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Background: Anger is a common problem in society, and anger's relationship with mortality, in particular with cardiovascular mortality, has been studied mainly in male western population. There are...

Potential health benefits of melatonin have been suggested. Although melatonin is present in various foods, little is known about the health effects of dietary melatonin intake. We estimated habitual dietary melatonin intake and examined its association with total and cause-specific mortality in a population-based cohort study in Japan. Study subjects included 13,355 men and 15,724 women aged ≥35 years who responded to a self-administered questionnaire in 1992. Their diets were assessed via a food frequency questionnaire at baseline. The melatonin content in various foods on the questionnaire was measured to estimate melatonin intake. Mortality was ascertained during 16 years of follow-up (1992–2008). Hazard ratios (HRs) and 95% confidence intervals (CIs) for total and cause-specific mortality were calculated according to melatonin quartiles. A total of 5,339 deaths occurred during follow-up. Melatonin intake was significantly associated with decreased risks of total mortality, cardiovascular mortality, and noncancer, noncardiovascular mortality after controlling for covariates; HRs for the highest quartile of melatonin intake versus the lowest were 0.90 (95% CI: 0.82, 0.98; P for trend = 0.05), 0.85 (95% CI: 0.72, 0.99; P for trend = 0.10), and 0.77 (95% CI: 0.67, 0.90; P for trend = 0.003), respectively. The data suggest a potential benefit of dietary melatonin with regard to mortality rates.

Background Few studies have examined the association between seaweed intake and blood pressure in children. We conducted an intervention study to investigate whether seaweed intake affects blood pressure. Methods Subjects were children aged 4 to 5 years attending a preschool in Aichi Prefecture, Japan, in 2010. Among 99 students, 89 (89.9%) were enrolled in our study. Nori (dried laver), an edible seaweed widely consumed in Japan, was used as a dietary intervention. Children in the intervention group were asked to consume 1.76 grams per day of roasted nori in addition to standard meals for 10 weeks. Children in the control group consumed their usual diet. Before the intervention and at the 10th week of the intervention, children's blood pressure was measured three times successively using an automated sphygmomanometer with subjects in a sitting position. Changes in systolic (SBP) and diastolic blood pressure (DBP) were compared between 55 children in the intervention group and 26 in the control group after adjustment for SBP and DBP before the intervention. Results Changes in SBP were -8.29 mm Hg in the intervention group and +0.50 mm Hg in the control group (P for difference in change = 0.051). Changes in DBP were -6.77 mm Hg in the intervention group and -0.05 mm Hg in the control group (P = 0.031). In girls, no difference in blood pressure changes was found between the intervention and control groups. Conclusion Nori intake lowered DBP level in boys. Seaweed intake might have preventive effects on elevated blood pressure in childhood.

Aims/Introduction The mechanisms underlying hypertriglyceridemia‐induced impaired glucose tolerance in Japanese individuals remain unclear. We aimed to evaluate the effect of hypertriglyceridemia on glucose metabolism in comparison with that of increased low‐density lipoprotein or decreased high‐density lipoprotein levels and to elucidate the sex differences in hypertriglyceridemia‐related dietary intake among Japanese individuals. Materials and Methods We randomly selected 898 (384 men and 514 women) participants aged 40–78 years in the Gifu Diabetes Study; those taking medication for dyslipidemia or diabetes mellitus were excluded. Serum levels of glucose metabolism parameters and the food frequency were measured cross‐sectionally. The glycated hemoglobin was measured again after 5 years. Results Glucose metabolism parameters and the percentage of individuals with impaired glucose tolerance were significantly higher in the high triglyceride group in men and women. Similar trends were observed in the low high‐density lipoprotein group, but only in men. Meanwhile, only the homeostasis model assessment of insulin resistance was higher in the high low‐density lipoprotein group. In non‐obese men, the percentage of energy intake from alcohol per total daily energy intake was significantly greater in the high triglyceride group. In obese women, the total energy intake was significantly greater in the high triglyceride group. At the 5‐year follow up, the risk of elevated glycated hemoglobin levels with hypertriglyceridemia was increased in men. Conclusions Hypertriglyceridemia is a stronger risk factor for impaired glucose tolerance than increased low‐density lipoprotein or decreased high‐density lipoprotein. For dietary habits, increased daily alcohol energy intake in non‐obese men and increased total energy intake in obese women were associated with hypertriglyceridemia., Hypertriglyceridemia has a negative effect on glucose metabolism by increasing insulin resistance and secretion. Further, such effect was stronger than hyper‐LDL or lower‐HDL cholesterolemia in the Japanese with dyslipidemia‐induced impaired glucose tolerance. For dietary habits, increased daily alcohol energy intake in non‐obese men and increased total energy intake in obese women were associated with hypertriglyceridemia.

Aims/Introduction The aim of the current study was to prospectively evaluate the association between passive smoking from a spouse and the risk of diabetes among never‐smoking Japanese women. Passive smoking at a workplace (or public facilities) was assessed as a secondary measure. Materials and Methods In the Japan Public Health Center‐based Prospective Study (baseline 1990 or 1993), we followed 25,391 never‐smoking women aged 40–69 years and without diabetes. Passive smoking was defined as having a husband who was a self‐reported smoker, and the exposure at a workplace (or public facilities) was self‐reported by women. The development of diabetes was identified in questionnaires administered at the 5‐year and 10‐year surveys. A pooled logistic regression model was used to assess the association between passive smoking and the development of diabetes with adjustment for age and possible confounders. Results Compared with women whose husbands had never smoked, women whose husband smoked ≥40 cigarettes/day had significantly higher odds of developing diabetes in an age‐adjusted model, but the association was attenuated in a multivariable model (odds ratio 1.34, 95% confidence interval 0.96–1.87). There was a dose–response trend between the number of cigarettes smoked by a husband and the odds of developing diabetes (P = 0.02). Women reporting daily passive smoking at a workplace (or public facilities) had higher odds of developing diabetes than women reporting no such exposure (odds ratio 1.23, 95% confidence interval 0.995–1.53). Conclusions Our results indicated a higher risk of diabetes among never‐smoking Japanese women with higher exposure to passive smoking from a spouse., There was a dose–response trend between the number of cigarettes smoked by a husband and the odds of developing diabetes among never‐smoking Japanese women.

Numerous epidemiological studies have suggested that nut intake is associated with a reduced risk of mortality. Although diets and lifestyles differ by regions or races/ethnicities, few studies have investigated the associations among non-white, non-Western populations. We evaluated the associations of total nut and peanut intakes with all-cause and cause-specific mortality in a population-based prospective cohort in Japan. Participants (age: ≥35 years at baseline in 1992; n 31 552) were followed up until death or the end of follow-up in 2008. Those with cancer, CHD or stroke at baseline were excluded. Dietary intake was assessed only at baseline by using a validated FFQ. In total, 2901 men died during 183 299 person-years and 2438 women died during 227 054 person-years. The mean intakes of total nuts were 1·8 and 1·4 g/d in men and women, respectively. Although peanut intake accounted for approximately 80 % of the total nut intake, total nut and peanut intakes were inversely associated with all-cause mortality in men after adjusting for all potential confounders. For example, compared with the lowest quartile category, the adjusted hazard ratio (95 % CI) of total nut intake for all-cause mortality in men of the highest quartile category was 0·85 (95 % CI 0·75, 0·96) (Pfor trend = 0·034). Peanut intake was inversely associated with digestive disease mortality in men and CVD mortality in women. Total nut and peanut intakes, even in low amounts, were associated with a reduced risk of mortality particularly in men.

Although several experimental studies have reported that oxidative stress levels decrease during smoking cessation, how they change among general smokers has yet to be completely elucidated. In the present study, a total of 23 smokers who underwent smoking cessation treatment were observed for two-week changes in their levels of 8-OHdG and 8-isoprostane. Physical and nutritional characteristics were measured at the initial patient visit, and casual urine samples were collected at the initial visit and at a follow-up visit two weeks later. Oxidative stress was measured by a high performance liquid chromatography electrochemical detector, and the two-week difference in the levels of oxidative stress was assessed according to demographic and nutrient factors. Neither the urinary level of 8-OHdG nor that of 8-isoprostane decreased, although the cotinine level was decreased at two weeks. A Two-way repeated ANOVA revealed a significant interaction for fat intake by time for the change in the 8-OHdG level (P=0.03) and significant interactions for α-tocopherol intake (P=0.03), iron intake, and carbohydrate intake (P=0.03), all of which were time-dependent for the change in the 8-isoprostane level. The 8-OHdG level decreased among smokers with a high fat intake and was increased with a low fat intake. The 8-isoprostane levels were decreased among smokers with a high carbohydrate intake and increased with a low carbohydrate intake, decreased with a low iron intake and increased with a high iron intake and decreased with a low α-tocopherol intake and increased with a high α-tocopherol intake. Although the present study failed to observe a decrease in oxidative stress levels during the two-week smoking cessation period, we hypothesize that the intake levels of specific nutrients when initiating smoking cessation treatment may predict any subsequent changes in the oxidative stress levels.

Background Available evidence for associations between sugar intake and body weight is largely from short-term controlled trials and studies focusing on sugar-sweetened beverages. Studies on long-term weight change related to the intake of types of sugar are thus needed. Objective We examined the associations between weight change and the intake of various types of carbohydrates, including starch, total sugars, and free or naturally occurring sugars and saccharides (i.e., glucose, fructose, sucrose, and lactose), among Japanese men and women. Methods This prospective cohort study included 14,971 residents of Takayama City in Japan who were aged 35-69 y at the first survey in 1992 and responded to a self-administrated questionnaire at the second survey in 2002. We excluded those with cancer, coronary artery disease, stroke, or diabetes on the first survey and those with missing information about body weight on both surveys, leaving 13,229 participants for analysis (5879 men and 7350 women). Mean (95% CI) values of 10-y weight change according to types of carbohydrates were estimated using linear regression models with adjustment for total energy intake and other dietary and lifestyle factors. Dietary intake was assessed at the first survey using a validated FFQ. Results Among men, free sugar intake was associated with weight gain and the estimated means (95% CIs) of weight change were -0.60 (-0.67, -0.54), -0.31 (-0.38, -0.24), -0.12 (-0.19, -0.05), and 0.20 (0.13, 0.27) kg from the first to fourth quartiles (P-trend = 0.002). Moreover, high intakes of sucrose and fructose were associated with weight gain (P-trend: 0.018 for sucrose and 0.001 for fructose). Among women, the intake of any type of carbohydrate was not significantly associated with weight change. Conclusions These results suggested that high intakes of free sugars, sucrose, and fructose were associated with long-term weight gain among Japanese men.

Background Reportedly, green tea has a preventive effect against colorectal cancer in animal models. Nevertheless, results from epidemiological studies of the association between green tea consumption and colorectal cancer have been inconsistent. We aimed to evaluate colorectal cancer risk in relation to green tea consumption in a population-based prospective cohort study. Methods Subjects were 13 957 men and 16 374 women aged ≥35 years in September 1992. The participants' green tea consumption was elicited by administering a food frequency questionnaire. The colorectal cancer incidence was confirmed through regional population-based cancer registries and histological identification from colonoscopy in two main hospitals in the study area. Colorectal cancer was defined as the sum of code C18 (colon cancer) and codes C19 and C20 (rectal cancer) according to ICD-10. Results Up to March 2008, 429 men and 343 women were diagnosed with colorectal cancer. No significant association was found between green tea consumption and colorectal cancer in men and women, respectively. However, for men, compared with the group of 'none or less than once per day' of green tea consumption, the multiple-adjusted relative risks (95% CIs) for colon cancer were 1.32 (0.90, 1.94), 0.76 (0.57, 1.02), and 0.78 (0.49, 1.22), respectively, in the group of 'once per day,' '2-3 times per day', and 'four times per day or more' (trend P = 0.045). Conclusions This study observed no overall significant associations between green tea consumption and colorectal cancer risk, except that there was a weak trend for greater consumption of green tea with decreased risk of male colon cancer.

Aim To examine the association between body mass index (BMI) and mortality among middle-aged people with diabetes in Japan. Methods A total of 3032 men and 1615 women, aged 40–69 years, with diabetes were analyzed. Cox proportional hazards models, adjusted for potential confounding factors, were used to estimate mortality hazard ratios (HRs) across BMI categories at the baseline. Results There were 1761 deaths during a mean follow-up period of 18.5 years. Increased all-cause mortality was observed at both ends of the BMI distribution; compared with the reference BMI category (23.0–24.9 kg/m2), the HRs were 1.25 (95% confidence interval [CI], 0.9997–1.56) in the lowest (14.0–18.9 kg/m2) and 1.36 (95% CI, 1.06–1.74) in the highest (30.0–39.9 kg/m2) categories (P = 0.001). Similar all-cause mortality trends were observed after excluding deaths within 3 years of follow-up, as well as for men and men who had ever smoked. While a similar non-linear pattern was observed for cancer-specific mortality, heart disease-specific mortality was only increased in the highest BMI category (HR, 1.86; 95% CI, 1.06–3.25). Conclusion This population-based prospective study demonstrated increased all-cause mortality at both ends of the BMI distribution among Japanese people with diabetes.

Aim Several studies have suggested that cigarette-smoking affects insulin sensitivity in Western populations. The present study evaluated glucose tolerance, pancreatic β-cell function and insulin sensitivity in relation to active and passive smoking among the Japanese. Methods A total of 411 men and 586 women were recruited into a community-based cross-sectional study in Gifu, Japan. Diabetes, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) were screened for by a 75g oral glucose tolerance test. HOMA and insulinogenic (ΔI 0−30 /ΔG 0−30 ) indexes were used to estimate insulin secretion and sensitivity. To assess the possible association of self-reported smoking status and parameters of glucose metabolism, logistic regression was applied after adjusting for potential confounders. Results Currently smoking women were more likely to have diabetes, IGT or IFG compared with never-smoking women (OR: 2.26, 95% CI: 1.05–4.84). Heavy-smoking men (≥25 cigarettes/day) were likely to be in the lowest tertile group of ΔI 0–30 /ΔG 0–30 compared with never-smoking men (OR: 2.64, 95% CI: 1.05–6.68, P trend =0.04). The number of cigarettes/day was borderline significantly associated with diabetes in men. Also with borderline significance, never-smoking women with smoking husbands were more likely to have diabetes, IGT or IFG (OR: 1.62, 95% CI: 1.00–2.62) and significantly more likely to have lower HOMA-β (OR: 2.17, 95% CI: 1.36–3.48) than those without smoking husbands. Conclusion The greater the number of cigarettes smoked per day appears to be associated with diabetes among men whereas, among women, both active and passive smoking appear to be associated with diabetic states, including IGT and IFG. An association between smoking status and insulin secretion is also suggested, whereas no significant association was observed with HOMA-IR in this Japanese subjects, suggesting that the influence of smoking on glucose metabolism may differ among races.

Objective: The aim of this study was to evaluate the past attendance for cervical cancer screening with knowledge of risk factors, access to health-related information, health profiles and health competence beliefs among Japanese women. Methods: Women ages 25, 30, 35, 40, 45, 50, 55, and 60 were contacted cross-sectionally as part of a project for the Japanese Ministry of Health, Labour and Welfare in Nikaho, Akita prefecture Japan between June 2010 and March 2011, and 249 women were analyzed for the current study. The questionnaire asked about past cervical cancer screening. Knowledge of each cervical cancer risk factor was determined on a four-point scale. A barriers to information access scale was utilized to assess the degree of difficulty in accessing health-related information. Health profiles were measured using the EuroQOL EQ-5D. Perceived health competence was measured using a scale (PHCS). The association was evaluated with odds ratios with 95% confidence interval were calculated from a logistic regression analysis after adjustment for age and potential confounders. The trend across the level was also assessed. Results: Women who knew that sexual intercourse at young age was a risk factor were significantly more likely to have participated in cervical cancer screening sometime in their lives (p for trend =0.02). Women who had pain/discomfort and those who had anxiety/depression were significantly more likely to have participated in cervical screening within the past two years (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.04–3.94; OR: 2.32, 95% CI: 1.05–5.16, respectively). Women with higher PHCS were significantly more likely to have attended for cervical screened at some point in their lives (p=0.04). Conclusion: This study observed that specific knowledge of cervical cancer risk factors, health profiles and PHCS were associated with the past attendance for cervical cancer screening among women in a community. Further researches are warranted.

Compared with the abundant data from Western countries, evidence regarding meat consumption and colorectal cancer is limited in the Japanese population. We evaluated colorectal cancer risk in relation to meat consumption in a population-based prospective cohort study in Japan. Participants were 13 957 men and 16 374 women aged ≥35 years in September 1992. Meat intake, assessed with a validated food frequency questionnaire, was controlled for the total energy intake. The incidence of colorectal cancer was confirmed through regional population-based cancer registries and histological identification from colonoscopy in two main hospitals in the study area. From September 1992 to March 2008, 429 men and 343 women developed colorectal cancer. After adjustments for multiple confounders, a significantly increased relative risk of colorectal cancer was observed in the highest versus lowest quartile of the intake of total and red meat among men; the estimated hazard ratios were 1.36 (95% CI: 1.03, 1.79) for total meat (P for trend = 0.022), and 1.44 (95% CI: 1.10, 1.89) for red meat (P for trend = 0.009). A positive association between processed meat intake and colon cancer risk was also observed in men. There was no significant association between colorectal cancer and meat consumption in women. These results suggest that the intake of red and processed meat increases the risk of colorectal or colon cancer among Japanese men. Abstaining from excessive consumption of meat might be protective against developing colorectal cancer.

ObjectiveTo assess general knowledge of diabetes and its determinants among adult men and women in a Japanese community.SettingA cross-sectional study with the residential registry in Gifu City. Blood tests were conducted to measure fasting blood glucose levels and the levels after 2 hours of a 75-gram oral glucose load. Participants’ previous diagnosis of diabetes and demographic status were identified from a questionnaire. A validated food frequency questionnaire was also administered. To assess the association between good knowledge of diabetes and the level of each factor, a logistic regression was utilised with adjustments for age, education and parental history of diabetes.ParticipantsA total of 1019 men and women aged 40–78 years.Primary outcome measureThe Diabetes Knowledge Questionnaire was administered. Participants with ≥75% of answers correct were defined as having a good knowledge of diabetes.ResultsPrevious diagnosis of diabetes was significantly associated with good knowledge of diabetes (OR=2.36; 95% CI 1.19 to 4.68). Among individuals with no previous diagnosis of diabetes, age ≥60 years (OR=0.55; 95% CI 0.36 to 0.86, p value for trend=0.02) and education ConclusionsSome diabetes risk factors were implied to determine the general knowledge of diabetes. Conducting further studies of knowledge in various populations is warranted.

BackgroundAlthough dietary patterns have been linked to depression, a frequently observed precondition for suicide, no study has yet examined the association between dietary patterns and suicide risk.AimsTo prospectively investigate the association between dietary patterns and death from suicide.MethodParticipants were 40 752 men and 48 285 women who took part in the second survey of the Japan Public Health Center-based Prospective Study (1995–1998). Dietary patterns were derived from principal component analysis of the consumption of 134 food and beverage items ascertained by a food frequency questionnaire. Hazard ratios of suicide from the fourth year of follow-up to December 2005 were calculated.ResultsAmong both men and women, a ‘prudent’ dietary pattern characterised by a high intake of vegetables, fruits, potatoes, soy products, mushrooms, seaweed and fish was associated with a decreased risk of suicide. The multivariable-adjusted hazard ratio of suicide for the highest v. lowest quartiles of the dietary pattern score was 0.46 (95% CI 0.28–0.75) (P for trend, 0.005). Other dietary patterns (Westernised and traditional Japanese) were not associated with suicide risk.ConclusionsOur findings suggest that a prudent dietary pattern may be associated with a decreased risk of death from suicide.

The relationship between different types of meat intake and the risk of type 2 diabetes remains unclear. We prospectively examined the association between total meat, total red meat, unprocessed red meat, processed meat and poultry intake and the incidence of type 2 diabetes. Subjects were 27 425 men and 36 424 women aged 45–75 years who participated in the second survey of the Japan Public Health Center-based Prospective Study, and had no history of type 2 diabetes, cancer, stroke, IHD, chronic liver disease or kidney disease. Meat intake was estimated using a validated 147-item FFQ. OR of self-reported, physician-diagnosed type 2 diabetes over 5 years were estimated using a multiple logistic regression. A total of 1178 newly diagnosed cases of type 2 diabetes were self-reported. Intakes of total meat and total red meat were associated with the increased risk of type 2 diabetes in men but not in women. The multivariate-adjusted OR for the highest quartile compared with the lowest quartile of total meat and total red meat intake were 1·36 (95 % CI 1·07, 1·73; P for trend = 0·006) and 1·48 (95 % CI 1·15, 1·90; P for trend = 0·003) for men, respectively, and 0·82 (95 % CI 0·62, 1·09; P for trend = 0·14) and 0·77 (95 % CI 0·57, 1·02; P for trend = 0·08) for women, respectively. Intakes of processed red meat and poultry were not associated with the increased risk of diabetes in either men or women. In conclusion, elevated intake of red meat is associated with the increased risk of type 2 diabetes in Japanese men but not in women.

This study evaluated the associations between the characteristics of high school students and irregular breakfast consumption and explored the association with knowledge regarding diet and dietary education in a community in Japan.A cross-sectional survey using a self-administered questionnaire was conducted in 2007 among all the high school students in the second grade in Imari, Saga. Data for 318 male and 292 female students were analyzed. Irregular breakfast consumption was defined as consuming breakfast three times or less in a week. The associations between the characteristics of students and irregular breakfast consumption were assessed using logistic regression with adjustments for sex and school.Among male students, a strong association between the consumption of juice or pop and irregular breakfast consumption was observed (OR comparing "=2 servings" vs "rarely"=8.97, 95% CI=2.99-26.9). The associations with wake times and bed times were strong among male students, and the association with regular bowel movements was strong among female students. Students who had knowledge of regional agricultural and livestock products were more likely to consume breakfast regularly, and this association was significant among female students (OR=2.89, 95% CI=1.23-6.82). Significant associations were also observed with the consumption of snacks, and traditional greeting before meals.Several characteristics, including specific knowledge, were associated with the irregular consumption of breakfast. The results are of interest to policy makers, nutrition specialists, and educators working to enhance regular breakfast consumption among students.背景与目的：该研究分析了高中生的特点与不规则早餐消费间的关系，探讨了 日本社区饮食相关知识与饮食教育的关系。方法与研究设计：采用自填式问 卷，于2007 年在日本佐贺伊万里所有高二学生中进行横断面调查。对318 名男 生和292 名女生的数据进行了分析。每周吃3 次及以下早餐称为不规律早餐消 费。使用logistic 回归模型分析调整了性别和学校因素后学生的特点和不规则早 餐消费之间的关系。结果：男生中，果汁和汽水与不规则的早餐消费之间有强 关联（“=2 次”和“很少”相比，OR=8.97，95% CI 为2.99-26.9）。男生清醒 次数和睡觉次数与不规则的早餐消费有关，女生规律排便与不规则的早餐消费 有关。有区域农业和畜产品知识的学生更有可能有规律地吃早餐，而这种关系 在女学生中亦存在（OR=2.89，95% CI=1.23-6.82）。该研究还发现零食摄入量 和餐前传统的问候与不规则的早餐消费有关。结论：一些特征，包括特定的知 识，与不规律早餐消费之间有关系。研究结果有利于政策制定者、营养专家和 教育工作者提高学生的早餐消费量。.

We assessed the relationship of the dietary glycemic index (GI), glycemic load (GL), and intake of carbohydrate and rice, and risk of mortality from stroke and its subtypes. The cohort consisted of 12,561 men and 15,301 women residing in Takayama, Japan, in 1992. At the baseline, a food frequency questionnaire was administered; and the dietary GI, GL, and intake of carbohydrates and rice were estimated. Deaths from stroke occurring in the cohort were prospectively noted until 1999 with data from the office of the National Vital Statistics. The risk of mortality from stroke was assessed with a Cox proportional hazard model after adjusting for age; body mass index; smoking status; physical activity; history of hypertension; education; and intake of total energy, alcohol, dietary fiber, salt, and total fat. The risk of stroke subtypes was assessed in the age-adjusted model. The hazard ratios of total stroke comparing the highest vs the lowest quartiles of the dietary GI were 0.78 (95% confidence interval [CI], 0.41-1.47) with P(trend) = .50 in men and 2.09 (95% CI, 1.01-4.31) with P(trend) = .10 in women. Among women, the association was also significant with the risk of ischemic stroke (hazard ratio = 2.45; 95% CI, 1.01-5.92; P(trend) = .03); and a significant positive trend was also observed between dietary GL and mortality from hemorrhagic stroke (P(trend) = .05). The current study implies that diets with a high dietary GI increase the risk of mortality from stroke among Japanese women.

Although the inverse association between coffee consumption and risk of diabetes has been reported numerous times, the role of caffeine intake in this association has remained unclear. We evaluated the consumption of coffee and other beverages and food containing caffeine in relation to the incidence of diabetes. The study participants were 5897 men and 7643 women in a community-based cohort in Takayama, Japan. Consumption of coffee, green tea, oolong tea, black tea and chocolate snacks were measured with a semi-quantitative FFQ in 1992. At the follow-up survey in 2002, the development of diabetes and the time of diagnosis were reported. To assess the association, age, smoking status, BMI, physical activity, education in years, alcohol consumption, total energy intake, fat intake and women's menopausal status were adjusted. Among men who consumed one cup per month to six cups per week and among those who consumed one cup per d or more, the associated hazard ratios were 0·69 (95 % CI 0·50, 0·97) and 0·69 (95 % CI 0·49, 0·98) compared with those who drank little to no coffee, with a P value for trend of 0·32. The hazard ratios for women with the same coffee consumption patterns were 1·08 (95 % CI 0·74, 1·60) and 0·70 (95 % CI 0·44, 1·12), with a P value for trend of 0·03. The association between estimated total caffeine intake and risk of diabetes was insignificant both among men and among women. The results imply that coffee consumption decreased the risk of developing diabetes. The protective effect may exist aside from the influence of caffeine intake.

Background The Japanese Food Guide Spinning Top was developed by the Japanese Ministry of Health, Labor, and Welfare and the Ministry of Agriculture, Forestry, and Fishery to promote healthful diets. Objective Adherence to the Japanese Food Guide Spinning Top was evaluated in terms of future mortality in a prospective cohort study. Design A prospective cohort study among men and women in a general Japanese population. Subjects/setting The cohort consisted of 13,355 men and 15,724 women residing in Takayama, Japan, in 1992. At baseline, a food frequency questionnaire was administered, and adherence to the food guide was measured based on consuming the recommended number of servings of grains, vegetables, fish and meat, milk, and fruits, as well as total daily energy intake and energy from snacks and alcoholic beverages. Higher scores indicated better adherence to the recommendations on a scale of 0 to 70. Based on data obtained from the Office of the National Vital Statistics, deaths occurring among members of the cohort were prospectively noted from 1992 to 1999. Statistical analyses performed To assess the magnitude of association of adherence scores with subsequent mortality, a Cox proportional hazard model was applied to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Results Among women, the adherence score was significantly associated with a lower risk of mortality from all causes (comparing highest and lowest quartiles of the score, HR 0.78, 95% CI 0.65 to 0.94, P for trend 0.01) in a multivariate analysis; noncardiovascular, noncancer causes (HR 0.69, 95% CI 0.50 to 0.96, P for trend 0.04) and cardiovascular disease (HR 0.76, 95% CI 0.56 to 1.04, P for trend0.05). No statistically significant association was observed between the adherence score and mortality among men. Conclusions The results suggest that diets based on the food guide have the benefit of reducing future mortality in women.

Melatonin, which is contained in certain vegetables, may have an influence on circulatory melatonin concentrations. This study examined the effects of the consumption of vegetables on 6-sulfatoxymelatonin concentrations in morning urine. Ninety-four healthy women aged 24-55 were recruited through a city public health center in Japan. The women randomly allocated to the intervention group were requested to consume high amounts of six selected vegetables, with a target of 350 g/day for 65 days, while those in the control group were asked to avoid the same six vegetables during the same period. First-void morning urine was collected before and at the end of the intervention period, and creatinine-adjusted 6-sulfatoxymelatonin concentrations were measured. At the end of the intervention period, daily mean intake of melatonin from the six vegetables was 1288.0 ng in the intervention group and 5.3 ng in the control group. In the intervention group, the mean concentration of 6-sulfatoxymelatonin changed from 48.1 [95% confidence interval (CI): 40.4-57.2] ng/mg creatinine to 49.6 (95% CI: 42.8-57.3) ng/mg creatinine across the intervention period. In the control group, the mean concentration of 6-sulfatoxymelatonin changed from 55.5 (95% CI: 48.7-63.2) ng/mg creatinine to 50.8 (95% CI: 44.0-58.7) ng/mg creatinine across the intervention period. A comparison of the two groups with regard to the changes in the 6-sulfatoxymelatonin concentrations across the intervention period showed a significant difference (P = 0.03). The results indicate that increased consumption of vegetables raises circulatory melatonin concentrations.

We investigated the association between body mass index (BMI) values and the risk of death from stomach cancer later in life. From 1992 to 2000, 28 443 participants (13 211 men and 15 232 women) were followed, and 129 deaths from stomach cancer (86 men and 43 women) occurred. BMI (BMI at the baseline) and BMI20y (BMI at age 20 years) were obtained by questionnaire at the beginning of the study. Men in the middle and highest tertiles of BMI20y had a higher risk of death from stomach cancer than those in the lowest tertile (after controlling for covariates, hazard ratio [HR] = 2.73 with 95% confidence interval [CI] 1.26–5.89 for the middle tertile; HR = 2.15 with 95% CI 0.97–4.73 for the highest tertile), although there was no significant trend (P = 0.30). Likewise, women in the middle and highest tertiles of BMI20y had an increased risk of death from stomach cancer (HR = 5.17 with 95% CI 1.50–17.87 for the middle tertile; HR = 4.22 with 95% CI 1.18–15.05 for the highest tertile; P for trend = 0.05). The analysis of BMI at the baseline did not show a significant relationship with the risk of death from stomach cancer. These results suggest that a high BMI20y is associated with an increased risk of death from stomach cancer. (Cancer Sci 2007; 98: 1785–1789)

The relationship of the intake of soy products and the incidence of colon cancer was prospectively evaluated in a population-based cohort study in Japan. The total intake of soy products and isoflavones in a daily diet was estimated from a validated questionnaire administered at the baseline. The participation rate of the questionnaire was 92.0%. The participants were followed from 1992 to 2000, and colon cancer diagnoses were identified at the main hospitals in the study area. In the analysis, 13,894 men and 16,327 women were included. The medians for energy-adjusted soy product intake were 85.52 g/day for men and 79.60 g/day for women. During follow-up, 111 men and 102 women were diagnosed with colon cancer. A Cox-proportional hazard model was applied to assess the risk of colon cancer incidence. Among women, the risk was reduced with an increased soy product consumption; the hazard ratio in the highest tertile was 0.56 (95% CI 0.34-0.92) compared as the lowest tertile (trend: P=0.04), after adjusting for multiple potential confounders. Among men, no significant association was observed. Our results exhibited the weak benefit of soy foods only among women. Further research to confirm our results may be beneficial.

To evaluate the effect of a previous indication of hyperglycemia or previous diagnosis of diabetes on quality of life (QOL) in a randomly selected population from Gifu City, Japan. In total, 452 males and 648 females were enrolled in this study. We collected information on previous indications of hyperglycemia and previous diagnoses of diabetes using a self-reported questionnaire. Participants also completed the World Health Organization Quality of Life-26 (WHOQOL-26) questionnaire and provided blood samples for the measurement of fasting plasma glucose and glycated hemoglobin levels. A 75-g oral glucose tolerance test was also performed. We compared QOL scores between the previous indication of hyperglycemia group and previous diagnosis of the diabetes group to those of the control group. WHOQOL-26 scores were significantly lower in the previous diagnosis of diabetes group than in the control group (3.23 ± 0.43 vs. 3.45 ± 0.43; p

A decreased risk of breast cancer has been reported among women who have longer menstrual cycles or anovulatory cycles. The present study examined the relationships between intake of fat, soy, and dietary fiber and length of menstrual cycle among 341 Japanese women aged 18 to 29 yr old at two colleges and three nursing schools. Intake of nutrients and foods including fats, dietary fiber, and soy products was estimated through the use of a validated semi-quantitative food frequency questionnaire. The mean cycle length was determined for each women based on a prospective record of menstruation. Polyunsaturated fat intake was significantly inversely associated with cycle length; the means of cycle length were 33.2 and 31.0 days for the lowest and the highest quintiles of intake, respectively, after controlling for covariates (trend = 0.03). The odds ratio of a long cycle (35 days) for the highest vs. lowest quintile of dietary fiber intake was 2.12 (95% confidence interval 1.00-4.47), although the trend was not statistically significant. The data suggest that polyunsaturated fat and dietary fiber intake are associated with the parameters of menstrual cycle length, but further studies are required to better characterize these associations.

Objective Evidence is sparse and contradictory regarding the association between low-carbohydrate diet score and type 2 diabetes risk, and no prospective study examined the association among Asians, who consume greater amount of carbohydrate. We prospectively investigated the association of low-carbohydrate diet score with type 2 diabetes risk. Methods Participants were 27,799 men and 36,875 women aged 45–75 years who participated in the second survey of the Japan Public Health Center-Based Prospective Study and who had no history of diabetes. Dietary intake was ascertained by using a validated food-frequency questionnaire, and low-carbohydrate diet score was calculated from total carbohydrate, fat, and protein intake. The scores for high animal protein and fat or for high plant protein and fat were also calculated. Odds ratios of self-reported, physician-diagnosed type 2 diabetes over 5-year were estimated by using logistic regression. Results During the 5-year period, 1191 new cases of type 2 diabetes were self-reported. Low-carbohydrate diet score for high total protein and fat was significantly associated with a decreased risk of type 2 diabetes in women (P for trend

Dietary guidelines generally recommend avoiding a high-fat diet. However, the relationship between fat subtypes and mortality remains unclear especially in a population with a relatively low intake of fat. We aimed to prospectively examine the relationship between dietary fat intake and all-cause and cause-specific mortality in a Japanese community. In 1992, a total of 28,356 residents of Takayama, Japan, without cancer, stroke, or coronary heart disease, responded to a validated 169-item FFQ. We identified 4616 deaths during a 16-y follow-up. The HR of mortality according to the percentage of energy from the total and subtypes of fat when substituted for an isoenergic quantity of carbohydrate was calculated after controlling for potential confounders. A high intake of total fat and PUFA was associated with a decrease in all-cause mortality in men; the HR for the highest compared with the lowest quintile were 0.83 (95% CI: 0.70, 0.99; P-trend = 0.048) for total fat and 0.77 (95% CI: 0.62, 0.95; P-trend = 0.05) for PUFA. Both fats were associated with a decrease in mortality from cancer and diseases other than cardiovascular disease. In women, a higher SFA intake was associated with higher all-cause mortality [HR = 1.22 (95% CI: 0.99, 1.49; P-trend = 0.03)]. A favorable effect was suggested for total fat and PUFA intakes on mortality in men except for that from cardiovascular disease, whereas increased SFA intake may be associated with adverse health consequences in women.

Background Although fish intake can improve glucose metabolism, results of some prospective studies in Western populations suggest potential adverse effects of environmental contaminants in fish on type 2 diabetes risk. However, data from populations with high fish consumption are scarce. Objective We prospectively investigated the association between fish intake and type 2 diabetes risk in Japanese adults. Design The participants were 22,921 men and 29,759 women aged 45-75 y who completed a questionnaire of the second survey for the Japan Public Health Center-based Prospective Study and who had no history of diabetes. Diet was ascertained by using a 147-item food-frequency questionnaire. ORs of self-reported, physician-diagnosed type 2 diabetes over 5 y were estimated by using logistic regression. Results During the 5-y period, 971 new cases (572 men and 399 women) of type 2 diabetes were self-reported. In men, fish intake was significantly associated with a decreased risk of type 2 diabetes; multivariable-adjusted ORs of type 2 diabetes for the highest compared with the lowest quartile of intake were 0.73 (95% CI: 0.54, 1.00; P-trend = 0.04) for total fish and seafood and 0.68 (95% CI: 0.50, 0.92; P-trend = 0.016) for small and medium fish (horse mackerel and sardine, saury and mackerel, and eel). Additional analysis by fat content of fish did not detect any significant association for each category. In women, fish intake was not appreciably associated with type 2 diabetes risk. Conclusion In a population with high fish and seafood intake, fish consumption was associated with a lower risk of type 2 diabetes in men but not in women.

Daily diet may have implications for skin ageing. However, data on the relationship between diet and the parameters of skin conditions are scarce. The present study aimed to examine the associations of biophysical properties of the skin of women with intakes of fats and antioxidant micronutrients as well as food groups as sources of these nutrients. In a cross-sectional study, we measured the hydration, surface lipids and elasticity of the skin of 716 Japanese women using non-invasive techniques. The extent of facial wrinkles in the crow's-foot area was determined by observation using the Daniell scale. Each subject's usual diet was determined with the use of a validated FFQ. After controlling for covariates including age, smoking status, BMI and lifetime sun exposure, the results showed that higher intakes of total fat, saturated fat and monounsaturated fat were significantly associated with increased skin elasticity. A higher intake of green and yellow vegetables was significantly associated with a decreased Daniell wrinkling score. Intake of saturated fat was significantly inversely associated with the Daniell wrinkling score after additional adjustment for green and yellow vegetable intake. Further studies with more accurate measurement methods are needed to investigate the role of daily diet in skin ageing.

Certain dietary components which could affect oestrogen may have implications in the aetiology of uterine fibroids. We previously found that soya intake was inversely associated with a subsequent risk of hysterectomy, suggesting a potentially protective effect of soya against uterine fibroids, the major clinical indication for hysterectomy. We cross-sectionally assessed the associations of intakes of fat, soya foods, dietary fibre and alcohol with uterine fibroids. Study subjects were 285 premenopausal Japanese women participating in a health-check up programme, including gynaecological examinations, provided by a general hospital between October 2003 and March 2006. The presence of fibroids was confirmed by transvaginal sonogram. If women had undergone hysterectomy, self-report of fibroids was accepted. Each subject's usual diet, including alcohol, was determined with the use of a validated FFQ. Fifty-four women were identified as prevalent cases of fibroids or having had hysterectomy due to fibroids. The mean alcohol intake was statistically significantly higher among women with fibroids than among those without fibroids after controlling for known or suspected risk factors. For the highest compared with the lowest tertile of alcohol intake, the OR of uterine fibroids was 2.78 (95% CI 1.25, 6.20). There was no significant association of intake of fats, soya isoflavones or dietary fibre with uterine fibroids. The data suggest that higher alcohol intake is associated with a higher prevalence of uterine fibroids. Further studies on diet, especially phyto-oestrogens, and uterine fibroids are needed given the limited data currently available.

Background Although smoking is a well-known risk factor for the onset of airway diseases, the associations between smoking and asthma are inconsistent. Objective To examine the relationship of smoking in adulthood with the occurrence of asthma in Japanese individuals. Methods A total of 6,674 men and 8,301 women from a population-based cohort in Takayama, Japan, participated in this prospective study. Information on smoking was collected via a baseline questionnaire in 1992. In 2002, development of asthma and the time of physician diagnosis were reported. Results During 10-year follow-up, 105 men and 92 women reported the onset of physician-diagnosed asthma. Among men, compared with never smokers, current smokers at baseline had a significantly increased risk of asthma after adjustment for covariates (hazard ratio [HR], 2.79; 95% confidence interval [CI], 1.18–6.55), whereas women with a current or former history of smoking were at an increased but not significant risk of asthma (HR, 1.18; 95% CI, 0.58–2.38). An approximately 2- to 5-fold increased risk of asthma was observed in men who smoked for more than 30 years or more than 21 cigarettes daily, with a nonsignificant linear trend, but there was no dose-response relationship in current-smoking women. Ever-smoking women with husbands who were ever smokers had a higher risk of asthma (HR, 2.02; 95% CI, 0.72–5.65) than never-smoking women with husbands who had never smoked either. Conclusion These data suggest that smoking increases the risk of asthma onset in men.

Background: Diabetes mellitus has been reported to be a major risk factor for cardiovascular disease (CVD), and higher risk of CVD among women than that among men has been observed in many studies. Further, the association of diabetes with increasing risk of cancer has also been reported. Well-designed studies conducted among men and women in the general Japanese population remain scarce. Methods: Our cohort consisted of 13355 men and 15724 women residing in Takayama, Japan, in 1992. At the baseline, the subjects reported diabetes in a questionnaire. Any deaths occurring in the cohort until 1999 were noted by using data from the Office of the National Vital Statistics. The risk of mortality was separately assessed for men and women by using a Cox proportional hazard model after adjusting for age; smoking status; body mass index (BMI); physical activity; years of education; history of hypertension; and intake of total energy, vegetables, fat, and alcohol. Results: Diabetes significantly increased the risk of mortality from all causes [hazard ratio (HR): 1.35, 95% confidence interval (CI): 1.11-1.64] and from coronary heart disease (CHD) (HR: 2.96, 95% CI: 1.59-5.50) among men, and that from all causes (HR: 1.74, 95% CI: 1.34-2.26) and cancer (HR: 1.88, 95% CI: 1.16-3.05) among women. Diabetes was not significantly associated with mortality from CHD among women. Conclusion: The findings suggest that diabetes increases the risk of mortality from CVD among men and that from cancer among women. The absence of increased risk of mortality from CHD among women may suggest a particular pattern in the Japanese population.

Although soy isoflavone has been suggested to have both immune-enhancing and immune-suppressive effects, the effects of soy isoflavone intake on allergic disorders are unclear. A cross-sectional study indicated that a high intake of soy isoflavone is associated with a decreased risk of allergic rhinitis. We aimed to prospectively examine the relationship between soy isoflavone intake and risk of cedar pollinosis, the most common seasonal allergic rhinitis in Japan. The study was conducted in a population-based cohort of Japanese men and women. Each subject's usual diet, including soy isoflavone intake, was determined with the use of a validated FFQ in 1992. In 2002, a total of 11,229 persons who were 35-69 y old and had no history of cancer or allergic diseases at the baseline responded to a follow-up questionnaire asking about 4 symptoms related to cedar pollinosis. Cox hazard regression model was used to determine the association between soy isoflavone intake and the risk of cedar pollinosis. During the 10-y follow-up, 931 of these subjects reported that they had cedar pollinosis. There was no significant association between soy isoflavone intake and risk of cedar pollinosis in men and women after controlling for covariates. For the highest compared with the lowest quartile of soy isoflavone intake, hazard ratios were 1.07 (95% CI: 0.81-1.42) in men and 0.89 (95% CI: 0.68-1.15) in women. These data did not support an association between soy isoflavone intake and risk of cedar pollinosis.

Some epidemiological studies undertaken in Western countries have demonstrated that high intake of fruit and vegetables results in decreased risk of cardiovascular disease (CVD). The objective of this study was to examine the hypothesis that high intake of fruit and vegetables lowers CVD mortality in a population-based cohort of Japanese subjects. In 1992, fruit and vegetable intake was assessed in 13,355 men and 15,724 women in Takayama, Gifu, Japan using a validated FFQ. During the follow-up (1992-99), 200 men and 184 women died from CVD. For women, the highest quartile of vegetable intake compared with the lowest was marginally significant and inversely associated with CVD mortality after adjusting for total energy, age, and nondietary and dietary covariates [hazard ratio (HR) = 0.62; 95% CI, 0.36-1.08; P-trend = 0.007]. An inverse trend with borderline significance was also observed in fruit intake, excluding CVD deaths in the first 2 y of this study, after adjusting for the above-mentioned covariates (HR = 0.83; 95% CI, 0.51-1.34; P-trend = 0.10). In men, CVD death was not associated with fruit (HR = 1.16; 95% Cl, 0.77-1.74; P-trend = 0.61) and vegetable (HR = 0.81, 95% CI: 0.49-1.34; P-trend = 0.47) intake. These data suggest that higher intake of vegetables is associated with reduced risk of death from CVD for women.

The objective of this study was to evaluate the causal attributions for breast cancer and their association with the subsequent psychological adjustment. Sixty-three Japanese patients newly diagnosed with breast cancer were asked by an interviewer about risk factors and explanations for the etiology of breast cancer using a four-point scale. The General Health Questionnaire (GHQ-28) and the Center for Epidemiologic Studies Depression Scale (CES-D) were administered about 2 months later to measure psychological adjustment to the illness. The relationship between each causal attribution and measure of psychological adjustment was assessed with the Spearman rank correlation after adjusting for potential confounders (age, marital status, cancer stage at diagnosis, time between the day of diagnosis and follow-up, and physical symptoms at the follow-up). Attributions to several explanations, including “stress” and “personal characteristics,” were positively associated with the GHQ-28 measures. Of the attributions to risk factors, “body size” was significantly inversely (r = −0.29) associated and “never having children” was insignificantly and highly inversely (r = −0.77) associated with the GHQ-28 measures, indicating better adjustment to the illness. On the other hand, the attribution to “tobacco” was significantly and positively associated with the GHQ-28 measures (r = 0.34), indicating that the attributions antagonized adjustment to the illness. The current study indicates that forming causal attributions influences the adjustment to the illness in Japanese breast cancer patients and attributions to certain risk factors for breast cancer may contribute to better adjustment.

Background: Pollinosis induced by the cedar pollen antigen is the most common seasonal allergic reaction in Japan. We aimed to examine the relationship between smoking and risk of cedar pollinosis in a population-based cohort of the Japanese. Methods: Study subjects were 12,221 men and women from the Takayama Study cohort who were 35–69 years old at enrollment in 1992. A follow-up survey in 2002 was used to obtain information about four symptoms related to cedar pollinosis. Results: A total of 1,000 subjects had cedar pollinosis during the 10-year follow-up. As compared with those who had never smoked, current smokers at the baseline were at a significantly decreased risk of cedar pollinosis after controlling for covariates in men (hazard ratio [HR]: 0.64, 95% CI: 0.50–0.83) as well as in women (HR: 0.64, 95% CI: 0.47–0.88). There was a significant dose-response relationship between the risk of cedar pollinosis and the number of cigarettes smoked each day as well as with the number of years an individual had smoked. A significant risk reduction was observed among men and women who had continued to smoke cigarettes during the follow-up period in comparison with those who had never smoked. There was no risk increase for former smokers at the baseline as well as for those who quit smoking during the follow-up. Conclusions: Some components of tobacco may protect against cedar pollinosis. Our finding could provide clues about therapeutic strategies for protection against cedar pollinosis.

High hemoglobin A1c (HbA1c) levels are strongly associated with an increased risk of cardiovascular disease (CVD) in people with and without diabetes. However, information regarding the relationship between low HbA1c levels and the risk of CVD among people without known diabetes is limited. The aim of this large-scale, prospective, population-based cohort study was to clarify the association between HbA1c levels and CVD risk among people without known diabetes. We followed-up 10,980 men and 18,079 women (46–80 years old and free of CVD and cancer at baseline) in the Japan Public Health Center-based Prospective Study. Using Cox models, we estimated the hazard ratios for CVD risk with adjustments for age, sex, geographic areas, body mass index, smoking status, sports and physical exercise, alcohol intake, systolic blood pressure, non-high-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. During the median follow-up of 9.4 years, 935 CVD events (770 strokes and 165 coronary heart diseases) occurred. We observed a nonlinear association between HbA1c levels and CVD risk in participants without known diabetes. Compared with HbA1c levels of 5.0 to 5.4% (31–36 mmol/mol), the hazard ratios for CVD in participants without known diabetes were 1.50 (95% confidence interval: 1.15–1.95), 1.01 (0.85–1.20), 1.04 (0.82–1.32), and 1.77 (1.32–2.38) for HbA1c levels of