Prospective Observation Of Non-communicable Disease Research Articles

Abstract P443: Cross-Sectional Association Between Sedentary Behavior and Cardiometabolic Risk Factors in Japanese Population: The NIPPON DATA2010

Introduction: Physical inactivity is one of the major worldwide health concerns. Associations of sedentary behavior with cardiovascular diseases have been reported; however, there are few reports from Japanese population where obesity is less prevalent compared with Western populations. We investigated the association of sedentary behavior with cardiometabolic risk factors in a Japanese representative population. Methods: This is a cross-sectional study of 2,402 general Japanese populations (1,050 men, 1,352 women, aged 20 years and older) (the National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged 2010; the NIPPON DATA2010), who participated in the National Health and Nutrition Survey of Japan conducted in 2010. The most usual ways to spend time of the day for each participant were collected from self-completion questionnaire and interview by trained interviewers in the baseline survey of NIPPON DATA2010. The physical activities were categorized into vigorous physical activity, moderate physical activity, slight physical activity, TV-viewing, sitting, and basal level of activity. Sedentary time was calculated as the sum of TV-viewing and sitting time. Odds ratios and 95% confidence intervals for each cardiometabolic risk factors according to the tertiles of sedentary or TV-viewing time were estimated by logistic regression models, adjusting for age, smoking status, drinking status, residential area, and equivalent household expenditure. Results: The medians (25th percentiles, 75th percentiles) of sedentary time (hours/day) and TV-viewing time (hours/day) were 5.0 (3.0, 7.5) and 3.0 (2.0, 4.0) in men, and 4.5 (3.0, 7.0) and 2.0 (1.0, 3.5) in women, respectively. In total, sedentary time was positively associated with high triglycerides (OR [95% confidence intervals]: 1.30 [1.01-1.66]) and low HDL cholesterol (1.50 [1.08-2.07]), and TV-viewing time was positively associated with high triglycerides (1.65 [1.27-2.15]), low HDL cholesterol (2.09 [1.46-3.00]) and high LDL cholesterol (1.32 [1.05-1.66]). In men, sedentary time and TV-viewing time were positively associated with low HDL cholesterol (1.98 [1.13-3.49], 1.99 [1.13-3.53], respectively). In women, sedentary time was positively associated with high triglycerides (1.61 [1.09-2.37]), and TV-viewing time was positively associated with obesity (1.64 [1.13-2.38]), high triglycerides (1.96, [1.29-2.98]), low HDL cholesterol (2.05 [1.27-3.30]) and high LDL cholesterol (1.41, [1.02-1.95]). There were no significant associations of sedentary or TV-viewing time with hypertension and diabetes after adjusting for age. Conclusions: In conclusion, sedentary behavior including TV-viewing was positively associated with cardiometabolic risk factors, especially dyslipidemia in general Japanese population.

Effect of diabetes and prediabetes on the development of disability and mortality among middle-aged Japanese adults: A 22-year follow up of NIPPON DATA90.

To examine the association between diabetes and prediabetes at baseline, and disability, mortality over a 22-year period among middle-aged Japanese adults. Participants consisted of 1,788 adults aged 45-64 years at baseline from the cohort study National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 1990 (NIPPON DATA90). Disability, defined as having a decline in activities of daily living (ADL), was assessed by a modified Katz questionnaire at four time points. Disability and death without disability for 22-year follow up were used as outcomes to test the association with a diagnosis of diabetes or prediabetes at baseline, using multinomial logistic regression. Adjusted odds ratios (ORs) were obtained from four models that contained appropriate adjustment factors, such as age, sex, smoking status, drinking status, body mass index and cardiovascular risk factors (hypertension, hypercholesterolemia, triglycerides, low serum high-density lipoprotein), at baseline. In the present study, 334 participants (18.7%) reported at least one disability, and 350 (19.6%) were reported dead without observation of disability during follow up. Adjusting sex and other risk factors, participants with diabetes and prediabetes had a higher risk for disability (OR 1.43, 95% confidence interval [CI] 1.07-1.91 and OR 1.66, 95% CI 1.10-2.50, respectively) and for mortality (OR 1.56, 95% CI 1.16-2.08 and OR 1.77, 95% CI 1.18-2.65, respectively) than individuals with normal glucose tolerance. In middle-aged Japanese adults, individuals with diabetes and prediabetes were more likely to be associated with disability and mortality. Our findings suggest that prediabetes and diabetes in middle-aged adults should be paid more attention, and requires more intervention to prevent disability and mortality in later life.

Dietary Inflammatory Index Positively Associated With High-Sensitivity C-Reactive Protein Level in Japanese From NIPPON DATA2010.

BackgroundIt has been reported that chronic inflammation may play an important role in the pathogenesis of several serious diseases and could be modulated by diet. Recently, the Dietary Inflammatory Index (DII®) was developed to assess the inflammatory potential of the overall diet. The DII has been reported as relevant to various diseases but has not been validated in Japanese. Thus, in the present study, we analyzed the relationship between DII scores and high-sensitivity C-reactive protein (hs-CRP) levels in a Japanese population.MethodsData of the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010 (NIPPON DATA2010), which contained 2,898 participants aged 20 years or older from the National Health and Nutrition Survey of Japan (NHNS2010), were analyzed. Nutrient intakes derived from 1-day semi-weighing dietary records were used to calculate DII scores. Energy was adjusted using the residual method. Levels of hs-CRP were evaluated using nephelometric immunoassay. Multiple linear regression analyses were performed.ResultsAfter adjusting for age, sex, smoking status, BMI, and physical activity, a significant association was observed between DII scores and log(CRP+1) (standard regression coefficient = 0.05, P < 0.01). Although it was not statistically significant, the positive association was consistently observed in almost all age-sex subgroups and the non-smoker subgroup.ConclusionsThe current study confirmed that DII score was positively associated with hs-CRP in Japanese.

Exercise Habits Are Associated with Improved Long-Term Mortality Risks in the Nationwide General Japanese Population: A 20-Year Follow-Up of the NIPPON DATA90 Study.

Exercise habits are known as a protective factor for a variety of diseases and thus recommended worldwide; however, few studies have examined long-term effects of exercise habits on mortality. We continuously monitored death status in a nationwide population sample of 7,709 eligible persons from the National Integrated Project for Prospective Observation of Noncommunicable Disease and its Trends in the Aged in 1990 (NIPPON DATA90), for which baseline data were obtained in 1990. To investigate the long-term impact of baseline exercise habits, we calculated the relative risk of non-exercisers (participants without regular voluntary exercise habits) in reference to exercisers (those with these habits) for all-cause or cause-specific mortality using a Cox proportional hazard model, in which the following confounding factors were appropriately adjusted: sex, age, body mass index, total energy intake, smoking, drinking, and history of cardiovascular disease. During a median 20 years of follow-up, 1,747 participants died, 99 of heart failure. The risk for all-cause mortality was 12% higher in non-exercisers than in exercisers (95% confidence interval, 1%-24%), which was also observed for mortality from heart failure, as 68% higher in non-exercisers than in exercises (95% confidence interval, 3%-173%). These associations were similarly observed when the participants were divided to subgroups by sex, age, and the light, moderate, or vigorous intensity of physical activity, without any significant heterogeneities (P > 0.1). The present study has revealed significant impact of exercise habits on long-term mortality risks, supporting worldwide recommendations for improvement of exercise habits.

Having few remaining teeth is associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese individuals: findings from the NIPPON DATA2010

BackgroundOral health is thought to be associated with diet quality, and socioeconomic status (SES) affects both oral health and diet. The aim of this study was to investigate the association between the number of teeth and dietary intake as well as nutritional biomarker, considering the subjects’ SES.MethodsWe conducted a cross-sectional analysis of data from 2049 individuals aged ≥ 50 years from the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010. The number of remaining teeth was categorized into age-specific quartiles (Q1 to Q4). We assessed the adjusted means and 95% confidence intervals for dietary variables by the number of teeth using analysis of covariance. Stratified analyses by SES were also conducted.ResultsThe intake of grain products was 31 g higher, and those of vegetables and meat were 30 g and 8 g lower, respectively, in Q1 (fewer teeth) than in Q4 (more teeth). Carbohydrate intake was higher whereas protein, minerals (potassium, magnesium, and zinc), vitamins (vitamins A, E, B1, B6, β-carotene, and folic acid), and dietary fiber intakes were lower among individuals with fewer teeth. Adjusted mean serum albumin levels were low in Q1. The associations between the number of teeth and dietary intake were more evident in individuals with a low SES.ConclusionsHaving few remaining teeth was associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese adults, and these associations were more evident in individuals with low SES.

Comparison of methods for calculating healthy life expectancy in a Japanese population: An analysis of Nippon Data90

Introduction There are several methodological approaches to calculating healthy life expectancy (HLE). Sullivan's method (prevalence-based life tables), which uses age-specific disability prevalence, is conventionally employed to estimate HLE. The multistate life table method presents an alternative approach that permits transitions from one health state to another using Markov models. Although these two approaches are frequently applied to calculate regional and national HLE, little is known about the differences in their estimates. To examine these differences, we applied both approaches for estimating HLE in a nationwide cohort study of the Japanese population and compared the resulting estimates. Methods The National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged (NIPPON DATA90) is a nationwide cohort study involving nine thousand Japanese participants. Data from this project were used in our analysis. We identified participants who were aged 60 years or older at the baseline survey and had provided activities of daily living (ADL) information based on the Katz index. Two-wave interview surveys of ADL were conducted in 1995 and 2000. Participants who answered “not independent” to any of five stipulated items in the Katz ADL index were designated “disabled” in the analysis. Both Sullivan's method and the multistate life table method were used to estimate HLE in participants aged 60 to 99 years. In both estimations, smoking status was categorized into three groups (never-smokers, ex-smokers, and current smokers). Blood pressure was fixed at an optimal level (systolic blood pressure Results Our analysis was conducted on 6676 individuals (2840 men and 3836 women). The HLE estimates at age 60 from Sullivan's method in never-smokers, ex-smokers, and current smokers were 23.24, 22.55, and 19.33 in men and 25.04, 20.84, and 20.74 in women, respectively. The corresponding HLE estimates from the multistate life table method were quite similar to those of Sullivan's method both in men (23.32, 21.88, and 19.71, respectively) and in women (25.39, 23.37, and 22.22, respectively). The disparity in HLE estimates at age 60 between these two methods was virtually negligible but widened gradually as the index age increased. The HLE estimates at age 70 from Sullivan's method in never-smokers, ex-smokers, and current smokers were 14.95, 14.36, and 11.58 in men and 16.26, 12.68, and 12.41 in women, respectively. The corresponding HLE estimates from the multistate life table method were 14.98, 13.68, and 12.06 in men and 16.66, 14.82, and 14.02 in women, respectively. The HLE estimates at age 90 from Sullivan's method in never-smokers, ex-smokers, and current smokers were 3.45, 3.21, and 1.94 in men and 3.44, 2.16, and 1.55 in women, respectively. The corresponding HLE estimates from the multistate life table method were 4.06, 3.46, and 3.13 in men and 4.57, 3.70, and 3.67 in women, respectively. Conclusions Two different approaches to calculating HLE were compared using a nationwide Japanese cohort study. The HLE estimates at ages 60 and 70 were generally similar between Sullivan's method and the multistate life table method, but the latter produced higher estimates when the index age was 90 years. Analysts should be aware that the choice of method may influence HLE estimates.

The National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010 (NIPPON DATA2010): Objectives, Design, and Population Characteristics.

BackgroundThe structure and risk factors for cardiovascular diseases (CVD) in Japan may change because lifestyle, particularly nutrition, socioeconomic status, and medical care, which affect CVD, may markedly change over time. Therefore, a new prospective cohort study on a representative general Japanese population based on national surveys is required.MethodsIn November 2010, the baseline survey of the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010 (NIPPON DATA2010) was performed with the National Health and Nutrition Survey of Japan (NHNS2010) in 300 randomly selected districts throughout Japan. The survey included a questionnaire, electrocardiogram, urinalysis, and blood biomarkers added to the NHNS2010 examinations. Physical measurements, blood biomarkers, and dietary data were also obtained in NHNS2010. Socioeconomic factors were obtained by merging with the Comprehensive Survey of Living Conditions 2010 (CSLC2010) dataset. Participants are followed annually for the incidence of diabetes mellitus, CVD events (acute coronary events, heart failure, atrial fibrillation, and stroke), and cause-specific mortality. The activities of daily living are followed every 5 years.ResultsA total of 2,898 individuals aged 20 years or older agreed to participate in the baseline survey of NIPPON DATA2010. The participation rate was 74.6%. Of these, data from NHNS2010 was merged for 2,891 participants (1,236 men and 1,655 women). The data of 2,807 participants were also merged with CSLC2010 data.ConclusionsWe established NIPPON DATA2010 as a cohort study on a representative general Japanese population that covers all of Japan.

Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study.

ObjectivesTo evaluate the impact of dietary sodium and potassium (Na–K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population.SettingProspective cohort study.ParticipantsIn the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30–79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na–K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model.Primary outcome measuresMortality from total and subtypes of stroke, CVD and all causes.ResultsA total of 1938 deaths from all causes were observed over 176 926 person-years. Na–K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na–K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na–K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality.ConclusionsDietary Na–K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population.

Low-carbohydrate diets and cardiovascular and total mortality in Japanese: a 29-year follow-up of NIPPON DATA80.

Long-term safety of consuming low-carbohydrate diets (LCD) in Asian populations, whose carbohydrate intake is relatively high, is not known. In the present study, the association of LCD with CVD and total mortality was assessed using data obtained in the NIPPON DATA80 (National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged 1980) during 29 years of follow-up. At baseline in 1980, data were collected from study participants aged ≥ 30 years from randomly selected areas in Japan. LCD scores were calculated based on the percentage of energy as carbohydrate, fat and protein, estimated by 3 d weighed food records. A total of 9200 participants (56% women, mean age 51 years) were followed up. During the follow-up, 1171 CVD deaths (52% in women) and 3443 total deaths (48% in women) occurred. The multivariable-adjusted hazard ratio (HR) for CVD mortality using the Cox model comparing the highest v. lowest deciles of LCD score was 0·60 (95% CI 0·38, 0·94; P(trend) = 0·021) for women and 0·78 (95% CI 0·58, 1·05; P(trend) = 0·079) for women and men combined; the HR for total mortality was 0·74 (95% CI 0·57, 0·95; P(trend) = 0·029) for women and 0·87 (95% CI 0·74, 1·02; P(trend) = 0·090) for women and men combined. None of the associations was statistically significant in men. No differential effects of animal-based and plant-fish-based LCD were observed. In conclusions, moderate diets lower in carbohydrate and higher in protein and fat are significantly inversely associated with CVD and total mortality in women.

Abstract P072: Low-Carbohydrate-Diets and Cardiovascular and Total Mortality in Japanese. A 29-year Follow-up of NIPPON DATA80

Background: Long-term safety of low-carbohydrate-diets in Asian populations, whose carbohydrate intake is relatively high, is not known. Methods: We examined the association of low-carbohydrate-diets with CVD and total mortality using the National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in the Aged, (NIPPON DATA80) database with a 29-year follow-up. At the baseline in 1980, data were collected on study participants ages≥30 years from randomly selected areas in Japan. We calculated low-carbohydrate-diet scores based on the percentage of energy as carbohydrate, fat, and protein, estimated by 3-day weighed food records. We followed 9,200 participants (56% women, mean age 51 y). Results: During the follow-up, there were 1,171 CVD deaths (52% in women), and 3,443 total deaths (48% in women). The multivariate-adjusted hazard ratio (HR) for CVD mortality using the Cox model comparing highest versus lowest deciles for a low-carbohydrate-diet score was 0.59 (95% confidence interval [CI], 0.38-0.92, trend P=0.019) for women; 0.74 (95% CI: 0.55-0.99, trend P=0.033) for women and men combined; HR for total mortality was 0.73 (95% CI: 0.57-0.93, trend P=0.020) for women; 0.84 (95% CI: 0.72-0.99, trend P=0.030) for women and men combined. None of the associations in men alone were statistically significant. We did not note any differential effects between animal and plant based low-carbohydrate-diets. Conclusions: Moderate diets lower in carbohydrate and higher in protein and fat were significantly inversely associated with CVD and total mortality in women, and women and men combined.

Long-Term Outcome of Healthy Participants with Atrial Premature Complex: A 15-Year Follow-Up of the NIPPON DATA 90 Cohort

BackgroundAtrial premature complexes (APC) are among the most frequently encountered electrocardiographic abnormalities. However, their prognostic value among healthy individuals is unclear. This study aimed to clarify the role of APC in predicting cardiovascular events in a large Japanese community cohort using long-term follow-up data.MethodsNational Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged, 1990-2005, (NIPPON DATA 90) was a large cohort study of cardiovascular disease (CVD) in Japan. A total of 7692 otherwise healthy participants with no history of myocardial infarction, stroke, atrial fibrillation, or atrial flutter were enrolled (men, 41.5%; mean age, 52.5 ± 13.7 years).ResultsA total of 64 (0.8%) participants had at least one beat of APC on screening 12-lead electrocardiogram. During the follow-up of 14.0 ± 2.9 years (total, 107,474 patient-years), 338 deaths occurred due to CVD. The association between APC and CVD outcome was assessed using Cox proportional hazard models. Cox regression analysis revealed that the presence of APC was an independent predictor for CVD deaths (HR: 2.03, 95% CI: 1.12–3.66, P = 0.019). The association of APC on CVD death was more evident in participants with hypertension (P-value for interaction, 0.03).ConclusionsAPC recorded during the screening electrocardiogram are significantly associated with an increased risk of CVD deaths in a Japanese community-dwelling population and are a strong prognostic factor for hypertensive participants.

Impact of Metabolic Syndrome on the Risk of Cardiovascular Disease Mortality in the United States and in Japan

The United States has a higher prevalence of metabolic syndrome (MS) and cardiovascular disease (CVD) mortality than Japan, but it is unknown how much of the difference in MS accounts for the mortality difference. The aim of this study was to examine the impact of MS on the excess CVD mortality in the United States compared with that in Japan. Data from the United States Third National Health and Nutrition Examination Survey (NHANES III; n = 12,561) and the Japanese National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in Aged (NIPPON DATA; n = 7,453) were analyzed. MS was defined as ≥3 of 5 risk factors (obesity, high blood pressure, decreased high-density lipoprotein cholesterol, elevated glycosylated hemoglobin, and elevated triglycerides). The results show that after a median of 13.8 years of follow-up in the United States, 1,683 patients died from CVD (11.75 per 1,000 person-years), and after a median of 15 years of follow-up in Japan, 369 patients died from CVD (3.56 per 1,000 person-years). The age-adjusted prevalence of MS was 26.7% in the United States and 19.3% in Japan. Of 5 MS factors, obesity, high blood pressure, elevated triglycerides, and glycosylated hemoglobin in the United States, and high blood pressure and elevated glycosylated hemoglobin in Japan were significant risk factors for CVD mortality. Estimates of 13.3% and 44% of the excess CVD mortality for the United States could be explained by the higher prevalence of MS and MS plus baseline CVD history than in Japan. In conclusion, the present study is the first to quantitatively demonstrate that MS and MS plus baseline CVD history may significantly contribute to the explanation of excess CVD mortality in the United States compared with Japan.

Cumulative impact of axial, structural, and repolarization ECG findings on long-term cardiovascular mortality among healthy individuals in Japan: National Integrated Project for Prospective Observation of Non-Communicable Disease and its Trends in the Aged, 1980 and 1990

Various cohort studies have shown a close association between long-term cardiovascular disease (CVD) outcomes and individual electrocardiographic (ECG) abnormalities such as axial, structural, and repolarization changes. The combined effect of these ECG abnormalities, each assumed to be benign, has not been thoroughly investigated. Community-dwelling Japanese residents from the National Integrated Project for Perspective Observation of Non-Communicable Disease and its Trends in the Aged, 1980-2004 and 1990-2005 (NIPPON DATA80 and 90), were included in this study. Baseline ECG findings were classified using the Minnesota Code and categorized into axial (left axis deviation, clockwise rotation), structural (left ventricular hypertrophy, atrial enlargement), and repolarization (minor and major ST-T changes) abnormalities. The hazard ratios of the cumulative impacts of ECG findings on long-term CVD death were estimated by stratified Cox proportional hazard models, including adjustments for cohort strata. In all, 16,816 participants were evaluated. The average age was 51.2 ± 13.5 years; 42.7% participants were male. The duration of follow up was 300,924 person-years (mean 17.9 ± 5.8 years); there were 1218 CVD deaths during that time. Overall, 4203 participants (25.0%) had one or more categorical ECG abnormalities: 3648 (21.7%) had a single abnormality, and 555 (3.3%) had two or more. The risk of CVD mortality increased as the number of abnormalities accumulated (single abnormality HR 1.29, 95% CI 1.13-1.48; ≥2 abnormalities HR 2.10, 95% CI 1.73-2.53). Individual ECG abnormalities had an additive effect in predicting CVD outcome risk in our large-scale cohort study.

Abstract WP194: Impact Of Total Energy Intake On Stroke Mortality Is Greater Than That Of Coronary Heart Disease: A 24-year Follow-up Of Representative Japanese (NIPPON DATA80), 1980-2004

INTRODUCTION: Previous studies showed that calorie restriction decreased blood pressure and plasma lipid, and increased longevity. However, impact of total energy intake (EI) on mortality from cardiovascular disease (CVD) including types of CVD has not been studied. We assessed the hypothesis that lower EI was associated with decreased risk of CVD, coronary heart disease (CHD), and stroke mortality. Methods: We studied the association between EI and mortality form all CVD, CHD, and stroke using the National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in the Aged (NIPPON DATA80) database with a 24-year follow-up. We followed a random sample of 8,825 Japanese aged ≥30 years (mean age, 50.0 years at baseline in 1980; 43.3% men) without history of CVD, kidney disease, or diabetes. Those with lack of information about EI or extreme EI (sex-specific intake of highest or lowest 0.5%) were also excluded. EI was calculated from a 3 days weighed food record method. We classified the participants into sex-specific quintiles of EI (the lowest quintile: men&lt;2,025.1 kcal/day, women&lt;1,627.0 kcal/day, the highest quintile: men≥2,776.8 kcal/day, women≥2,219.7 kcal/day). We used Cox proportional-hazards models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for sex, age, body mass index, smoking, drinking, systolic blood pressure, blood glucose, and total cholesterol. Results: Multivariate HR in the lowest quintile (in reference to the highest quintile) from all CVD was significantly decreased (HR: 0.78, 95%CI: 0.62-0.98). The association was more remarkable for stroke mortality (HR: 0.67, 95%CI: 0.48-0.93) than for CHD mortality (HR: 0.82, 95%CI: 0.49-1.37). After further adjustment of multivariate HRs for sodium/potassium ratio, we observed similar results. Conclusion: A 24-year follow-up of NIPPON DATA80 demonstrated that lower EI was associated with decreased risk of CVD mortality: the association was more remarkable for stroke mortality than for CHD mortality.

Prognostic Values of Clockwise and Counterclockwise Rotation for Cardiovascular Mortality in Japanese Subjects

Background— Although clockwise rotation and counterclockwise rotation are distinct findings of the ECG, their prognostic significance is rarely studied. Methods and Results— We studied prognostic values of clockwise and counterclockwise rotation on total, cardiovascular disease (CVD), and subtype mortality using the National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in the Aged, 1980–2004 (NIPPON DATA80) database with a 24-year follow-up. At baseline in 1980, data were collected on study participants aged ≥30 years from randomly selected areas in Japan. We followed 9067 participants (44% men; mean age, 51 years). During the 24-year follow-up, mortality was as follows: 2581 total, 887 CVD, 179 coronary heart disease, 173 heart failure, and 411 stroke. The multivariate-adjusted hazard ratio (HR) with the use of the Cox model including biochemical and other ECG variables revealed that clockwise rotation was significantly positively associated with heart failure in men and women combined (HR=1.79; 95% confidence interval [CI], 1.13–2.83; P =0.013), CVD in men and in men and women combined (HR=1.49; 95% CI, 1.12–1.98; P =0.007 in men; HR=1.28; 95% CI, 1.02–1.59; P =0.030 in combined), and total mortality in men and in men and women combined (HR=1.19; 95% CI, 1.00–1.49; P =0.0496 in men; HR=1.15; 95% CI, 1.00–1.32; P =0.045 in combined). Counterclockwise rotation was significantly inversely associated stroke in men and women combined (HR=0.77; 95% CI, 0.62–0.96; P =0.017), CVD in men and in men and women combined (HR=0.74; 95% CI, 0.59–0.94; P =0.011 in men; HR=0.81; 95% CI, 0.70–0.94; P =0.006 in combined), and total mortality in women (HR=0.87; 95% CI, 0.77–0.98; P =0.023). Conclusions— We found a significant positive association of clockwise rotation and a significant inverse association of counterclockwise rotation with CVD mortality in men and in men and women combined, independent of confounding factors including other ECG changes.

Dyslipidemia and Cardiovascular Disease: A Series of Epidemiologic Studies in Japanese Populations

Although the causal relationships of high serum levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) with coronary artery disease (CAD) are well established, there have been few community-based epidemiologic studies of these relations in Japan. Furthermore, even when analysis is restricted to ischemic stroke, the relationship between dyslipidemia and stroke is very weak. Accordingly, it is difficult to perform cohort studies of dyslipidemia and cardiovascular disease. A series of studies, such as the NIPPON DATA (National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged) cohort study of a representative sample of Japanese, have greatly increased existing evidence. NIPPON DATA80 revealed a clear positive relationship between TC and CAD, and indicated that reverse causality between hypocholesterolemia and liver disease may increase all-cause mortality in hypocholesterolemic Japanese. NIPPON DATA90 showed that serum high-density lipoprotein cholesterol (HDL-C) was inversely associated with all-cause mortality, even when HDL-C was very high. NIPPON DATA80 revealed that low-normal levels of serum albumin and TC are associated with a decline in activity during old age, especially in women. The Suita study—a unique cohort study of urban residents—showed that LDL-C and non–HDL-C were equally accurate in predicting the incidence of myocardial infarction. Further research of this quality is needed to ascertain the public health burden of dyslipidemia in Japan.

Lower Levels of Serum Albumin and Total Cholesterol Associated with Decline in Activities of Daily Living and Excess Mortality in a 12‐Year Cohort Study of Elderly Japanese

To examine the association between levels of serum albumin and total cholesterol (TC) and risk of subsequent mortality and future decline in activities of daily living (ADLs) in elderly people. Population-based cohort study. National Integrated Project for Prospective Observation of Non-Communicable Disease and Its Trends in the Aged, 1980. One thousand eight hundred forty-four Japanese individuals aged 60 to 74 randomly selected throughout Japan and followed for 12.4 years. Decline in ADLs and mortality. After adjusting for other covariates, the multivariable odds ratios (ORs) of impaired ADLs were highest in the lowest albumin quartile (< or = 40 g/L) for women. The multivariable OR of having a composite outcome of death or impaired ADL for the lowest albumin quartile compared with the highest was 1.56 (95% confidence interval (CI)=1.94-2.57) for men and 3.06 (95% CI=1.89-4.95) for women. Serum albumin was significantly and inversely associated with a composite outcome of death or impaired ADLs in the group below the median of TC in both sexes (multivariable OR for 1-g/L increase in serum albumin=0.88 for men (95% CI=0.79-0.97) and 0.79 for women (95% CI=0.72-0.87)), which was not significantly associated in the group with TC at or above the median. In the Japanese general population, low-normal serum albumin and TC levels are associated with loss of activity during old age, especially for women.

White Blood Cell Count and Risk of All-Cause and Cardiovascular Mortality in Nationwide Sample of Japanese

The association of white blood cell (WBC) count with all-cause and cardiovascular disease (CVD) mortality were examined in the National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged (NIPPON DATA) 90. A total of 6,756 Japanese residents (2,773 men and 3,983 women) throughout Japan without a history of CVD were followed for 9.6 years. A Cox proportional hazards regression model was used to estimate the relative risk (RR) and 95% confidence interval (CI). We documented 576 deaths with 161 deaths from CVD. Overall, after adjusting for several confounders including age, sex, body mass index at baseline, smoking status, alcohol consumption, regular exercise, diastlic blood pressure, total cholesterol, high-density lipoprotein-cholesterol and hemoglobin A1c, a graded association between WBC count and higher risk of all-cause mortality was observed (WBC of 9,000-10,000 cells/mm(3) vs WBC of 4,000-4,900: RR =1.61, 95% CI: 1.07-2.40, p for trend =0.02). Elevated WBC count was almost significantly associated with high risk of CVD mortality (WBC of 9,000-10,000 vs WBC of 4,000-4,900: RR =1.79, 95% CI: 0.97-3.71). These associations strengthened among women. Stratified by smoking status, never-smokers with WBC counts of 9,000-10,000 had a 3.2 fold elevated risk for CVD death compared with those with WBC counts of 4,000-4,900. The WBC count may have potential as a predictor for all-cause mortality, particularly CVD mortality.

Different effects of blood pressure on mortality from stroke subtypes depending on BMI levels: a 19-year cohort study in the Japanese general population—NIPPON DATA80

To evaluate the relationship between blood pressure and cerebrovascular death depending on body mass index (BMI) levels, we analysed a database of 9338 subjects from the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged, which was originally conducted a baseline survey in 1980 and followed up in 1999. Relative risk (RR) and a 95% confidence interval (CI) of death from total stroke, cerebral infarction, and intracerebral haemorrhage after adjusting for age, sex, serum cholesterol, albumin, glucose, the use of antihypertensive agents, a past history of diabetes, BMI, smoking, and drinking were estimated with the Cox-proportional hazard model in the BMI tertile groups of a representative Japanese population. Cutoff points of BMI tertiles are 21.2 and 23.8 kg/m2. The results indicated that a 10 mmHg systolic blood pressure (SBP) increase was associated with mortality from intracerebral haemorrhage at low and middle BMI groups (RR= 1.38 and 1.23; 95% CI=1.17-1.62 and 1.03-1.47, respectively). SBP was positively associated with mortality from cerebral infarction in middle and high BMI groups (RR=1.19 and 1.21; 95% CI=1.06-1.33 and 1.06-1.38, respectively). The effects of diastolic blood pressure on intracerebral haemorrhage and infarction had the same tendency as those of SBP. These results suggested that the causal effect of blood pressure on stroke subtypes might be modified by BMI.

Egg consumption, serum cholesterol, and cause-specific and all-cause mortality: the National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged, 1980 (NIPPON DATA80)

Because egg yolk has a high cholesterol concentration, limited egg consumption is often suggested to help prevent ischemic heart disease (IHD). We epidemiologically examined the validity of this recommendation. We analyzed the relations of egg consumption to serum cholesterol and cause-specific and all-cause mortality by using the NIPPON DATA80 (National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged, 1980) database. At the baseline examination in 1980, a nutritional survey was performed by using the food-frequency method in Japanese subjects aged > or =30 y. We followed 5186 women and 4077 men for 14 y. The subjects were categorized into 5 egg consumption groups on the basis of their responses to a questionnaire (> or =2/d, 1/d, 1/2 d, 1-2/wk, and seldom). There were 69, 1396, 1667, 1742, and 315 women in each of the 5 groups, respectively. Age-adjusted total cholesterol (5.21, 5.04, 4.95, 4.91, and 4.92 mmol/L in the 5 egg consumption categories, respectively) was related to egg consumption (P < 0.0001, analysis of covariance). In women, unadjusted IHD mortality and all-cause mortality differed significantly between the groups [IHD mortality: 1.1, 0.5, 0.4, 0.5, and 2.0 per 1000 person-years, respectively (P = 0.008, chi-square test); all-cause mortality: 14.8, 8.0, 7.5, 7.5, and 14.5 per 1000 person-years, respectively (P < 0.0001, chi-square test)]. In men, egg consumption was not related to age-adjusted total cholesterol. Cox analysis found that, in women, all-cause mortality in the 1-2-eggs/wk group was significantly lower than that in the 1-egg/d group, whereas no such relations were noted in men. Limiting egg consumption may have some health benefits, at least in women in geographic areas where egg consumption makes a relatively large contribution to total dietary cholesterol intake.