Search

Evidence is limited regarding the association between low-carbohydrate diet (LCD) score and mortality among Asians, a population that consumes a large amount of carbohydrates.The present study examined the association between low-carbohydrate diet (LCD) score (based on percentage of energy as carbohydrate, fat, and protein) and the risk of total and cause-specific mortality among Asians.This study was a prospective cohort study in Japan with follow-up for a median of 16.9 years involving 43008 men and 50646 women aged 45-75 years. Association of LCD score, LCD score based on animal sources of protein and fat, and LCD score based on plant sources of protein and fat with risk of mortality was assessed using Cox proportional hazards model.A U-shaped association was observed between LCD score and total mortality: the multivariable-adjusted hazard ratios (HRs) (95% CI) of total mortality for lowest through highest scores were 1.00, 0.95 (0.91, 1.01), 0.93 (0.88, 0.98), 0.93 (0.88, 0.98), and 1.01 (0.95, 1.07) (P-non-linearity0.01). A similar association was found for mortality from cardiovascular disease (CVD) and heart disease. LCD score based on carbohydrate, animal protein, and animal fat also showed a U-shaped association for total mortality (P-non-linearity0.01). In contrast, LCD score based on carbohydrate, plant protein, and plant fat was linearly associated with lower total (HR, 0.89; 95% CI: 0.83, 0.94 for highest versus lowest quintile), CVD [0.82 (0.73, 0.92)], heart disease [0.83 (0.71, 0.98)], and cerebrovascular disease [0.75 (0.62, 0.91) mortality.Both LCD with high animal protein and fat and high-carbohydrate diet with low animal protein and fat were associated with higher risk of mortality. Meanwhile, LCD high in plant-based sources of protein and fat was associated with a lower risk of total and CVD mortality.

Background The minerals, vitamins, soluble dietary fibers, and flavonoids of seaweed are protective for preventing cardiovascular diseases. However, the association between seaweed intake and risk of cardiovascular disease has not been established. Objectives We examined the dietary intake of seaweed and its impact upon stroke and ischemic heart disease risk among a Japanese study population. Methods We surveyed 40,707 men and 45,406 women from 2 large cohorts (age range: 40-69 y). Seaweed intake was determined by FFQ at baseline (1990-1994). Incidences of stroke and ischemic heart disease were ascertained until the end of 2009 (Cohort I) or 2012 (Cohort II). Sex-specific cardiovascular disease HRs (95% CIs) were estimated using Cox proportional hazard models after stratification by area and adjustment for cardiovascular disease risk and dietary factors. Results During 1,493,232 person-years of follow-up, 4777 strokes (2863 ischemic stroke, 1361 intraparenchymal hemorrhages, and 531 subarachnoid hemorrhages) and 1204 ischemic heart disease cases were identified. Among men, significant multivariable HRs (95% CIs) for almost daily consumption compared with almost no consumption of seaweed were seen in ischemic heart disease [0.76 (0.58, 0.99); P-trend = 0.04] and total cardiovascular diseases [0.88 (0.78, 1.00); P-trend = 0.08]. Among women, such inverse associations were 0.56 (0.36, 0.85; P-trend = 0.006) for ischemic heart disease and 0.89 (0.76, 1.05; P-trend = 0.10) for total cardiovascular diseases. No significant associations were observed between seaweed intake and risk of total stroke or stroke types among either men or women. Conclusions Seaweed intake was inversely associated with risk of ischemic heart disease.

Background: Published findings on breast cancer risk associated with different types of menopausal hormone therapy (MHT) are inconsistent, with limited information on long-term effects. We bring together the epidemiological evidence, published and unpublished, on these associations, and review the relevant randomised evidence. Methods: Principal analyses used individual participant data from all eligible prospective studies that had sought information on the type and timing of MHT use; the main analyses are of individuals with complete information on this. Studies were identified by searching many formal and informal sources regularly from Jan 1, 1992, to Jan 1, 2018. Current users were included up to 5 years (mean 1·4 years) after last-reported MHT use. Logistic regression yielded adjusted risk ratios (RRs) comparing particular groups of MHT users versus never users. Findings: During prospective follow-up, 108 647 postmenopausal women developed breast cancer at mean age 65 years (SD 7); 55 575 (51%) had used MHT. Among women with complete information, mean MHT duration was 10 years (SD 6) in current users and 7 years (SD 6) in past users, and mean age was 50 years (SD 5) at menopause and 50 years (SD 6) at starting MHT. Every MHT type, except vaginal oestrogens, was associated with excess breast cancer risks, which increased steadily with duration of use and were greater for oestrogen-progestagen than oestrogen-only preparations. Among current users, these excess risks were definite even during years 1–4 (oestrogen-progestagen RR 1·60, 95% CI 1·52–1·69; oestrogen-only RR 1·17, 1·10–1·26), and were twice as great during years 5–14 (oestrogen-progestagen RR 2·08, 2·02–2·15; oestrogen-only RR 1·33, 1·28–1·37). The oestrogen-progestagen risks during years 5–14 were greater with daily than with less frequent progestagen use (RR 2·30, 2·21–2·40 vs 1·93, 1·84–2·01; heterogeneity p Interpretation: If these associations are largely causal, then for women of average weight in developed countries, 5 years of MHT, starting at age 50 years, would increase breast cancer incidence at ages 50–69 years by about one in every 50 users of oestrogen plus daily progestagen preparations; one in every 70 users of oestrogen plus intermittent progestagen preparations; and one in every 200 users of oestrogen-only preparations. The corresponding excesses from 10 years of MHT would be about twice as great.

Summary Background & aims The associations between dietary magnesium intake and stroke and coronary heart disease (CHD) incidences are inconsistent and not established in Asian. We aimed to determine the association between dietary magnesium intake and the risk of stroke and CHD in a Japanese population. Subjects/Methods We studied 85,293 Japanese subjects by questionnaire at baseline (age 45–74 years, without cardiovascular disease or cancer in 1995 and 1998 for Cohorts I and II, respectively). The participants were followed until the end of 2009 and 2010 in Cohorts I and II, respectively. Dietary magnesium intake was estimated from a self-administered 138-item food-frequency questionnaire. Results After 1,305,738 person-years of follow-up, 4110 strokes and 1283 cases of CHD were documented. The multivariable-adjusted hazard ratios (HRs, 95% confidence intervals, 95%CIs) of CHD for the fourth and fifth quintiles of dietary magnesium intake were 0.70 (0.50–0.99) and 0.66 (0.44–0.97) in men (P for trend = 0.036), respectively, and third quintile of dietary magnesium intake was 0.61 (0.39–0.96) in women (P for trend = 0.241), compared with the lowest quintile in men and women. We observed no decreased risks of incident stroke in men or women with higher dietary magnesium intakes. Conclusions Higher dietary magnesium intake was associated with a reduced risk of CHD in Japanese men.

This large-scale population-based cohort study in Japan was conducted to clarify the effects of menstrual and reproductive factors on the risk of later-life vertebral fractures in women. Significant associations were seen for later menarche, irregular menstruation, and shorter reproductive years, corresponding to the effect of reproductive hormonal disturbance on bone metabolism. This study investigated the association between menstrual and reproductive factors and the risk of later-life vertebral fractures in women. Participants were 43,652 women aged 40–69 years who were followed in the 10-year survey of the Japan Public Health Center-based prospective (JPHC) study. Menstrual/reproductive factors were as follows: age at menarche and menopause, menstrual regularity and cycle length, natural or surgical menopause, years since menopause, reproductive years, parity, age at first birth, number of births, breastfeeding, and female hormone use. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression analysis with adjustment for well-known fracture risk factors and menstrual/reproductive factors. During the 10-year period, 250 women reported first onset of vertebral fractures. Menarche at ≥16 years [OR (95% CI) = 2.08 (1.24–3.48)] compared to ≤ 13 years and irregular menstruation [1.42 (1.01–2.00)] compared to regular menstruation showed significantly higher adjusted ORs. Longer reproductive years had significant inverse association [0.96 (0.92–0.99)] in menopausal women. Women with both menarche ≥ 15 years and irregular menstruation had higher adjusted ORs (95% CI) [2.37 (1.51–3.73) in all women, 2.25 (1.35–3.76) in menopausal women] compared to women without these, and both factors had significant interaction, particularly in menopausal women (additive p = 0.025, multiplicative p = 0.0499). Menstrual and reproductive factors, corresponding to the effect of reproductive hormonal disturbance on bone metabolism, might affect the risk of later-life vertebral fractures.

A finding between dietary pattern and cancer may provide visions beyond the assessment of individual foods or nutrients. We examined the influence of dietary pattern with colorectal cancer (CRC) among a Japanese population.A total of 93,062 subjects (43,591 men, 49,471 women) who participated in the Japan Public Health Center-based Prospective Study were followed from 1995-1998 to the end of 2012, during which 2482 cases of CRC (1514 men, 968 women) were newly identified. Dietary data was obtained from a validated food-frequency questionnaire between 1995 and 1998.Three dietary pattern was derived from principal components factor: prudent, westernized, and traditional pattern. After controlled for potential confounders, the prudent pattern showed a decreased association of CRC risk in men (HR for highest quintile vs lowest: 0.85; 95% CI: 0.72-1.00; P trend0.05), slightly more strongly with distal colon cancer (P trend0.05); but an increased risk of rectal cancer in women (P trend0.05). The westernized pattern showed a significant positive linear trend for colon (P trend0.05) and distal cancer (P trend0.05) in women. There was no apparent association of traditional Japanese dietary pattern on the overall or any specific sites risk of CRC.A prudent dietary pattern showed an inverse association with CRC risk in men, and a westernized pattern was related with a higher risk of colon and distal cancer in women.

Objectives: Adult height is reported to be related with the risk of various diseases. Some previous studies also suggest a possible link between height and oral health, but no study has been conducted in Japan. The current study aimed at examining if height was linked with the dentition status in Japanese adults. Methods: The subjects were 1,214 adults(mean age: 65.5 ±5.76 years, men: 565, women: 649) who lived in Akita Prefecture, Japan. A selfcomplete questionnaire survey and clinical dental examination were conducted. Results: After adjustment for confounding variables, the number of total teeth (p for trend =0.022), and the sub-categories of anterior (p for trend=0.040) or posterior teeth (p for trend =0.027) significantly increased with an increment of height in men. The increasing trend of prevalence of having fewer than 24 teeth with the decrease of height was not significant but approached the significant level (p for trend=0.073). There was not a significant relationship between height and prevalence of subjects who were edentate. On the other hand, no corresponding significant associations between height and dentition status were found in women. Conclusion: A potential positive relationship between adult height and the number of teeth was suggested in men. The current findings imply the importance to promote both oral and general health by improving nutrition and diet as well as preventing and treating problems or diseases at an early age, in achieving good oral health later in life.

Background Few studies have assessed associations of non-enzymatic antioxidant capacity (NEAC) in the overall diet with all-cause or specific mortality, and their results have been inconsistent. Objectives The present study investigated the association between dietary NEAC and all-cause or cause-specific mortality. Methods The study was a large-scale population-based prospective cohort study in Japan consisting of 42,520 men and 50,207 women aged 44-76 y, who had no history of cancer, stroke, ischemic heart disease, or chronic liver disease. We evaluated FFQ-based dietary NEAC with use of published databases in which the NEACs of individual foods were analyzed by ferric reducing antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC) assays. Dietary NEAC was calculated by multiplying the estimated NEAC with the consumed amount and summing up those values for all foods, and was categorized in quartiles. We identified death and cause of death with use of residential registry and death certificates. HRs and 95% Cls for death from the second survey, which was conducted from April 1995 to December 2014 were estimated with Cox proportional hazards regression analysis. Results After 1,498,308 person-years of follow-up, 12,978 total deaths occurred. The multivariable-adjusted HRs (95% Cls) for all-cause mortality for the highest compared with the lowest quartile of FRAP and ORAC were 0.85 (0.80, 0.89) and 0.84 (0.79, 0.89), respectively. Dietary NEACs were inversely associated with mortality from cardiovascular disease (CVD), but not from cancer. The multivariable-adjusted HRs (95% Cls) for CVD for the highest compared with the lowest quartile of FRAP and ORAC were 0.83 (0.75, 0.92) and 0.79 (0.70, 0.89), respectively. Conclusions Higher dietary NEACs from FRAP and ORAC were associated with lower risk of all-cause mortality and mortality from CVD in Japanese adults.

Aims Coping strategies may be significantly associated with health outcomes. This is the first study to investigate the association between baseline coping strategies and cardiovascular disease (CVD) incidence and mortality in a general population cohort. Methods and results The Japan Public Health Center-based prospective Study asked questions on coping in its third follow-up survey (2000–04). Analyses on CVD incidence and mortality included 57 017 subjects aged 50–79 without a history of CVD and who provided complete answers on approach- and avoidance-oriented coping behaviours and strategies. Cox regression models, adjusted for confounders, were used to determine hazard ratios (HRs) according to coping style. Mean follow-up time was 7.9 years for incidence and 8.0 years for mortality. The premorbid use of an approach-oriented coping strategy was inversely associated with incidence of stroke (HR = 0.85; 95% CI, 0.73–1.00) and CVD mortality (HR = 0.74; 95% CI, 0.55–0.99). Stroke subtype analyses revealed an inverse association between the approach-oriented coping strategy and incidence of ischaemic stroke (HR = 0.79; 95% CI, 0.64–0.98) and a positive association between the combined coping strategy and incidence of intra-parenchymal haemorrhage (HR = 2.03; 95% CI, 1.01–4.10). Utilizing an avoidance coping strategy was associated with increased mortality from ischaemic heart disease (IHD) only in hypertensive individuals (HR = 3.46; 95% CI, 1.07–11.18). The coping behaviours fantasizing and positive reappraisal were associated with increased risk of CVD incidence (HR = 1.24; 95% CI, 1.03–1.50) and reduced risk of IHD mortality (HR = 0.63; 95% CI, 0.40–0.99), respectively. Conclusion An approach-oriented coping strategy, i.e. proactively dealing with sources of stress, may be associated with significantly reduced stroke incidence and CVD mortality in a Japanese population-based cohort.

Aim To examine the association between body mass index (BMI) and mortality among middle-aged people with diabetes in Japan. Methods A total of 3032 men and 1615 women, aged 40–69 years, with diabetes were analyzed. Cox proportional hazards models, adjusted for potential confounding factors, were used to estimate mortality hazard ratios (HRs) across BMI categories at the baseline. Results There were 1761 deaths during a mean follow-up period of 18.5 years. Increased all-cause mortality was observed at both ends of the BMI distribution; compared with the reference BMI category (23.0–24.9 kg/m2), the HRs were 1.25 (95% confidence interval [CI], 0.9997–1.56) in the lowest (14.0–18.9 kg/m2) and 1.36 (95% CI, 1.06–1.74) in the highest (30.0–39.9 kg/m2) categories (P = 0.001). Similar all-cause mortality trends were observed after excluding deaths within 3 years of follow-up, as well as for men and men who had ever smoked. While a similar non-linear pattern was observed for cancer-specific mortality, heart disease-specific mortality was only increased in the highest BMI category (HR, 1.86; 95% CI, 1.06–3.25). Conclusion This population-based prospective study demonstrated increased all-cause mortality at both ends of the BMI distribution among Japanese people with diabetes.

Aims To assess the predictive ability of a genetic risk score for the incidence of Type 2 diabetes in a general Japanese population. Methods This prospective case-control study, nested within a Japan Public Health Centre-based prospective study, included 466 participants with incident Type 2 diabetes over a 5-year period (cases) and 1361 control participants, as well as 1463 participants with existing diabetes and 1463 control participants. Eleven susceptibility single nucleotide polymorphisms, identified through genome-wide association studies and replicated in Japanese populations, were analysed. Results Most single nucleotide polymorphism loci showed directionally consistent associations with diabetes. From the combined samples, one single nucleotide polymorphism (rs2206734 at CDKAL1) reached a genome-wide significance level (odds ratio 1.28, 95% CI 1.18-1.40; P = 1.8 × 10-8 ). Three single nucleotide polymorphisms (rs2206734 in CDKAL1, rs2383208 in CDKN2A/B, and rs2237892 in KCNQ1) were nominally significantly associated with incident diabetes. Compared with the lowest quintile of the total number of risk alleles, the highest quintile had a higher odds of incident diabetes (odds ratio 2.34, 95% CI 1.59-3.46) after adjusting for conventional risk factors such as age, sex and BMI. The addition to the conventional risk factor-based model of a genetic risk score using the 11 single nucleotide polymorphisms significantly improved predictive performance; the c-statistic increased by 0.021, net reclassification improved by 6.2%, and integrated discrimination improved by 0.003. Conclusions Our prospective findings suggest that the addition of a genetic risk score may provide modest but significant incremental predictive performance beyond that of the conventional risk factor-based model without biochemical markers.

Self-reported measures of oral health are often used to assess oral health in populations or groups, but their validity or reliability needs repeated confirmation. The objective of this cross-sectional study was to evaluate the validity of self-reported tooth counts and masticatory status, using data obtained from a sample of Japanese adults. A total of 2356 adults aged 40 to 75 years participated in a questionnaire survey and a clinical oral examination from 2013 through 2016. Self-reported measures were compared with clinically measured values. For tooth counts, mean clinical and self-reported tooth counts in all participants were 23.68 and 23.78 teeth, and no significant difference was detected. Spearman's, Pearson's and intra-class correlation coefficients between clinical and self-reported tooth counts were 0.771, 0.845 and 0.843, respectively. According to the Bland-Altman analysis, the mean difference between clinical and self-reported tooth counts was -0.098 (95% CI: -0.242, 0.047). The upper limit of agreement was 6.919 (95% CI: 6.669, 7.169), and the lower limit of agreement was -7.115 (95% CI: -7.365, -6.865). No significant fixed or proportional bias was observed. For masticatory status, the crude or age- and gender-adjusted mean numbers of total teeth, posterior teeth and 3 kinds of functional tooth units significantly decreased with the deterioration of masticatory status. This study indicated that self-reports were within an acceptable range of clinical measures. Therefore, self-reports were considered valid alternatives to clinical measures to estimate tooth counts and masticatory status in a current Japanese adult population.

BACKGROUND: Experimental and epidemiological studies suggest a protective role for vitamin D in colorectal carcinogenesis, but evidence is inconclusive. Circulating 25-hydroxyvitamin D (25(OH)D) concentrations that minimize risk are unknown. Current Institute of Medicine (IOM) vitamin D guidance is based solely on bone health. METHODS: We pooled participant-level data from 17 cohorts, comprising 5706 colorectal cancer case participants and 7107 control participants with a wide range of circulating 25(OH)D concentrations. For 30.1% of participants, 25(OH)D was newly measured. Previously measured 25(OH)D was calibrated to the same assay to permit estimating risk by absolute concentrations. Study-specific relative risks (RRs) for prediagnostic season-standardized 25(OH)D concentrations were calculated using conditional logistic regression and pooled using random effects models. RESULTS: Compared with the lower range of sufficiency for bone health (50–

Background and aims Higher intake of fish or n-3 polyunsaturated fatty acids (PUFAs) has been associated with reduced risk of coronary heart disease (CHD). However, it is unclear whether increased blood levels of n-3 PUFAs are associated with reduced risk of CHD in the Japanese population. Methods The relationship between circulating levels of n-3 PUFAs (eicosapentaenoic acid + docosapentaenoic acid + docosahexaenoic acid) and risk of CHD was examined in a nested case-control study among participants in the Japan Public Health Center (JPHC)-based Study Cohort. Plasma n-3 PUFA phospholipid levels were measured at baseline by gas chromatography in 209 cases with CHD and 418 controls matched for sex, age, date of blood draw, time elapsed since last meal before blood collection, and study location. The CHD cases (n = 209) comprised 168 cases of myocardial infarction and 41 of sudden cardiac death, otherwise classified as 157 non-fatal and 52 fatal coronary events, respectively. Mean duration of follow-up was 13.5 years. Results Multivariate conditional logistic analysis showed no significant association between n-3 PUFAs and risk of total CHD. The odds ratio (OR) for the highest versus lowest quartiles of plasma n-3 PUFAs was 0.79 (95% confidence interval [95% CI]: 0.41–1.51, p for trend = 0.51). Subtype analysis of CHD revealed that the multivariate ORs for the highest versus lowest quartiles for n-3 PUFAs were 0.91 (95% CI: 0.43–1.89, p for trend = 0.90) for myocardial infarction, 0.08 (95% CI: 0.01–0.88, p for trend = 0.04) for sudden cardiac death, 0.89 (95% CI: 0.42–1.89, p for trend = 0.97) for nonfatal coronary events, and 0.12 (95% CI: 0.02–0.75, p for trend = 0.03) for fatal coronary events. Conclusions Plasma n-3 PUFA levels were not associated with risk of total CHD but were inversely associated with risks of sudden cardiac death and fatal coronary events among middle-aged Japanese individuals.

Background and Purpose— There is limited evidence on the association between total physical activity and stroke in Asian populations experiencing a greater burden of hemorrhagic stroke than Western populations. We aimed to understand their optimal level of physical activity for stroke prevention. Methods— A total of 74 913 Japanese people 50 to 79 years of age without histories of cardiovascular disease or cancer were followed from 2000 to 2012. Results— During the 698 946 person-years of follow-up, we documented a total of 2738 incident cases of stroke, including 1007 hemorrhagic strokes (747 intraparenchymal and 260 subarachnoid hemorrhages) and 1721 ischemic strokes (1206 nonembolic and 515 embolic infarctions). Individuals in the second or third metabolic equivalents of task–hours per day quartile had the lowest risks of total stroke (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.75–0.93), intraparenchymal hemorrhage (HR, 0.79; 95% CI, 0.64–0.97), subarachnoid hemorrhage (HR, 0.78; CI, 0.55–1.11), and nonembolic infarction (HR, 0.78; CI, 0.67–0.92), whereas those in the fourth quartile had the lowest risk of embolic infarction (HR, 0.76; CI, 0.59–0.97). Cubic spline graphs revealed a steep decrease in stroke risk (30% risk reduction) from the lowest level to a plateau at 5 to 10 metabolic equivalents of task–hours per day (50th percentile). The associations of total physical activity level with hemorrhage stroke showed U or J shape, which were because of vigorous-intensity activities, whereas the association with ischemic stroke showed L shape. Conclusions— For Japanese people, moderate levels of total physical activity, particularly achieved by moderate-intensity activities, may be optimal for stroke prevention because excessive vigorous-intensity activities might not be beneficial or even disadvantageous for prevention of hemorrhagic stroke.

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

Background Prospective evidence is inconsistent regarding the association between vegetable/fruit intake and the risk of gastric cancer. Methods In an analysis of original data from four population-based prospective cohort studies encompassing 191 232 participants, we used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of gastric cancer incidence according to vegetable and fruit intake and conducted a meta-analysis of HRs derived from each study. Results During 2 094 428 person-years of follow-up, 2995 gastric cancer cases were identified. After adjustment for potential confounders, we found a marginally significant decrease in gastric cancer risk in relation to total vegetable intake but not total fruit intake: the multivariate-adjusted HR (95% CI; P for trend) for the highest versus the lowest quintile of total vegetable intake was 0.89 (0.77–1.03; P for trend = 0.13) among men and 0.83 (0.67–1.03; P for trend = 0.40) among women. For distal gastric cancer, the multivariate HR for the highest quintile of total vegetable intake was 0.78 (0.63–0.97; P for trend = 0.02) among men. Conclusion(s) This pooled analysis of data from large prospective studies in Japan suggests that vegetable intake reduces gastric cancer risk, especially the risk of distal gastric cancer among men.

Seafood/fish intake has been regarded as a protective factor for coronary heart disease (CHD), while smoking is a strong risk factor. To examine whether associations between smoking and risk of CHD are modified by seafood/fish intake, we studied 72,012 Japanese men and women aged 45-74 years who completed 2 food frequency questionnaires, 5 years apart, during the period 1995-2009. After 878,163 person-years of follow-up, 584 incident cases of CHD (101 fatal and 483 nonfatal), including 516 myocardial infarctions, were documented. There was a clear dose-response association between smoking and CHD risk among subjects with a low seafood/fish intake (

Estrogen receptor-negative (ER(-)) breast cancer has few known or modifiable risk factors. Because ER(-) tumors account for only 15% to 20% of breast cancers, large pooled analyses are necessary to evaluate precisely the suspected inverse association between fruit and vegetable intake and risk of ER(-) breast cancer.Among 993 466 women followed for 11 to 20 years in 20 cohort studies, we documented 19 869 estrogen receptor positive (ER(+)) and 4821 ER(-) breast cancers. We calculated study-specific multivariable relative risks (RRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression analyses and then combined them using a random-effects model. All statistical tests were two-sided.Total fruit and vegetable intake was statistically significantly inversely associated with risk of ER(-) breast cancer but not with risk of breast cancer overall or of ER(+) tumors. The inverse association for ER(-) tumors was observed primarily for vegetable consumption. The pooled relative risks comparing the highest vs lowest quintile of total vegetable consumption were 0.82 (95% CI = 0.74 to 0.90) for ER(-) breast cancer and 1.04 (95% CI = 0.97 to 1.11) for ER(+) breast cancer (P (common-effects) by ER status.001). Total fruit consumption was non-statistically significantly associated with risk of ER(-) breast cancer (pooled multivariable RR comparing the highest vs lowest quintile = 0.94, 95% CI = 0.85 to 1.04).We observed no association between total fruit and vegetable intake and risk of overall breast cancer. However, vegetable consumption was inversely associated with risk of ER(-) breast cancer in our large pooled analyses.

Epidemiologic evidence on the relationship between antioxidant vitamin intake and stroke is limited. We aimed to investigate the association between dietary intake of antioxidant vitamins and the incidence of total stroke and ischemic stroke.The subjects were 82 044 Japanese men and women aged 45-74 years under the Japan Public Health Center-based Prospective Cohort Study. Between 1995 and 1997, dietary assessment was done using a food frequency questionnaire. During 983 857 person-years of follow-up until the end of 2009 we documented 3541 incident total strokes and 2138 ischemic strokes.Dietary intakes of α-carotene, β-carotene, α-tocopherol and vitamin C were not inversely associated with the incidence of total stroke and ischemic stroke adjustment for cardiovascular risk factors and selected lifestyle variables. When stratified by current smoking status, the inverse association between dietary vitamin C intake and incidence of total stroke observed among non-smokers but not smokers, with respective multivariable hazard ratios for the highest versus lowest quintiles of vitamin C of 0.81 (95% confidence interval (CI), 0.68-0.96; P-trend=0.03) among non-smokers; and 1.03 (0.84-1.25; P-trend=0.55) among smokers. As for ischemic stroke, the corresponding multivariable hazard ratios were 0.76 (0.60-0.96; P-trend=0.02) among non-smokers; and 1.00 (0.78-1.28; P-trend=0.61) among smokers.Dietary vitamin C intake was inversely associated with the incidence of total stroke and ischemic stroke among non-smokers.

Background Breast cancer aetiology may differ by estrogen receptor (ER) status. Associations of alcohol and folate intakes with risk of breast cancer defined by ER status were examined in pooled analyses of the primary data from 20 cohorts. Methods During a maximum of 6-18 years of follow-up of 1 089 273 women, 21 624 ER+ and 5113 ER- breast cancers were identified. Study-specific multivariable relative risks (RRs) were calculated using Cox proportional hazards regression models and then combined using a random-effects model. Results Alcohol consumption was positively associated with risk of ER+ and ER- breast cancer. The pooled multivariable RRs (95% confidence intervals) comparing ≥ 30 g/d with 0 g/day of alcohol consumption were 1.35 (1.23-1.48) for ER+ and 1.28 (1.10-1.49) for ER- breast cancer (Ptrend ≤ 0.001; Pcommon-effects by ER status: 0.57). Associations were similar for alcohol intake from beer, wine and liquor. The associations with alcohol intake did not vary significantly by total (from foods and supplements) folate intake (Pinteraction ≥ 0.26). Dietary (from foods only) and total folate intakes were not associated with risk of overall, ER+ and ER- breast cancer; pooled multivariable RRs ranged from 0.98 to 1.02 comparing extreme quintiles. Following-up US studies through only the period before mandatory folic acid fortification did not change the results. The alcohol and folate associations did not vary by tumour subtypes defined by progesterone receptor status. Conclusions Alcohol consumption was positively associated with risk of both ER+ and ER- breast cancer, even among women with high folate intake. Folate intake was not associated with breast cancer risk.

We describe a patient with subcutaneous hematoma associated with manual cervical massage during carotid artery stenting. A 73-year-old man with left cervical carotid artery stenosis presented with left amaurosis fugax. We performed carotid artery stenting using distal embolic protection with balloon occlusion. Dual antiplatelet therapy was maintained in the periprocedural period and an anticoagulant agent was administered during the procedure. Because the aspiration catheter became entrapped by the stent, it did not reach the distal side of the stenotic lesion, and manual compression of the cervical region was therefore performed. Immediately afterwards, a subcutaneous hemorrhage occurred in the cervical region. There was no postoperative dyspnea due to enlargement of the hematoma, which was absorbed spontaneously. Cervical subcutaneous hematoma can occur in the cervical region due to cervical massage in patients who are receiving adjuvant antiplatelet therapy and anticoagulation therapy.

Limited data are available with regard to longitudinal changes in body weight by food taste preference. Here, we examined the associations between taste preferences and weight change in adults for a large-scale cohort study in Japan. Longitudinal analysis of data from a population-based cohort study, the Japan Public Health Center-based Prospective Study (JPHC Study). A total of 29 103 middle-aged men and women, who participated in a JPHC Study and returned questionnaires on lifestyle and diet, including taste preferences, at both baseline and the 10th year of follow-up. We assessed the relations of preferences for rich and heavy taste and a sweet taste to weight changes between the age of 20 years and baseline and those during the 10-year follow-up period. Preferences for rich and heavy taste and for sweet taste were significantly positively associated with weight increases between the age of 20 years and baseline (P for trend

In a population-based prospective study of 19,998 Japanese individuals, consumption of vegetables, green-yellow and green leafy vegetables was inversely associated with the risk of hepatocellular carcinoma (101 cases), with multivariable hazard ratios for the highest vs lowest tertile of 0.61 (95% confidence interval (CI)=0.36-1.03, P(trend)=0.07), 0.65 (95% CI=0.39-1.08, P(trend)=0.06) and 0.59 (95% CI=0.35-1.01, P(trend)=0.04), respectively.

Objectives: Previous studies have suggested that living in a multi-generational household (a type of family structure prevalent in Japan) confers mixed health benefits and stresses, especially for women who report such living arrangements. In this prospective cohort study, we sought to examine the impact of living arrangements on coronary heart disease incidence and mortality as well as all-cause mortality in a large prospective cohort of Japanese population. Methods: We examined prospectively the association between living arrangement and risk of coronary heart disease incidence and mortality within a cohort of 90,987 Japanese women and men aged 40-69 years, free of prior diagnosis of cancer and cardiovascular disease. A total of 671 cases of newly diagnosed coronary heart disease, 339 coronary heart disease deaths, and 6,255 all-cause deaths occurred between the baseline questionnaire (1990-1994) and the end of follow-up in January 2004. Results: After adjustment of potentially confounding variables, women living in multi-generational households (living with spouse-children-parents; or spouse-parents) had 2.0 to 3.0-fold higher risk of coronary heart disease compared to women living with spouses only. Women living with spouses and children also had 2.1-fold higher risk of coronary heart disease incidence compared to married women living without children. Conclusions: Women in a multi-generational family had a higher risk of coronary heart disease incidence, probably due to stress from multiple family roles.

Obesity and weight gain are associated with increased risk of coronary heart disease in Western countries. However, their impact is not well elucidated in Asia, where body mass index (BMI) levels are generally lower than in Western countries. We examined associations of BMI (kg/m2) and weight change with risk of coronary heart disease in Japanese people. A total of 43 235 men and 47 444 women aged 40–69 years living in communities were followed up from 1990 to 2001 in the Japan Public Health Center-based (JPHC) prospective study . During 879 619 person-years of follow-up, we documented 399 cases of coronary heart disease (334 myocardial infarction and 65 sudden cardiac death) for men and 119 (95 myocardial infarction and 24 sudden cardiac death) for women. Compared with persons with BMI 23.0–24.9, men, but not women, with BMI ⩾30.0 had higher risk of coronary heart disease and myocardial infarction; the multivariable relative risks for men were 1.8 (1.1–3.0) and 1.9 (1.1–3.2), respectively. When weight change was examined according to BMI at age 20 years, men with initial BMI

Despite its decreasing trend in Japan, gastric cancer remains an important public health problem. Although the age standardised rates of gastric cancer have been declining for decades, the absolute numbers are increasing because of the rapid aging of the population. A large proportion of Japanese gastric cancers are detected at an early stage, with a better overall survival rate. As with Western developed countries, a change in the social environment such as reduced salt use and increased fresh vegetable and fruit intake as well as improvement of food storage may play an important part in the decline. Differences in Helicobacter pylori infection rates between generations presumably have contributed to the generation related variation in the declining trends. It is expected that most gastric cancers in Japan may be preventable by lifestyle modification such as salt reduction and increased fruit and vegetable intake, together with avoidance of smoking and countermeasures against H pylori infection so that the level now evident in Western developed countries can be reached.

We examined the association between green tea consumption and mortality due to all causes, cancer, heart disease, cerebrovascular disease, respiratory disease, injuries, and other causes of death in a large-scale population-based cohort study in Japan.We studied 90,914 Japanese (aged between 40 and 69 years) recruited between 1990 and 1994. After 18.7 years of follow-up, 12,874 deaths were reported. The association between green tea consumption and risk of all causes and major causes of mortality was assessed using the Cox proportional hazards regression model with adjustment for potential confounders.Hazard ratios for all-cause mortality among men who consumed green tea compared with those who drank less than 1 cup/day were 0.96 (0.89-1.03) for 1-2 cups/day, 0.88 (0.82-0.95) for 3-4 cups/day, and 0.87 (0.81-0.94) for more than 5 cups/day (P for trend.001). Corresponding hazard ratios for women were 0.90 (0.81-1.00), 0.87 (0.79-0.96), and 0.83 (0.75-0.91; P for trend.001). Green tea was inversely associated with mortality from heart disease in both men and women and mortality from cerebrovascular disease and respiratory disease in men. No association was found between green tea and total cancer mortality.This prospective study suggests that the consumption of green tea may reduce the risk of all-cause mortality and the three leading causes of death in Japan.

Little is known about correlates of vitamin D status in Asian populations. In this study, we established the prevalence of vitamin D sufficiency in the Murakami region (latitude N38°13') in Niigata, Japan, and examined demographic, environmental, and lifestyle factors that might be associated with vitamin D sufficiency, with the aim of clarifying the relative contributions of previously described determinants of vitamin D status as well as identifying new determinants in this Japanese population.This study involved a cross-sectional analysis of baseline data obtained from a cohort study conducted in 2011-2013. Participants were 9084 individuals aged between 40 and 74 years who provided blood samples for the determination of plasma 25-hydroxyvitamin D [25(OH)D] concentrations. Lifestyle information was obtained from 8498 participants, with some missing values regarding different lifestyle factors. Multiple logistic regression analysis was used to obtain odds ratios for vitamin D sufficiency, which was defined as a plasma 25(OH)D concentration ≥ 75 nmol/L.The prevalence of vitamin D sufficiency (i.e., plasma 25(OH)D concentration ≥ 75 nmol/L) was 9.1%, and significant associations were observed with male gender (P0.0001; OR=2.37, 95% CI: 1.84-3.05), older age (P for trend0.0001), lower BMI (P for trend0.0001), higher METs score (P for trend=0.0138), higher vitamin D intake (P for trend=0.0467), summer season (P for trend0.0001), longer duration outdoors (P for trend=0.0026), no sunscreen use (P=0.0135; OR=1.40, 95% CI: 1.07-1.82), higher salmon consumption (P for trend0.0001), higher alcohol consumption (P for trend0.0001), and lower coffee consumption (P for trend=0.0025). Unlike other populations previously reported, vitamin D sufficiency was associated with older age.The prevalence of vitamin D sufficiency (i.e., 25[OH]D ≥ 75 nmol/L) was low (9.1%) in this Japanese population. A number of demographic, environmental, and lifestyle factors are associated with vitamin D sufficiency, and thus lifestyle modification may present an opportunity to achieve vitamin D sufficiency.

Objective Compared with western populations, the consumption of soy foods among Japanese is very high and the incidence of endometrial cancer very low. We evaluated the association of soy food and isoflavone intake with endometrial cancer risk in Japanese women. Design Prospective cohort study. Setting Ten public health centre areas in Japan. Population Forty nine thousand one hundred and twenty-one women of age 45–74 years who responded to a 5-year follow-up survey questionnaire. Methods Intakes of soy foods as well as other covariates were assessed in 1995–1998 by a self-administered food frequency questionnaire. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Main outcome measure Incidence of endometrial cancer. Results During an average of 12.1 years of follow up, 112 newly diagnosed endometrial cancer cases were identified. Energy-adjusted intakes of soy food and isoflavone were not associated with the risk of endometrial cancer. The multivariate-adjusted HR per 25 g/day increase in the intake of soy food was 1.02 (95% CI 0.94–1.10), and the corresponding value for isoflavone intake per 15 mg/day was 1.01 (95% CI 0.84–1.22). Conclusion In this population-based prospective cohort study of Japanese women, we observed no evidence of a protective association between soy food or isoflavone intake and endometrial cancer risk.

Dietary patterns in Western populations have been linked to type 2 diabetes, but the association of distinctive dietary patterns of Japanese population remains unclear. We prospectively investigated the association between dietary patterns and risk of developing type 2 diabetes among Japanese adults.Participants were 27, 816 men and 36,889 women aged 45-74 years who participated in the second survey of the Japan Public Health Center-based prospective study and had no history of diabetes. Dietary patterns were derived by using principal component analysis of the consumption of 134 food and beverage items ascertained by a food frequency questionnaire. Odds ratios of self-reported physician-diagnosed type 2 diabetes over 5 year were estimated using logistic regression analysis.A total of 1194 new cases (692 men and 502 women) of type 2 diabetes were self-reported. We identified three dietary patterns: prudent, westernized and traditional Japanese patterns. Any dietary pattern was not significantly associated with type 2 diabetes risk after adjustment for covariates in both men and women. The multivariate-adjusted odds ratios (95% confidence interval) for type 2 diabetes for the highest versus lowest quartile of each dietary pattern score in men and women, respectively, were 0.93 (0.74-1.16) and 0.90 (0.69-1.16) for the prudent pattern, 1.15 (0.90-1.46) and 0.81 (0.61-1.08) for the westernized pattern, and 0.97 (0.74-1.27) and 0.87 (0.66-1.15) for the traditional pattern.Although a small protective effect of the prudent dietary pattern cannot be excluded, dietary patterns may not be appreciably associated with type 2 diabetes risk in Japanese.

Background/Objectives: There has been no study with regard to the association between dietary fibers and the incidence of stroke and coronary heart disease (CHD) in Asia. We investigated the association between dietary fiber and the risk of cardiovascular disease (CVD), which we defined as stroke or CHD, in a Japanese population. Subjects/Methods: We studied 86 387 Japanese subjects (age 45–65 years, without CVD or cancer in 1995 as Cohort I and in 1998 as Cohort II) and used a self-administered questionnaire to follow-up the participants until the end of 2004. Dietary fiber intake was estimated from food-frequency questionnaires comprising 138 food items. Results: After 899 141 person-years of follow-up, we documented the incidence of 2553 strokes and 684 cases of CHD. Multivariable-adjusted hazard ratios (95% confidence intervals (CIs)) of CVD for the third to fifth quintiles of total fiber were 0.79 (0.63–0.99), 0.70 (0.54–0.89) and 0.65 (0.48–0.87) in women, respectively, compared with the lowest quintile. Total fiber intake was inversely associated with the incidence of stroke, either cerebral infarction or intracerebral hemorrhage in women. The results for insoluble fiber in women were similar to those for total fiber, whereas those for soluble fiber were weak. An inverse association of total fiber with CVD was observed primarily in non-smokers (P for trend=0.045 and 0.001) and not in smokers (probability values for interaction between total fiber and smoking were 0.06 and 0.01 in men and women, respectively). Conclusions: Higher total dietary fiber was associated with reduced risk of CVD in Japanese non-smokers.

The effect of cooking loss on vitamin intake is an important consideration in dietary and epidemiological studies in Japanese. However, because few published food values have considered cooking effect, allowing for cooking loss in the assessment of vitamin intake in Japan has been difficult.Seven-day dietary records and a fasting blood sample were collected from 102 men and 113 women in August of 1994 or 1995. Vitamin intake were estimated using two food databases, one composed of raw food only and the second of cooked food. Estimates were compared with blood levels.Water-soluble vitamin intake using a food database including cooked food was lower than intakes estimated using a database composed of raw food only, except for pantothenic acid and vitamin B(12) intake. In particular, vitamin B(1) intake was 18.9% lower in men and 16.8% lower in women. However, when subjects were classified into the same and adjacent categories by joint classification by quintiles, appreciable change in ranking of a subject was not observed. Furthermore, the relationship between vitamin intake and biomarker did not improve when intake was calculated using a food database including cooked food.Although the effect of cooking loss on absolute values is not negligible, this might not significantly impact the ranking of subject intake estimations of vitamin intake in epidemiological studies.

This study examined the association between magnesium intake and type II diabetes risk among Japanese adults. Participants were 25 872 men and 33 919 women aged 45-75 years who had no history of diabetes. Magnesium intake was ascertained using a 147-item food frequency questionnaire. Odds ratio of self-reported physician-diagnosed type II diabetes over 5 years was estimated using logistic regression analysis. A total of 1114 new cases of type II diabetes were self-reported. Magnesium intake was not significantly associated with type II diabetes in either men or women. The multivariable-adjusted odds ratios (95% confidence intervals) of type II diabetes for the highest versus lowest quintile of magnesium intake were 0.86 (0.63-1.16) and 0.92 (0.66-1.28) for men and women, respectively. Although a small effect cannot be excluded in men, magnesium intake may not be appreciably associated with risk of type II diabetes for Japanese adults.

The Japan Public Health Center-based prospective Study examined the association of body mass index (BMI) and weight change with incident stroke in Japanese individuals, for whom BMI levels are generally low.We used initial data from 1990 to 1994 and 5-year follow-up surveys from 1995 to 1999. We calculated weight change over a 5-year period for 32,847 men and 38,875 women, aged 45-74 years, with no history of cardiovascular disease or cancer. Subjects were followed from the 1995-1999 survey to the end of 2005, and hazard ratios of self-reported BMI levels and weight change for incident stroke were estimated using Cox's proportional hazard models adjusted for potential confounders.During the follow-up period (median 7.9 years) there were 2019 incident strokes, including subtypes. Multivariable-adjusted hazard ratios for all stroke events by BMI levels of 27.0-29.9 and ≥ 30 kg m(-2) versus 23.0-24.9 kg m(-2) were 1.09 (95% confidence interval 0.88, 1.36) and 1.25 (0.86, 1.84) in men (P for trend=0.22), and 1.29 (1.01, 1.65) and 2.16 (1.60, 2.93) in women (P for trend0.001), respectively. A weight change of ≥ 10% in the previous 5 years was associated with total strokes and ischemic strokes in women.Higher BMI levels and a weight gain of ≥ 10% over 5 years were associated with an increased risk of stroke in women, whereas this association was weak in men.

It is unclear whether weight change during adulthood influences subsequent mortality in Asian populations, who have a relatively lean body mass.To assess the relation of weight change over 5 years to all-cause, cancer and cardiovascular disease mortality among Japanese men and women.Subjects were 36 220 men and 44 091 women aged between 45 and 75 years without a history of serious disease at baseline. Weight change was calculated as the difference of body weight between two surveys with a 5-year interval.During 699 963 person-years of follow-up, we identified 4232 deaths of all-cause, 1872 cancer deaths and 1021 cardiovascular deaths. The relation between weight change and all-cause mortality was reverse J-shaped. Multivariate hazard ratios (95% confidence interval) for weight loss of 5 kg or more versus weight change of less than 2.5 kg were 1.62 (1.45-1.81) in men and 1.76 (1.51-2.05) in women, whereas those for weight gain of 5 kg or more were 1.40 (1.22-1.59) in men and 1.25 (1.02-1.54) in women. These associations remained statistically significant even after the exclusion of deaths in the first 3 years of follow-up. The weight change-mortality association was pronounced in underweight persons or in nonsmoking men. The risk of cancer mortality increased in both men and women who lost weight by 5 kg or more. With regard to cardiovascular disease, mortality risk tended to increase with weight loss both in men and women, whereas its increase with weight gain was observed only in women.A large weight change, both loss and gain, was associated with an increased risk of mortality. Weight loss and gain may be predictors of early death in apparently healthy adult Japanese.

Calcium and vitamin D have been implicated in the development of type 2 diabetes, but epidemiological evidence is limited. We examined prospectively the relation of calcium and vitamin D intake to type 2 diabetes risk in a Japanese cohort. Participants were 59,796 middle-aged and older men and women, who participated in the Japan Public Health Center-based Prospective Study and had no history of type 2 diabetes or other serious diseases. Dietary intake of calcium and vitamin D were estimated using a validated food frequency questionnaire. Logistic regression was used to assess the association between intake of these nutrients and self-reported newly diagnosed type 2 diabetes. During a 5 year follow-up, 1,114 cases of type 2 diabetes were documented. Overall, calcium intake was not associated with a significantly lower risk of type 2 diabetes; the multivariable odds ratio for the highest vs lowest quartiles was 0.93 (95% CI 0.71–1.22) in men and 0.76 (95% CI 0.56–1.03) in women. However, among participants with a higher vitamin D intake, calcium intake was inversely associated with diabetes risk; the odds ratio for the highest vs lowest intake categories was 0.62 (95% CI 0.41–0.94) in men and 0.59 (95% CI 0.38–0.91) in women. Dairy food intake was significantly associated with a lower risk of type 2 diabetes in women only. Calcium and vitamin D may not be independently associated with type 2 diabetes risk. Our finding suggesting a joint action of these nutrients against type 2 diabetes warrants further investigation.

Limited data are available regarding longitudinal changes in body weight. Here, we describe changes in the prevalences of overweight and obesity and calculated the incidence of these indices during a 10-year follow-up period for a large-scale cohort study in Japan.Longitudinal analysis of data from a population-based cohort study, the Japan Public Health Center (JPHC) Study.A total of 65 095 Japanese men and women, who were between the ages of 40 and 69 years at baseline and participated in the 5th- and 10th-year follow-up surveys of the JPHC, were enroled in the study.Mean body mass index (BMI), calculated using self-reported height and weight, and the prevalences of overweight (BMIor=25 kg/m(2)) and obesity (BMIor=30 kg/m(2)) at each survey period. Incidences of overweight and obesity during the 10-year period.On an average, individuals living in Okinawa had much higher BMIs than those living on the Main islands for all sex and age groups. During the follow-up period, the prevalences of overweight and obesity steadily increased in the cohorts aged less than 50 years at baseline in both sexes. Men in younger cohorts had a higher mean BMI than those in the same age group of older cohorts, whereas the opposite trend was observed in women. The incidence of overweight individuals was greater in Okinawa than on the Main islands and among younger generations than among older ones.A longitudinal analysis at the individual level showed that the prevalences of overweight and obesity increased among middle-aged Japanese participants during the follow-up period. Among men, an increasing prevalence of obesity was observed among the younger generations. These findings should be taken into consideration when planning preventive strategies for obesity and its related diseases.

Background: Smoking is associated with the number of teeth. The purpose of this study was to determine the relationship of number of teeth with smoking and smoking cessation. Methods: Subjects included 547 males aged between 55 and 75 years. Oral examinations were conducted in 2005. Smoking status information was collected from questionnaire surveys conducted in 1990, 1995, 2000, and 2005. The relationship between having more than eight missing teeth and smoking status was estimated with adjusted odds ratio. Results: Comparing with never smokers, odds ratios of having more than eight missing teeth among current and former smokers were 1.96 and 1.86, respectively. The odds ratios in those who had stopped smoking for ≤10 years was 3.02, and for those who had ceased smoking for 11–20 years was 2.66. In those who stopped smoking for 21 years or more, there was no increase in the odds ratio. Conclusion: Smoking had a positive association with the number of missing teeth and smoking cessation is beneficial for maintaining teeth. The odds of having more than eight missing teeth in those who had never smoked was equal to that of individuals who reported that they had stopped smoking for 21 years or more.

In giant, large internal carotid ophthalmic artery aneurysms, revised double lumen balloon catheters introduced directly into the cervical carotid arteries were used successfully to perform suction decompression methods. No general heparinization was used during these maneuvers except for continuous intraluminal irrigation of heparin contained saline. Intraoperative multi-directional portable DSA ascertained complete neck clippings and patency of parent vessels. These methods were tried for 8 cases of large, giant IC ophthalmic aneurysms. Among these 5 patients who complained of incomplete visual failures, visual acuity improved in 3 cases. Postoperative transient hemiparesis were seen in two cases which had partially thrombosed, calcified giant aneurysm and the other was due to prolonged proximal ICA occlusion at its cavernous portion. Neither dead nor severely disabled cases were seen, fortunately. Delayed postoperative conventional angiography disclosed complete neck clippings sparing parent arteries except for only one case. This revised direct carotid puncture method is simple and acceptable because of minimal morbidity.

In giant, large internal carotid ophthalmic artery aneurysms, revised double lumen balloon catheters introduced directly into the cervical carotid arteries were used successfully to perform suction decompression methods. No general heparinization was used during these maneuvers except for continuous intraluminal irrigation of heparin contained saline. Intraoperative multi-directional portable DSA ascertained complete neck clippings and patency of parent vessels. These methods were tried for 8 cases of large, giant IC ophthalmic aneurysms. Among these 5 patients who complained of incomplete visual failures, visual acuity improved in 3 cases. Postoperative transient hemiparesis were seen in two cases which had partially thrombosed, calcified giant aneurysm and the other was due to prolonged proximal ICA occlusion at its cavernous portion. Neither dead nor severely disabled cases were seen, fortunately. Delayed postoperative conventional angiography disclosed complete neck clippings sparing parent arteries except for only one case. This revised direct carotid puncture method is simple and acceptable because of minimal morbidity.

Cancer incidence rates among first-generation Japanese immigrants in the city of São Paulo, Brazil, were estimated from the data of the São Paulo Cancer Registry during the years 1969 to 1978. From all registered cases, 2,179 cancer cases of Japan-born residents (1,288 males, 891 females) were selected and age-specific and summary age-adjusted incidence rates (AAIR) were calculated for the selected sites of cancer. The AAIR for all sites except non-melanoma skin cancer was 195.2 per 100,000 population (95 percent confidence interval: 176.4-214.1) in males and 147.3 (134.6-160.0) in females. Stomach cancer had the highest incidence rate of all cancers in both sexes (males, 69.3; females, 32.0). This was followed by cancer of the lung (22.5), esophagus (10.2), colon (8.3), and prostate (7.1) in males; and by breast (24.0), cervix (18.0), colon (8.4), and lung (7.2) in females. When these rates were compared with those among Japanese in Japan, cancer of the stomach and rectum revealed significantly lower rates, while non-melanoma skin cancer, and prostate and breast cancer showed higher rates. No significant increase of colorectal cancer was recognized among Japanese immigrants in São Paulo, contrary to the remarkably high rates of colorectal cancer being observed among Japanese immigrants in the US.

A survey of hepatitis B virus (HBV) markers of Japanese immigrants, their descendants and native Bolivians was performed in two agricultural settlements in Bolivia. The prevalence of HBV markers in sera, either hepatitis B surface antigen (HBsAg) or its antibody (HBsAb), was higher in the Japanese (46.4%) than in the native Bolivian (12.9%) adult generations of both colonies. There was no significant difference between Japanese (4.3%) and Bolivian (0.9%) school children in one colony, but a high percentage (32.6%) was recognized among Japanese children in the other colony. The numbers of adw subtypes were unexpectedly high among these HBsAg positive Japanese children, compared to those in Japan. Antibody to hepatitis delta virus (HDV) was detected in one case. These data suggested that although horizontal transmission of adw HBV had occurred within the Japanese population, HBV and HDV were not endemic to this geographic area.