Japanese-American Men Research Articles

Abstract PR9: Diabetes and racial/ethnic differences in hepatocellular carcinoma risk: The Multiethnic Cohort

Abstract Background: Hepatocellular carcinoma (HCC) incidence has tripled in the US over the past three decades. Diabetes has been suggested as an emerging risk factor for HCC and its increasing prevalence may contribute to the rising incidence of HCC. Data from prospective studies on the relationship between diabetes and HCC in multiethnic populations are scarce. Here we examined whether the association between diabetes and HCC risk differs across racial/ethnic groups, and whether the association is modified by known HCC risk factors. Methods: We conducted a prospective analysis of 169,479 African-American, Native Hawaiian, Japanese-American, Latino and white men and women who were recruited into the Multiethnic Cohort (MEC) Study between 1993 and 1996. During a median follow-up period of 15.7 years, a total of 506 incident HCC cases (59 whites, 81 African Americans, 33 Hawaiians, 158 Japanese, and 175 Latinos) were identified among the cohort participants. Data on known and suspected risk factors were obtained from baseline questionnaire. Serologic testing for hepatitis B (HBV) and C (HCV) infection was performed on a subset of cohort subjects (233 cases and 460 non cases). Cox proportional hazards models stratified by sex and adjusted for age, alcohol drinking, body mass index (BMI in kg/m2) and cigarette smoking were used to calculate relative risks (RRs) and 95% confidence intervals (CIs) for HCC associated with diabetes for each ethnic group. The population attributable risk percent associated with diabetes was also calculated for each ethnic group. Results: Incidence rates of HCC markedly differed across race/ethnic groups; the age-adjusted RRs for HCC (vs. whites) were 2.77 (95% CI: 2.03, 3.78) for Latinos, 2.48 (95% CI: 1.59, 3.86) for Native Hawaiians, 2.16 (95% CI: 1.52, 3.07) for African Americans, and 2.07 (95% CI: 1.51, 2.38) for Japanese. The age- and sex-adjusted prevalence of diabetes at baseline also varied across ethnic groups: 16% in Hawaiians, 15% in Latinos, 15% in African Americans, 10% in Japanese, and 6% whites (P<0.0001). Diabetes was strongly associated with HCC risk in all ethnic groups (P-heterogeneity=0.40); the RR was 3.33 (95% CI: 2.39, 4.63) in Latinos, 2.54 (95% CI: 1.13, 5.70) in Hawaiians, 2.33 (95% CI: 1.60, 3.40) in Japanese, 2.02 (95% CI: 1.17, 3.49) in African Americans, and 2.17 (95% CI: 0.95, 4.93) in whites. BMI, smoking status, and alcohol intake did not modify the diabetes-HCC association (P interaction ≥ 0.19). Within a subset of cohort participants with available HBV and HCV serologic data, diabetes was not associated with infection status (P ≥ 0.07). We estimated that 26% of HCC cases in Latinos, 20% in Hawaiians, 13% in African Americans, 12% in Japanese, and 6% in whites were attributed to diabetes. Conclusions: In the MEC, Latinos were at the highest risk of developing HCC, followed by Native Hawaiians, African Americans, Japanese and whites. We showed that diabetes is a strong risk factor for HCC in all ethnic groups and that the inter-ethnic differences in the prevalence of diabetes was consistent with the pattern of HCC incidence observed across ethnicities. Finally, we showed that eliminating diabetes could potentially reduce HCC incidence in all racial/ethnic groups, with the largest potential for reduction in Latinos. This abstract is also presented as Poster C91. Citation Format: Veronica Wendy Setiawan, Brenda Hernandez, Daniel Stram, Lynne Wilkens, Loic Le Marchand, Brian E. Henderson. Diabetes and racial/ethnic differences in hepatocellular carcinoma risk: The Multiethnic Cohort. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr PR9. doi:10.1158/1538-7755.DISP13-PR9

Abstract LB-261: Atopic allergic conditions and colorectal cancer risk in the Multiethnic Cohort

Abstract Previous studies have provided suggestive evidence of an inverse association between atopic allergic conditions (AAC) and colorectal cancer (CRC) incidence and mortality in predominantly White populations. Here we examined the association between AAC and CRC among White, African American, Native Hawaiian, Japanese American, and Latino men and women in the Multiethnic Cohort (MEC). AAC exposure status was ascertained via self-reported physician diagnosis using a baseline 26-page validated questionnaire. The analysis included 4259 incident CRC cases and 1221 CRC-related deaths ascertained between 1993 and 2010. We also examined associations by ethnic group, location, and stage of cancer as well as potential effect modification by CRC risk factors. AAC was associated with a reduced risk of colorectal cancer incidence among both men and women (RR = 0.85, 95% CI 0.79, 0.91, p < 0.0001). The reduction in risk was noted in each population and was significant in Whites (RR = 0.84, 95% CI 0.71, 0.98, p = 0.03), African Americans (RR = 0.81, 95% CI 0.69, 0.95, p = 0.01), and Japanese Americans (RR = 0.85, 95% CI 0.75, 0.97, p = 0.01). Suggestive evidence of effect modification was noted by smoking (p = 0.07) and aspirin use (p = 0.08), with a greater protective effect observed among current smokers (RR = 0.72, 95% CI 0.58, 0.89, p = 0.002) and never users of aspirin (RR = 0.81, 95% CI 0.73, 0.89, p < 0.0001). Individuals with AAC also had a 19% reduction in CRC-related mortality (P = 0.004). Colonoscopy screening is unlikely to explain these inverse associations, as individuals with AAC were more likely to be screened than those without AAC (p < 0.003 for all ethnic groups). These findings provide support for an association between immune pathology and colorectal cancer, potentially through modulation of the immune system's IgE-mediated pathways systemically and within the gut. Citation Format: Neal A. Tambe, Dan O. Stram, Lynne R. Wilkens, Peggy Wan, Frank D. Gilliland, Brian E. Henderson, Loic Le Marchand, Christopher A. Haiman. Atopic allergic conditions and colorectal cancer risk in the Multiethnic Cohort. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-261. doi:10.1158/1538-7445.AM2014-LB-261

Abstract LB-281: Coffee intake reduces hepatocellular carcinoma risk: The Multiethnic Cohort

Abstract Background: Coffee consumption has been suggested to reduce hepatocellular carcinoma (HCC) risk in epidemiological studies. Yet, data from prospective studies in US populations are nonexistent. Here we evaluated the association between coffee intake and HCC incidence in multiethnic US populations. Methods: We conducted a prospective analysis of 179,890 African-American, Native Hawaiian, Japanese-American, Latino and white men and women who were recruited into the Multiethnic Cohort Study between 1993 and 1996. Participants reported their coffee consumption and other dietary and lifestyle factors at baseline and were followed up to 18 years for HCC incidence. Serologic testing for hepatitis B (HBV) and C (HCV) infection was performed on a subset of cohort participants (152 HCC cases and 460 non-cases). Hazard rate ratios (RRs) and 95% confidence intervals (CIs) were calculated using Cox regression adjusting for sex, ethnicity, education, alcohol intake, smoking status, body mass index (BMI), and history of diabetes mellitus. Results: During a median follow-up period of 16.6 years, 498 participants had developed HCC. High levels of regular coffee consumption were associated with reduced risk of HCC (P for trend <0.0001). Compared to non-drinkers/low consumers (up to six cups per week) of coffee, individuals who consumed one to three cups of coffee per day had a 29% reduction in risk of HCC (RR=0.71; 95% CI: 0.60, 0.86) and those who had four or more cups of coffee per day had a 42% reduction in risk of HCC (RR=0.58; 95% CI: 0.36, 0.92). The inverse relationships between coffee and HCC were similar regardless of the participants’ ethnicity, sex, BMI, smoking status, alcohol intake, or diabetes status. Within a subset of cohort participants with available HBV and HCV serologic data, coffee consumption was not associated with infection status (P=0.63). Conclusions: These results suggest that an increased coffee consumption may reduce the risk of developing HCC in multiethnic US populations. Citation Format: Veronica Wendy Setiawan, Lynne R. Wilkens, Brenda Y. Hernandez, Loic Le Marchand, Brian E. Henderson. Coffee intake reduces hepatocellular carcinoma risk: The Multiethnic Cohort. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-281. doi:10.1158/1538-7445.AM2014-LB-281

Abstract P039: Brachial-ankle Pulse Wave Velocity is Independently Associated with Presence of Coronary Calcification among 1131 Healthy Middle-aged Men. The ERA JUMP Study

Objective: In an international population-based cross-sectional study among men aged 40-49 years, we examined the association between brachial-ankle pulse wave velocity (baPWV): a biomarker of combined arterial stiffness of central and peripheral arteries, and the presence of coronary artery calcification (CAC). Methods: Out of 1,335 men without clinical cardiovascular disease recruited during 2002-06, a total of 204 participants taking anti-hypertensive medications, or having missing data were excluded. Remaining participants were 281 Whites and 83 Blacks in Pittsburgh, 235 Japanese Americans in Honolulu, 280 Koreans in Ansan, South Korea, and 292 Japanese in Kusatsu, Japan. baPWV was measured using automated waveform analyzer (VP2000, Omron, Japan). Intra-class correlations of baPWV within and between technicians were 0.97 and 0.91 respectively. CAC was determined using electron-beam computed tomography (Imatron C-150) at all centers; all images were read at University of Pittsburgh by trained staff. Using logistic regression, presence of CAC (≥ 10 Agatston Units) was evaluated with increasing baPWV as a predictor variable (per 100 cm/s; per 1 SD change). Results: Prevalence of CAC among individual racial groups was Whites (25%), Blacks (16%), Japanese Americans (28%), Japanese (10%), and Koreans (10%). Overall, increased baPWV was significantly associated with presence of CAC in unadjusted model (Odds ratio=1.31, 95% CI 1.20, 1.44) as well as multivariable adjusted model (Odds ratio=1.19, 95% CI 1.06, 1.35). There was no effect-modification by race in the models. Similar odds ratios for presence of CAC with increasing baPWV were seen for individual races, but were statistically non-significant among Japanese American men and Japanese men in Japan, possibly due to inadequate power. Conclusion: Increasing baPWV is associated with presence of CAC, independent of other cardiovascular disease risk factors.

Abstract P343: Racial Differences In The Progression Of Carotid Intima-media Thickness In Middle-aged Men-the Era Jump Study

Introduction: Intima-media thickness (IMT) of the carotid artery is an independent predictor of future cardiovascular events. A few studies have examined the racial differences in IMT progression. We aimed to study the racial differences in IMT progression over 4-6 years among middle-aged Caucasian, African and Japanese American men. Methods: Population-based samples of 393 men (Caucasian=199, African Americans=39, Japanese Americans=155; aged 40-49 years at baseline) free of clinical cardiovascular disease and not on lipid lowering, anti-diabetic or anti-hypertension medications at baseline were examined for IMT at two time points (baseline (2004-07) and follow-up (2008-13). Measurements of IMT were standardized and performed by University of Pittsburgh. Progression of IMT was defined as (follow-up IMT [[Unable to Display Character: –]] baseline IMT)/duration of follow-up (years). Multivariable linear regression analyses were used and models were adjusted for traditional cardiovascular risk factors (Table). Results: In the unadjusted analyses, IMT progression was significantly associated with age and race, and marginally significantly associated with systolic blood pressure and diabetes. The progression rate of IMT (mean ± SE) was the highest in Japanese American (16 ± 1.2μm/year) compared with Caucasian (10.3 ± 1.0μm/year; P < 0.01) and African American men (3 ± 2μm/year; P < 0.01). In the adjusted analyses, age and race remained significantly associated with IMT progression. Japanese Americans progressed significantly faster than Caucasians. African Americans progressed slower than Caucasians but this difference was not significant. Diabetes was marginally significantly associated with IMT progression. Conclusions: Age and race are the major determinants of IMT progression in these middle-aged men. Racial differences in progression are prominent with fastest progression in Japanese Americans.

Low Dietary Vitamin D in Mid-Life Predicts Total Mortality in Men with Hypertension: The Honolulu Heart Program

Background: Vitamin D deficiency was associated with total mortality in previous epidemiological studies. Little is known about the effects of dietary vitamin D intake on mortality. We examined the association between mid-life dietary vitamin D intake and 45-year total mortality. Methods: The Honolulu Heart Program is a longitudinal cohort study of 8006 Japanese American men in Hawaii aged 45 to 68 at baseline (1965–1968). Mid-life dietary vitamin D intake was calculated from 24-hour dietary recall using Nutritionist IV v3 software. We divided subjects into quartiles of dietary vitamin D. Total mortality data were available over 45 years through 2010. Results: Age-adjusted total mortality rates were higher in the lower quartiles of dietary vitamin D intake compared to the highest (p for trend = 0.011). Using Cox regression, low dietary vitamin D was significantly associated with total mortality; quartile (Q) 1 hazard ratio (HR) = 1.14, 95% confidence interval (95% CI) = 1.07–1.22, p < 0.001; Q2 HR = 1.11, 95% CI = 1.04–1.18, p = 0.002; and Q3 HR = 1.08, 95% CI = 1.01–1.15, p = 0.027; Q4 = reference. After adjusting for age, kilocalories, cardiovascular risk factors, and prevalent chronic diseases, only Q2 remained significant (HR = 1.08, 95% CI = 1.00–1.15, p = 0.037). Among hypertensive subjects only, those in the lower 2 quartiles had higher total mortality; Q1 HR = 1.12, 95% CI = 1.01–1.25, p = 0.039, and Q2 HR = 1.13, 95% CI = 1.02–1.26, p = 0.025, compared to Q4. There was no significant relationship in subjects without hypertension. Conclusions: Low dietary vitamin D intake in mid-life was a weak predictor of total mortality over 45 years of follow-up. We found a significant association between low dietary vitamin D intake and higher total mortality only among hypertensive subjects. Vitamin D may have cardioprotective effects.

Proteinuria in midlife and 39-year total mortality: the Honolulu Heart Program

BackgroundPrevious population-based studies have shown that proteinuria is an independent predictor of total mortality. However, no studies have examined multiple proteinuria measurements or had a follow-up period longer than two decades. MethodsProteinuria was measured by urine dipstick on 6,815 Japanese–American men on two occasions, 6 years apart. Participants were classified into the “no proteinuria” group if both examinations were negative, “transient proteinuria” if either was positive, and “persistent proteinuria” if both were positive and followed for total mortality over 39 years. ResultsPrevalence of transient and persistent proteinuria was 6.4% and 1.3%, respectively. Age-adjusted total mortality rates were 41.9, 55.0, and 71.9 per 1000 person-years follow-up for no, transient, and persistent proteinuria groups, respectively (p for trend <.0001). Multivariate Cox proportional hazards models showed increased total mortality risk in a dose-response manner: HR, 1.40; P < .001 and HR, 2.26; P < .001 for transient and persistent proteinuria groups, respectively (using no proteinuria as reference). Stratified analyses showed stronger associations between proteinuria and mortality among those with prevalent cardiovascular diseases compared with those without. ConclusionsProteinuria was independently associated with higher total mortality risk over 39 years. This risk was stronger among high-risk populations but also remained significant in low-risk populations. Simple urine dipstick can be a good risk assessment tool in the general population.

Incidence Rates of Dementia, Alzheimer Disease, and Vascular Dementia in the Japanese American Population in Seattle, WA

There are few studies on the incidence of dementia in representative minority populations in the United States; however, no population-based study has been conducted on Japanese American women. We identified 3045 individuals aged 65+ with at least 1 parent of Japanese descent living in King County, WA in the period 1992 to 1994, of whom 1836 were dementia-free and were examined every 2 years (1994 to 2001) to identify incident cases of all dementias, Alzheimer disease (AD), vascular dementia (VaD), and other dementias. Cox regression was used to examine associations with age, sex, years of education, and apolipoprotein (APOE)-ε4. Among 173 incident cases of dementia, the overall rate was 14.4/1000/y, with rates being slightly higher among women (15.9/1000) than men (12.5/1000). Rates roughly doubled every 5 years for dementia and AD; the age trend for VaD and other dementias was less consistent. Sex was not significantly related to incidence of dementia or its subtypes in adjusted models. There was a trend for an inverse association with increasing years of education. APOE-ε4 was a strong risk factor for all dementias [hazard ratio (HR)=2.89; 95% confidence interval (CI), 1.88-4.46], AD (HR=3.27; 95% CI, 2.03-5.28), and VaD (HR=3.33; 95% CI, 1.34-8.27). This study is the first to report population-based incidence rates for both Japanese American men and women.

Culturally Related Health Risks: Gastric Cancer and Asian Americans

ulture influences health status. Cultural awareness on the part of health care proCviders improves both health outcomes and care quality. Gastric cancer is a leading cause of death worldwide, particularly in Eastern Asians (Chinese, Japanese, Koreans, Mongolians). The incidence rate for gastric cancer was number 1 among Eastern Asians in 2008 (30 per 100,000 populations), which is about 6 in 10 new cases. Korea has the highest rate of gastric cancer (41.4 per 100,000) among Asians, followed by Mongolia (34 per 100,000), Japan (31.1 per 100,000), and China (29.9 per 100,000). Gastric cancer in the United States is the 14th leading cancer, with 21,600 new cases and 10,990 deaths in 2013. According to the 2006-2010 California cancer incidence data, which is the only available data for individual Asians, gastric cancer is the 3rd most common cancer in both Korean American men and women in California and the 5th most common in Japanese and Vietnamese American men. Although nationwide campaigns are regularly mounted to screen for breast, cervical, and colorectal cancers in the US, gastric cancer screening is totally overlooked, perhaps because of its low incidence among non-Hispanic whites. Asian Americans have been largely neglected with regard to health status assessment, program development, and resource allocation. Absence of national guidelines for gastric cancer screening and a lack of awareness of culturally related health risks by US health care providers has hindered early detection and treatment of gastric cancer in Asian Americans. Therefore, gastric cancer is frequently diagnosed in a later stage with a lower cure rate. For example, the 5-year survival rate was 67% in Korea from 20062010, whereas the survival rate was 26.9% in America from 2002-2008. Asian Americans are the fastest growing minority population in the US, currently numbering more than 17 million (nearly 6% pecent of the population), an increase of 43% between 2000 and 2010. Asians

Antihypertensive medication use and risk of cognitive impairment

To determine the associations between classes of antihypertensive medication use and the risk of cognitive impairment among elderly hypertensive men. The Honolulu-Asia Aging Study is a prospective, community-based cohort study of Japanese American men conducted in Honolulu, Hawaii. We examined 2,197 participants (mean age 77 years at cohort entry, 1991-1993, followed through September 2010) with hypertension and without dementia or cognitive impairment at baseline, who provided information on medication use. Cognitive function was assessed at 7 standardized examinations using the Cognitive Abilities Screening Instrument (CASI). Cognitive impairment was defined as a CASI score <74. A total of 854 men developed cognitive impairment (median follow-up, 5.8 years). β-Blocker use as the sole antihypertensive drug at baseline was consistently associated with a lower risk of cognitive impairment (incidence rate ratio [IRR] 0.69; 95% confidence interval [CI] 0.50-0.94), as compared with men not taking any antihypertensive medications, adjusting for multiple potential confounders. The use of diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, or vasodilators alone was not significantly associated with cognitive impairment. Results were similar excluding those with cardiovascular disease or <1 year of follow-up, and additionally adjusting for pulse pressure, heart rate, baseline and midlife systolic blood pressure, and midlife antihypertensive treatment (IRR 0.65; 95% CI 0.45-0.94). The association between β-blocker use and cognitive impairment was stronger among men with diabetes, men aged >75 years, and those with pulse pressure ≥70 mm Hg. β-blocker use is associated with a lower risk of developing cognitive impairment in elderly Japanese American men.

Particle numbers of lipoprotein subclasses and arterial stiffness among middle-aged men from the ERA JUMP study

We examined the association between serum lipoprotein subclasses and the three measures of arterial stiffness i.e. (i) carotid-femoral pulse wave velocity (cfPWV) which is a gold standard measure of central arterial stiffness, (ii) brachial-ankle PWV (baPWV) which is emerging as a combined measure of central and peripheral arterial stiffness, and (iii) femoral-ankle PWV (faPWV) which is a measure of peripheral arterial stiffness. Among a population-based sample of 701 apparently healthy Caucasian, Japanese American and Korean men aged 40–49 years, concentrations of lipoprotein particles were assessed by nuclear magnetic resonance (NMR) spectroscopy, and PWV was assessed with an automated waveform analyzer (VP2000, Omron, Japan). Multiple linear regressions were performed to analyze the association between each NMR lipoprotein subclasses and PWV measures, after adjusting for cardiovascular risk factors and other confounders. A cut-off of p<0.01 was used for determining significance. All PWV measures had significant correlations with total and small low-density lipoprotein particle number (LDL-P) (all p<0.0001) but not LDL-cholesterol (LDL-C) (all p>0.1), independent of race and age. In multivariate regression analysis, no NMR lipoprotein subclass was significantly associated with cfPWV (all p>0.01). However, most NMR lipoprotein subclasses had significant associations with both baPWV and faPWV (p<0.01). In this study of healthy middle-aged men, as compared to cfPWV, both baPWV and faPWV had stronger associations with particle numbers of lipoprotein subclasses. Our results may suggest that both baPWV and faPWV are related to arterial stiffness and atherosclerosis, whereas cfPWV may represent arterial stiffness alone.

Impact of Diet on Mortality From Stroke: Results From the U.S. Multiethnic Cohort Study

Objectives: Stroke is the fourth leading cause of death in the United States and stroke mortality rates vary by ethnicity. The purpose of this study was to examine the associations between food group consumption and risk of death from stroke among 5 ethnic groups in the United States. Methods: The Multiethnic Cohort includes >215,000 participants, the majority of whom are African American, Native Hawaiian, Japanese American, Latino, and Caucasian men and women recruited by mail survey in Hawaii and Los Angeles in 1993–1996. Deaths from stroke were identified by linkage to the state death files and the U.S. National Death Index. Diet was assessed using a validated food frequency questionnaire. Associations were examined using multivariable Cox proportional hazards models, stratified by ethnicity and gender. Results: A total of 860 deaths from stroke were identified among the cohort participants. Vegetable intake was associated with a significant reduction in risk for fatal stroke among African American women (relative risk [RR] = 0.60; 95% CI: 0.36–0.99). Among Japanese American women only, high fruit intake was significantly associated with a risk reduction for stroke mortality (RR = 0.43; 95% confidence interval [CI]: 0.22–0.85), whereas meat intake increased risk (RR = 2.36; 95% CI: 1.31–4.26). Among men, a significant reduction in stroke mortality was observed among Native Hawaiians (RR = 0.26; 95% CI: 0.07–0.95). After pooling the data for the ethnic groups, the findings support an elevated risk for high meat intake among women overall (RR = 1.56; 95% CI: 1.12–2.16); no significant effects of dietary intake on risk for fatal stroke were observed among men. Conclusions: Although some variations were observed for the associations between diet and stroke mortality among ethnic groups, the findings suggest that these differences are not substantial and may be due to dietary intake of specific food subgroups. Additional investigations including dietary subgroups and nutrients sources are needed to clarify these findings.

Contribution of meat to vitamin B12, iron and zinc intakes in five ethnic groups in the USA: implications for developing food‐based dietary guidelines

To describe the sources of meat and their contributions to vitamin B₁₂, iron and zinc in five ethnic groups in the USA. Dietary data for the Multiethnic Cohort, established in Hawaii and Los Angeles, were collected using a quantitative food frequency questionnaire from more than 215,000 subjects, aged 45-75 years at baseline (1993-1996). Participants included African American, Latino, Japanese American, Native Hawaiian and Caucasian men and women. Servings of meat items were calculated based on the US Department of Agriculture recommendations and their contributions to intakes of total meat, red meat, vitamin B₁₂, iron and zinc were determined. Of all types of meat, poultry contributed the most to meat consumption, followed by red meat and fish among all ethnicities, except for Latino (born in Mexico and Central/South America) men who consumed more beef. Lean beef was the most commonly consumed red meat for all ethnic-sex groups (9.3-14.3%), except for Native Hawaiian and Japanese American men, and Japanese American women whose top contributor was stew/curry with beef/lamb and stir-fried beef/pork with vegetables, respectively. The contribution of meat was most substantial for zinc (11.1-29.3%) and vitamin B₁₂ (19.7-40%) and, to a lesser extent, for iron (4.3-14.2%). This is the first large multiethnic cohort study to describe meat sources and their contributions to selected nutrients among ethnic minorities in the USA. These findings may be used to develop ethnic-specific recommendations for meat consumption aiming to improve dietary quality among these groups.

Diet impacts mortality from cancer: results from the multiethnic cohort study

Cancer is the second leading cause of death in the United States and mortality varies by ethnicity. The objective of this study was to examine the association between cancer mortality and dietary intake among a large multiethnic population. A prospective cohort design was used to examine cancer mortality among 146,389 participants. Multiethnic cohort study participants represent five ethnic groups: African American, Native Hawaiian, Japanese American, Latino, and Caucasian. Hazard ratios for cancer mortality by intake levels of five food groups and discretionary fat were calculated using Cox proportional hazards models stratified by sex and ethnicity. There were a total of 2,028 male and 1,464 female fatal cancer cases at the end of follow-up. Among Japanese American men only, there was a significant protective effect seen in those reporting a high grain intake (HR = 0.49, 95 % CI 0.35-0.69); there was no effect of grain consumption in any other ethnic-sex group. There was no evidence that ethnicity modified associations between fruit, vegetable, meat, dairy, or discretionary fat intake and cancer mortality among men. Associations between food group consumption and risk for cancer mortality among women were similar across ethnic groups. The considerable reduction in cancer risk associated with high grain consumption among a specific ethnic-sex group, Japanese American men, warrants further investigation. Additional research is needed to validate this observation and determine whether this was a chance finding, or possibly due to differential intake of specific grain subtypes, and/or related to a sex-specific cancer type.

“Give Me the Stump Which Gives You the Right to Hold Your Head High” — A Homoerotics of Disability in Asian Americanist Critique

This essay performs a reading of John Okada's novel No-No Boy that examines the latent homoeroticism between the two main characters, one a disabled veteran and the other a draft resister. It shows how male-male desire may heal ruptures among Japanese American men in the wake of World War II. In doing so, this essay urges a rethinking of the terms on which Okada's novel was embraced by Asian American literary cultural nationalism in the 1970s.

Abstract 18282: Atrial Fibrillation Independently Increases Risk of All-Cause Mortality: The Honolulu Heart Program

Introduction: Atrial fibrillation (AF) increases cardiovascular and cerebrovascular mortality. However, there are few studies examining the natural history of AF in Asian populations in the US. Objective: To determine the long-term effect of AF detected in mid-life and late-life on all-cause mortality in a population of Japanese-American men. Methods: The Honolulu Heart Program prospective cohort included Japanese-American males (born 1900-1919) living on O`ahu, Hawai`i in 1965. Analyses included 6,860 and 2,675 participants with electrocardiograms from mid-life and late-life, followed over 36 years and 13 years, respectively. Mid-life AF was defined as having fibrillation or flutter at any of the 3 mid-life exams (ages 45-68 years old) and late-life AF was defined as having fibrillation or flutter at any of 2 late-life exams (ages 71-94 years old). The primary outcome was all-cause mortality. Results: AF prevalence was 0.74% and 4.36% in mid-life and late-life, respectively, and increased significantly with age (p&lt;0.05), up to 12% in nonagenarians. After adjustment for multiple potential confounders, AF was an independent predictor of mortality in mid-life (RR=1.37, 95% CI=1.03-1.82, p=0.033) and late-life (RR=1.44, 95% CI=1.13-1.83, p=0.003). This relationship remained significant even in those without prevalent coronary heart disease, left ventricular hypertrophy, heart failure, and rheumatic heart disease in both mid-life (RR=1.45, 95% CI=1.04-2.02, p=0.029) and late-life (RR=1.51, 95% CI=1.13-2.02, p=0.005). Conclusions: In conclusion, atrial fibrillation was a significant independent predictor of all-cause mortality in both mid-life and late-life, including previously healthy participants.

Mean Per-Core Biopsy Volume as a Predictor of Failure for Gleason 7 Prostate Cancer Patients Undergoing High-dose-rate Brachytherapy (HDR)

Purpose/Objective(s): The objective of this study was to assess relationships between race, treatment, and cause-specific mortality for prostate cancer. Materials/Methods: The Surveillance, Epidemiology and End Results (SEER) database yielded 328,151 prostate cancer patients diagnosed between 1990 and 2007 including 5,129 Japanese-American, 50,717 Black-American, and 282,305 White-American men. Japanese-American men were selected as they have the lowest incidence of prostate cancer and best treatment outcomes. Cox proportional-hazards regression analysis was used to assess association of race with prostate-cancer specific mortality before and after adjusting for age, health, and treatment. To assess impact of race on treatment selection, we compared mean incidence of treatment type [external beam radiation therapy (EBRT), brachytherapy, and surgery] by race using one-way ANOVA and post-testing with Bonferroni correction. Results: Race significantly impacted survival after prostate cancer treatment. Blacks had the highest (HR Z 1.198; 95% CI: 1.159 to 1.239, p < 0.001) and Japanese the lowest (HR Z .618; 95% CI: .560 to .682, p < 0.001) mortality hazard compared to Whites. Tumor grade was the strongest predictor of survival (p < 0.001). Treatment was also significant: Brachytherapy had the lowest mortality hazard for radiation treatments and surgery was associated with lower mortality hazard compared to no surgery. A total of 37.8%, 44.1%, and 29.1% of Blacks, Whites, and Japanese-Americans underwent surgery (p < 0.05), 27.3%, 23.8%, and 38.2% of Blacks, Whites, and Japanese-Americans underwent EBRT, (p < 0.05), and 4.9%, 6.7%, and 4.7% of Blacks, Whites, and JapaneseAmericans underwent brachytherapy, with Whites significantly different from the other groups(p < 0.05). Conclusions: SEER database analysis revealed race impacts prostate cancer survival. Treatment selection for prostate cancer differs among racial groups and race is associated with differential treatment outcomes. Comparisons between treatments must be viewed with caution, as confounding variables likely exist not accounted for in the SEER database. Future research on race, treatment, and socioeconomic impact on cancerspecific mortality is warranted. Author Disclosure: C. Duarte: None. N. Sarkisian: None. E. Garroutte: None. P. Nguyen: None. M. Hurwitz: None.

The Honolulu-Asia Aging Study: Epidemiologic and Neuropathologic Research on Cognitive Impairment

The Honolulu-Asia Aging Study (HAAS) is a longitudinal epidemiologic investigation of rates, risk factors, and neuropathologic abnormalities associated with cognitive decline and dementia in aged Japanese-American men. The project was established in 1991 and will be brought to closure in 2012. Age-specific rates of total dementia and the major specific types of dementia in HAAS participants are generally similar to those reported from other geographic, cultural, and ethnic populations. Risk factors for dementia in the HAAS include midlife hypertension and other factors previously shown to influence cardiovascular disease. The autopsy component of the project has yielded novel findings, the most illuminating of which is the demonstration of 5 important lesion types linked independently to cognitive impairment. While one of these--generalized atrophy--is strongly associated with both Alzheimer lesions and microinfarcts, it also occurs in the absence of these lesions and is independently correlated with dementia. Each lesion type is viewed as representing a distinct underlying pathogenic process. Their summed influences is an especially robust correlate of dementia in the months and years prior to death.

Low Dietary Vitamin D Predicts 34-Year Incident Stroke

Vitamin D deficiency has been reported to contribute to the risk of cardiovascular disease, especially stroke. We examined the relationship between dietary vitamin D intake and 34-year incident stroke. The Honolulu Heart Program is a prospective population-based cohort study of 8006 Japanese-American men in Hawaii who were 45 to 68 years old at the baseline examination in 1965 to 1968. Dietary vitamin D intake was calculated using the Nutritionist IV Version 3 software from a 24-hour dietary recall. Subjects with prevalent stroke were excluded, leaving 7385 men followed through 1999 for incident stroke. Subjects were divided into quartiles of dietary vitamin D for analyses. During 34 years of follow-up, 960 subjects developed stroke. Age-adjusted rates of incident stroke were significantly higher in the lowest dietary vitamin D quartile compared with the highest (all stroke: 6.38 versus 5.14 per 1000 person-years follow-up, P=0.030; thromboembolic stroke: 4.36 versus 3.30, P=0.033). Using Cox regression, adjusting for age, total kilocalories, body mass index, hypertension, diabetes mellitus, pack-years smoking, physical activity index, serum cholesterol, and alcohol intake, those in the lowest quartile had a significantly increased risk of incident stroke (all stroke hazard ratio, 1.22; 95% CI, 1.01-1.47; P=0.038; thromboembolic stroke hazard ratio, 1.27; 95% CI, 1.01-1.59; P=0.044) with the highest as the reference. We found no significant associations between dietary vitamin D and hemorrhagic stroke. Low dietary vitamin D intake was an independent risk factor for 34-year incidence of all stroke and thromboembolic stroke in Japanese-American men. Additional research is needed on vitamin D supplementation to prevent stroke.

Potential risk factors for incident glioblastoma multiforme: the Honolulu Heart Program and Honolulu-Asia Aging Study.

Glioblastoma multiforme (GBM) is the most common adult primary malignant brain tumor. Ninety percent of adult GBM patients die within 24 months after diagnosis. The etiology of GBM is unknown. The Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS) are prospective, cohort studies of cardiovascular and neurodegenerative disease based on 8,006 Japanese-American men followed since 1965. The Japan Hawaii Cancer Study provides data on incident cancer cases in the HHP/HAAS cohort. We used data from these studies to obtain epidemiologic information about GBM. GBM cases were identified by searching the 1965-1998 databases using International Classification of Diseases (ICD-9) codes. Nine histologically confirmed GBM cases, 58-80 years old, were identified. The incidence rate was 6.2/100,000 person-years. Records of each case were reviewed. Selected variables from the first three examinations (1965-1968; 1968-1970; 1971-1974) were used to identify potential candidate GBM risk factors. A multivariate Cox proportional hazards model showed sugar intake and occupational exposure to carbon tetrachloride were independently and significantly associated with development of GBM.