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The aim of this study was to determine the cross-sectional associations between frequency of eating with others and depressive symptoms in Japanese employees while accounting for lifestyle and dietary factors. We also examined the relationship with stratification by living arrangement. Participants were 1876 workers aged 18–74 years who participated in a health survey at a periodic checkup. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale. Frequency of eating with others was categorized into ranges between daily and <1 day/week. Associations between frequency of eating with others and depressive symptoms were assessed using logistic regression analysis, with adjustment for lifestyle and dietary factors. The prevalence of depressive symptoms was 32.9%. The prevalence of depressive symptoms tended to increase with decreasing frequency of eating with others, with multivariate-adjusted odds ratios (95% confidence intervals) for the highest through lowest frequency groups of eating meals with others being 1.00 (reference), 1.27 (0.92–1.74), 1.56 (1.11–2.21), 1.86 (1.29–2.67), and 2.22 (1.53–3.22), respectively (P for trend<0.001). In analysis stratified by living arrangement, a significant association was found with those living with others but not those living alone (P for interaction <0.001). Lower frequency of eating with others may be associated with higher odds of depressive symptoms among Japanese workers living with others, even after controlling for lifestyle and dietary factors. • We examined the association between eating alone and depressive symptoms. • Eating alone was related to higher depression levels among those living with others. • The association was significant after adjusting for lifestyle and dietary factors. [ABSTRACT FROM AUTHOR]

Objective: Accumulating evidence suggests that amino acids, particularly tryptophan and glutamate, play an important role in the pathology of depression, but prospective epidemiologic data on this issue is scarce. We examined the association between circulating amino acids and the risk of depressive symptoms in a Japanese working population. Methods: Participants were 841 workers who were free from depressive symptoms and provided blood at baseline and completed 3-yr follow-up survey. 30 varieties of amino acid concentrations in serum were measured using liquid chromatography/mass spectrometry. Depressive symptoms were defined using the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to calculate the odds ratios of depressive symptoms according to serum amino acids with adjustment for lifestyle factors. Results: A total of 151 (18.0%) workers were newly identified as having depressive symptoms at the follow-up. Baseline tryptophan and glutamate concentrations in serum were not appreciably associated with the risk of depressive symptoms. Risk of depressive symptoms tended to increase with increasing arginine concentrations; the multivariable-adjusted odds ratio for the highest versus lowest tertile of serum arginine was 1.65 (95% confidence interval: 0.96–2.83; P for trend = 0.07). No clear association was found for other amino acids. Conclusions: Results of the present study do not support a significant role of circulating amino acids in the development of depressive symptoms among Japanese. [ABSTRACT FROM AUTHOR]

Highlights • We prospectively studied the association of breakfast with depressive symptoms. • We found skipping breakfast is related to a higher risk of depressive symptoms. • The associations remained after controlling for dietary and lifestyle factors. Abstract Breakfast consumption has been suggested to influence mood, but prospective evidence on this issue is limited. We prospectively investigated the association between the frequency of breakfast consumption and the risk of depressive symptoms in Japanese employees. Participants were 716 employees aged 19–68 years who were free from depressive symptoms and mental disorders at baseline and who attended the 3-year follow-up survey. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. The frequency of breakfast consumption was categorized into "daily", "5–6 times/week", "3–4 times/week", "1–2 times/week", or "≤1 times/week". Logistic regression was used to estimate odds ratios of depressive symptoms according to breakfast consumption adjusted for dietary and lifestyle factors. Participants who consumed breakfast ≤1 times/week had an increased risk of depressive symptoms compared to those who ate breakfast every day, even after adjusting for other dietary factors (multivariable-adjusted odds ratio 2.92; 95% confidence interval, 1.37–6.22) The risk of depressive symptoms tended to increase with decreasing frequency of breakfast consumption (P for trend = 0.02). The omission of breakfast is related to increased risk of depressive symptoms among Japanese employees, independently of other dietary and non-dietary factors. [ABSTRACT FROM AUTHOR]

This study was aimed to examine the cross-sectional association of protein, carbohydrate, and fat intake with depressive symptoms among 1794 Japanese male workers aged 18–69 years who participated in a health survey. Dietary intake was assessed with a validated self-administered diet history questionnaire. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Odds ratio of depressive symptoms (CES-D scale of ≥16) was estimated by using multiple logistic regression with adjustment for covariates including folate, vitamin B6, vitamin B12, polyunsaturated fatty acid, magnesium, and iron intake. Multivariable-adjusted odds ratio of depressive symptoms for the highest quartile of protein intake was 26%, albeit not statistically significant, lower compared with the lowest. The inverse association was more evident when a cutoff value of CES-D score ≥19 was used. The multivariable-adjusted odds ratios (95% confidence intervals) for the highest through lowest quartile of protein intake were 1.00 (reference), 0.69 (0.47–1.01), 0.69 (0.44–1.09), and 0.58 (0.31–1.06) ( P for trend=0.096). Neither carbohydrate nor fat intake was associated with depressive symptoms. Our findings suggest that low protein intake may be associated with higher prevalence of depressive symptoms in Japanese male workers. [ABSTRACT FROM AUTHOR]

Background: Living alone has been positively associated with the prevalence of depressive symptoms. We examined how a combination of living alone and pet ownership relates to depressive symptoms. Methods: As part of the Japan Epidemiology Collaboration on Occupational Health Study, we conducted a survey on health-related lifestyles, including living arrangements and pet ownership, among 12,763 employees of five companies in 2018–2021. Depressive symptoms were assessed using the 11-item Center for Epidemiological Studies-Depression Scale (cutoff score ≥ 9). A Poisson regression model with a robust variance estimator was used to calculate prevalence ratio and 95% confidence interval (CI) while adjusting for covariates. Results: Among the participants, 30.9% were depressed, 17.7% had pets, and 29.1% lived alone. Compared to individuals living with others but not with a pet, those living alone and not with a pet had a 1.17 times higher prevalence ratio of depressive symptoms (95% CI: 1.08-1.26). The corresponding figures were 1.03 (95% CI: 0.95-1.11) for those living with others and pet(s) and 1.42 (95% CI: 1.18-1.69) for those living alone but with pet(s). Conclusion: Living alone was significantly associated with a higher prevalence of depressive symptoms. The association was rather stronger among individuals with vs. without pets. Pet ownership may not be associated with decreased depressive symptoms. [ABSTRACT FROM AUTHOR]

Highlights • Serum BDNF concentrations were significantly positively associated with BMI. • Current smokers had higher mean BDNF concentrations than never-smokers. • Serum BDNF were not associated with serum folate and 25-hydroxyvitamin D. • Serum BDNF were also not associated with dietary EPA and DHA intake. Abstract This study aimed to examine the cross-sectional association of demographic and lifestyle factors with serum brain-derived neurotrophic factor (BDNF) concentrations in a Japanese working population. Participants were 1678 men and 172 women aged 19–69 years who received health check-ups and participated in a nutrition and health survey. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Dietary intake was assessed using a validated self-administered diet history questionnaire. Serum BDNF concentrations were measured using a solid phase sandwich enzyme-linked immunosorbent assay. Multiple linear regression analysis was used to estimate the mean and 95% confidence interval of serum BDNF concentrations according to demographic and lifestyle factors. Higher body mass index (BMI) was significantly associated with higher circulating BDNF concentrations. Current smokers had significantly higher mean BDNF concentrations than never-smokers. BDNF concentrations were not associated with folate and 25-hydroxyvitamin D concentrations in serum, or dietary eicosapentaenoic acid and docosahexaenoic acid intake. Serum BDNF concentrations were not associated with depressive symptoms or CES-D score per se. In this study, higher BMI and smoking were associated with higher concentrations of serum BDNF, while nutrients that have been linked to depression were not associated with BDNF concentrations among Japanese workers. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) is associated with cancer risk; however, little is known regarding its relationship with the risk of cancer-related premature death and long-term sick leave (LTSL), which can lead to a substantial loss in working years. The present study aimed to quantify the all-site and site-specific associations between MetS and the risk of severe cancer events (a composite outcome of LTSL and mortality due to cancer) in a large working population in Japan. Methods: We recruited 70,875 workers (59,950 men and 10,925 women), aged 20–59 years, who attended health check-ups in 2011 (10 companies) and 2014 (2 companies). All workers underwent follow up for severe cancer events until March 31, 2020. MetS was defined in accordance with the Joint Interim Statement. Cox regression models were used to quantify the association between baseline MetS and severe cancer events. Results: During 427,379 person-years of follow-up, 523 participants experienced the outcome consisting of 493 LTSLs of which 124 eventually resulted in death, and 30 deaths without taking LTSL. The adjusted hazard ratios (HR) (95% confidence intervals [CI]) for composite severe events due to all-site, obesity-related, and non-obesity-related cancer among those with vs. without MetS were 1.26 (1.03, 1.55), 1.37 (1.04, 1.82), and 1.15 (0.84, 1.56), respectively. In cancer site-specific analyses, MetS was associated with an increased risk of severe events due to pancreatic cancer (HR, 2.06; 95% CI, 0.99–4.26). When mortality was treated solely as the endpoint, the association was significant for all-site (HR, 1.58; 95% CI, 1.10–2.26), and obesity-related (HR, 1.59; 95% CI, 1.00–2.54) cancer. Additionally, a greater number of MetS components was associated with a greater risk of both severe cancer events and cancer-related mortality (P trend < 0.05). Conclusion: Among Japanese workers, MetS was associated with an increased risk of severe cancer events, especially those due to obesity-linked cancer. [ABSTRACT FROM AUTHOR]

Aims: We aimed to assess the cross-sectional association of heated tobacco product (HTP) use with prediabetes and diabetes. Methods: The present analysis included 8950 workers from 5 companies (Study I) and 31,341 workers from another large company (Study II), who participated in the Japan Epidemiology Collaboration on Occupational Health Study. The participants were divided into five groups: never smokers, past smokers, exclusive HTP users, dual users of cigarettes and HTPs, and exclusive cigarette smokers. Diabetes and prediabetes were defined according to the fasting blood glucose and HbA1c levels and self-reported diabetes treatment, using the American Diabetes Association criteria. We analyzed the data of Study I and II separately, and then pooled these estimates using the fixed-effect models, with adjustment for a wide range of covariates. Results: In this study that included 40,291 participants (mean age, 46.6 years; men, 84.3%), about half of the current tobacco-related product users reported using HTPs. Exclusive HTP users had higher odds of prediabetes (pooled odds ratio 1.36; 95% CI 1.25–1.47) and diabetes (1.68; 95% CI 1.45–1.94) than never smokers. Similarly, dual users also had increased odds of prediabetes (pooled odds ratio, 1.26; 95% CI 1.13–1.39) and diabetes (1.93; 95% CI 1.63–2.29). The strength of these associations was comparable to that of cigarette smokers. We observed significantly higher HbA1c and fasting blood glucose levels among both exclusive HTP users and dual users compared to never smokers. Conclusion: HTP use was associated with an increased likelihood of prediabetes and diabetes. Prospective studies are warranted to confirm the cross-sectional association. [ABSTRACT FROM AUTHOR]

We aimed to assess the association between heated tobacco product (HTP) use and high-density lipoprotein cholesterol (HDL-C) concentration. Our study included 12,268 workers from five companies (Study I) and 36,503 workers from another large company (Study II). Participants were categorized into five groups: never smokers, past smokers, exclusive HTP users, dual users of cigarettes and HTPs, and exclusive cigarette smokers. We analyzed the data of Studies I and II separately and then pooled these estimates using a fixed-effect model. Of the 48,771 participants, 9.3% were exclusive HTP users, and 6.0% were dual users. Exclusive HTP users had modestly but significantly lower concentrations of HDL-C than never smokers, with the pooled mean difference being − 1.1 (95% CI − 1.5 to − 0.6) mg/dL. Dual users showed a further reduction (mean difference − 3.7 (− 4.2 to − 3.2) mg/dL), which was comparable to that of exclusive cigarette smokers versus never smokers (mean difference − 4.3 (− 4.7 to − 3.9) mg/dL). The pooled odds ratios (95% CIs) of having low HDL-C (< 40 mg/dL for men and 50 mg/dL for women) were 1, 0.99 (0.90–1.11), 1.25 (1.09–1.43), 2.02 (1.76–2.32), and 2.09 (1.88–2.32) for never smokers, past smokers, exclusive HTP users, dual users, and exclusive cigarette smokers, respectively. In conclusion, exclusive HTP users had lower HDL-C concentrations than never smokers, although higher than exclusive cigarette smokers. Moreover, dual users had HDL-C concentrations similar to those in exclusive cigarette smokers. [ABSTRACT FROM AUTHOR]

While late chronotype and greater social jetlag have been associated with poor dietary behavior among the general population, these associations have not been investigated among workers, who struggle to align their sleep timings with work schedules. We aimed to explore the cross-sectional association of social jetlag and a late chronotype with adherence to a healthy diet among Japanese workers. Participants were 1,435 non-shift workers (18–78 years) who attended a nutritional survey. Social jetlag was defined as the difference in the midpoint of sleep times between weekdays and weekends, while chronotype was estimated using the mid-sleep time on weekends that was corrected with sleep debt on weekdays. We calculated the adherence score of the Japanese Food Guide Spinning Top (JFGST) – healthy diet guidelines for Japanese. Multivariable linear regression analyses were used to calculate the adjusted means and 95% confidence intervals (CI) for adherence scores of social jetlag and chronotype. We found that greater social jetlag was associated with a lower JFGST score. The multivariable-adjusted mean (95% CI) of JFGST scores were 39.7 (39.1–40.2), 38.7 (37.9–39.6), and 38.1 (36.6–39.7) for <1 hour, 1 to <2 hours, and ≥2 hours of social jetlag, respectively (P-trend = 0.02). Workers with late chronotypes had significantly lower adherence scores on JFGST [36.3 (34.7–37.8); P-trend = 0.002]. Results suggest that a late chronotype and social jetlag are inversely associated with adherence to a healthy diet among Japanese workers. [ABSTRACT FROM AUTHOR]

Aims: Data are limited regarding how shift work is linked to the development of type 2 diabetes, especially among workers at high risk of diabetes. We examined the risk of diabetes according to shift-work conditions over several years among Japanese adults. Methods: This prospective study enrolled 17,515 workers (age 40–78 years). Shift work was self-reported at annual health examinations over time from 2004 to 2017 and categorized as shift workers or non-shift workers. Diabetes was defined as fasting plasma glucose, random glucose, HbA1c, and self-reported use of antidiabetic medications. The association of shift work and diabetes was quantified using Cox regression. Results: During a follow-up of 8.1 years in median, 2071 incident cases of diabetes were documented. Compared with non-shift work, shift work showed a significantly elevated hazard ratios of developing diabetes. Shift work showed a 19% (95% confidence intervals: 3–37%) higher hazard ratios for diabetes, after adjustment for demographic-, cardiometabolic-, and work-related factors. Further adjustment for lifestyle factors and body mass index did not materially change this association (a 16% increase; 95% confidence intervals, 1–34%). This relationship was replicated among workers with prediabetes. Conclusions: Engaging in shift work may increase the risk of developing diabetes independently of lifestyle factors and body mass index, even among prediabetic workers. [ABSTRACT FROM AUTHOR]

Objective: Prediabetes has been suggested to increase risk for death; however, the definitions of prediabetes that can predict death remain elusive. We prospectively investigated the association of multiple definitions of prediabetes with the risk of death from all causes, cardiovascular disease (CVD), and cancer in Japanese workers.Research Design and Methods: The study included 62,785 workers who underwent a health checkup in 2010 or 2011 and were followed up for death from 2012 to March 2019. Prediabetes was defined according to fasting plasma glucose (FPG) or glycated hemoglobin (HbA1c) values or a combination of both using the American Diabetes Association (ADA) or World Health Organization (WHO)/International Expert Committee (IEC) criteria. The Cox proportional hazards regression model was used to investigate the associations.Results: Over a 7-year follow-up, 229 deaths were documented. Compared with normoglycemia, prediabetes defined according to ADA criteria was associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.53; 95% CI 1.12-2.09) and death due to cancer (HR 2.37; 95% CI 1.45-3.89) but not with death due to CVD. The results were materially unchanged when prediabetes was defined according to ADA FPG, ADA HbA1c, WHO FPG, or combined WHO/IEC criteria. Diabetes was associated with the risk of all-cause, CVD, and cancer deaths.Conclusions: In a cohort of Japanese workers, FPG- and HbA1c-defined prediabetes, according to ADA or WHO/IEC, were associated with a significantly increased risk of death from all causes and cancer but not CVD. [ABSTRACT FROM AUTHOR]

Objectives: While several experimental studies in animals and humans have suggested the protective effect of nightly fasting duration (NFD) against cardiometabolic risk factors, few population‐based studies have been conducted. This study aimed to investigate the association between NFD and metabolic syndrome (MetS) among Japanese non‐shift workers. Methods: A subset of 1054 non‐shift workers from the Furukawa Nutrition and Health Study were included in this analysis. Participants completed dietary and lifestyle surveys during a periodic checkup. NFD was defined as the time between dinner and breakfast and was categorized into four groups (ie, ≥12 hours, 11 hours, 10 hours, and ≤9 hours). MetS was defined as ≥3 of the following components: high waist circumference (≥90 cm [men] and ≥80 cm [women]), high triglycerides (≥150 mg/dL), low high‐density lipoprotein cholesterol (<40 mg/dL [men] and <50 mg/dL [women]), hypertension (systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg), and high fasting glucose (fasting plasma glucose ≥100 mg/dL or hemoglobin A1c ≥5.6%). A multivariable logistic regression model was used to examine the association between NFD and MetS. Results: The odds ratios (95% confidence intervals) of MetS for the highest (≥12 hours) through lowest (≤9 hours) NFD categories were 1.00 (reference), 0.83 (0.51‐1.35), 0.83 (0.48‐1.43), and 0.80 (0.43‐1.48) (P for trend = 0.50) after adjusting for covariates. Further analyses on the relationship between NFD and each MetS component found no significant associations. Conclusions: We did not find any evidence of a significant association between NFD and MetS among non‐shift workers in Japan. [ABSTRACT FROM AUTHOR]

Introduction: The effect of weight gain following smoking cessation on cardiovascular risks is unclear. We aimed to prospectively investigate the association of weight gain following smoking cessation with the trajectory of estimated risks of coronary heart disease (CHD).Methods: In a cohort of 18 562 Japanese male employees aged 30-64 years and initially free of cardiovascular diseases, participants were exclusively grouped into sustained smokers, quitters with weight gain (body weight increase ≥5%), quitters without weight gain (body weight increase <5% or weight loss), and never smokers. Global 10-year CHD risk was annually estimated by using a well-validated prediction model for the Japanese population. Linear mixed models and piecewise linear mixed models were used to compare changes in the estimated 10-year CHD risk by smoking status and weight change following smoking cessation.Results: During a maximum of 8-year follow-up, both quitters with and without weight gain had a substantially decreased level of estimated 10-year CHD risk after quitting smoking, compared with sustained smokers (all ps for mean differences < .001). The estimated 10-year CHD risk within the first year after cessation decreased more rapidly in quitters without weight gain than in quitters with weight gain (change rate [95% confidence interval, CI] -0.90 [-1.04 to -0.75] vs. -0.40 [-0.60 to -0.19] % per year, p < .0001). Thereafter, the estimated 10-year CHD risk in both groups increased at similar rates (change rate [95% CI] -0.07 [-0.21 to 0.07] vs. 0.11 [-0.09 to 0.30] % per year, p = .16, from year 1 to year 2; and 0.10 [0.05 to 0.15] vs. 0.11 [0.04 to 0.18] % per year, p = .80, from year 2 to year 8).Conclusions: In this population of middle-aged, Japanese male workers, smoking cessation greatly reduces the estimated 10-year risk of CHD. However, weight gain weakens the beneficial effect of quitting smoking in a temporary and limited fashion.Implications: To the best of our knowledge, this study is the first to examine the effect of weight gain following smoking cessation on the trajectory of the absolute risk of CHD. Our data imply that the benefits of cessation for reducing the absolute risk of CHD outweigh the potential risk increase due to weight gain, and suggest that in order to maximize the beneficial effects of quitting smoking, interventions to control post-cessation weight gain might be warranted. [ABSTRACT FROM AUTHOR]

Aims/Introduction: We examined the association between hemoglobin A1c (HbA1c) and anemia, which was categorized into three groups according to mean corpuscular volume (MCV), as well as the association between hemoglobin in the non‐anemic range and HbA1c. Materials and Methods: We used the 2016 health checkup data from 36,422 workers without diabetes. Anemic people were divided into three groups based on MCV: <80, 80–90 and >90 fL. Non‐anemic people were divided into four groups based on their hemoglobin levels. We carried out multiple linear regression models to estimate the means and 95% confidence intervals (CIs) of HbA1c. Results: For men, 0.2% had anemia with MCV <80 fL, 0.5% had anemia with MCV 80–90 fL, 0.9% had anemia with MCV >90 fL and 98.4% had no anemia. For women, the corresponding values were 6.1, 6.4, 2.8 and 84.7%, respectively. The adjusted mean HbA1c (%) values for men with anemia with MCV <80, 80–90 and >90 fL were 5.67 (95% CI 5.60–5.74), 5.58 (95% CI 5.54–5.62) and 5.41 (95% CI 5.37–5.44), respectively. Among men without anemia, HbA1c (%) increased from 5.36 (95% CI 5.34–5.39) in those with hemoglobin ≥17.5 mg/dL to 5.45 (95% CI 5.45–5.46) in those with hemoglobin 13.0 to <14.5 mg/dL (P for trend <0.001). The HbA1c values were higher in men with anemia with MCV <80 fL or MCV 80–90 fL, but lower in men with MCV >90 fL, compared with non‐anemic men with hemoglobin 13.0 to <14.5 mg/dL (All P < 0.001). Similar findings were observed in women. Conclusions: We observed elevated HbA1c among anemic people with MCV <80 fL or MCV 80–90 fL, and decreased HbA1c among anemic people with MCV >90 fL, suggesting that different types of anemia might influence HbA1c differently. In addition, non‐anemic people with lower hemoglobin levels had higher HbA1c levels, suggesting that hemoglobin levels are in need of consideration when interpreting HbA1c values among non‐anemic people. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between suicide death and serum cholesterol levels as measured at times close to suicide death. Methods: We conducted a nested case-control study of 41 cases of suicide deaths and 205 matched controls with serum total cholesterol (TC) levels till 3 years before suicide death in a large cohort of Japanese workers. Results: Individuals in the lowest versus highest tertile/predefined category of TC in a Japanese working population had a three- to four-fold greater risk of suicide death. Each 10 mg/dl decrement of average TC was associated with an 18% increased chance of suicide death (95% confidence interval, 2–35%). Similar results were found for TC levels at each year. Conclusion: These results suggest that a low serum TC level in recent past is associated with an increased risk of suicide death. [ABSTRACT FROM AUTHOR]

Aims/Introduction: We examined a prospective association between serum creatinine levels and diabetes. Materials and Methods: The present study included 31,343 male workers without diabetes, and aged between 20 and 64 years at baseline. We calculated the cumulative average of their serum creatinine over the study period. We defined diabetes as either glycated hemoglobin levels ≥6.5%, random glucose levels ≥200 mg/dL, fasting glucose levels ≥126 mg/dL or receiving antidiabetic treatment. Cox proportional hazards regression analysis was carried out to estimate the hazard ratio (HR) and 95% confidence interval (CI). Results: With a median observation of 7.7 years, 2,509 participants developed diabetes. After adjusting for age, smoking, body mass index, hypertension and dyslipidemia, lower cumulative average serum creatinine levels were related to a greater diabetes risk: HRs were 1.56 (95% CI 1.35–1.82), 1.22 (1.09–1.35) and 1.06 (0.96–1.17) for the participants with serum creatinine <0.70, 0.70–0.79 and 0.80–0.89 mg/dL, respectively, compared with those with 0.90–1.20 mg/dL (P for trend <0.001). The serum creatinine‐diabetes association was more pronounced among older adults (serum creatinine <0.70 vs 0.90–1.20 mg/dL, HR 1.66, 95% CI 1.37–2.00) than younger adults (HR 1.32, 95% CI 1.02–1.71; P for interaction by age group = 0.001). Conclusions: Low serum creatinine is associated with an increased risk of diabetes. Screening serum creatinine levels can be used to identify those who are at high risk of diabetes. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to determine the prospective association of smoking status, smoking intensity, and smoking cessation with the risk of hearing loss in a large Japanese cohort.Methods: The cohort study included 50195 employees, who were aged 20-64 years and free of hearing loss at baseline. Participants were followed up for a maximum of 8 years. Pure-tone audiometric testing was performed annually to identify hearing loss at 1 and 4 kHz. Cox proportional hazards regression models were used to investigate the association between smoking and hearing loss.Results: During follow-up, 3532 individuals developed high-frequency hearing loss, and 1575 developed low-frequency hearing loss. The hazard ratio (HR) associated with current smokers was 1.6 (95% confidence interval [CI] = 1.5 to 1.7) and 1.2 (95% CI = 1.1 to 1.4) for high- and low-frequency hearing loss, respectively, as compared with never smokers. The risk of high- and low-frequency hearing loss increased with the number of cigarettes smoked per day (both p for trend <.001). The HR associated with former smokers was 1.2 (95% CI = 1.1 to 1.3) and 0.9 (95% CI = 0.8 to 1.1) for high- and low-frequency hearing loss, respectively. The analysis by quitting years showed a decline in risk of hearing loss after quitting smoking, even among those who quitted less than 5 years before baseline.Conclusions: Smoking is associated with increased risk of hearing loss, especially at the high frequency, in a dose-response manner. The excess risk of hearing loss associated with smoking disappears in a relatively short period after quitting.Implications: The prospective association between smoking and hearing loss has not been well studied. To the best of our knowledge, our study is the largest to date investigating the association between smoking and incident hearing loss. Our results indicate that smoking is associated with increased risk of hearing loss in a dose-response manner. Quitting smoking virtually eliminates the excess risk of hearing loss, even among quitters with short duration of cessation. These results suggest that smoking may be a causal factor for hearing loss, although further research would be required to confirm this. If so, this would emphasize the need for tobacco control to prevent or delay the development of hearing loss. [ABSTRACT FROM AUTHOR]

Objective: Social jetlag, ie, the mismatch between biological and social timing, has been suggested to induce obesity and cardiometabolic abnormalities. Yet, no study has currently linked social jetlag to metabolic syndrome (MetS) among Asians. The aim of this study was to investigate the cross-sectional association of social jetlag with MetS in a Japanese working population.Methods: Participants were 1164 employees, aged 18-78 years, who completed a health survey at a periodic checkup. Social jetlag was calculated as the difference in hours of midpoint of sleep times between weekdays and weekends. MetS was defined according to the Joint Interim Statement criteria. Multivariable logistic regression was used to examine the association between social jetlag and MetS with adjustment for potential confounding variables.Results: Greater social jetlag was significantly associated with an increased likelihood of having MetS. The multivariable adjusted odds ratio (95% confidence intervals) for ≥2 h of social jetlag was 1.92 (1.01-3.67) compared to those with <1 h of social jetlag. Of the components of MetS, greater social jetlag was significantly associated with an increased likelihood of having high waist circumference; the multivariable adjusted odds ratio (95% confidence intervals) for ≥2 h of social jetlag was 2.26 (1.33-3.84) compared to those with <1 h of social jetlag.Conclusion: Social jetlag may be associated with an increased likelihood of having MetS among non-shift workers. [ABSTRACT FROM AUTHOR]

Abstract Background and aims We aimed to examine the risk of cardiovascular disease (CVD) with persistent prediabetes during the last four years prior to a CVD event in a large occupational cohort in Japan. Methods We performed a nested case-control study using data from the Japan Epidemiology Collaboration on Occupational Health Study. A total of 197 registered cases of CVD were identified and matched individually with 985 controls according to age, sex, and worksite. Prediabetes was defined as fasting plasma glucose 100-125 mg/dL and/or HbA1c 5.7–6.4%. Persistent prediabetes was defined as having prediabetes at years one and four prior to the onset/index date; persistent normoglycemia was similarly defined. Associations between prediabetes and CVD risk were assessed using conditional logistic regression models. Results Compared with people with persistent normoglycemia over the four years prior to the onset/index date, the unadjusted odds ratio (95% confidence interval) for CVD was 2.88 (1.56, 5.32) for people with persistent prediabetes. After adjusting for BMI, smoking, hypertension, and dyslipidemia assessed four years before the onset/index date, the association was slightly attenuated to an OR (95% confidence interval) of 2.62 (1.31, 5.25). Prediabetes assessed at single time points was also associated with an elevated risk of CVD, with multivariable-adjusted odds ratio (95% confidence interval) of 1.72 (1.12, 2.64) and 2.13 (1.32, 3.43) for prediabetes at one and four years prior to the onset/index date, respectively. Conclusions Prediabetes is associated with an increased risk of CVD. Identification and management of prediabetes are important for the prevention of CVD. Highlights • Prediabetes assessed at single time points was associated with an elevated risk of CVD. • Much higher risk of CVD was observed among people with persistent prediabetes compared with persistent normoglycemia. • Prediabetes is associated with a higher risk of CVD. [ABSTRACT FROM AUTHOR]

Abstract: Aims/Introduction: We previously developed a 3‐year diabetes risk score in the working population. The objective of the present study was to develop and validate flexible risk models that can predict the risk of diabetes for any arbitrary time‐point during 7 years. Materials and Methods: The participants were 46,198 Japanese employees aged 30–59 years, without diabetes at baseline and with a maximum follow‐up period of 8 years. Incident diabetes was defined according to the American Diabetes Association criteria. With routine health checkup data (age, sex, abdominal obesity, body mass index, smoking status, hypertension status, dyslipidemia, glycated hemoglobin and fasting plasma glucose), we developed non‐invasive and invasive risk models based on the Cox proportional hazards regression model among a random two‐thirds of the participants, and used another one‐third for validation. Results: The range of the area under the receiver operating characteristic curve increased from 0.73 (95% confidence interval 0.72–0.74) for the non‐invasive prediction model to 0.89 (95% confidence interval 0.89–0.90) for the invasive prediction model containing dyslipidemia, glycated hemoglobin and fasting plasma glucose. The invasive models showed improved integrated discrimination and reclassification performance, as compared with the non‐invasive model. Calibration appeared good between the predicted and observed risks. These models performed well in the validation cohort. Conclusions: The present non‐invasive and invasive models for the prediction of diabetes risk up to 7 years showed fair and excellent performance, respectively. The invasive models can be used to identify high‐risk individuals, who would benefit greatly from lifestyle modification for the prevention or delay of diabetes. [ABSTRACT FROM AUTHOR]

We prospectively examined diabetes risk in association with a summary measure of degree and duration of weight change. The study participants were 51,777 employees from multiple companies in Japan, who were aged 30-59years, free of diabetes at baseline, and followed up for 7years (2008-2015). Exposure was cumulative body mass index (BMI)-years, which was defined as the area of BMI units above or below baseline BMI during follow-up, and was treated as a time-dependent variable in the Cox proportional hazards regression models. During the 263,539 person-years of follow-up, 3465 participants developed diabetes. The adjusted hazard ratio (HR) of diabetes for a 1-unit increase in cumulative BMI-years was 1.11 (95% confidence interval (CI): 1.09, 1.12). The association was more pronounced among overweight (HR=1.11; 95% CI: 1.08, 1.14) and obese (HR=1.12; 95% CI: 1.08, 1.15) adults compared with normal- and under-weight (HR=1.07; 95% CI: 1.03, 1.11) adults (P for interaction of cumulative BMI-years X baseline BMI-group=0.002). The association of higher cumulative BMI-years with incident diabetes did not substantially differ by metabolic phenotype. The present results emphasize the importance of avoiding additional weight gain over an extended period of time for the prevention of type 2 diabetes, especially among overweight and obese adults, irrespective of metabolic health status. [ABSTRACT FROM AUTHOR]

Aims: The control of blood glucose levels, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) levels reduces the risk of diabetes complications; however, data are scarce on control status of these factors among workers with diabetes. The present study aimed to estimate the prevalence of participants with diabetes who meet glycated hemoglobin (HbA1c), BP, and LDL-C recommendations, and to investigate correlates of poor glycemic control in a large working population in Japan. Methods: The Japan Epidemiology Collaboration on Occupational Health (J-ECOH) Study is an ongoing cohort investigation, consisting mainly of employees in large manufacturing companies. We conducted a cross-sectional analysis of 3,070 employees with diabetes (2,854 men and 216 women) aged 20–69 years who attended periodic health examinations. BP was measured and recorded using different company protocols. Risk factor targets were defined using both American Diabetes Association (ADA) guidelines (HbA1c < 7.0%, BP < 140/90 mmHg, and LDL-C < 100 mg/dL) and Japan Diabetes Society (JDS) guidelines (HbA1c < 7.0%, BP < 130/80 mmHg, and LDL-C < 120 mg/dL). Logistic regression models were used to explore correlates of poor glycemic control (defined as HbA1c ≥ 8.0%). Results: The percentages of participants who met ADA (and JDS) targets were 44.9% (44.9%) for HbA1c, 76.6% (36.3%) for BP, 27.1% (56.2%) for LDL-C, and 11.2% (10.8%) for simultaneous control of all three risk factors. Younger age, obesity, smoking, and uncontrolled dyslipidemia were associated with poor glycemic control. The adjusted odds ratio of poor glycemic control was 0.58 (95% confidence interval, 0.46–0.73) for participants with treated but uncontrolled hypertension, and 0.47 (0.33–0.66) for participants with treated and controlled hypertension, as compared with participants without hypertension. There was no significant difference in HbA1c levels between participants with treated but uncontrolled hypertension and those with treated and controlled hypertension. Conclusion: Data from a large working population, predominantly composed of men, suggest that achievement of HbA1c, BP, and LDL-C targets was less than optimal, especially in younger participants. Uncontrolled dyslipidemia was associated with poor glycemic control. Participants not receiving antihypertensive treatment had higher HbA1c levels. [ABSTRACT FROM AUTHOR]

Objective: Risk models and scores have been developed to predict incidence of type 2 diabetes in Western populations, but their performance may differ when applied to non-Western populations. We developed and validated a risk score for predicting 3-year incidence of type 2 diabetes in a Japanese population. Methods: Participants were 37,416 men and women, aged 30 or older, who received periodic health checkup in 2008–2009 in eight companies. Diabetes was defined as fasting plasma glucose (FPG) ≥126 mg/dl, random plasma glucose ≥200 mg/dl, glycated hemoglobin (HbA1c) ≥6.5%, or receiving medical treatment for diabetes. Risk scores on non-invasive and invasive models including FPG and HbA1c were developed using logistic regression in a derivation cohort and validated in the remaining cohort. Results: The area under the curve (AUC) for the non-invasive model including age, sex, body mass index, waist circumference, hypertension, and smoking status was 0.717 (95% CI, 0.703–0.731). In the invasive model in which both FPG and HbA1c were added to the non-invasive model, AUC was increased to 0.893 (95% CI, 0.883–0.902). When the risk scores were applied to the validation cohort, AUCs (95% CI) for the non-invasive and invasive model were 0.734 (0.715–0.753) and 0.882 (0.868–0.895), respectively. Participants with a non-invasive score of ≥15 and invasive score of ≥19 were projected to have >20% and >50% risk, respectively, of developing type 2 diabetes within 3 years. Conclusions: The simple risk score of the non-invasive model might be useful for predicting incident type 2 diabetes, and its predictive performance may be markedly improved by incorporating FPG and HbA1c. [ABSTRACT FROM AUTHOR]

Depression has been linked to the overall diet using both exploratory and pre-defined methods. However, neither of these methods incorporates specific knowledge on nutrient-disease associations. The aim of the present study was to empirically identify dietary patterns using reduced rank regression and to examine their relations to depressive symptoms. Participants were 2006 Japanese employees aged 19–69 years. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Diet was assessed using a validated, self-administered diet history questionnaire. Dietary patterns were extracted by reduced rank regression with 6 depression-related nutrients as response variables. Logistic regression was used to estimate odds ratios of depressive symptoms adjusted for potential confounders. A dietary pattern characterized by a high intake of vegetables, mushrooms, seaweeds, soybean products, green tea, potatoes, fruits, and small fish with bones and a low intake of rice was associated with fewer depressive symptoms. The multivariable-adjusted odds ratios of having depressive symptoms were 0.62 (95% confidence interval, 0.48–0.81) in the highest versus lowest tertiles of dietary score. Results suggest that adherence to a diet rich in vegetables, fruits, and typical Japanese foods, including mushrooms, seaweeds, soybean products, and green tea, is associated with a lower probability of having depressive symptoms. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association of diabetes and prediabetes with long-term sickness absence (LTSA) due to mental disorders or specific mental disorders.Methods: A prospective cohort study was conducted using data from the Japan Epidemiology Collaboration on Occupational Health Study. A total of 62,065 workers who received health check-ups in 2011 (nine companies) or 2014 (two companies) and were followed up to March 31, 2020 were included in this study. Diabetes status was defined based on the American Diabetes Association criteria, and diabetes was differentiated into diabetes with/without anti-diabetic treatment for additional analysis. A Cox proportional hazards regression model was used to investigate these associations.Results: During maximum 8-year follow-up period, 1024 participants underwent LTSA due to mental disorders. The adjusted hazard ratio (aHR) and corresponding 95% confidence interval (CI) of LTSA due to all mental disorders were 1.10 (0.88-1.38) and 1.45 (1.07-1.98) for prediabetes and diabetes, respectively. Diabetic individuals with/without treatment were both at a high risk of LTSA due to mental disorders. For specific mental disorders, diabetes was associated with a higher risk of LTSA due to reaction to severe stress and adjustment disorders (aHR = 3.02, 95% CI = 2.01-4.52) while it was marginally associated with LTSA due to depressive episode (aHR = 1.25, 95% CI = 0.98-1.60). Prediabetes was also associated with LTSA due to reaction to severe stress and adjustment disorders (aHR = 1.41, 95% CI = 1.08-1.84).Conclusions: The present study suggests the importance of screening diabetes status and providing psychological support for decreasing the risk of LTSA due to mental disorders within working populations. [ABSTRACT FROM AUTHOR]

Aims: To examine the association of smoking status, smoking intensity, and smoking cessation with the risk of type 2 diabetes (T2D) using a large database. Methods: The present study included 53,930 Japanese employees, aged 15 to 83 years, who received health check-up and did not have diabetes at baseline. Diabetes was defined as fasting plasma glucose ≥126 mg/dl, random plasma glucose ≥200 mg/dl, HbA1c ≥6.5% (≥48 mmol/mol), or receiving medication for diabetes. Cox proportional-hazards regression models were used to investigate the association between smoking and the risk of diabetes. Results: During 3.9 years of median follow-up, 2,441 (4.5%) individuals developed T2D. The multivariable-adjusted hazard ratios (95% CI) for diabetes were 1 (reference), 1.16 (1.04 to 1.30) and 1.34 (1.22 to 1.48) for never smokers, former smokers, and current smokers, respectively. Diabetes risk increased with increasing numbers of cigarette consumption among current smokers (P for trend <0.001). Although the relative risk of diabetes was greater among subjects with lower BMIs (< 23 kg/m2), attributable risk was greater in subjects with higher BMIs (≥ 23 kg/m2). Compared with individuals who had never smoked, former smokers who quit less than 5 years, 5 to 9 years, and 10 years or more exhibited hazards ratios for diabetes of 1.36 (1.14 to 1.62), 1.23 (1.01 to 1.51), and 1.02 (0.85 to 1.23), respectively. Conclusions: Results suggest that cigarette smoking is associated with an increased risk of T2D, which may decrease to the level of a never smoker after 10 years of smoking cessation. [ABSTRACT FROM AUTHOR]

Objective Experimental studies have shown that some nutrients are involved in initiating and maintaining sleep, but epidemiological evidence on overall dietary patterns and insomnia is scarce. We investigated the relationship between dietary patterns and sleep symptoms in a Japanese working population. Methods The participants were 2025 workers, aged 18–70 years, who participated in a health survey during a periodic checkup in 2012 and 2013. Dietary intake was assessed with a self-administered diet history questionnaire. Dietary patterns were extracted by principal component analysis on the basis of the energy-adjusted intake of 52 food and beverage items. Sleep duration, difficulty initiating and maintaining sleep, and poor quality of sleep were self-reported. Logistic regression was used to estimate the odds ratios of each sleep symptom according to quartile categories of each dietary pattern with adjustment for potential confounding variables. Results We identified three major dietary patterns. A healthy pattern, characterized by a high intake of vegetables, mushrooms, potatoes, seaweeds, soy products, and eggs, was associated with a decreased prevalence of difficulty initiating sleep once or more a week (P for trend = 0.03); the multivariate adjusted odds ratio in the highest quartile of this score compared with the lowest was 0.75 (95% CI: 0.57–0.99). This association persisted after the exclusion of individuals with severe depressive symptoms. However, there was no significant association with difficulty initiating sleep at least three times a week. Conclusions Our findings suggest that a healthy dietary pattern may be associated with difficulty initiating sleep at least once a week. [ABSTRACT FROM AUTHOR]

Long working hours have been associated with an increased risk of cardiovascular disease, but its relationship with hypertension remains unclear. The objective of this study is to examine the relationship between overtime and presence of hypertension using data from a large-scale multi-company study in Japan. Participants were 52 365 workers of four companies that provided both health-checkup data and self-reported data on overtime worked. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, and/or the use of antihypertensive drug. Logistic regression analysis was performed to determine the odds ratio for hypertension for each category of overtime work (<45, 45-79, 80-99 or ≥100 h/month) with adjustments for age, sex, company, smoking status and body mass index. The prevalence of hypertension tended to decrease with increasing overtime work: 17.5, 12.0, 11.1 and 9.1% for the shortest (<45 h/month) through the longest overtime category (≥100 h/month). The age-, sex- and company-adjusted odds ratios (95% confidence interval) were 1.00 (reference), 0.81 (0.75-0.86), 0.73 (0.62-0.86), 0.58 (0.44-0.76), respectively ( p for linear trend <0.001). In a sub-cohort, the inverse association remained statistically significant after an additional adjustment for other potential confounders. Results of the present large-scale study among Japanese workers suggest an inverse association between overtime work and presence of hypertension. [ABSTRACT FROM AUTHOR]

Aims Few studies have examined the prevalence of diabetes using glycated hemoglobin (HbA1c), a newly recommended diagnostic test. We examined the prevalence of diabetes and pre-diabetes using both HbA1c and fasting plasma glucose (FPG) and their associations with risk factors for type 2 diabetes in a large-scale Japanese working population. Methods Participants were 47,172 men and 8280 women aged 20–69 years who received periodic health checkup in nine companies which participated in the Japan Epidemiology Collaboration on Occupational Health study. Participants were categorized into diabetes (HbA1c ≥6.5% (≥48 mmol/mol), FPG ≥126 mg/dl (≥7.0 mmol/L), or medication for diabetes), pre-diabetes (HbA1c 6.0–6.4% (42–46 mmol/mol) or FPG 110–125 mg/dl (6.1–6.9 mmol/L) among those without diabetes), and normal glucose regulation. Results The prevalence of diabetes was 8.0% and 3.3% in men and women, respectively. Of individuals with diabetes, approximately 80% were defined by HbA1c ≥6.5% (≥48 mmol/mol) criterion. The prevalence of pre-diabetes was 14.1% in men and 9.2% in women. Prevalence of these glucose abnormalities increased with advancing age, especially during mid-40s and 50s. Higher body mass index and waist circumference, hypertension, dyslipidemia, and current smoking were each associated with higher prevalence of diabetes in both men and women. Conclusions Using HbA1c and FPG criteria or current medication, one in 13 men and one in 30 women had diabetes in the present Japanese working population. Interventions targeted for those in an early stage of impaired glucose metabolism would be required to prevent diabetes. [ABSTRACT FROM AUTHOR]

Objective: Epidemiologic evidence on long working hour and diabetes has been conflicting. We examined the association between overtime work and prevalence of diabetes among Japanese workers. Methods: The subjects were 40,861 employees (35,170 men and 5,691 women), aged 16 to 83 years, of 4 companies in Japan. Hours of overtime were assessed using self-reported questionnaires. Diabetes was defined as a fasting plasma glucose ≥126 mg/dl (7.0 mmol/l), hemoglobin A1c ≥6.5% (48 mmol/mol), or current use of anti-diabetic drug. Multiple logistic regression analysis was used to calculate odds ratio of diabetes for each category of overtime. Results: After adjustment for age, sex, company, smoking, and BMI, there was a suggestion of U-shaped relationship between overtime work and prevalence of diabetes (P for quadratic trend = 0.07). Compared with those who worked <45 hours of overtime per month, the adjusted odds ratios (95% confidence interval) of diabetes were 0.86 (0.77–0.94), 0.69 (0.53–0.89), and 1.03 (0.72–1.46) for those who worked 45–79, 80–99, and ≥100 hours of overtime per month, respectively. In one company (n = 33,807), where other potential confounders including shift work, job position, type of department, alcohol consumption, sleep duration, leisure time physical activity, and family history of diabetes was additionally adjusted for, similar result was obtained (P for quadratic trend = 0.05). Conclusions: Long hours of overtime work may not be associated with increased prevalence of diabetes among Japanese workers. [ABSTRACT FROM AUTHOR]

Abstract: Several previous studies have shown that the intake of soup negatively correlates with the body mass index (BMI), serum cholesterol and triacylglycerol levels, and blood pressure, suggesting that soup intake reduces metabolic risk. However, the correlation between soup intake and various metabolic risk factors has not been well-established. Especially, it has not been investigated in Asian countries. The aim of this study was to investigate the association of the frequency of soup intake and metabolic risk factors such as BMI, waist circumference, waist-to-hip ratio, serum cholesterol, serum triacylglycerol, blood glucose, and glycated hemoglobin. A cross-sectional study of 103 Japanese men aged 24 to 75 years was conducted. The intake of soup and other food was investigated by semi-quantitative food frequency questionnaires. The correlation between the frequency of soup intake and metabolic risk factors was analyzed by multiple regression analysis with a linear model. The median value of frequency of soup intake was 7.0 times per week. After adjusting for confounding factors such as age, energy intake, energy from alcohol intake, current smoking, and estimated energy expenditure, the frequency of soup intake was found to have a significant inverse association with BMI (P=0.040), waist circumference (P=0.024), and waist-to-hip ratio (P=0.001). However, no significant associations with other metabolic risk factors were found. Frequency of soup intake is negatively correlated with obesity-related physical parameters in Japanese men. [Copyright &y& Elsevier]

Abstract: Previous studies have shown that the intake of soup negatively correlates with the body mass index (BMI), suggesting that soup intake reduces the risk of obesity. In this study, to clarify the association of the intake of soup and various nutrients with plasma leptin concentration, a cross-sectional study on 504 Japanese adults aged 20–76 years (103 men and 401 women) was performed. The intake of soup and various nutrients was investigated by food frequency questionnaires. Plasma leptin concentration was measured in fasting blood by radioimmunoassay. The correlation was analyzed by multiple regression analysis. The average frequency of soup intake was 7.6 times/week. The average plasma leptin concentration was 7.76ng/ml. After adjusting the confounding factors, the frequency of soup intake has a significant inverse association with plasma leptin concentration. Among the macronutrients, only dietary fiber intake negatively correlated with plasma leptin concentration after the adjustment for potential confounding factors. These results suggest that the intakes of soup and dietary fiber were negatively correlated with plasma leptin concentration in Japanese adults. [Copyright &y& Elsevier]

Objective: To examine the association of diabetes and prediabetes with suicide deaths in a Japanese working population.Methods: A nested case-control study was conducted using data from the Japan Epidemiology Collaboration on Occupational Health Study. During 8 years of follow-up, we identified 56 registered cases of suicide death that had information on fasting plasma glucose or glycated hemoglobin A1c at any health check-up during the past 3 years prior to suicide. For each case, we randomly selected five controls matched for age, sex, and worksite. We used the latest health check-up data for analysis. We defined diabetes status based on the American Diabetes Association criteria and used a conditional logistic regression model to investigate the association.Results: Adjusted odds ratios and 95% confidence intervals for suicide death were 0.67 (0.32-1.41) and 3.53 (1.05-11.91) for prediabetes and diabetes, respectively, compared to normoglycemia. Similar results were obtained when diabetes status was exclusively defined by the fasting plasma glucose or glycated hemoglobin A1c level.Conclusion: Diabetes, but not prediabetes, was associated with a higher risk of suicide death, compared with normoglycemia, among a Japanese working population. [ABSTRACT FROM AUTHOR]