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Background: Although fat mass index (FMI) and fat-free mass index (FFMI) affect lung function, FMI and FFMI are not independent of each other, since FMI and FFMI were calculated as fat mass and fat-free mass divided by height squared, respectively. We aimed to examine the association of combined FMI and FFMI with lung function. Methods: In this cross-sectional study, lung function was evaluated using forced expiratory volume at 1 s (FEV1) and forced vital capacity (FVC) measured using spirometry. Both FMI and FFMI were classified into sex-specific quartiles (16 groups). Analysis of covariance was used to assess the associations of combined FMI and FFMI with lung function. The trend test was conducted by stratifying the FMI and FFMI, scoring the categories from 1–4 (lowest–highest), and entering the number as a continuous term in the regression model. Results: This study included 3,736 men and 8,821 women aged ≥20 years living in Miyagi Prefecture, Japan. The mean FEV1 was 3.0 (standard deviation [SD], 0.7) L for men and 2.3 (SD, 0.5) L for women. The mean FVC was 3.8 (SD, 0.7) L for men and 2.8 (SD, 0.5) L for women. FMI was inversely associated with lung function among all FFMI subgroups in both sexes. Conversely, FFMI was positively associated with lung function in all FMI subgroups in both sexes. Conclusion: Higher FMI was associated with lower lung function independent of FFMI; higher FFMI was associated with higher lung function independent of FMI. Reducing FMI and maintaining FFMI might be important for respiratory health.

Background: While tall stature has been linked to an increase in the risk of colorectal cancer (CRC), its association with cancer in the colorectum and its subsites remains unclear among Asians. Methods: We conducted a pooled analysis of 10 population-based cohort studies among adults in Japan. Each study estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC incidence associated with adult height were estimated using Cox proportional hazards regression with adjustment of the same set of covariates were then pooled to estimate summary HRs incidence using random-effect models. Results: We identified 9,470 CRC incidences among 390,063 participants during 5,672,930 person-years of follow-up. Men and women with tall stature had a higher risk of CRC and colon cancer. HRs for CRC, colon cancer, and distal colon cancer for the highest versus lowest height categories were 1.23 (95% CI, 1.07–1.40), 1.22 (95% CI, 1.09–1.36), and 1.27 (95% CI, 1.08–1.49), respectively, in men and 1.21 (95% CI, 1.09–1.35), 1.23 (95% CI, 1.08–1.40), and 1.35 (95% CI, 1.003–1.81), respectively, in women. The association with proximal colon cancer and rectal cancer was less evident in both sexes. Conclusion: This pooled analysis confirms the link between tall stature and a higher risk of CRC and colon cancer (especially distal colon) among the Japanese and adds evidence to support the use of adult height to identify those at a higher risk of CRC.

Background: Although cigarette smoking is an established risk factor for bladder cancer, assessment of smoking impact on bladder cancer in Asian populations has been hindered by few cohort studies conducted in Asian populations. Therefore, we investigated the risk of bladder cancer associated with smoking status, cumulative smoking intensity, and smoking cessation in Japan. Methods: We analyzed data for 157,295 men and 183,202 women in 10 population-based cohort studies in Japan. The risk associated with smoking behaviors was estimated using Cox regression models within each study, and pooled hazard ratios (HRs) and their 95% confidence intervals (CIs) for the incidence of bladder cancer were calculated. Results: During 4,729,073 person-years of follow-up, 936 men and 325 women developed bladder cancer. In men, former smokers (HR 1.47; 95% CI, 1.18–1.82) and current smokers (HR 1.96; 95% CI, 1.62–2.38) had higher risk than never smokers. In women, current smokers had higher risk than never smokers (HR 2.35; 95% CI, 1.67–3.32). HRs in men linearly increased with increasing pack-years. Risk decreased with increasing years of smoking cessation in men, with a significant dose-response trend. Former smokers with a duration of more than 10 years after smoking cessation had no significantly increased risk compared with never smokers (HR 1.26; 95% CI, 0.97–1.63). Conclusion: Data from a pooled analysis of 10 population-based cohort studies in Japan clearly show an association between cigarette smoking and bladder cancer risk. The risk of smokers may approximate that of never smokers following cessation for many years.

Background: Desired longevity represents how strongly people esteem possible extensions of their own lifetime. The association between desired longevity and mortality risk has been reported in only one prospective study, which examined a small sample of older participants. We aimed to examine the hypothesis that desired longevity at middle-age predicted long-term survival. Methods: In the prospective cohort study, residents aged 40–64 years were asked how long they would like to live and asked to choose one from three options: longer than, as long as, or shorter than the life expectancy. We used Cox proportional hazards model to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality according to the three groups for desired longevity, treating the “longer than” group as the reference. We conducted mediation analysis to investigate the mechanism for the association between desired longevity and mortality. Results: We recruited 39,902 residents to the study. Risk of all-cause mortality was significantly higher in the “shorter than” group (HR 1.12; 95% CI, 1.04–1.21). The association was independent of sex, age, marital status, education, medical history, and health status. Regarding cause of death, mortality risk of cancer (HR 1.14; 95% CI, 1.00–1.29) and suicide (HR 2.15; 95% CI, 1.37–3.38) were also higher in the “shorter than” group. The unhealthy lifestyle mediated this association with all-cause mortality by 30.4%. Conclusion: Shorter desired longevity was significantly associated with an increased risk of all-cause mortality, and mortality from cancer and suicide. Lifestyle behaviors particularly mediated this association.

Abstract Purpose The objective of the present study was to examine the relationship between anxiety and sleep disorder during the COVID-19 pandemic and to evaluate whether sleep disorder is mediated by the decreased frequency of going out. Methods The data of a total of 1976 residents aged 18 years and over who had responded to a self-reported questionnaires at a health survey in 2020 were analyzed. The subjects were divided into four groups based on their response to the questionnaire on anxiety about the COVID-19 pandemic. Sleep disorder was measured using the Athens Insomnia Scale (AIS). A cross-sectional analysis was performed to examine the association between anxiety about the COVID-19 pandemic and AIS scores. Mediation analysis was used to calculate the association between anxiety and AIS scores during the COVID-19 pandemic, with decreased frequency of going out as a potential mediating variable. Results In the cross-sectional study, the level of anxiety about the COVID-19 pandemic was significantly associated with the AIS score (p

Abstract Background Low back pain and sleep disturbance are common health problems worldwide which are also commonly observed among people after natural disasters. These symptoms are well known to coexist, and recent reports have indicated that sleep disturbance is a risk factor for low back pain. However, the influence of low back pain on sleep disturbance has rarely been assessed; therefore, this study aimed to clarify the association of low back pain with sleep disturbance, especially focusing on the frequency of low back pain, using 3-year cohort data after the Great East Japan Earthquake. Methods This study used the data obtained from people living in the disaster-affected areas after the Great East Japan Earthquake (n = 2,097). Low back pain and sleep disturbance were assessed at 4, 5, 6, and 7 years after the disaster. The frequency of low back pain was defined as the number of low back pain episodes at and before the evaluation time point and categorized into five groups such as absence, 1, 2, 3, and 4 at the fourth time point and four groups such as absence, 1, 2, and 3 at the third time point. Multivariate logistic regression analyses were conducted to assess the association of low back pain with sleep disturbance. Results Low back pain was significantly associated with sleep disturbance, and the association was stronger in participants with more frequent low back pain (adjusted odds ratios [95% confidence intervals],1.46 [1.10–1.95] in “1”; 2.02 [1.49–2.74] in “2”; 2.38 [1.67–3.40] in “3”; and 4.08 [2.74–6.06] in “4” in the frequency of low back pain) (P for trend

Abstract Background Functional disability is a major health issue in an aging population. Low back pain (LBP) is a common health concern that can lead to functional disability in the elderly; nonetheless, their association has not yet been clarified. This study aimed to examine the association between LBP and functional disability in the elderly, with a focus on its dose-dependent effects. Methods This study used the 4-year longitudinal data of people living in disaster-affected areas after the Great East Japan Earthquake (aged ≧65, n = 914). LBP and physical function were assessed at 2, 4, and 6 years after the disaster. Multivariate logistic regression analyses were performed to assess the association between LBP and low physical function, as well as the effect of preceding LBP on the onset of low physical function. Results LBP was significantly associated with low physical function, and the association became stronger as the duration of LBP increased. Adjusted odds ratios (95% confidence intervals) were 1.27 (0.79–2.06) in “

Abstract Background Tooth loss has been reportedly associated with shorter disability-free life expectancy (DFLE). However, no study has explored whether oral self-care offsets reduction in DFLE. The present study aimed to assess the association between oral self-care and DFLE in older individuals with tooth loss. Methods Data on the 13-year follow-up from a cohort study of 14,206 older Japanese adults aged ≥ 65 years in 2006 were analyzed. Information on the number of remaining teeth was collected using a questionnaire, and the participants were then categorized into three groups (0–9, 10–19, and ≥ 20 teeth). Additionally, “0–9” and “10–19” groups were divided into two subgroups based on whether they practiced oral self-care. DFLE was defined as the average number of years a person could expect to live without disability, and was calculated by the multistate life table method based on a Markov model. Results DFLE (95% confidence interval) was 19.0 years (18.7–19.4) for 0–9 teeth, 20.1 (19.7–20.5) for 10–19 teeth, and 21.6 (21.2–21.9) for ≥ 20 teeth for men. For women, DFLE was 22.6 (22.3–22.9), 23.5 (23.1–23.8), and 24.7 (24.3–25.1), respectively. Practicing oral self-care was associated with longer DFLE, by 1.6–1.9 years with brushing ≥ 2 times a day in people with 0–9 and 10–19 teeth, and by 3.0–3.1 years with the use of dentures in those with 0–9 teeth. Conclusions Practicing oral self-care is associated with an increase in DFLE in older people with tooth loss.

Background: Although social participation has been reported to be associated with significantly lower risks of mortality and disability, to our knowledge, no study has estimated its impact on disability-free life expectancy (DFLE). Therefore, this study aimed to investigate the association between social participation and DFLE in community-dwelling older people. Methods: We analyzed 11-year follow-up data from a cohort study of 11,982 Japanese older adults (age ≥65 years) in 2006. We collected information on the number of social participations using a questionnaire. Using this information, we categorized the participants into four groups. DFLE was defined as the average number of years a person could expect to live without disability. The multistate life table method using a Markov model was employed for calculating DFLE. Results: The results revealed that DFLE according to the number of social participations was 17.8 years (95% confidence interval [CI], 17.3–18.2) for no activities, 20.9 (95% CI, 20.4–21.5) for one activity, 21.5 (95% CI, 20.9–22.0) for two activities, and 22.7 (95% CI, 22.1–23.2) for three activities in men, and 21.8 (95% CI, 21.5–22.2), 25.1 (95% CI, 24.6–25.6), 25.3 (95% CI, 24.7–25.9), and 26.7 years (95% CI, 26.1–27.4), respectively, in women. This difference in DFLE did not change after the participants were stratified for smoking, body mass index, physical activity, and depression. Conclusion: Social participation is associated with longer DFLE among Japanese older people; therefore, encouraging social participation at the population level could increase life-years lived in good health.

Background: Alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) are enzymes associated with diabetes mellitus (DM) prevalence. However, limited information is available regarding the association of liver enzymes and DM consistently present in obese and non-obese individuals. We examined whether the combination of ALT and GGT enzymes is associated with the prevalence of DM, regardless of obesity, in a general Japanese population. Methods: We conducted a cross-sectional study of 62,786 participants aged ≥20 years who lived in Miyagi and Iwate, Japan. We divided all the participants into eight groups according to the ALT level (low:

Background: Both weight loss and cognitive impairment are common in late-life, but it remains unknown whether weight change is associated with risk of incident dementia among elderly Japanese. Our study aimed to investigate the association between long-term weight change since midlife and risk of incident disabling dementia using a community-based cohort study of elderly Japanese. Methods: In 2006, we conducted a cohort study of 6,672 disability-free Japanese adults aged ≥65 years. In both 1994 and 2006, the participants reported their weight using a self-reported questionnaire. Based on weight obtained at these two time points, participants were classified into: stable weight (−1.4 to +1.4 kg), weight gain (≥+1.5 kg), and weight loss of −2.4 to −1.5 kg, −3.4 to −2.5 kg, −4.4 to −3.5 kg, −5.4 to −4.5 kg, and ≥−5.5 kg. Incident disabling dementia was retrieved from the public Long-term Care Insurance database. Participants were followed-up for 5.7 years (between April 2007 and November 2012). Cox proportional hazards model was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident disabling dementia. Results: During 32,865 person-years of follow-up, 564 participants were ascertained as having incident disabling dementia. Compared with stable weight, the multivariable-adjusted HRs were 0.97 (95% CI, 0.70–1.34) for weight loss of −2.4 to −1.5 kg, 0.98 (95% CI, 0.70–1.38) for −3.4 to −2.5 kg, 1.28 (95% CI, 0.91–1.81) for −4.4 to −3.5 kg, 1.27 (95% CI, 0.92–1.77) for −5.4 to −4.5 kg, and 1.64 (95% CI, 1.29–2.09) for ≥−5.5 kg. Conclusion: Our study suggested that a ≥−3.5 kg weight loss over 12 years might be associated with higher risk of incident disabling dementia among elderly Japanese.

Abstract Aims/Introduction Fat mass and fat‐free mass affect glycated hemoglobin A1c (HbA1c) levels and blood glucose levels, respectively. The aim of the present study was to examine the association between the fat mass index and fat‐free mass index with HbA1c. Materials and Methods We carried out a cross‐sectional study that included 3,731 men and 9,191 women aged ≥20 years, living in Miyagi Prefecture, Japan, who were not treated for diabetes. The fat mass index and fat‐free mass index were calculated as fat mass and fat‐free mass divided by the height squared, respectively. The indices were classified into sex‐specific quartiles and combined into 16 groups. An analysis of covariance was used to assess associations between the combined fat mass index and fat‐free mass index with HbA1c adjusted for potential confounders. The linear trend test was carried out by stratifying the fat mass index and fat‐free mass index, entering the number as a continuous term in the regression model. Results In multivariable models, a higher fat mass index was related to higher HbA1c levels in men and women in all fat‐free mass index subgroups (P

Abstract Background Neck pain is a common health problem in the general population as well as in people after natural disasters. Sleep disturbances are gaining attention as risk factors for musculoskeletal pain; however, the association between sleep disturbance and neck pain has not been clarified. The present study aimed to clarify the association between sleep disturbance and neck pain, especially focusing on the effect of the duration of sleep disturbance, after the Great East Japan Earthquake. Methods This study used 3-year longitudinal data obtained from individuals (n = 2,059) living in disaster-affected areas after the Great East Japan Earthquake. Sleep disturbance and neck pain were investigated at 4, 5, 6, and 7 years after the disaster. Multivariate logistic regression analyses were used for the assessment. Results Sleep disturbance was significantly associated with neck pain, and the association was stronger as the duration of sleep disturbance increased (adjusted odds ratios [95% confidence intervals]: 1.84 [1.23–2.75] for “

Introduction: Limited data exist on the efficacy of combination therapy with ustekinumab and budesonide in patients with Crohn’s disease. Our objective was to compare the clinical outcomes of ustekinumab and budesonide combination therapy with those of ustekinumab monotherapy. Methods: In this phase 2 single-center, double-blind, randomized controlled trial, we assigned 19 patients with Crohn’s disease with a Crohn’s disease activity index (CDAI) equal to or greater than 220 and less than 450 in a 1:1 ratio to receive ustekinumab and budesonide or ustekinumab for 32 weeks. The primary endpoint was the clinical remission rate at 8 weeks. The secondary endpoints were the clinical remission rate at 32 weeks and mucosal healing rates at 8 and 32 weeks. Results: Of 19 patients, the mean age was 37.8 years, and 42.1% were women (CDAI ≥220 and

Abstract Globally, the cancer burden is expected to increase as populations are ageing. Therefore, cancer prevention among older age groups is important. This prospective cohort study examined the relationship between the number of remaining teeth, maximum occlusal force, and incidence of gastrointestinal cancer in community-dwelling older Japanese individuals using data from the Tsurugaya project; 847 participants were included. The exposure variables were the number of remaining teeth and the maximum occlusal force, with the outcome being the incidence of gastrointestinal cancer. Covariates were age, sex, medical history, smoking, alcohol consumption, educational attainment, and physical function. The Cox proportional hazard model was used to examine the relationship between the number of remaining teeth, maximum occlusal force, and incidence of gastrointestinal cancer. With a median follow-up of 7.6 years, 63 participants were confirmed to have gastrointestinal cancer. The risk of gastrointestinal cancer was significantly higher in those with an occlusal force lower than the median (hazard ratio, 2.80; 95% confidence interval, 1.54–5.10). No significant risk difference was found according to the number of remaining teeth. Low maximum occlusal force was associated with the incidence of gastrointestinal cancer in community-dwelling older Japanese adults.

Abstract Background We determined the prevalence of current cigarette smokers and alcohol drinkers among cancer survivors and subjects with no history of cancer in Japan and compared the findings with nationally representative studies in other countries. Methods We conducted a cross‐sectional study of baseline data from a prospective cohort study. A self‐administered questionnaire was surveyed during 2013–2015 with residents aged ≥20 years attending a community‐based cardiometabolic screening program in Miyagi prefecture in north‐eastern Japan. Subjects with past cancer histories were classified as cancer survivors. Sex‐specific, age‐standardized prevalence of current smokers, and drinkers were calculated. Age‐adjusted prevalence ratios (PRs: the cancer survivors’ rate divided by the rate of subjects with no history of cancer) and 95% confidence intervals (CIs) were estimated with log‐binomial regressions. Results 36,786 subjects, including 2760 cancer survivors, responded and provided usable information (58.9% of recruited subjects). For men, the age‐standardized prevalence of current smokers and drinkers among survivors was 18.8% and 74.4%, respectively, with an age‐adjusted PR (95%CI) of 0.76 (0.66–0.86, p

Abstract After disasters, people are often forced to reconstruct or move to new residences. This study aimed to reveal the association between the types of reconstructed residences and psychosocial or psychiatric conditions among the population. A total of 1071 adult residents in a coastal town, whose houses were destroyed by the tsunami caused by the Great East Japan Earthquake, enrolled in the study five years after the disaster. The type of reconstructed post-disaster residences (reconstructed on the same site/disaster-recovery public condominium/mass-translocation to higher ground/privately moving to remote areas) and the current psychosocial indicators were investigated. The results revealed that individuals living in public condominiums showed significantly worse scores on the Lubben Social Network Scale-6 (p

Background A higher body fat percentage is associated with hypertension, even in non-obese individuals. The difference in body composition may be related to hypertension. The fat mass index (FMI) and fat-free mass index (FFMI) are proposed indicators of body composition. This study aimed to examine the relationship of a combination of FMI and FFMI with hypertension. Methods We conducted a cross-sectional study of 5,058 men and 11,842 women aged ≥ 20 years in the Miyagi Prefecture, northeastern Japan. The FMI and FFMI were calculated as the fat mass and fat-free mass divided by the height squared, respectively. The indices were classified into quartiles and combined into 16 groups. Hypertension was defined as casual blood pressure ≥ 140/90 mmHg and/or self-reported treatment for hypertension. Multivariable logistic regression models, adjusted for potential confounders, were used to assess the relationship of a combination of FMI and FFMI with hypertension. Results Higher FMI was associated with hypertension in most of the FFMI subgroups. Similarly, a higher FFMI was associated with hypertension in most of FMI subgroups. For men, the association between FFMI and hypertension in the lowest FMI group was not significant. Conclusions Reducing the FMI and FFMI may be important in preventing hypertension. For men, the relationship between the FFMI and hypertension in the lowest FMI group might be weak.

OBJECTIVES Using a dataset from a survey on national health and productivity management, we identified health and productivity factors associated with organizational profitability. METHODS The Ministry of Economy, Trade and Industry conducted an annual survey on Health and Productivity Management between 2014 and 2021. We assessed the associations of organizational health and productivity management using survey questions collected in 2017 and 2018, with the rate of change in profits from 2017 and 2018 to 2020. We identified factors associated with organizational profitability using eXtreme Gradient Boosting, and calculated SHapley Additive exPlanation (SHAP) values for each factor. RESULTS Among 1,593 companies (n= 4,359,834 employees), the mean age of employees at baseline was 40.3 years and the proportion of women was 25.8%. A confusion matrix for evaluating model performance had an accuracy of 0.997, precision of 0.993, recall of 0.997, and area under the precision-recall curve of 0.999. The most important factors related to an increase in corporate profits were the percentage of current smokers (SHAP value, 0.121), per-employee cost of health services (0.084) and medical services (0.050); the percentage of full-time employees working in sales departments (0.074) and distribution or customer service departments (0.054); the percentage of employees who slept well (0.055); and the percentage of employees within a company who regularly exercised (0.043). CONCLUSIONS Employees’ lifestyle-related health risk factors and organizations’ management systems were associated with organizational profitability. Lifestyle medicine professionals may demonstrate a significant return on investment by creating a healthier and more productive workforce.

Abstract Prior studies reported the association of reproductive factors with breast cancer (BC), but the evidence is inconsistent. We conducted a pooled analysis of nine cohort studies in Japan to evaluate the impact of six reproductive factors (age at menarche/age at first birth/number of births/age at menopause/use of female hormones/breastfeeding) on BC incidence. We conducted analyses according to menopausal status at the baseline or at the diagnosis. Hazard ratio (HR) and 95% confidence interval (CI) were estimated by applying Cox proportional‐hazards model in each study. These hazard ratios were integrated using a random‐effects model. Among 187,999 women (premenopausal: 61,113, postmenopausal: 126,886), we observed 873 premenopausal and 1,456 postmenopausal cases. Among premenopausal women, use of female hormones significantly increased BC incidence (HR: 1.53 [1.04–2.25]). Although P value for trend was not significant for age at first birth and number of births (P for trend: 0.15 and 0.30, respectively), women giving first birth at ages ≥36 experienced significantly higher BC incidence than at ages 21–25 years, and women who had ≥2 births experienced significantly lower BC incidence than nulliparous women. Among postmenopausal women, more births significantly decreased BC incidence (P for trend: 0.03). Although P value for trend was not significant for age at first birth and age at menopause (P for trend: 0.30 and 0.37, respectively), women giving first birth at ages 26–35 years experienced significantly higher BC incidence than at ages 21–25 years, and women with age at menopause: ≥50 years experienced significantly higher BC incidence than age at menopause: ≤44 years. BC incidence was similar according to age at menarche or breastfeeding history among both premenopausal and postmenopausal women. In conclusion, among Japanese women, use of female hormones increased BC incidence in premenopausal women, and more births decreased BC incidence in postmenopausal women.

Background: We established a community-based cohort study to assess the long-term impact of the Great East Japan Earthquake on disaster victims and gene-environment interactions on the incidence of major diseases, such as cancer and cardiovascular diseases. Methods: We asked participants to join our cohort in the health check-up settings and assessment center based settings. Inclusion criteria were aged 20 years or over and living in Miyagi or Iwate Prefecture. We obtained information on lifestyle, effect of disaster, blood, and urine information (Type 1 survey), and some detailed measurements (Type 2 survey), such as carotid echography and calcaneal ultrasound bone mineral density. All participants agreed to measure genome information and to distribute their information widely. Results: As a result, 87,865 gave their informed consent to join our study. Participation rate at health check-up site was about 70%. The participants in the Type 1 survey were more likely to have psychological distress than those in the Type 2 survey, and women were more likely to have psychological distress than men. Additionally, coastal residents were more likely to have higher degrees of psychological distress than inland residents, regardless of sex. Conclusion: This cohort comprised a large sample size and it contains information on the natural disaster, genome information, and metabolome information. This cohort also had several detailed measurements. Using this cohort enabled us to clarify the long-term effect of the disaster and also to establish personalized prevention based on genome, metabolome, and other omics information.

Abstract The nature of the recovery process of posttraumatic stress disorder (PTSD) symptoms is multifactorial. The Massive Parallel Limitless-Arity Multiple-testing Procedure (MP-LAMP), which was developed to detect significant combinational risk factors comprehensively, was utilized to reveal hidden combinational risk factors to explain the long-term trajectory of the PTSD symptoms. In 624 population-based subjects severely affected by the Great East Japan Earthquake, 61 potential risk factors encompassing sociodemographics, lifestyle, and traumatic experiences were analyzed by MP-LAMP regarding combinational associations with the trajectory of PTSD symptoms, as evaluated by the Impact of Event Scale-Revised score after eight years adjusted by the baseline score. The comprehensive combinational analysis detected 56 significant combinational risk factors, including 15 independent variables, although the conventional bivariate analysis between single risk factors and the trajectory detected no significant risk factors. The strongest association was observed with the combination of short resting time, short walking time, unemployment, and evacuation without preparation (adjusted P value = 2.2 × 10−4, and raw P value = 3.1 × 10−9). Although short resting time had no association with the poor trajectory, it had a significant interaction with short walking time (P value = 1.2 × 10−3), which was further strengthened by the other two components (P value = 9.7 × 10−5). Likewise, components that were not associated with a poor trajectory in bivariate analysis were included in every observed significant risk combination due to their interactions with other components. Comprehensive combination detection by MP-LAMP is essential for explaining multifactorial psychiatric symptoms by revealing the hidden combinations of risk factors.

Abstract Background The physical and psychological health impacts on victims of the Great East Japan Earthquake (GEJE) have lasted for a long time. Some cross-sectional studies have reported a relationship between social networks and/or social support and mental health among victims. Previous studies were cross-sectional observations at one time point after a disaster, it remains unclear whether the lack of social trust soon after the GEJE predicts long-term mental health outcomes among the victims. The objective of the present study was to examine prospectively the association between social trust soon after the GEJE and trends in sleep disorders up to 6 years after the GEJE. Methods We conducted a health survey on residents living in two areas affected by the GEJE. We analyzed data from 1293 adults (aged ≥18 years) who had participated in an initial health survey. The participants responded to a self-administrated questionnaire composed of items on health condition, mental health, including sleep disorders (based on the Athens Insomnia Scale [AIS]), and social trust. We classified the participants into two categories (high or low) based on the level of social trust at the first health survey. A linear mixed model was used to estimate trends in AIS scores in relation to social trust at the first health survey. Results The AIS scores of participants in the low social trust group were significantly higher than those in the high social trust group throughout the 6 years after the GEJE (P

Background: The association of alcohol drinking with bladder cancer risk remains unclear in East Asian populations. Aldehyde dehydrogenase 2 (ALDH2) enzyme oxidizes alcohol-metabolized carcinogenic acetaldehyde into acetate. It is well known that the inactive ALDH2 carriers, specific to East Asian populations, have an increased risk of several cancer types because of increased exposure to acetaldehyde after alcohol consumption. The aim of this study was to examine the association between alcohol drinking and bladder cancer risk using data from ten population-based prospective cohort studies in Japan, where approximately 40% of the population has inactive ALDH2 enzyme. Methods: We analyzed 340,497 Japanese participants with average follow-up of 13.4 years. The association between alcohol drinking and bladder cancer risk was evaluated using Cox regression models within each study, and random-effects models were used to estimate pooled hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). Results: During 4,729,071 person-years, 936 men and 325 women were newly diagnosed with bladder cancer. Our results showed no evidence of significant association between alcohol drinking and bladder cancer risk even among men who consumed alcohol of ≥69 g/week, with HR of 1.02 (95% CI, 0.79–1.33). The null result was observed consistently among women. Conclusions: Our findings do not support an association between alcohol drinking and bladder cancer risk in the Japanese, at least without consideration of the polymorphisms of alcohol-metabolizing enzymes.

Abstract Background Low back pain (LBP) is a common health problem experienced after natural disasters. LBP is often concurrent with other musculoskeletal pain; however, the effects of preexisting musculoskeletal pain on the development of LBP are not clear. The purpose of this study was to elucidate the association of musculoskeletal pain in other body sites with new-onset LBP among survivors of the Great East Japan Earthquake (GEJE). Methods A longitudinal study was conducted with survivors of the GEJE. The survivors who did not have LBP at the 3 year time period after the GEJE were followed up 1 year later (n = 1782). Musculoskeletal pain, such as low back, hand and/or foot, knee, shoulder, and neck pain, were assessed with self-reported questionnaires. The outcome of interest was new-onset LBP, which was defined as LBP absent at 3 years but present at 4 years after the disaster. The main predictor was musculoskeletal pain in other body sites 3 years after the GEJE, which was categorized according to the number of pain sites (0, 1, ≥ 2). Multiple regression analyses were performed to calculate the odds ratio (OR) and 95% confidence interval (CI) for new-onset LBP due to musculoskeletal pain in other body sites. Results The incidence of new-onset LBP was 14.1% (251/1782). Musculoskeletal pain in other body sites was significantly associated with new-onset LBP. Including people without other musculoskeletal pain as a reference, the adjusted OR and 95% CI for new-onset LBP were 1.73 (1.16–2.57) for people with one musculoskeletal pain site and 3.20 (2.01–5.09) for people with ≥ 2 sites (p

Background: A growing number of epidemiology studies have shown that poor oral health is associated with an increased incidence of functional disability. However, there are few studies in which the confounding bias is adjusted appropriately. In this study, we examined whether dental status is associated with functional disability in elderly Japanese using a 13-year prospective cohort study after elimination of confounding factors with propensity score matching. Methods: Participants were community-dwelling Japanese aged 70 years or older who lived in the Tsurugaya district of Sendai (n = 838). The number of remaining teeth (over 20 teeth vs 0–19 teeth) was defined as the exposure variable. The outcome was the incidence of functional disability, defined as the first certification of long-term care insurance (LTCI) in Japan. The variables that were used to determine propensity score matching were age, sex, body mass index (BMI), medical history (stroke, hypertension, myocardial infarction, cancer, and diabetes), smoking, alcohol consumption, educational attainment, depression symptoms, cognitive impairment, physical function, social support, and marital status. Results: As a result of the propensity score matching, 574 participants were selected. Participants with 0–19 teeth were more likely to develop functional disability than those with 20 or more teeth (hazard ratio 1.33; 95% confidence interval, 1.01–1.75). Conclusions: In this prospective cohort study targeting community-dwelling older adults in Japan, having less than 20 teeth was confirmed to be an independent risk factor for functional disability even after conducting propensity score matching. This study supports previous publications showing that oral health is associated with functional disability.

Background: We sought to investigate the optimal values of BMI for the lowest risk of all-cause death and whether the optimal BMI differs according to smoking status in large-scale pooled analysis of 13 Japanese cohorts. Methods: Data from 179,987 participants of 13 well-qualified cohort studies conducted throughout Japan were used for our analysis. A cohort-stratified Cox proportional hazard model was used. P values for interactions were calculated based on the cross product of BMI and age, sex, or smoking status. Results: In the entire study population, all-cause mortality risk was lowest when the BMI was 22.0–24.9 kg/m2. This was also the case for selected healthy participants (never smoked, baseline total cholesterol level ≥4.1 mmol/L; the first 5 years of follow-up data were excluded). No effect modification of age, sex, or smoking status was observed. Regardless of their BMI, never smokers always had a lower all-cause mortality risk than did current smokers even with an ideal BMI in terms of mortality risk. Conclusion: A BMI of 22–24.9 kg/m2 correlated with the lowest risk of mortality, regardless of whether all participants or selected healthy participants were analyzed. The fact that smoking was more strongly associated with mortality than obesity emphasizes the urgency for effective anti-smoking programs.

Abstract Aims The study aims to evaluate the prognostic significance of impaired glucose tolerance (IGT) with reference to albuminuria in patients with chronic heart failure (CHF). Methods and results We examined 535 CHF patients (mean 66 years, women 25%) in the control arm of our SUPPORT trial, in which we examined additive impact of olmesartan in hypertensive patients with symptomatic CHF treated with β‐blockers and/or angiotensin‐converting enzyme inhibitors. We examined the association between glycaemic abnormality (assessed by 75 g of oral glucose tolerance test) and albuminuria for a composite outcome of all‐cause death, myocardial infarction, stroke, and HF hospitalization. IGT patients (N = 113, mean 67.2 years) were older and more frequently treated with β‐blockers compared with those with normal glucose regulation (N = 142, mean 64.0 years) and those with diabetes mellitus (N = 280, mean 65.7 years). Multivariable Cox proportional hazard models revealed that, as compared with normal glucose regulation (NGR), IGT was associated with increased risk of the outcome when complicated by albuminuria [hazard ratio (HR) 2.25; 95% confidence interval (CI) 1.14–4.42; P = 0.019] but not when uncomplicated by albuminuria (HR 0.76; 95% CI 0.35–1.60, P = 0.47) (P for interaction = 0.041). This was also the case for diabetes mellitus and albuminuria (HR 2.06; 95% CI 1.17–3.61; P = 0.012). Among IGT patients without albuminuria, 21 (29%) developed albuminuria at 1‐year visit, which was again associated with poor prognosis (HR 7.36; 95% CI 1.39–38.98, P = 0.019). Conclusions These results indicate that IGT is associated with poor prognosis when complicated by albuminuria in CHF patients, demonstrating the importance of combined early stages of glucose intolerance and renal dysfunction in the management of CHF.

Objectives The COVID-19 pandemic has forced many people to stay at home and to maintain social distancing. This study aimed to assess the association of reduced physical activity during the COVID-19 pandemic with new onset of neck pain (katakori) among a rural Japanese population living in areas damaged by the Great East Japan Earthquake (GEJE).Design, setting and participants This prospective cohort study has been conducted continuously since 2011 after the GEJE. This study used longitudinal data from 1608 adults who responded to the self-reported questionnaire before and during the COVID-19 pandemic. Changes in physical activity due to the COVID-19 pandemic were categorised into four groups: ‘no change’, ‘decreased by 20%–30%’, ‘decreased by half’ and ‘almost never go out’. Multiple logistic regression analysis was used to estimate the OR and 95% CI of the association between COVID-19 pandemic-related physical inactivity and new-onset neck pain.Results In total, ‘no change’, ‘decreased by 20%–30%’, ‘decreased by half’, and ‘almost never go out’ were reported by 9.2%, 27.7%, 31.2% and 21.9% of respondents, respectively. Among them, 9.8% reported new-onset neck pain. A significantly higher rate of new-onset neck pain was observed in participants who reported ‘decreased by half’ (adjusted OR 1.85, 95% CI 1.04 to 3.30) and who ‘almost never go out’ (adjusted OR 2.13, 95% CI 1.16 to 3.91), compared with those who reported ‘no change.’Conclusions Decreased physical activity has increased due to the COVID-19 pandemic and was significantly associated with new-onset neck pain among GEJE survivors.

Background: Japan became the first country where heat-not-burn tobacco products were sold. Therefore, there was no information for actual status on the actual use status or the harms of heat-not-burn tobacco products. The objectives of the study profile are to generate data that can be freely available to external researchers, and to create collaborative research projects in the future. Methods: The Japan “Society and New Tobacco” Internet Survey (JASTIS) is a longitudinal internet cohort study which investigates perception, attitude, and use of heat-not-burn tobacco, electronic cigarettes (e-cigarettes), and conventional tobacco products in Japan. The survey also includes demographic, health-related, and socioeconomic factors. Participants were randomly selected and invited from internet panelists. The baseline survey was closed when the target number of respondents who had answered the questionnaire was met. Results: The study includes three cohorts (1–3) from the 2015 baseline survey and a cohort (4) from the 2017 baseline survey: cohorts 1 and 4 were recruited based on sex and age: men and women aged 15–69 years (n = 8,240 for cohort 1 and n = 5,897 for cohort 4); cohorts 2 and 3 were created using status-based recruiting: e-cigarette and/or heat-not-burn tobacco ever users (n = 2,188; cohort 2) and combustible cigarette smokers without e-cigarette/heat-not-burn tobacco experience (n = 724; cohort 3). The completion rates were 8.5% to 9.9%. All subjects were followed and assessed annually. Response rates for the follow-up survey were 65.5% in 2016, 55.3% in 2017, and 50.9% in 2018. Because Internet-based responders are not a representative sample of the general population of Japan, we conducted adjustment to account for “being an internet survey respondent” and reported tobacco product use in Japan. A recent JASTIS study reported that prevalence of IQOS current-use among Japanese adults had rapidly increased from 0.3% in 2015 to 3.6% in 2017. Conclusion: The JASTIS study provides the first estimates for heat-not-burn tobacco use in the world and e-cigarette use in Japan. For information on collaboration, please contact the corresponding author.

Abstract Background Functional disability is a significant problem after natural disasters. Musculoskeletal pain is reported to increase after disasters, which can cause functional disability among survivors. However, the effects of musculoskeletal pain on functional decline after natural disasters are unclear. The present study aimed to examine the association between musculoskeletal pain and new-onset poor physical function among elderly survivors after the Great East Japan Earthquake. Methods A longitudinal study was conducted on survivors aged ≥65 years at three and 4 years after the Great East Japan Earthquake. A total of 747 persons were included in this study. Physical function was assessed using the Kihon Checklist. New-onset poor physical function was defined as low physical function not present at 3 years but present at 4 years after the disaster. Knee, hand or foot, low back, shoulder, and neck pain was assessed using a self-reported questionnaire and was defined as musculoskeletal pain. Musculoskeletal pain at 3 years after the disaster was categorized according to the number of pain regions (0, 1, ≥ 2). Multiple logistic regression analyses were performed to calculate the odds ratio (OR) and 95% confidence interval (95% CI) for new-onset poor physical function due to musculoskeletal pain. Results The incidence of new-onset poor physical function was 14.9%. New-onset poor physical function was significantly associated with musculoskeletal pain. Compared with “0” musculoskeletal pain region, the adjusted ORs (95% CI) were 1.39 (0.75–2.58) and 2.69 (1.52–4.77) in “1” and “≥ 2” musculoskeletal pain regions, respectively (p for trend = 0.003). Conclusions Musculoskeletal pain is associated with new-onset poor physical function among elderly survivors after the Great East Japan Earthquake. Monitoring musculoskeletal pain is important to prevent physical function decline after natural disasters.

Abstract Background Although our previous study using a food frequency questionnaire simulated nutritional characteristics of the traditional Japanese diet, this issue has not been sufficiently evaluated. This study was conducted to examine the relationship between the traditional Japanese diet and nutrient density (ND). Methods A cross-sectional study employing the dietary record method was conducted among 2221 community-dwelling Japanese adults (40–88 years) living in Aichi Prefecture, Japan, in 2006–2008. Based on previous studies, a 9-component Japanese Diet Index (JDI) and a 12-component modified JDI (mJDI12) were defined. To develop a new weighted index, a multiple linear regression model was used to select food components which were significantly associated with an ND score (integrated by 11 nutrient components) from the mJDI12 and weight them. Correlation analyses were performed between JDI, mJDI12, the new weighted JDI score and the ND score and its 11 nutrient components. The findings were validated with data from 2008 to 2010 by assessing the associations between the JDIs scores and the ND score. Results Scores of the JDI and mJDI12 were positively correlated with the ND score (corresponding Spearman’s ρ [95% confidence interval; CI], 0.34 [0.31, 0.38] and 0.44 [0.41, 0.48], respectively; P

Background: Although lower household economic status is known to be a risk factor for obesity among school-age children, such an association among toddlers remains unclear. The present study investigated the association between household economic status and obesity in toddlers. Design: We conducted a cross-sectional study of children aged 4 years attending daycare centers in Japan. Information on subjective household economic status [“affluent”, “neither”, “less affluent”, or “non-affluent”] was collected via questionnaire from the children’s guardians in 2015. Based on measured values of height and weight, obesity was defined using the International Obesity Task Force cut-offs of overweight (BMI ≥17.47 for boys and ≥17.19 for girls). We used the logistic regression model to investigate the association between household economic status and obesity. Results: Among 1,848 respondents, the prevalence of obesity was 6.8%. Non-affluent household economic status was associated with a significantly higher probability of obesity in toddlers; the multivariate adjusted odds ratio for “non-affluent” households was 2.31 (95% confidence interval, 1.23–4.33) compared with “affluent” households. Conclusion: Perception of non-affluent economic status by the guardian was associated with a higher probability of toddler obesity. This result suggests that non-affluent household economic status is associated with obesity in toddlers.

The Japanese dietary pattern has long been discussed as one of the factors behind the longevity of Japanese people. However, the health benefits of the Japanese dietary pattern have not been fully elucidated. We published the first report in the world regarding the relation between the Japanese dietary pattern and cardiovascular disease mortality in 2007 using cohort studies including Japanese residents of Ohsaki City, Miyagi Prefecture, Japan. Since then, we have developed the Japanese Diet Index (JDI) that was based on previous findings to assess the degree of the Japanese dietary pattern and to advance the evidence on the health effects of the Japanese dietary pattern. So far, we have explored the associations between the JDI score (in quartiles) and various outcomes. For all-cause mortality, in comparison to Q1 (the lowest), the multivariable hazard ratios (HRs) and 95% confidence intervals (95%CIs) were 0.92 (0.85–1.00) for Q2, 0.91 (0.83–0.99) for Q3, and 0.91 (0.83–0.99) for Q4 (the highest). For functional disability, the multivariable HRs (95%CIs) were 0.94 (0.81–1.09) for Q2, 0.90 (0.77–1.05) for Q3, and 0.79 (0.68–0.92) for Q4. For dementia, the multivariable HRs (95%CIs) were 0.88 (0.74–1.05) for Q2, 0.87 (0.73–1.04) for Q3, 0.79 (0.66–0.95) for Q4. In addition, people with higher adherence to the Japanese dietary pattern also showed decreases in disability and dementia risks. The purpose of this article was to review all six papers, summarize the health effects of the Japanese dietary pattern, and discuss implications for future research.

Objective The aim of this study was to investigate the effect of a financial incentive on the number of daily walking steps among community-dwelling adults in Japan.Study design Two-arm, parallel-group randomised controlled trial.Setting/participants We recruited physically inactive community-dwelling adults from Sendai city, Japan. Eligible participants were randomly allocated to an intervention or a wait list control group. Pedometers were used to assess the mean number of daily steps in three periods: baseline (weeks 1–3), intervention (weeks 4–6) and follow-up (weeks 7–9).Intervention The intervention group was offered a financial incentive (shopping points) to meet the target number of increased daily steps in the intervention period.Main outcome measures The primary outcome was an increase in the mean number of daily steps in the intervention and follow-up periods compared with baseline.Results Seventy-two participants (69.4% women; mean age, 61.2±16.2 years; mean number of daily steps at baseline, 6364±2804) were randomised to the intervention (n=36) and control groups (n=36). During the intervention period, the increase in mean daily steps was significantly higher in the intervention group (1650, 95% CI=1182 to 2119) than in the control group (514, 95% CI=136 to 891; p

Background: The association between eczema and mental health problems in schoolchildren has been underexplored. We aimed to investigate this association with the validated questionnaires. Methods: Of 46,648 invited children, we analyzed 9954 (21.3%) in the 2nd to the 8th grades from the ToMMo Child Health Study conducted in 2014 and 2015, a cross-sectional survey in Miyagi Prefecture, Japan. We defined eczema status as “normal,” “mild/moderate,” or “severe,” based on the presence of persistent flexural eczema and sleep disturbance, according to the International Study of Asthma and Allergies in Childhood (ISAAC) Eczema Symptom Questionnaire. Clinical ranges of Strengths and Difficulties Questionnaire (SDQ) total difficulties scores and four SDQ subcategories of emotional symptoms, conduct problems, hyperactivity/inattention, and peer problems were defined as scores ≥16, ≥5, ≥5, ≥7, and ≥5, respectively. Results: The mean SDQ total difficulties score significantly increased as eczema status worsened (all P ≤ 0.004 for trend). The OR of scores in the clinical range for SDQ total difficulties were 1.51 (95% CI, 1.31–1.74) for mild/moderate eczema and 2.63 (95% CI, 1.91–3.63) for severe eczema (P

Abstract Background Although maternal age at first birth has been rising in many developed countries, its long-term effects on the health of the mothers themselves are unclear. In this study, we investigated the relationship between maternal age at first birth and long-term mortality. Methods We conducted a cohort study of 20,624 parous Japanese women aged between 40 and 79 years in 1994 and followed up their survival for 14 years. Based on maternal age at first birth, the women were divided into four groups: ≤19 years, 20–24 years, 25–29 years, and ≥30 years. Using the 20–24 years group as a reference, hazards ratios (HRs) for all-cause and cause-specific mortality were calculated. Results Multivariate HRs for all-cause mortality were 1.17 in the ≤19 years group, 1.09 in the 25–29 years group, and 1.33 in the ≥30 years group. A U-shaped relationship was apparent between maternal age at first birth and mortality. This relationship was also observed for mortality attributable to cancer, cardiovascular disease and other diseases. This U-shaped relationship was observed only for women born before 1935 and the birth year of the first child before 1960. Conclusion A U-shaped relationship was apparent between maternal age at first birth and mortality. As maternal age at first birth is rising worldwide, the risk it imposes appears to have significance in the context of public health.

Objective To study the association of educational level and risk of death from all causes, cardiovascular disease (CVD) and cancer among Asian populations.Design A pooled analysis of 15 population-based cohort studies.Setting and participants 694 434 Asian individuals from 15 prospective cohorts within the Asia Cohort Consortium.Interventions None.Main outcome measures HRs and 95% CIs for all-cause mortality, as well as for CVD-specific mortality and cancer-specific mortality.Results A total of 694 434 participants (mean age at baseline=53.2 years) were included in the analysis. During a mean follow-up period of 12.5 years, 103 023 deaths were observed, among which 33 939 were due to cancer and 34 645 were due to CVD. Higher educational levels were significantly associated with lower risk of death from all causes compared with a low educational level (≤primary education); HRs and 95% CIs for secondary education, trade/technical education and ≥university education were 0.88 (0.85 to 0.92), 0.81 (0.73 to 0.90) and 0.71 (0.63 to 0.80), respectively (ptrend=0.002). Similarly, HRs (95% CIs) were 0.93 (0.89 to 0.97), 0.86 (0.78 to 0.94) and 0.81 (0.73 to 0.89) for cancer death, and 0.88 (0.83 to 0.93), 0.77 (0.66 to 0.91) and 0.67 (0.58 to 0.77) for CVD death with increasing levels of education (both ptrend

As the factors that link education level with incident functional disability in elderly Japanese have never been investigated, the present study investigated this issue in an elderly Japanese population. A 9-year prospective cohort study (2006-2015) was conducted among 8,680 Japanese individuals (≥65 years), Ohsaki city, Japan. In a baseline survey, we collected data on education level and potential mediators. Data on incident functional disability were retrieved from the Long-term Care Insurance database. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident functional disability by education level (below upper-secondary education (reference), and upper secondary education and above). Mediating effects were estimated using accelerated failure time model and a logistic regression model. During 9-year follow-up period, 2,742 cases (31.6%) of incident functional disability were observed, and education level showed an inverse association with functional disability (P for trend

Objectives: We examined whether selected factors were associated with activity limitation used to calculate the healthy life expectancy in accordance with the target of Health Japan 21 (the second term). Methods: Data for 6251 subjects were obtained from the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey, both of which were conducted by the Ministry of Health, Labour and Welfare of Japan in 2010. The age-adjusted odds ratios (AOR) of limitation of activity for the assessed factors were estimated using a logistic model. Results:, The percentage of persons with activity limitation was 12.1% of men and 15.6% of women. For men, low body mass index (BMI) (AOR: 2.02, p=0.008), high blood pressure (AOR: 1.53, p=0.021), high hemoglobin A1c (HbA1c) (AOR: 1.99, p=0.000), a small number of steps (AOR: 1.68, p=0.002), and high intake of salt (AOR: 0.69, p=0.010) were significantly associated with limitation of activity. For women, high BMI (AOR: 1.49, p=0.003), a small number of steps (AOR: 1.48, p=0.009), and high intake of salt (AOR: 0.77, p=0.017) were significantly associated with activity limitation. Conclusion: We identified several factors that were associated with activity limitation. Our results from cross-sectional data require careful interpretation before concluding whether these relationships are causal

Household air pollution (HAP) is of public health concern, with ~3 billion people worldwide (including >15 million in the US) exposed. HAP from coal use is a human lung carcinogen, yet the epidemiological evidence on carcinogenicity of HAP from biomass use, primarily wood, is not conclusive. To robustly assess biomass’s carcinogenic potential, prospective studies of individuals experiencing a variety of HAP exposures are needed. We have built a global consortium of 13 prospective cohorts (HAPCO: Household Air Pollution Consortium) that have site- and disease-specific mortality and solid fuel use data, for a combined sample size of 587,257 participants and 57,483 deaths. HAPCO provides a novel opportunity to assess the association of HAP with lung cancer death while controlling for important confounders such as tobacco and outdoor air pollution exposures. HAPCO is also uniquely positioned to determine the risks associated with cancers other than lung as well as nonmalignant respiratory and cardiometabolic outcomes, for which prospective epidemiologic research is limited. HAPCO will facilitate research to address public health concerns associated with HAP-attributed exposures by enabling investigators to evaluate sex-specific and smoking status-specific effects under various exposure scenarios.

Background: Previous studies have reported that a higher dietary inflammatory index (DII®) score is related to a higher risk of mortality and conditions that result in functional disability, such as cardiovascular disease, dementia, and fractures. Although these findings suggest that higher DII scores would affect disability-free survival, this has never been investigated directly. The present study investigated the association between the DII score and disability-free survival. Methods: We analyzed follow-up data covering a 12-year period for 793 older adults (≥70 years) participating in a Japanese community-based cohort study. DII scores were computed on the basis of dietary intake and assessed using the Brief Self-Administered Diet History Questionnaire. Data on incident functional disability were retrieved from the public Long-Term Care Insurance database. We applied the Cox model for estimating the adjusted hazard ratios (HRs) of the composite outcome (incident functional disability or death) according to DII score tertiles (T1–T3). Results: The proportion of men was 47.3%; mean (SD) age was 75.2 (4.5) years. The 12-year incidence of the composite outcome was 65.5%. A higher DII score was related to a higher risk for the composite outcome: HRs (95% confidence interval) were 1.05 (0.84, 1.32) for T2 and 1.26 (1.01, 1.57) for T3 (p-trend = 0.040) compared to the most anti-inflammatory T1 reference (HR = 1.00). Conclusions: These results suggest that a pro-inflammatory diet might be a modifiable factor affecting disability-free survival in the older population. Additional prospective studies are needed to confirm this relationship.

Isoalantolactone, a medicinal plant-derived natural compound, is known to induce apoptosis in various cancer cell lines. However, its effect on apoptosis in prostate cancer cells has not been addressed. Thus, we examined the effects of isoalantolactone on prostate cancer cells. It was found that isoalantolactone inhibits growth of both androgen-sensitive (LNCaP) as well as androgen-independent (PC3 and DU-145) prostate cancer cells in a dose-dependent manner. Furthermore, our results indicate that isoalantolactone-induced apoptosis in prostate cancer PC3 cells is associated with the generation of ROS and dissipation of mitochondrial membrane potential (Δψm). In addition, isoalantolactone triggers apoptosis in prostate cancer cells via up-regulation of Bax, down-regulation of Bcl-2, survivin, and significant activation of caspase-3. Isoalantolactone-induced apoptosis is markedly abrogated when the cells were pretreated with N-acetylcysteine (NAC), a specific ROS inhibitor, suggesting that the apoptosis-inducing effect of isoalantolactone in prostate cancer cells is mediated by reactive oxygen species. These findings indicate that isoalantolactone induces reactive oxygen species-dependent apoptosis in prostate cancer cells via a novel mechanism involving inhibition of survivin and provide the rationale for further in vivo and preclinical investigation of isoalantolactone against human prostate cancer.

Despite the availability of several therapeutic options, a safer and more effective modality is urgently needed for treatment of bladder cancer. Costunolide, a member of sesquiterpene lactone family, possesses potent anticancer properties. In this study, for the first time we investigated the effects of costunolide on the cell viability and apoptosis in human bladder cancer T24 cells. Treatment of T24 cells with costunolide resulted in a dose-dependent inhibition of cell viability and induction of apoptosis which was associated with the generation of ROS and disruption of mitochondrial membrane potential (Δψm). These effects were significantly blocked when the cells were pretreated with N-acetyl- cysteine (NAC), a specific ROS inhibitor. Exposure of T24 cells to costunolide was also associated with increased expression of Bax, down-regulation of Bcl-2, survivin and significant activation of caspase-3, and its downstream target PARP. These findings provide the rationale for further in vivo and clinical investigation of costunolide against human bladder cancer.

On March 11, 2011, Japan experienced an earthquake of magnitude 9.0 and subsequent enormous tsunamis. This disaster destroyed many coastal cities and caused nearly 20,000 casualties. In the aftermath of the disaster, many tsunami survivors who lost their homes were forced to live in small temporary apartments. Although all tsunami survivors were at risk of deteriorating health, the elderly people were particularly at a great risk with regard to not only their physical health but also their mental health. In the present study, we performed a longitudinal cohort study to investigate and analyze health conditions and cognitive functions at 28, 32, and 42 months after the disaster in the elderly people who were forced to reside in temporary apartments in Kesennuma, a city severely damaged by the tsunamis. The ratio of people considered to be cognitively impaired significantly increased during the research period. On the other hand, the mean scores of the Kessler Psychological Distress Scale-6 and Athens Insomnia Scale improved based on the comparison between the data at 24 and 42 months. The multiple logistic regression analysis revealed that frequency of "out-of-home activities" and "walking duration" were independently associated with an increase in the ratio of people with cognitive impairment. We concluded that the elderly people living in temporary apartments were at a high risk of cognitive impairment and "out-of-home activities" and "walking" could possibly maintain the stability of cognitive functions.

Previous observational studies have indicated that green tea (GT) consumption is associated with reduced mortality from cerebral infarction but not with mortality from cerebral hemorrhage. Therefore, we hypothesized that GT exerts a direct antiatherosclerotic effect without any effect on hypertension. To investigate this hypothesis, we focused on adiponectin that seems to be among the several key players in atherosclerosis.The objective of this randomized controlled trial (RCT) was to assess whether the consumption of catechin-enriched GT affects serum adiponectin levels and cardiovascular disease (CVD) risk factors among apparently healthy subjects.A total of 51 individuals participated in the study. Eligible participants were randomly assigned into GT consumption groups with either high catechin (400 mg/day) or low catechin (100 mg/day). The study participants were asked to stop GT consumption for 2 weeks (washout period), following which they were to start drinking the provided GT beverages everyday for 9 weeks. The outcome measures were changes in the adiponectin levels and CVD risk factors (body weight, body mass index, waist circumference, blood pressure, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, fasting plasma glucose, as well as aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, uric acid, and high-sensitive C-reactive protein).After intervention for 9 weeks, we found no significant difference between the high- and low catechin group with respect to changes in the serum adiponectin level: 0.35 µg/ml (95% confidence interval (CI): −1.03, 1.74). Also, no significant difference was observed between the high- and low catechin groups with respect to changes in any of the measured CVD risk factors.This RCT showed no significant difference between the high- and low catechin groups with respect to changes in the serum adiponectin level and any CVD risk factors.