Public Health Center-based Prospective Study Research Articles

Physical activity and 10-year incidence of self-reported vertebral fractures in Japanese women: the Japan Public Health Center-based Prospective Study.

This study assessed the effects of physical activity on a 10-year incidence of self-reported vertebral fractures in adult women of a large Japanese cohort. Medium levels of strenuous activity and long-duration sedentary activity were associated with a lower incidence of vertebral fractures; association patterns appear to be different from hip fractures. Physical activity helps prevent hip fracture, but little is known about the longitudinal association between physical activity and vertebral fractures. The purpose of this study was to evaluate the effects of physical activity on the 10-year incidence of symptomatic vertebral fractures using data from the Japan Public Health Center-based Prospective Study. Baseline studies were conducted in 1993-1994, and the follow-up study was conducted 10 years later. We analyzed 23,757 women aged 40-69 years. At baseline, physical activity was assessed as a predictor by using a questionnaire. Subjects were asked to report vertebral fractures that occurred during the 10-year follow-up period. Relative risks (RRs) adjusted for confounders were estimated by multiple logistic regression analysis. The 10-year cumulative incidence of vertebral fractures was 0.67%. Those who engaged in strenuous physical activity of <1 h/day had a significantly lower incidence of vertebral fractures than those who did not engage in such activity (RR = 0.52, 95% CI 0.28-0.97), while those engaged in such activity ≥1 h/day did not (RR = 0.82, 95% CI 0.58-1.14). Long-duration sedentary activity was associated with a low incidence of vertebral fractures (P for trend = 0.0002), but the frequencies of sports activities and metabolic equivalents were not (P for trend = 0.0729 and 0.4341, respectively). Strenuous activity and sedentary activity are associated with the incidence of vertebral fractures, although the association may not be linear. The pattern of association between physical activity and vertebral fractures appears to be different from that of hip fractures.

Associations of all-cause mortality with census-based neighbourhood deprivation and population density in Japan: a multilevel survival analysis.

BackgroundDespite evidence that neighbourhood conditions affect residents' health, no prospective studies of the association between neighbourhood socio-demographic factors and all-cause mortality have been conducted in non-Western societies. Thus, we examined the effects of areal deprivation and population density on all-cause mortality in Japan.MethodsWe employed census and survival data from the Japan Public Health Center-based Prospective Study, Cohort I (n = 37,455), consisting of middle-aged residents (40 to 59 years at the baseline in 1990) living in four public health centre districts. Data spanned between 1990 and 2010. A multilevel parametric proportional-hazard regression model was applied to estimate the hazard ratios (HRs) of all-cause mortality by two census-based areal variables —areal deprivation index and population density—as well as individualistic variables such as socioeconomic status and various risk factors.ResultsWe found that areal deprivation and population density had moderate associations with all-cause mortality at the neighbourhood level based on the survival data with 21 years of follow-ups. Even when controlling for individualistic socio-economic status and behavioural factors, the HRs of the two areal factors (using quartile categorical variables) significantly predicted mortality. Further, this analysis indicated an interaction effect of the two factors: areal deprivation prominently affects the health of residents in neighbourhoods with high population density.ConclusionsWe confirmed that neighbourhood socio-demographic factors are significant predictors of all-cause death in Japanese non-metropolitan settings. Although further study is needed to clarify the cause-effect relationship of this association, the present findings suggest that health promotion policies should consider health disparities between neighbourhoods and possibly direct interventions towards reducing mortality in densely populated and highly deprived neighbourhoods.

Death by suicide and other externally caused injuries following a cancer diagnosis: the Japan Public Health Center‐based Prospective Study

There have been very few population-based prospective studies that have investigated the risks of deaths by suicide and other externally caused injuries (ECIs) among cancer patients in an Asian population. This study investigated whether the risk of death by both suicide and ECIs increases during the first year following the initial diagnosis of cancer. Data were analyzed from a population-based cohort of Japanese residents between 1990 and 2010, collected during the Japan Public Health Center-based Prospective Study. Poisson regression models were used to calculate adjusted risk ratios (RRs) for both suicide and ECI deaths. To adjust for unmeasured confounding factors, case-crossover analyses were conducted for all patients with cancer who died by suicide and ECIs. A population-based cohort of 102,843 Japanese residents was established. During the follow-up period, there were 34 suicides and 48 ECI deaths among patients with cancer, as compared with 527 suicides and 707 ECI deaths among those who did not have cancer. Analyses revealed that those who were newly diagnosed with cancer were at a greatly increased risk of death by suicide and ECIs within the first year after their diagnosis (suicide RR = 23.9, 95% CI: 13.8-41.6; ECI RR = 18.8, 95% CI: 11.4-31.0). Furthermore, the case-crossover analyses generally confirmed the results of the Poisson regressions. The risks of suicide and ECI deaths within the first year after a cancer diagnosis were higher than those among cancer-free populations. A diagnosis of cancer is a critical experience that may increase the risk of fatal outcomes.

日本の運動疫学コホート（6） 多目的コホート研究 The Japan Public Health Center-based prospective Study (JPHC Study)

日本の運動疫学コホート（6） 多目的コホート研究 The Japan Public Health Center-based prospective Study (JPHC Study)

Rice, bread, noodle and cereal intake and colorectal cancer in Japanese men and women: the Japan Public Health Center-based prospective Study (JPHC Study)

Background:Colorectal cancer (CRC) incidence rate increased rapidly in Japan between the 1950s and 1990s. We examined the association between rice intake and CRC risk in comparison with bread, noodles and cereal among Japanese adults enrolled in the Japan Public Health Center-based prospective Study.Methods:A total of 73 501 Japanese men and women were followed-up from 1995 to 1999 until the end of 2008 for an average of 11 years. During 801 937 person-years of follow-up, we identified 1276 incident cases of CRC. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) of CRC for rice, noodle, bread and cereal intake were calculated by Cox proportional hazards model.Results:Overall, no significant association was observed for the highest quartile of rice intake compared with the lowest and the risk of CRC and its subsites in men (HR, 0.77; 95% CI, 0.56–1.07) and women (HR, 1.10; 95% CI, 0.71–1.68). However, a non-significant inverse trend was observed between rice intake and rectal cancer in men. No clear patterns of association were observed in bread, noodle and cereal intake.Conclusion:Our findings suggest that the consumption of rice does not have a substantial impact on the risk of CRC in the Japanese population.

Coping behaviors and suicide in the middle-aged and older Japanese general population: the Japan Public Health Center-based Prospective Study

PurposeCross-sectional studies have shown an association between different coping styles and suicidal behavior. It is unknown whether there is any prospective association between coping behaviors and suicide in the general population. MethodsThe study population consisted of participants of the Japanese Public Health Center-based Prospective Study. In the 10-year follow-up questionnaire, subjects aged 50–79 years were asked how they handle daily problems. Coping behaviors were used to determine two coping strategies (approach coping and avoidance coping). Of 99,439 subjects that returned the 10-year follow-up questionnaire, 70,213 subjects provided complete answers on coping and were included in our analyses. Cox regression models, adjusted for confounders, were used to determine the risk of committing suicide according to coping style. Mean follow-up time was 8.8 years. ResultsTwo coping behaviors were significantly associated with suicide over time: planning (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.41–0.98) and self-blame (HR, 2.20; 95% CI, 1.29–3.76). Of the coping strategies, only the avoidance coping strategy was significantly associated with suicide (HR, 2.45; 95% CI, 1.24–4.85). ConclusionsFor the first time, two coping behaviors and one coping strategy have been shown to have a significant prospective association with suicide in a general population.

History of Having a Macrosomic Infant and the Risk of Diabetes: The Japan Public Health Center-Based Prospective Diabetes Study

ObjectiveThe aim of the present study was to test a hypothesis that a history of having a macrosomic infant (≥4000g) is associated with the risk of diabetes.MethodsData on the Japan Public Health Center-based Prospective diabetes cohort were analyzed, which is a population-based cohort study on diabetes. The survey of diabetes was performed at baseline and at the 5-year follow-up. A history of having a macrosomic infant was assessed using a self-administered questionnaire. A cross-sectional analysis was performed among 12,153 women who participated in the 5-year survey of the cohort. Logistic regression was used to examine the relationship between a history of having a macrosomic infant and the presence of diabetes. A longitudinal analysis was also conducted among 7,300 women without diabetes who participated in the baseline survey. Logistic regression was used to investigate the relationship between a history of having a macrosomic infant and the incidence of diabetes between the baseline survey and the 5-year survey. ResultsIn the cross-sectional analysis, parous women with a positive history were more likely to have diabetes in relation to parous women without (OR = 1.44, 95% CI = 1.13-1.83). The longitudinal analysis showed a modest but non-significant increased risk of developing diabetes among women with a positive history (OR = 1.24, 95% CI = 0.80-1.94). ConclusionsAn increased risk of diabetes was implied among women with a history of having a macrosomic infant although the longitudinal analysis showed a non-significant increased risk.

Dietary patterns and suicide in Japanese adults: The Japan Public Health Center-based Prospective Study

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

Dietary glycemic index, glycemic load and incidence of type 2 diabetes in Japanese men and women: the Japan public health center-based prospective study

BackgroundJapanese diets contain a relatively high amount of carbohydrates, and its high dietary glycemic index and glycemic load may raise the risk of diabetes in the Japanese population. The current study evaluated the associations between the dietary glycemic index, glycemic load, and the risk of type 2 diabetes in a population based cohort in Japan.MethodsWe observed 27,769 men and 36,864 women (45–75 y) who participated in the second survey of the Japan Public Health Center-based Prospective Study. The dietary glycemic index and glycemic load were estimated using a food-frequency questionnaire. The development of diabetes was reported in a questionnaire administered five years later, and the associations were analyzed using logistic regression after controlling for age, area, total energy intake, smoking status, family history of diabetes, physical activity, hypertension, BMI, alcohol intake, magnesium, calcium, dietary fiber and coffee intake, and occupation.ResultsThe dietary glycemic load was positively associated with the risk of diabetes among women: the multivariable-adjusted odds ratio comparing the highest vs. the lowest quartile was 1.52 (95% CI, 1.13-2.04; P-trend = 0.01). The association was implied to be stronger among women with BMI < 25 than the women with BMI ≥ 25. The dietary glycemic index was positively associated with the risk of diabetes among men with a high intake of total fat: the multivariable-adjusted odds ratio comparing the highest vs. the lowest quartile was 1.46 (95% CI, 0.94-2.28; P-trend = 0.04). Among women with a high total fat intake, those in the first and second quartiles of the dietary glycemic index had a significant reduced risk of diabetes, compared with those in the first quartile who had a lower total fat level (multivariable-adjusted odds ratio = 0.59 with 95% CI, 0.37-0.94, and odds ratio = 0.63 with 95% CI, 0.40-0.998 respectively).ConclusionsThe population-based cohort study in Japan indicated that diets with a high dietary glycemic load increase the risk of type 2 diabetes among women. Total fat intake may modify the association between the dietary glycemic index and the risk of type 2 diabetes among men and women.

Fruit and vegetable intake and breast cancer risk defined by estrogen and progesterone receptor status: the Japan Public Health Center-based Prospective Study

Epidemiological evidence for the impact of fruit and vegetable intake on breast cancer risk among the Japanese populations is scarce. The purpose of this study was to evaluate the association between fruit and vegetable intake and breast cancer risk among 47,289 Japanese women. The study was conducted under a population-based prospective cohort design. Dietary assessment was performed using a validated food frequency questionnaire. A Cox proportional hazards regression model was used to calculate relative risks (RRs) and their corresponding 95 % confidence intervals (CIs). During an average of 10.2 years of follow-up, 452 cases of breast cancer were newly diagnosed. No association with breast cancer risk was seen for intake of total fruits and vegetables, cruciferous vegetables, green-leaf vegetables, yellow vegetables, or tomato products in overall or postmenopausal women. Cruciferous vegetable intake was associated with a statistically significant decrease in risk of premenopausal breast cancer [multivariable-RRQ4 vs. Q1 = 0.64 (95 % CI = 0.38-1.10; p trend = .046)] and showed a marginally inverse association with ER+ PR+ tumors [RRper 100 g increment = 0.64 (95 % CI = 0.41-1.00)]. In contrast, positive associations were seen between intake of total fruits and citrus fruits and breast cancer risk in overall and premenopausal women. However, these associations for fruit were all attenuated with additional adjustment for vitamin C intake. Our results suggest an overall null association between total fruit and vegetable intake and breast cancer risk. Intake of cruciferous vegetable showed a statistically significant association with a decreased risk of breast cancer among premenopausal women.

Impact of five modifiable lifestyle habits on the probability of cancer occurrence in a Japanese population-based cohort: Results from the JPHC study

ObjectiveThe present work aims to provide 10-year estimates of the probability of cancer occurrence in the Japanese population based on age, sex, and the pattern of adherence to five healthy lifestyle habits. MethodsThe study population consisted of 74,935 participants in the Japan Public Health Center-Based Prospective Study (aged 45 to 74years) who answered a 5-year follow-up questionnaire about various lifestyle habits between 1995 and 1999. The relationship between five previously identified healthy lifestyle habits (never smoking, moderate or no alcohol consumption, adequate physical activity, moderate salt intake, and appropriate body mass index) and cancer occurrence was assessed using a sex-specific parametric survival model. ResultsCompared to individuals not adhering to any of the five habits, never-smoking men had a nearly 30% reduction in the 10-year probability of cancer occurrence (e.g., 20.5% vs. 28.7% at age 70), and never-smoking women had a 16% reduction (e.g., 10.5% vs. 12.5% at age 70). Adherence to all five habits was estimated to reduce the 10-year probability of cancer occurrence by 1/2 in men and 1/3 in women. ConclusionBy quantifying the impact of lifestyle habits on the probability of cancer occurrence, this study emphasizes the importance of lifestyle improvement.

Alcohol and smoking and subsequent risk of prostate cancer in Japanese men: The Japan Public Health Center‐based prospective study

Although alcohol and smoking have not been established as risk factors for prostate cancer, they are important risk factors for other human cancers and potentially major avoidable factors. Alcohol drinkers and smokers might be less likely to get screening, which might lead to attenuation of the positive association. Here, we investigated the association of alcohol drinking and smoking and prostate cancer according to stage, as well as prostate cancer detected by subjective symptoms, in a large prospective study among Japanese men. The Japan Public Health Center-based prospective study (JPHC study) was established in 1990 for Cohort I and in 1993 for Cohort II. Subjects were 48,218 men aged 40-69 years who completed a questionnaire, which included their alcohol and smoking habits at baseline, and who were followed until the end of 2010. During 16 years of follow-up, 913 men were newly diagnosed with prostate cancer; of whom 248 had advanced cases, 635 were organ-localized and 30 were of an undetermined stage. Alcohol consumption was dose-dependently associated with advanced prostate cancer [nondrinkers: reference, 0-150 g/week: hazard ratio (HR) = 1.23, 95% confidence interval (CI) = 0.83-1.82; 150-300 g/week: HR = 1.51, 95% CI = 1.04-2.19; ≥ 300 g/week: HR = 1.41, 95% CI = 0.97-2.05, p for trend = 0.02]. The positive association was not substantially changed among cancers detected by subjective symptoms. Smoking was inversely associated with prostate cancer among total subjects, but tended to increase the risk of advanced prostate cancer detected by subjective symptoms. In conclusion, abstinence from alcohol and prohibition of smoking might be important factors in the prevention of advanced prostate cancer.

Plasma Isoflavone Concentrations Are Not Associated with Gastric Cancer Risk among Japanese Men and Women1,2

The incidence of gastric cancer throughout the world is ∼2–3 times higher in men than in women. Previous research suggested that isoflavones, which are structurally similar to 17β-estradiol, may prevent gastric cancer. Based on a large, population-based, prospective study, we recently reported a null association between dietary isoflavone intake and gastric cancer. However, epidemiologic studies using blood concentrations of isoflavones might better reflect the effect of isoflavones on gastric cancer carcinogenesis than dietary assessment. We therefore conducted a nested case-control study within the Japan Public Health Center-Based Prospective Study. Participants were followed-up from 1990 to 2004. Among 36,745 participants who answered the baseline questionnaire and provided blood samples, 483 gastric cancer cases matched to 483 controls were used in the analysis. ORs and 95% CIs were estimated with a conditional logistic regression model. The overall distribution of plasma isoflavone concentrations was not associated with the development of gastric cancer. Compared with groups with the lowest plasma concentrations (reference groups), the groups with the highest daidzein and genistein concentrations had adjusted ORs and 95% CIs of 1.11 (0.74–1.66; P-trend = 0.6) and 0.96 (0.64–1.44; P-trend = 0.9), respectively. The results did not change when analysis was based on sex, subsite, or histological type. We found no association of plasma isoflavone concentrations with gastric cancer risk. Our data support the previously observed null association between isoflavone intake and gastric cancer risk.

Alcohol consumption and risk of stroke and coronary heart disease among Japanese women: The Japan Public Health Center-based prospective study

ObjectiveThe study aims to examine the association between a wide range of alcohol consumption and risk of stroke and coronary heart disease. MethodsThe Japan Public Health Center-based prospective study was initiated in 1990 in Cohort I and in 1993 in Cohort II, with follow-up until 2009. The sample consisted of 47,100 women aged 40–69years. ResultsDuring an average of 16.7-years, the incidence of 1846 strokes and 292 coronary heart diseases was observed. Heavy drinking (≥300gethanol/week) was associated with increased risk of total stroke. The multivariable hazard ratios for heavy versus occasional drinkers were 2.19 (95% confidence interval: 1.45–3.30) for total stroke, 2.25 (1.29–3.91) for hemorrhagic stroke, 2.24 (1.05–4.76) for intraparenchymal hemorrhage, 2.26 (1.01–5.09) for subarachnoid hemorrhage and 2.04 (1.09–3.82) for ischemic stroke. In the exposure-updated analysis, the positive association between heavy drinking and risks of total stroke, hemorrhagic stroke and intraparenchymal hemorrhage became more evident. Light drinking (<150gethanol/week) was not associated with risk of ischemic stroke. There was also no association between alcohol consumption and risk of coronary heart disease. ConclusionHeavy drinking was associated with increased risk of hemorrhagic and ischemic strokes among Japanese women.

Dietary arsenic intake and subsequent risk of cancer: the Japan Public Health Center-based (JPHC) Prospective Study.

PurposeArsenic is a known human carcinogen and has been linked to adverse health outcomes, including cancer. However, the effects of arsenic exposure from food on health are still unknown. We researched to examine the association between arsenic exposure from food and incidence of cancer in a Japanese population.MethodsWe conducted a population-based prospective study in 90,378 Japanese men and women aged 45–74 years. Participants responded to a validated questionnaire that included 138 food items. We estimated dietary arsenic intake from 12 food groups (75 items) based on the questionnaire data. During 11 years of follow-up, 7,002 cancer cases were identified. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for cancer were calculated by Cox proportional hazards modeling.ResultsTotal arsenic and inorganic arsenic showed no association with the risk of total cancer in both men and women. Total arsenic and inorganic arsenic intake tended to be associated with an increased risk of lung cancer in men. In particular, these positive associations were strengthened in currently smoking men, with HRs (95 % CI) in the highest categories of arsenic and inorganic arsenic intake compared with the lowest of 1.29 (95 % CI = 1.03–1.61) and 1.36 (95 % CI = 1.09–1.70), respectively. We also detected an interaction between arsenic and inorganic arsenic intake and smoking status in men (p interaction < 0.01 and 0.07, respectively).ConclusionA significant dose–response trend was seen in the association of arsenic and inorganic intake with lung cancer risk in currently smoking men.

Red meat consumption is associated with the risk of type 2 diabetes in men but not in women: a Japan Public Health Center-based Prospective Study

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

Correction: Smoking Cessation Increases Short-Term Risk of Type 2 Diabetes Irrespective of Weight Gain: The Japan Public Health Center-Based Prospective Study

Correction: Smoking Cessation Increases Short-Term Risk of Type 2 Diabetes Irrespective of Weight Gain: The Japan Public Health Center-Based Prospective Study

Development of a Point-based Prediction Model for the Incidence of Total Stroke

An individualized risk score for the development of stroke may be a useful tool to motivate patients to modify their risk behaviors. We developed and validated a point-based prediction model (risk score) for stroke incidence using a Japanese cohort of general men and women. The Japan Public Health Center-based prospective study cohort II (age range, 40-69 years at baseline in 1993-1994; n=15 672) was used to derive the point-based model according to Cox regression results. The model was externally validated using the Japan Public Health Center study cohort I and also by bootstrap methods within cohort II. The model discrimination was evaluated by the area under the receiver operating characteristic curve, model calibration, by the Grønnesby-Borgan χ(2) statistic. Vascular age was also calculated. During 14 years of follow-up, 790 incident stroke cases occurred. Variables selected for the model were age, sex, current smoking, body mass index, blood pressure, antihypertensive medication use, and diabetes mellitus. Interactions of sex with current smoking and of antihypertensive medication use with systolic blood pressure were statistically significant. The point-based model discriminated reasonably well (area under the receiver operating characteristic curve, 0.73). The area under the receiver operating characteristic curve of the point-based model applied externally to cohort I was reasonably good: 0.69. A 50-year-old man with diabetes mellitus and hypertension has an estimated vascular age of 69 years. High normal blood pressure and grade 1 hypertension accounted for one third of the stroke incidence. We developed score to predict 10-year stroke risk using variables that are easily available in the community setting.

Dietary intake of saturated fatty acids and incident stroke and coronary heart disease in Japanese communities: the JPHC Study

Aims Although dietary saturated fatty acids (SFA) are considered atherogenic, associations between SFAs intake and stroke and coronary heart disease are still debated. We sought to test the hypothesis that SFA intake is associated inversely with risk of stroke and its subtypes and positively with coronary heart disease among Japanese, whose average SFA intake is lower than that of Westerners. Methods and results The Japan Public Health Center-based prospective Study involves two subcohorts: Cohort I, aged 45-64 in 1995 and followed-up through 2009, and Cohort II, aged 45-74 in 1998 and followed-up through 2007. A total of 38 084 men and 43 847 women were included in this report. Hazards ratios for incident total stroke, ischaemic stroke, intraparhenchymal haemorrhage, subarachnoid haemorrhage, myocardial infarction, and sudden cardiac death across quintiles of dietary SFAs were examined. We found inverse associations between SFA intake and total stroke [multivariable hazard ratio (95% confidence interval) for the highest vs. lowest quintiles = 0.77 (0.65-0.93), trend P = 0.002], intraparenchymal haemorrhage [0.61 (0.43-0.86), P for trend = 0.005], and ischaemic stroke [0.84 (0.67-1.06), trend P = 0.08], primarily for deep intraparenchymal haemorrhage [0.67 (0.45-0.99), P for trend = 0.04] and lacunar infarction [0.75 (0.53, 1.07), trend P = 0.02]. We also observed a positive association between SFAs intake and myocardial infarction [1.39 (0.93-2.08), trend P = 0.046] primarily among men. No associations were observed between SFAs intake and incidence of subarachnoid haemorrhage or sudden cardiac death. Conclusions In this Japanese population, SFAs intake was inversely associated with deep intraparenchymal haemorrhage and lacunar infarction and positively associated with myocardial infarction.

Nutritional Epidemiology of Type 2 Diabetes and Depressive Symptoms

In Japan, the prevalences of type 2 diabetes and depression are increasing, but evidence linking these diseases to diet is limited. The present study reviewed the association of type 2 diabetes with intakes of rice, fish/seafood, and soy product and isoflavone, and the association of depressive symptoms with folate, vitamin D, and dietary pattern, in the Japanese population. The analysis of type 2 diabetes comprised around 55 000 men and women aged 45 to 75 years who completed a questionnaire for the Japan Public Health Center-based Prospective Study and were free of type 2 diabetes at baseline. The odds ratio of self-reported physician-diagnosed type 2 diabetes during the subsequent 5 years increased with rice intake among women and among physically inactive men but decreased with total fish/seafood intake among men. In addition, risk tended to decrease with soy product and isoflavone intake among overweight and postmenopausal women. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. The participants were approximately 530 workers aged 21 to 67 years who participated in a health survey at the time of a periodic health check. A cross-sectional and prospective inverse association between serum folate and depressive symptoms was observed. Serum 25-hydroxyvitamin D level was suggestively associated with decreased prevalence of depressive symptoms in late autumn. In addition, a healthy Japanese pattern—characterized by high intakes of vegetables, fruit, mushrooms, and soy products—was inversely associated with depressive symptoms. The findings suggest that diet has a role in the development of type 2 diabetes and depression in Japanese.