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Objective. Despite considerable study, the relevance of leptin and adiponectin for atherosclerosis development is still unsettled. We investigated relations of serum leptin and adiponectin to serum C-reactive protein (CRP), using the INTERLIPID dataset on Japanese emigrants living in Hawaii and Japanese in Japan.Design and Methods. Serum leptin, adiponectin, and CRP were measured by standardized methods in men and women of ages 40 to 59 years from two population samples, one Japanese-American in Hawaii (83 men, 89 women) and the other Japanese in central Japan (111 men, 104 women). Participants with CRP >10 mg/L were excluded.Results. Sex-specific multiple linear regression analyses, with log-transformed leptin and adiponectin (log-leptin, log-adipo), site (Hawaii = 1, Japan = 0), SBP, HbA1c, smoking (cigarettes/day), and physical activity index score of the Framingham Offspring Study as covariates, showed that log-leptin directly related and log-adipo inversely related to log-CRP for both sexes (Ps < 0.05 to P=0.006).Conclusions. Leptin directly related to CRP independent of BMI and other confounding factors in men but not in women.

BACKGROUND: Most epidemiological studies exploring the association between smokeless tobacco (SLT) use and coronary heart disease (CHD) have been in Western populations, and have focused on SLT products used in those countries. Few studies come from South Asian countries. Our objective was to determine the association between SLT use and CHD among non-smoking adults in Bangladesh. METHODS: A matched case-control study of non-smoking Bangladeshi adults aged 40-75 years was conducted in 2010. Incident cases of CHD were selected from two cardiac hospitals. Community controls, matched to CHD cases, were selected from neighbourhoods, and hospital controls were selected from outpatient departments of the same hospitals. The Rose Angina Questionnaire (RAQ) was also used to re-classify cases and controls. RESULTS: The study enrolled 302 cases, 1,208 community controls and 302 hospital controls. Current use was higher among community controls (38%) compared to cases (33%) and hospital controls (32%). Current use of SLT was not significantly associated with an increased risk of CHD when community controls were used (adjusted OR 0.87, 95% CI 0.63-1.19), or when hospital controls were used (adjusted OR 1.00, 95% CI 0.63-1.60), or when both control groups were combined (adjusted OR 1.00, 95% CI 0.74-1.34). Risk of CHD did not increase with use of individual types except gul, frequency, duration, past use of SLT products, or using the RAQ to re-classify cases and controls. There was a significant association between gul use and CHD when both controls were combined (adjusted OR 2.93, 95% CI 1.28-6.70). CONCLUSIONS: There was no statistically significant association between SLT use in general and CHD among non-smoking adults in Bangladesh. Further research on the association between gul use and CHD in Bangladesh along with SLT use and CHD in other parts of the subcontinent will guide public health policy and interventions that focus on SLT-related diseases.

The study aimed to determine whether hospital controls could be used in case-control studies with minimal bias, where resource constraints limit recruitment of community controls. Hospital controls and community controls were compared for socio-demographic and risk factor variables in a study of Smokeless Tobacco (SLT) use and Coronary Heart Disease (CHD) in Bangladesh in 2010. Incident cases of CHD and hospital controls were selected from cardiac hospitals. Community controls were selected from neighbourhoods of CHD cases. We enrolled 302 cases, 302 hospital controls, and 1208 community controls. Distribution of age, gender, marital status, occupation, and socio-economic status was similar between hospital controls and community controls. Compared to community controls, hospital controls were more educated, had higher rates of hypertension and reported more family history of heart diseases. But they reported relatively less physical activity. Current use of SLT was higher amongst community controls compared to hospital controls, but was not significant (adjusted OR 0.81, 95% CI 0.58-1.12). Current use of SLT was not associated with an increased risk of CHD when community controls were used (adjusted OR 0.87, 95% CI 0.63 to 1.19, p > 0.05), nor when hospital controls were used (adjusted OR 1.00, 95% CI 0.63 to 1.60, p > 0.05). There were significant differences between two control groups but only on confounding variables which could be measured and adjusted for during multivariate analyses. For comparable future studies in resource-scarce settings, it is possible to enrol hospital controls with careful planning which are similar to potential community controls, whilst minimising selection bias.

Excess energy, saturated fat, sugar and salt from processed and fast foods are a major cause of chronic disease worldwide. In 2010 The Food Monitoring Group established a global branded food composition database to track the nutritional content of foods and make comparisons between countries, food companies and over time. A protocol for the project was agreed and published in 2011 with 24 collaborating countries. Standardised tools and a website have been developed to facilitate data collection and entry. In 2010 data were obtained from nine countries, in 2011 from 12 and in 2012 data are anticipated from 10 additional countries. This collaborative approach to the collation of food composition data offers potential for cross-border collaboration and support in developed and developing countries. The project should contribute significantly to tracking progress of the food industry and governments towards commitments made at the recent UN high level meeting on chronic disease.

Little is known about the prognostic value of ST-segment depression and/or T wave (ST-T abnormalities) with or without left high R waves on electrocardiogram recorded at rest for death from cardiovascular disease (CVD) in Asian populations. Japanese participants without a history of CVD and free of major electrocardiographic (ECG) abnormalities were followed for 24 years. Subjects were divided into 4 groups based on baseline ECG findings: isolated left high R waves, isolated ST-T abnormalities, ST-T abnormalities with left high R waves, and normal electrocardiogram. Cox proportional hazard model was used to estimate risk of CVD mortality in groups with ECG abnormalities compared to the normal group. Of 8,572 participants (44.4% men, mean age 49.5 years; 55.6% women, mean age 49.4 years), 1,142 had isolated left high R waves, 292 had isolated ST-T abnormalities, and 128 had ST-T abnormalities with left high R waves at baseline. Multivariable-adjusted hazard ratios of ST-T abnormalities with left high R waves for CVD mortality were 1.95 (95% confidence interval 1.25 to 3.04) in men and 2.68 (95% confidence interval 1.81 to 3.97) in women. Isolated ST-T abnormalities increased the risk for CVD death by 1.66 times (95% confidence interval 1.01 to 2.71) in men and 1.62 times (95% confidence interval 1.18 to 2.24) in women. Association of ECG abnormalities with CVD mortality was independent of age, body mass index, systolic blood pressure, serum cholesterol, blood glucose, smoking and drinking, and antihypertensive medication. In conclusion, ST-T abnormalities with or without left high R waves on electrocardiogram recorded at rest constitute an independent predictor of CVD mortality in Japanese men and women.

Aim: There have been few studies on the relationships of the dietary polyunsaturated to saturated fatty acid ratio (P/S) to cardiovascular risk factors and metabolic syndrome. We hypothesized that there would be favorable relationships.Methods: Metabolic cardiovascular risk factors from dietary nutrient intake were investigated in 1,004 men and women aged 40-59 years from 4 population samples of Japanese. Multiple linear regression analysis was used to examine the relationship of the dietary P/S ratio to the following risk factors: hemoglobin A1c, blood pressure, serum triglycerides, LDL and total cholesterol, and HDL-cholesterol. Adjusted odds ratio of having metabolic syndrome was also calculated.Results: The dietary P/S ratio was significantly and inversely related to serum total and LDL cholesterol with control for possible confounding variables. We did not find any significant relationship between the P/S ratio and single metabolic risk factors or the prevalence of metabolic syndrome.Conclusions: Managing the P/S ratio is important to control serum LDL-cholesterol; however, increasing the P/S ratio may not improve metabolic risk factors. Other countermeasures, such as weight control, greater physical activity, and smoking cessation should be recommended to prevent and control metabolic syndrome.

Background and Purpose— Some previous Japanese cohort studies failed to show an association between smoking and stroke risk. Because such an association has been noted in other populations, this issue should be re-examined in a recent representative Japanese cohort with a higher total cholesterol level. Methods— A total of 9638 men and women aged 30 years and older without a history of cardiovascular disease (CVD) at baseline in 1980 were followed-up for 14 years. Results— We observed 203 stroke deaths (107 cerebral infarctions, 45 cerebral hemorrhages, and 51 others), 191 heart disease deaths, and 413 CVD deaths. The average serum total cholesterol level was ≈4.91 mmol/L. Cox proportional hazard ratios were calculated adjusting for age, systolic blood pressure, and other conventional risk factors. The hazard ratios for men who smoked 1 to 20 cigarettes/day for all strokes, cerebral infarction, and cerebral hemorrhage were 1.60 (95% CI, 0.91 to 2.79), 2.97 (CI, 1.27 to 6.98), and 0.42 (CI, 0.16 to 1.09), respectively, and for those who smoked ≥21 cigarettes/day, they were 2.17 (CI, 1.09 to 4.30), 3.26 (CI, 1.11 to 9.56), and 0.68 (CI, 0.20 to 2.33), respectively. For women who smoked ≥21 cigarettes/day, the hazard ratio for all strokes was 3.91 (CI, 1.18 to 12.90). For CVD, all heart disease, and ischemic heart disease, the hazard risks of smoking were significant (1.49 to 4.25) for men but not significant for women. Conclusions— Smoking in a cohort with moderate serum total cholesterol level was a potent risk factor for stroke, especially cerebral infarction, for both men and women, and for CVD and ischemic heart disease for men.

BACKGROUND: Strategies for preventing premature cardiovascular disease include measures to control its risk factors. To plan such activities, prevalence of these factors must be known. Data regarding risk factor prevalence is limited in Bangladesh and measurement of biochemical factors is no always feasible. The aim of our study is to describe the non-biochemical risk factors in a clinic-based rural population of Bangladesh that would reflect at least a part of the problem in the rural area. METHODS: A cross sectional study was done in a clinic based patient population aged 20 years and older (471 males and 800 females) in a rural community of Bangladesh. A questionnaire on lifestyle including dietary and smoking habit was administered and physical examinations including height, weight, waist circumference, and blood pressure were measured in standardized way. RESULTS: Mean body mass index was 18.5 kg/m2 (standard deviation [SD]: 2.9 kg/m2) in males and 18.7 kg/m2 (SD: 3.3 kg/m2) in females. Mean systolic blood pressure was 120.0 mmHg (SD: 18.5 mmHg) and mean diastolic blood pressure 77.2 mmHg (SD: 9.9 mmHg) in all subjects. The prevalence of hypertension (140+/90+ mmHg and/or on treatment) was 17.8%. Prevalence of tobacco consumption (smoking and chewing) was 43.8% in males and 27.1 in females. Prevalence of abdominal obesity (waist circumference >94 cm in males, >80 cm in females) was 1.6 % and 11.4 % for males and females respectively. Proportion of overweight (BMI 25.0+) was 3.6%. CONCLUSION: Prevention programs and measures should be emphasized for the control of tobacco and hypertension in general, and central obesity in females, as far as rural population of Bangladesh is concerned.

Epidemiologic evidence shows an inverse relationship between fish consumption and coronary heart disease (CHD) mortality. Associations between dietary intake of long chain n-3 polyunsaturated fatty acids (PUFA) and serum high density lipoprotein (HDL) cholesterol concentration are unknown. In this study, the association between n-3 PUFA (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA)) intake and serum HDL cholesterol among Japanese men and women in Japan and Hawaii was examined. The study population consisted of Japanese ancestries from five research centers of the International Study of Macronutrients and Blood Pressure (INTERMAP) study, in Japan and Hawaii (672 men and 676 women), surveyed between 1996 and 1998. Four 24-h dietary recalls and one set of serum lipid measurements were performed. For men, n-3 PUFA intake and HDL cholesterol were higher in Japan than in Hawaii (n-3 PUFA: 1.32 g/day versus 0.47 g/day, p < 0.001). For women, n-3 PUFA intake was higher in Japan than in Hawaii (p < 0.001) but HDL cholesterol was not significantly different (p = 0.752). After adjustment for age, body mass index, physical activity, number of cigarettes per day, alcohol intake, and hormone replacement therapy (for women), n-3 PUFA intake was positively associated with serum HDL cholesterol in men (4.6 mg/dl higher HDL cholesterol with 1%kcal higher n-3 PUFA intake, p = 0.011). This association was not observed in women. This positive association of dietary n-3 PUFA with serum HDL cholesterol may partially explain the low mortality from CHD among Japanese men.

Despite increase in serum total cholesterol, high smoking rate, and frequency of adverse blood pressure levels in Japan, coronary heart disease (CHD) incidence and mortality apparently remain substantially lower at all ages in Japan than in the US and other Western societies. To better understand these differences, we compared CHD biomedical risk factors and dietary variables in Japanese living in Japan and 3rd and 4th generation Japanese emigrants living a primarily Western lifestyle in Hawaii, in an ancillary study of the INTERMAP. Men and women aged 40-59 years were examined by common standardized methods-four samples in Japan (574 men, 571 women) and a Japanese-American sample in Hawaii (136 men, 131 women). Average systolic (SBP) and diastolic (DBP) blood pressures were significantly higher in men in Japan than in Hawaii; there were no significant differences in women. The treatment rate of hypertension was much lower in Japan than Hawaii. Smoking prevalence was higher, markedly so for men, in Japan than Hawaii. Body mass index, serum total and low-density lipoprotein cholesterol, HbA1c, and fibrinogen were significantly lower in Japan than in Hawaii; high-density lipoprotein cholesterol was higher in Japan. Total fat, saturated fatty acid intake, and Keys dietary lipid score were lower in Japan than in Hawaii. Polyunsaturated/saturated fatty acid ratio and omega-3 fatty acid intake were higher in Japan than in Hawaii. In conclusion, levels of several, especially lipid, CHD risk factors were generally lower in Japanese in Japan than in Japanese in Hawaii. These differences were smaller for women than men between Japan and Hawaii. They may partly explain lower CHD incidence and mortality in Japan than Western industrialized countries.

The association between alcohol consumption and the risk of diabetes in Japanese with a low-body mass index (BMI) (≤22.0 kg/m 2 ), middle-BMI (22.1–24.9 kg/m 2 ) and high-BMI (≥25.0 kg/m 2 ) was investigated among a cohort of 5,636 employees of a Japanese insurance company. Participants were free of diabetes at baseline and were followed up for a mean of 5.7 years with annual assessments of fasting plasma glucose (FPG). The outcome was a clinical diagnosis of diabetes on the basis of a questionnaire administered at each follow-up assessment or a follow-up FPG level of 7.8 mmol/l or more. Relative risks and 95% confidence intervals (95% CIs) were estimated by fitting pooled logistic regression models, which included age, gender, BMI, baseline FPG level, current tobacco use and current alcohol consumption. A total of 264 outcome events were recorded. The relative risk of diabetes associated with current alcohol consumption was 3.19 (95% CI 1.09–9.37) among low-BMI individuals, 0.41 (0.23–0.73) among middle-BMI individuals and 0.74 (0.44–1.25) among high-BMI individuals. In this study, current alcohol consumption was associated with an increased risk of diabetes among low-BMI individuals and a decreased risk of diabetes among middle-BMI individuals. A tendency for an association of alcohol consumption with a decreased risk of diabetes among high-BMI individuals was noted, although without statistical significance.

Background This paper describes incidence rates and case-fatality for sub-types of stroke using data collected in Takashima, Shiga, Japan, from 1989 to 1993 and compares these with similar registers in other parts of Japan. Methods Registered patients included all residents of the county who experienced a first-ever stroke. Stroke was defined as sudden onset of neurological symptoms which continued for a minimum of 24 hours or led to death. Almost all such patients are hospitalized in this country. Early case fatality was defined as patients who died within 28 days of stroke onset. Diagnosis of stroke type was based on clinical symptoms as well as computed tomography (CT) scans. Results Age-adjusted incidence rates for stroke per 100,000 population aged 35 years and older were 268.7 for men and 167.5 for women. The age-specific incidence rate of both cerebral infarction and cerebral haemorrhage increased with advancing age. The occurrence of cerebral infarction in men was twice as high as in women. The 28-day case fatality for all sub-types of stroke was 16.1% in men and 15.8% in women. Case fatality for cerebral infarction, cerebral haemorrhage, and subarachnoid haemorrhage was 10.7%, 22.4% and 28.6% respectively. Conclusions Takashima County has a moderately high stroke incidence rate and case fatality compared with other similar studies in Japan. The incidence rate of cerebral infarction in men is twice that in women, while other sub-types of stroke showed smaller differences. In order to decrease the incidence of stroke in Japan, greater efforts at primary prevention will be necessary, in particular, it is important to prevent cerebral infarction in men.

The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) (1) defined metabolic syndrome as a presence of any three of the following (in women): 1 ) waist circumference >88 cm, 2 ) high triglycerides (≥150 mg/dl), 3 ) low HDL cholesterol (

To clarify the relationships between blood pressure and alcohol, nutrients and electrolytes intakes in Japanese men.A dietary survey was conducted in a rural population of Japan by the 2-day dietary record method, and blood pressure was measured with a standard sphygmomanometer. Blood pressure levels, nutrients and electrolytes intakes were compared among the non-drinkers and the tertiles of the alcohol-drinking subjects. The relationships between blood pressure and nutrients, electrolytes and alcohol intakes were also determined by multiple regression analysis.Age and systolic blood pressure (SBP) were positively, and percentage of energy from fat and carbohydrates was negatively, related to the drinking categories. Univariate analysis showed that SBP was significantly related to age, body mass index (BMI) and alcohol intake, and diastolic blood pressure (DBP) was also significantly related to age, BMI and alcohol intake. Both SBP and DBP had a significant inverse relationship with the percentage of energy from fat (P0.01). Both SBP and DBP were significantly related to drinking categories when the effects of age, BMI and percentage energy from fat intake on blood pressure were adjusted for (P0.001). Multiple regression analysis revealed SBP to be significantly and positively associated with age, BMI and alcohol intake, and negatively associated with potassium intake, whereas DBP was significantly and positively associated with BMI and total energy intake, and was negatively associated with potassium and the percentage of energy intake from fat and carbohydrates.The positive association between alcohol drinking and blood pressure persisted even after consideration of the effects of age, BMI and other macronutrient and electrolytes intakes. The reduction of alcohol intake should be an important public health strategy in the primary prevention of hypertension in this population.

BACKGROUND Previous epidemiological and clinical studies have shown that alcohol, which increases high density lipoprotein (HDL) cholesterol levels, has an anti-atherogenic effect. But data on the effects of alcohol on low density lipoprotein (LDL) cholesterol are scarce. In this paper a cross-sectional study on the associations of alcohol in graded doses with serum lipids in a Japanese population is presented. METHODS The daily alcohol intake of 832 Japanese men aged 35-59 was determined and the subjects were divided into five categories according to their daily alcohol consumption. The associations of alcohol intake and the kind of alcoholic beverage with serum lipids were determined by multiple regression analyses taking into consideration the differences of other confounding factors, i.e. age, body mass index (BMI) and smoking. RESULTS Serum triglycerides and HDL-cholesterol were higher (P < 0.001) with higher alcohol intake while LDL-cholesterol was lower (P < 0.01). In multiple regression analysis, after adjusting for age, BMI and number of cigarettes smoked per day, HDL-cholesterol and the ratio of HDL-cholesterol to LDL-cholesterol were found to have a significant positive relationship with daily alcohol consumption (P < 0.001) and LDL-cholesterol to have a significant negative relationship (P < 0.001). The kind of alcoholic beverage had no significant relationship with serum HDL-cholesterol and LDL-cholesterol; however, serum triglycerides were found to be significantly lower in those who drank beer (P < 0.05). CONCLUSIONS Alcohol drinkers have a higher HDL-cholesterol level and lower LDL-cholesterol level than non-drinkers. This anti-atherogenic lipid profile in alcohol drinkers may be explained by the effect of alcohol on serum lipids independent of age, BMI and smoking.

Objective: To examine exposure to second-hand smoke (SHS) at home, in workplace, and in various public places in Bangladesh. Materials and Methods: Data from 2009 Global Adult Tobacco Survey (GATS) conducted in Bangladesh was analyzed. The data consists of 9,629 respondents from a nationally representative multi-stage probability sample of adults aged 15 years and above. Exposure to second-hand smoke was defined as respondents who reported being exposed to tobacco smoke in the following locations: Indoor workplaces, homes, government building or office, health care facilities, public transportation, schools, universities, restaurants, and cafes, coffee shops or tea houses. Exposure to tobacco smoke in these places was examined by gender across various socioeconomic and demographic sub-groups that include age, residence, education and wealth index using SPSS 17.0 for complex samples. Results: The study shows high prevalence of SHS exposure at home and in workplace and in public places. Exposure to SHS among adults was reported high at home (54.9%) (male-58.2% and female-51.7%), in workplace (63%) (male-67.8% and female-30.4%), and in any public place (57.8%) (male-90.4% and female-25.1%) 30 days preceding the survey. Among the public places examined exposure was low in the educational institutions (schools-4.3%) and health care facilities (5.8%); however, exposure was high in public transportation (26.3%), and restaurants (27.6%). SHS exposure levels at home, in workplace and public places were varied widely across various socioeconomic and demographic sub-groups. Conclusions: Exposure was reported high in settings having partial ban as compared to settings having a complete ban. Following the WHO FCTC and MPOWER measures, strengthening smoke-free legislation may further the efforts in Bangladesh towards creating and enforcing 100% smoke-free areas and educating the public about the dangers of SHS. Combining these efforts can have a complementary effect on protecting the people from hazardous effect of SHS as well as reducing the social acceptance of smoking both at home and in public and workplaces. Ongoing surveillance in Bangladesh is necessary to measure progress towards monitoring SHS exposure.

Background A nationally representative survey was carried out to determine the distribution of blood glucose and cholesterol in adult population of Bangladesh in the absence of existing data. Methods The study adopted a multistage and geographically clustered sampling technique of households. A total of 2610 individuals (1444 men and 1166 women) aged 25–64 years were selected from rural and urban areas. Capillary blood glucose and total cholesterol levels were measured using an overnight fasting state. Results The mean age of the participants was 41 years [standard deviation (SD), 11 years]. Half of them (49%) were from urban areas. Half of them (51%) had primary or higher education. Mean glucose was 74 mg/dL (SD 23 mg/dL). Men had higher mean glucose levels (79 mg/dL) than women (67 mg/dL). Age-standardized prevalence of diabetes (blood glucose level ≥126 mg/dL and/or use of anti-diabetic medication) was 5.5%. In men, it was almost two-and-half times (7.6%) compared with women (2.8%). It was also double in urban areas (7.8%) compared with rural areas (3.4%). Mean cholesterol level among all participants was 167 mg/dL (SD 26 mg/dL). Men and women had almost similar levels (169 mg/dL versus 166 mg/dL, respectively). Prevalence of high cholesterol level (≥240 mg/dL) was very low (1.3%) in both men (2.2%) and women (0.5%). However, the prevalence of borderline high cholesterol was substantial (5.8%) in this sample. Conclusion The prevalence of high hypercholesterolemia is low, whereas there is a high prevalence of borderline high cholesterol and diabetes in the adult population of Bangladesh. This warrants population-based interventions to tackle this problem.

BACKGROUND: Elevated levels of body mass index (BMI) and smoking are well established lifestyle risk factors for coronary heart disease (CHD) and stroke. If these two risk factors have a synergistic relationship, rigorous lifestyle modification may contribute to greater reduction in cardiovascular burden than previously expected. METHODS: A pooled analysis of individual participant data from 38 cohorts, involving 378,579 participants. Hazards ratios (HRs) and 95% confidence intervals (CIs) for BMI by cigarette smoking status were estimated using Cox proportional hazard models. RESULTS: During a mean follow-up of 3.8 years, 2706 CHD and 3264 strokes were recorded. There was a log-linear, positive relationship of BMI with CHD and stroke in both smokers and non-smokers with evidence of a synergistic effect of smoking on the association between BMI and CHD only: HRs (95% CIs) associated with a 2 kg/m2 higher BMI were 1.13 (1.10-1.17) in current smokers and 1.09 (1.06-1.11) in non-smokers (p-value for interaction=0.04). CONCLUSION: Smoking amplifies the positive association between BMI and CHD but not stroke. If confirmed, these results suggest that effective strategies that target smoking cessation and weight loss are likely to have a greater impact than anticipated on reducing the burden of CHD., published_or_final_version

BACKGROUND In initial analyses, we found significant differences between serum adiponectin in Japanese living in Japan and Hawaii. OBJECTIVE We investigated whether differences in dietary and other lifestyle factors explain higher serum adiponectin concentrations in Japanese in Japan compared with Japanese emigrants living a Western lifestyle in Hawaii. DESIGN Serum adiponectin and nutrient intakes were examined by standardized methods in men and women aged 40-59 y from 2 population samples, one Japanese American in Hawaii (99 men, 104 women), the other Japanese in central Japan (124 men, 125 women). Multiple linear regression models were used to assess the role of dietary and other lifestyle traits in accounting for serum adiponectin difference between Hawaii and Japan. RESULTS Mean adiponectin was significantly higher in Japan than in Hawaii (10.5 +/- 5.5 mug/mL compared with 6.7 +/- 3.2 mug/mL in men, P = 0.002; 12.9 +/- 5.9 mug/mL compared with 9.4 +/- 4.2 in women, P < 0.0001). In men, the difference in body mass index (BMI; in kg/m(2)) in the 2 populations explained approximately 90% of the difference in serum adiponectin; in women, only 29%. In multiple linear regression analyses in women further adjustment for physical activity and 4 nutrients (nonvegetable protein, n-3 polyunsaturated fatty acid, arachidonic acid, dietary cholesterol) produced a further reduction in the coefficient for the difference (total 56%); P value for the difference became 0.074. CONCLUSIONS The significantly higher mean serum adiponectin concentration in Japan than in Hawaii may be attributable largely to differences in BMI. Differences in nutrient intake in the 2 samples were associated with only modest relation to the adiponectin difference.