference ≥80 cm) in women (adjusted prevalence ratio between the extreme tertiles 1·07; 95 % CI 1·02, 1·12; P for trend=0·003). Dietary energy density was also positively but non-significantly associated with general obesity (BMI≥25 kg/m2) in women (P for trend=0·08). There were no such associations in men. In conclusion, lower energy density of the diets of Japanese adults was associated with favourable food and nutrient intake patterns, except for higher Na, and, in only women, a lower prevalence of abdominal obesity.

Background & Aims: We aimed to develop and validate a risk scoring system to determine the risk of severe lower gastrointestinal bleeding (LGIB) and predict patient outcomes., Methods: We first performed a retrospective analysis of data from 439 patients emergently hospitalized for acute LGIB at the National Center for Global Health and Medicine in Japan, from January 2009 through December 2013. We used data on comorbidities, medication, presenting symptoms, and vital signs, and laboratory test results to develop a scoring system for severe LGIB (defined as continuous and/or recurrent bleeding). We validated the risk score in a prospective study of 161 patients with acute LGIB admitted to the same center from April 2014 through April 2015. We assessed the system's accuracy in predicting patient outcome using area under the receiver operating characteristics curve (AUC) analysis. All patients underwent colonoscopy., Results: In the first study, 29% of the patients developed severe LGIB. We devised a risk scoring system based on nonsteroidal anti-inflammatory drugs use, no diarrhea, no abdominal tenderness, blood pressure of 100 mm Hg or lower, antiplatelet drugs use, albumin level less than 3.0 g/dL, disease scores of 2 or higher, and syncope (NOBLADS), which all were independent correlates of severe LGIB. Severe LGIB developed in 75.7% of patients with scores of 5 or higher compared with 2% of patients without any of the factors correlated with severe LGIB (P < .001). The NOBLADS score determined the severity of LGIB with an AUC value of 0.77. In the validation (second) study, severe LGIB developed in 35% of patients; the NOBLADS score predicted the severity of LGIB with an AUC value of 0.76. Higher NOBLADS scores were associated with a requirement for blood transfusion, longer hospital stay, and intervention (P < .05 for trend)., Conclusions: We developed and validated a scoring system for risk of severe LGIB based on 8 factors (NOBLADS score). The system also determined the risk for blood transfusion, longer hospital stay, and intervention. It might be used in decision making regarding intervention and management., (Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Evidence from Western countries shows that higher consumption of sugar-sweetened beverages (SSBs) is associated with lower quality of young children's diets, but little is known about these relations in non-Western countries with relatively low consumption levels of SSBs. We hypothesized that SSB consumption in infancy would be associated with poor quality of later food and nutrient intake patterns among Japanese young children. The study subjects were 493 Japanese mother-child pairs from a prospective birth cohort study. Dietary data on children were collected from the mothers using self-administered questionnaires when the children were aged 16-24 months and 41-49 months. Multiple linear regression analyses were used to examine the relationships between SSB consumption frequency in infancy and later intake of foods and nutrients. At 16-24 months of age, more than half of the children (56.4%) consumed SSBs less than once a week, whereas 11.6% consumed SSBs at least once daily. More frequent consumption of SSBs in infancy was associated with higher intake of confectionaries and SSBs and lower intake of fruits and vegetables at 41-49 months of age. These associations were still evident after adjustment for maternal SSB consumption and socioeconomic status. At the nutrient level, SSB consumption frequency was positively associated with energy intake and inversely associated with intake of many nutrients, such as protein, dietary fiber, and most of the micronutrients examined. In conclusion, higher consumption frequency of SSBs at an early age is associated with poor quality of overall dietary intake among young Japanese children 1.5-2.5 years later., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: The intrauterine environment, including maternal nutrition status, may affect the development, formation, and mineralization of children's teeth. We assessed the relationship between self-reported maternal dietary vitamin D intake during pregnancy and the risk of dental caries among young Japanese children., Methods: This study is based on a prospective analysis of 1210 Japanese mother-child pairs. Information on maternal intake during pregnancy was collected using a validated diet history questionnaire. Data on oral examination at 36-46 months of age were obtained from the mothers, who transcribed the information from their maternal and child health handbooks to our self-administered questionnaire. Children were classified as having dental caries if one or more primary teeth had decayed or had been filled., Results: Compared with the lowest quartile of maternal vitamin D intake during pregnancy, adjusted odds ratios (95% confidence intervals) for quartiles 2, 3, and 4 were 1.06 (0.72-1.56), 0.53 (0.34-0.81), and 0.67 (0.44-1.02), respectively (P for trend = .01). When maternal vitamin D intake was treated as a continuous variable, the adjusted odds ratio (95% confidence interval) was 0.94 (0.89-0.995)., Conclusions: Higher maternal vitamin D intake during pregnancy may be associated with a lower risk of dental caries in children., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Simultaneous dietary achievement of a full set of nutritional recommendations is difficult. Diet optimization model using linear programming is a useful mathematical means of translating nutrient-based recommendations into realistic nutritionally-optimal food combinations incorporating local and culture-specific foods. We used this approach to explore optimal food intake patterns that meet the nutrient recommendations of the Dietary Reference Intakes (DRIs) while incorporating typical Japanese food selections., Methods: As observed intake values, we used the food and nutrient intake data of 92 women aged 31-69 years and 82 men aged 32-69 years living in three regions of Japan. Dietary data were collected with semi-weighed dietary record on four non-consecutive days in each season of the year (16 days total). The linear programming models were constructed to minimize the differences between observed and optimized food intake patterns while also meeting the DRIs for a set of 28 nutrients, setting energy equal to estimated requirements, and not exceeding typical quantities of each food consumed by each age (30-49 or 50-69 years) and gender group., Results: We successfully developed mathematically optimized food intake patterns that met the DRIs for all 28 nutrients studied in each sex and age group. Achieving nutritional goals required minor modifications of existing diets in older groups, particularly women, while major modifications were required to increase intake of fruit and vegetables in younger groups of both sexes. Across all sex and age groups, optimized food intake patterns demanded greatly increased intake of whole grains and reduced-fat dairy products in place of intake of refined grains and full-fat dairy products. Salt intake goals were the most difficult to achieve, requiring marked reduction of salt-containing seasoning (65-80%) in all sex and age groups., Conclusion: Using a linear programming model, we identified optimal food intake patterns providing practical food choices and meeting nutritional recommendations for Japanese populations. Dietary modifications from current eating habits required to fulfil nutritional goals differed by age: more marked increases in food volume were required in younger groups.

The relation of maternal caffeine intake with birth outcomes is still inconclusive and has not been examined in Japan, where the sources of caffeine intake are different from those in Western countries. We hypothesized that maternal consumption of total caffeine and culture-specific major sources of caffeine would be associated with birth outcomes among Japanese pregnant. The study subjects were 858 Japanese women who delivered singleton infants. Maternal diet during pregnancy was assessed using a validated, self-administered diet history questionnaire. Birth outcomes considered were low birth weight (LBW; <2500 g), preterm birth (PTB; <37 weeks of gestation), and small for gestational age (SGA; <10th percentile). The main caffeine sources were Japanese and Chinese tea (73.5%), coffee (14.3%), black tea (6.6%), and soft drinks (3.5%). After controlling for confounders, maternal total caffeine intake during pregnancy was significantly associated with an increased risk of PTB (odds ratio per 100 mg/d caffeine increase, 1.28; 95% confidence interval, 1.03-1.58; P for trend = .03). However, no evident relationships were observed between total caffeine intake and risk of LBW or SGA. As for caffeine sources, higher Japanese and Chinese tea consumption was associated with an increased risk of PTB (odds ratio per 1 cup/d increase, 1.14; 95% confidence interval, 1.00-1.30; P for trend = .04), but not LBW or SGA. There were no associations between consumption of the other beverages examined and birth outcomes. In conclusion, this prospective birth cohort in Japan suggests that higher maternal total caffeine intake, mainly in the form of Japanese and Chinese tea, during pregnancy is associated with a greater risk of PTB., (Copyright © 2015 Elsevier Inc. All rights reserved.)