Population-based Cohort Study In Japan Research Articles

Impact of Updating the Cardiopulmonary Resuscitation Guidelines on Out-of-Hospital Shockable Cardiac Arrest: A Population-Based Cohort Study in Japan.

International consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science and treatment recommendations (CoSTR) have reported updates on CPR maneuvers every 5 years since 2000. However, few national population-based studies have investigated the comprehensive effectiveness of those updates for out-of-hospital cardiac arrest due to shockable rhythms. The primary objective of the present study was to determine whether CPR based on CoSTR 2005 or 2010 was associated with improved outcomes in Japan, as compared with CPR based on Guidelines 2000. From the All-Japan Utstein Registry between 2005 and 2015, we included 73 578 adults who had shockable out-of-hospital cardiac arrest witnessed by bystanders or emergency medical service responders. The study outcomes over an 11-year period were compared between 2005 of the Guidelines 2000 era, from 2006 to 2010 of the CoSTR 2005 era, and from 2011 to 2015 of the CoSTR 2010 era. In the bystander-witnessed group, the adjusted odds ratios for favorable neurological outcomes at 30 days after out-of-hospital cardiac arrest by enrollment year increased year by year (1.19 in 2006, and 3.01 in 2015). Similar results were seen in the emergency medical service responder-witnessed group and several subgroups. Compared with CPR maneuvers for shockable out-of-hospital cardiac arrest recommended in the Guidelines 2000, CPR maneuver updates in CoSTR 2005 and 2010 were associated with improved neurologically intact survival year by year in Japan. Increased public awareness and greater dissemination of basic life support may be responsible for the observed improvement in outcomes. URL: https://www.umin.ac.jp/ctr/; Unique identifier: 000009918.

Association of perinatal factors with neurodevelopmental referrals in a population-based cohort study in Japan

Although the causes of neurodevelopmental disorders remain unknown, several environmental risk factors have attracted considerable attention. We conducted a retrospective, longitudinal, population-based cohort study using data from infant health examinations of children born to mothers with pregnancies between April 1, 2014 and March 31, 2016 in Kobe City to identify the perinatal factors associated with neurodevelopmental referrals in 3-year-old children. There were 15,223 and 1283 children in the normal and referral groups, respectively. Neurodevelopmental referrals at the health checkup for 3-year-old children were significantly associated with the lack of social support during pregnancy (adjusted odds ratio [aOR] 1.99, 99% CI 1.14–3.45, p = 0.001), history of psychiatric consultation (aOR 1.56, 99% CI 1.10–2.22, p = 0.001), no social assistance post-delivery (aOR 1.49, 99% CI 1.03–2.16, p = 0.006), Edinburgh Post-natal Depression Scale (EPDS) score ≥ 9 (aOR 1.36, 99% CI 1.01–1.84, p = 0.008), infant gender (male) (aOR 2.51, 99% CI 2.05–3.06, p < 0.001), and cesarean delivery (aOR 1.39, 99% CI 1.11–1.75, p < 0.001). In conclusion, this exploratory study in the general Japanese population identified six perinatal factors associated with neurodevelopmental referrals in 3-year-old children: infant gender (male), cesarean section, maternal history of psychiatric consultation, EPDS score ≥ 9, lack of social support during pregnancy, and no social assistance post-delivery.

Adult Height and Risk of Colorectal Cancer: A Pooled Analysis of 10 Population-based Cohort Studies in Japan.

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

Suicidal Thoughts and Trajectories of Psychopathological and Behavioral Symptoms in Adolescence

The suicidal risk of psychopathology in adolescence is suggested to differ based on its longitudinal trajectory, but the comorbidity of these symptom trajectories has not been well examined. This study comprehensively clustered trajectories of multiple psychopathological and behavioral symptoms and examined their associations with suicidal thoughts in adolescence. To determine which categories and trajectories of psychopathological and behavioral symptoms are associated with suicidal thoughts in adolescence, accounting for comorbid symptoms. This population-based cohort study in Japan used data from the Tokyo Teen Cohort (TTC) study, which was established in 2012 and is currently ongoing. Data from 3 waves of surveys conducted at ages 10, 12, and 16 years from October 2012 to September 2021 were used. Of the adolescents in the cohort, participants with at least 2 evaluations of psychopathological and behavioral symptoms were included. Data were analyzed from December 2022 to March 2023. Latent class growth analysis was used to cluster the trajectory of each psychopathological and behavioral symptom. The associations between symptom trajectories and suicidal thoughts at age 16 were examined. Suicidal thoughts were assessed using a self-report questionnaire. Psychopathological and behavioral symptoms were assessed using the 8 subscale scores of the caregiver-report Child Behavior Checklist. This study included 2780 adolescents (1306 female participants [47.0%]). Of the 1920 adolescents with data on suicidal thoughts, 158 (8.2%) had suicidal thoughts. The median (IQR) age was 10.2 (10.0-10.3) years at the first evaluation, 11.9 (11.8-12.1) years at the second evaluation, and 16.3 (16.1-16.5) years at the last evaluation. The clustering pattern of trajectories varied depending on symptom categories. After adjusting for each symptom trajectory and confounders, adolescents with persistent high withdrawn symptoms (odds ratio [OR], 1.88; 95% CI, 1.10-3.21) and those with increasing somatic symptoms (OR, 1.97; 95% CI, 1.16-3.34) had a significantly higher risk of suicidal thoughts than adolescents without these symptoms. There was no interaction between these symptom trajectories and the risk of suicidal thoughts. This cohort study found that persistent withdrawn symptoms and increasing somatic symptoms during early to midadolescence were associated with an increased risk of suicidal thoughts in midadolescence, even after accounting for comorbid symptoms and confounders. Attention should be paid to the suicidal risk associated with these symptoms, particularly when they persist or increase in the longitudinal follow-up.

Cigarette smoking, smoking cessation and bladder cancer risk: A pooled analysis of ten cohort studies in Japan.

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

Bowel movement frequency, stool consistency, and risk of disabling dementia: a population-based cohort study in Japan

ObjectivesThis population-based study aimed to evaluate the association between bowel habits from midlife and dementia. Study designThis was a cohort study using certification records for national long-term care insurance in Japan. MethodsParticipants aged 50 to 79 years who reported bowel habits from eight districts within the Japan Public Health Center-based Prospective Study (JPHC Study) were followed from 2006 to 2016 for incident dementia. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for men and women separately using Cox proportional hazards models accounting for various lifestyle factors and medical histories. ResultsAmong 19,396 men and 22,859 women, 1889 men and 2685 women were diagnosed with dementia. In men, the multivariable-adjusted HRs compared with bowel movement frequency (BMF) of once/day were 1.00 (95% CI: 0.87–1.14) for twice/day or more, 1.38 (1.16–1.65) for 5–6 times/week, 1.46 (1.18–1.80) for 3–4 times/week, and 1.79 (1.34–2.39) for <3 times/week (P for trend <0.001). In women, the corresponding HRs were 1.14 (0.998–1.31), 1.03 (0.91–1.17), 1.16 (1.01–1.33), and 1.29 (1.08–1.55) (P for trend = 0.043). Harder stool was associated with higher risk (P for trend: 0.0030 for men and 0.024 for women), with adjusted HRs compared to normal stool of 1.30 (1.08–1.57) for hard stool and 2.18 (1.23–3.85) for very hard stool in men, and 1.15 (1.002–1.32) and 1.84 (1.29–2.63) in women. ConclusionsLower BMF and harder stool were each associated with higher risk of dementia.

Trends and age- and sex-stratified analysis of hallux valgus correction surgery from 2014 to 2019: A nationwide population-based cohort study in Japan

BackgroundEpidemiological studies on hallux valgus (HV) are challenging owing to differences in sampling and diagnostic criteria across studies. This study aimed to indirectly clarify HV epidemiology using a national database. MethodsThe age- and sex-stratified annual number rate of HV correction (RHVC) per 100,000 people in Japan during 2014–2019 were examined. ResultsThe average annual RHVC was 3.0. RHVC had unimodal (peak, 65–79 years) and bimodal (peaks, 15–19 and 70–74 years) distributions among males and females, respectively, and increased over time in males aged 50–54 and 75–79 years and females aged 80–84 years. ConclusionsRHVC increases with increasing age and occurs commonly in female teens. The recent RHVC in Japan was lower than that reported in Europe and the United States, with an increasing trend among elderly people. Level of evidenceIII

Body mass index and esophageal and gastric cancer: A pooled analysis of 10 population-based cohort studies in Japan.

The effect of body mass index (BMI) on esophageal and gastric carcinogenesis might be heterogeneous, depending on subtype or subsite. However, findings from prospective evaluations of BMI associated with these cancers among Asian populations have been inconsistent and limited, especially for esophageal adenocarcinoma and gastric cardia cancer. We performed a pooled analysis of 10 population-based cohort studies to examine this association in 394,247 Japanese individuals. We used Cox proportional hazards regression to estimate study-specific hazard ratios (HRs) and 95% confidence intervals (CIs), then pooled these estimates to calculate summary HRs with a random effects model. During 5,750,107 person-years of follow-up, 1569 esophageal cancer (1038 squamous cell carcinoma and 86 adenocarcinoma) and 11,095 gastric (728 cardia and 5620 noncardia) cancer incident cases were identified. An inverse association was observed between BMI and esophageal squamous cell carcinoma (HR per 5-kg/m2 increase 0.57, 95% CI 0.50-0.65), whereas a positive association was seen in gastric cardia cancer (HR 1.15, 95% CI 1.00-1.32). A nonsignificant and significant positive association for overweight or obese (BMI ≥25 kg/m2 ) relative to BMI <25 kg/m2 was observed with esophageal adenocarcinoma (HR 1.32, 95% CI 0.80-2.17) and gastric cardia cancer (HR 1.24, 95% CI 1.05-1.46), respectively. No clear association with BMI was found for gastric noncardia cancer. This prospective study-the largest in an Asian country-provides a comprehensive quantitative estimate of the association of BMI with upper gastrointestinal cancer and confirms the subtype- or subsite-specific carcinogenic impact of BMI in a Japanese population.

Association of maternal pre-pregnancy body mass index with resilience and prosociality of the offspring aged 6-7years old: a population-based cohort study in Japan.

The association between maternal pre-pregnancy obesity and child behavior problems has been widely researched, leaving a gap in understanding the positive aspects of children's mental health. The present study aimed to investigate the association between maternal pre-pregnancy body mass index (BMI) and resilience and prosociality among 6-7year-old children in Japan. A retrospective cohort study was conducted using data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study, a population-based study in 2017 and 2019 including all first-grade students in public schools in Adachi, Tokyo, Japan (n = 7328, response rate = 84.7%). Resilience and prosociality were measured by the Children's Resilient Coping Scale and the Strength and Difficulties Questionnaire, respectively. Maternal pre-pregnancy weight and height were reported based on the Mother and Child Health Handbook, and BMI was categorized as underweight (BMI < 18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), and obesity (BMI ≥ 30). Linear regression models were employed to control for covariates. Maternal pre-pregnancy obesity was found to be negatively associated with child resilience (coefficient: -3.29; 95% CI -6.42--0.15), while maternal underweight was negatively associated with child prosociality (coefficient: -0.12; 95% CI -0.24--0.005) compared to mothers of pre-pregnancy normal BMI. Perinatal factors, such as gestational weight gain, gestational age, and birth weight, did not mediate the association. Our findings suggest that maternal pre-pregnancy obesity is linked to decreased resilience and maternal underweight is linked to decreased prosociality in children aged 6-7years. Maintaining an appropriate BMI range before pregnancy may be crucial for enhancing resilience and prosociality of offspring.

Basal ganglia lesions may be a risk factor for characteristic features of a glaucomatous optic disc: population-based cohort study in Japan

BackgroundWe conducted a study to investigate the relationship between optic nerve vertical cup-to-disc ratio (VCDR), body and ocular parameters, and brain lesions in middle-aged and above Japanese subjects, because although...

Dietary behaviours and related lifestyles according to the presence or absence of skipping breakfast in Japanese adults: the JPHC-NEXT study.

To assess dietary behaviours and related lifestyles according to the presence or absence of skipping breakfast. We analysed the cross-sectional data from a baseline survey of a large-scale population-based cohort study in Japan conducted in 2011-2016. Participants provided information on dietary behaviours and lifestyles through a self-administered questionnaire. Skipping breakfast was defined as not eating breakfast at least once a week and was classified according to the frequency of skipping breakfast as 1-2, 3-4 or ≥5 times/week. Sixteen municipalities in seven prefectural areas across Japan under the Japan Public Health Centre-based prospective study for the Next Generation. 112 785 residents (51 952 males and 60 833 females) aged 40-74 years. After adjustment for age, socio-demographic status, drinking status and smoking status, individuals who skipped breakfast at least once a week, compared with those who ate breakfast every day, were more likely to have adverse dietary behaviours such as frequent eating out (multivariable OR = 2·08, 95 % CI (1·96, 2·21) in males and 2·15, 95 % CI (1·99, 2·33) in females), frequent eating instant foods (1·89, 95 % CI (1·77, 2·01) in males and 1·72, 95 % CI (1·56, 1·89) in females). They had late bedtime (1·85, 95 % CI (1·75, 1·95) in males and 1·98, 95 % CI (1·86, 2·11) in females) and living alone (2·37, 95 % CI (2·17, 2·58) in males and 2·02, 95 % CI (1·83, 2·21) in females), using the logistic regression model. Both adult males and females who skipped breakfast were likely to eat out, to have a dietary habit of eating instant foods and have lifestyles such as late bedtime and living alone than those who ate breakfast.

Association Between Birth Weight and Risk of Pregnancy-Induced Hypertension and Gestational Diabetes in Japanese Women: JPHC-NEXT Study.

BackgroundAlthough prevalence of low birth weight has increased in the last 3 decades in Japan, no studies in Japanese women have investigated whether birth weight is associated with the risk of pregnancy complications, such as pregnancy-induced hypertension (PIH) and gestational diabetes mellitus (GDM).MethodsWe used data from the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT), a population-based cohort study in Japan that launched in 2011. In the main analysis, we included 46,365 women who had been pregnant at least once, for whom information on birth weight and events during their pregnancy was obtained using a self-administered questionnaire. Women were divided into five categories according to their birth weight, and the relationship between birth weight and risk of PIH and GDM was examined using multilevel logistic regression analyses with place of residence as a random effect.ResultsCompared to women born with birth weight of 3,000–3,999 grams, the risk of PIH was significantly higher among women born <1,500 grams (adjusted odd ratio [aOR] 1.60; 95% confidence interval [CI], 1.17–2.21), 1,500–2,499 grams (aOR 1.16; 95% CI, 1.03–1.30), and 2,500–2,999 grams (aOR 1.13; 95% CI, 1.04–1.22). The risk of GDM was significantly higher among women born 1,500–2,499 grams (aOR 1.20; 95% CI, 1.02–1.42), albeit non-significant association among women in other birthweight categories.ConclusionsWe observed an increased risk of PIH among women born with lower birth weight albeit non-significant increased risk of GDM among Japanese women.

Association between Coffee Consumption and Risk of Prostate Cancer in Japanese Men: A Population-Based Cohort Study in Japan.

Although numerous epidemiological studies have examined whether coffee consumption is associated with prostate cancer risk, the results remain controversial. Moreover, there are few studies in Asian populations. Therefore, we investigated the association between coffee consumption and the risk of prostate cancer in a large-scale prospective population-based cohort study in Japan. Study subjects were 48,222 men (40-69 years) who completed a questionnaire that included questions about their coffee consumption in 1990 for Cohort I and 1993 for Cohort II and were followed up until December 31, 2015. Newly diagnosed cases were classified into localized and advanced using information on local staging, the Gleason score, and degree of differentiation. Hazard ratios (HR) and 95% confidential intervals (95% CI) were estimated using Cox regression analysis. A total of 1,617 participants were newly diagnosed with prostate cancer during a mean follow-up period of 18.8 years. Of these, 1,099 and 461 patients had localized and advanced cancer, respectively. There was no association between coffee intake and prostate cancer risk. Comparison between the highest and lowest category of coffee consumption produced HRs of 1.08 (95% CI, 0.90-1.30), 1.08 (95% CI, 0.84-1.38), and 1.00 (95% CI, 0.67-1.47) for risk of total, localized, and advanced cancer, respectively. The same results were obtained even when we limited the analysis to patients with subjective symptoms. Our findings suggest that coffee consumption has no impact on prostate cancer risk in Japanese men. Coffee has no protective effects against prostate cancer among Japanese men.

Stroke Mortality in Cancer Survivors: A Population-Based Cohort Study in Japan

Stroke Mortality in Cancer Survivors: A Population-Based Cohort Study in Japan

Associations Between Dietary Melatonin Intake and Total and Cause-Specific Mortality Among Japanese Adults in the Takayama Study.

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.

Birth month and mortality in Japan: a population-based prospective cohort study

ABSTRACT Epidemiologic studies investigating the association between birth season and risk of mortality in adulthood are limited and have yielded inconclusive results. We aimed to examine the relationship between birth month and all-cause and cause-specific mortality, after controlling for potential confounders, including lifestyle and medical factors, in a population-based cohort study in Japan. We included 28,884 subjects (13,262 men and 15,622 women) from Takayama City, aged 35 years or older without cancer, stroke, and ischemic heart disease, who were born in Japan at baseline. Participants who were enrolled in 1992 were followed up for over 16 years. Information including place of birth, lifestyles, and medical history was obtained from a baseline questionnaire. We performed a Cox proportional hazards analysis to determine the association between birth month and all-cause and cause-specific mortality after adjusting for potential confounders. During the follow-up period (mean follow-up: 14.1 years), 5,303 deaths (2,881 men and 2,422 women) were identified. After controlling for multiple covariates, it was found that being born in April or June was associated with an increased risk of all-cause mortality compared to being born in January (hazard ratio [HR] 1.138; 95% confidence interval [CI], 1.006–1.288 and HR 1.169; 95% CI, 1.028–1.329, respectively). The HRs for cardiovascular mortality were significantly higher in participants born in March and May (HR 1.285; 95% CI, 1.056–1.565 and HR 1.293; 95% CI, 1.040–1.608, respectively). Our findings indicate that an individual’s birth month may be an indicator of the susceptibility to mortality in later life.

Association between meat intake and mortality due to all-cause and major causes of death in a Japanese population.

We examined the association between meat intake and mortality due to all-cause and major causes of death using a population-based cohort study in Japan. 87,507 Japanese aged between 45 and 74 years old at 5-year follow-up study were followed for 14.0 years on average. Associations between meat intake and mortality risk were assessed using a Cox proportional hazards model. A heavy intake of total meat was associated with a higher risk of all-cause mortality relative to the lowest quartile intake in men (Q4: HR,1.18; 95%CIs, 1.06-1.31). A higher intake of total meat was associated with a lower risk of stroke mortality in women (Q2: HR, 0.70; 95%CIs, 0.51-0.94, Q3: HR, 0.68; 95%CIs, 0.50-0.95, Q4: HR, 0.66; 95%CIs, 0.44-0.99). A heavy intake of red meat was also associated with all-cause mortality (Q4: HR, 1.13; 95%CIs, 1.02-1.26) and heart disease mortality (Q4: HR, 1.51; 95%CIs, 1.11-2.06) in men but not in women. Heavy intake of chicken was inversely associated with cancer mortality in men. Heavy intakes of total and red meat were associated with an increase in all-cause and heart disease mortality in men, while total meat intake was associated with a lower risk of stroke mortality in women.

Seizure prevalence in children aged up to 3 years: a longitudinal population-based cohort study in Japan

ObjectiveTo investigate the prevalence of seizures/febrile seizures in children up to 3 years of age and examine the effects of gestational age at birth on the risk for febrile seizures.DesignRetrospective...

The association between father involvement in caregiving and early childhood overweight or obesity.

Despite the increasing trend of paternal engagement in caregiving, fathers remain underrepresented in studies on parenting and childhood obesity. This study examined the association between father involvement in caregiving and child's weight status within a longitudinal dataset from Japan. The data were obtained from a population-based cohort study in Japan (N = 29 584). The association between father's involvement in child caregiving (age 18 months) on the weight status of the same children at age 3.5 years was examined by logistic regression and linear regression analysis. Furthermore, we checked the interaction between maternal employment & father involvement by creating four mutually exclusive groups of families. Children whose fathers were highly involved in caregiving were less likely to be overweight (OR = 0.90, 95% CI, 0.85-0.96). Employed mothers with high paternal involvement in caregiving were 30% less likely to have children with overweight or obesity compared to those with low paternal involvement (95% CI, 0.55-0.90). Father involvement in caregiving is associated with the development of overweight or obesity in early childhood, and may also modify the association between maternal employment and child's weight status. Social policies to support shared child-rearing such as expanding paid parental leave could help families to raise children with healthy weight.

Association Between the Use of Antidepressants and the Risk of Type 2 Diabetes: A Large, Population-Based Cohort Study in Japan.

This study aimed to reveal the associations between the risk of new-onset type 2 diabetes and the duration of antidepressant use and the antidepressant dose, and between antidepressant use after diabetes onset and clinical outcomes. In this large-scale retrospective cohort study in Japan, new users of antidepressants (exposure group) and nonusers (nonexposure group), aged 20-79 years, were included between 1 April 2006 and 31 May 2015. Patients with a history of diabetes or receipt of antidiabetes treatment were excluded. Covariates were adjusted by using propensity score matching; the associations were analyzed between risk of new-onset type 2 diabetes and the duration of antidepressant use/dose of antidepressant in the exposure and nonexposure groups by using Cox proportional hazards models. Changes in glycated hemoglobin (HbA1c) level were examined in groups with continuous use, discontinuation, or a reduction in the dose of antidepressants. Of 90,530 subjects, 45,265 were in both the exposure and the nonexposure group after propensity score matching; 5,225 patients (5.8%) developed diabetes. Antidepressant use was associated with the risk of diabetes onset in a time- and dose-dependent manner. The adjusted hazard ratio was 1.27 (95% CI 1.16-1.39) for short-term low-dose and 3.95 (95% CI 3.31-4.72) for long-term high-dose antidepressant use. HbA1c levels were lower in patients who discontinued or reduced the dose of antidepressants (F[2,49] = 8.17; P < 0.001). Long-term antidepressant use increased the risk of type 2 diabetes onset in a time- and dose-dependent manner. Glucose tolerance improved when antidepressants were discontinued or the dose was reduced after diabetes onset.