Traditional japanese diet score and the sustainable development goals by a global comparative ecological study

BACKGROUND

Reducing the environmental impact of the food supply is important for achieving Sustainable Development Goals (SDGs) worldwide. Previously, we developed the Traditional Japanese Diet Score (TJDS) and reported in a global ecological study that the Japanese diet is associated with reducing obesity and extending healthy life expectancy etc. We then examined the relationship between the TJDS and environmental indicators.

METHODS

The average food (g/day/capita) and energy supplies (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. The TJDS was calculated from eight food groups (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, and eggs; food components that are relatively unused in the traditional Japanese diet: wheat, milk, and red meat) by country using tertiles, and calculated the total score from - 8 to 8, with higher scores meaning greater adherence to the TJDS. We used Land Use (m2), Greenhouse gas (GHG) emissions 2007/2013 (kg CO2eq), Acidifying emissions (g SO2eq), Eutrophying emissions (g PO43- eq), Freshwater (L), and water use (L) per food weight by Poore et al. as the environmental indicators and multiplied these indicators by each country's average food supply. We evaluated the cross-sectional and longitudinal associations between the TJDS and environmental indicators from 2010 to 2020. This study included 151 countries with populations ≥ 1 million.

RESULTS

Land use (β ± standard error; -0.623 ± 0.161, p < 0.001), GHG 2007 (-0.149 ± 0.057, p < 0.05), GHG 2013 (-0.183 ± 0.066, p < 0.01), Acidifying (-1.111 ± 0.369, p < 0.01), and Water use (-405.903 ± 101.416, p < 0.001) were negatively associated with TJDS, and Freshwater (45.116 ± 7.866, p < 0.001) was positively associated with TJDS after controlling for energy supply and latitude in 2010. In the longitudinal analysis, Land Use (β ± standard error; -0.116 ± 0.027, p < 0.001), GHG 2007 (-0.040 ± 0.010, p < 0.001), GHG 2013 (-0.048 ± 0.011, p < 0.001), Acidifying (-0.280 ± 0.064, p < 0.001), Eutrophying (-0.132 ± 0.062, p < 0.05), and Water use (-118.246 ± 22.826, p < 0.001) were negatively associated with TJDS after controlling for confounders.

CONCLUSIONS

This ecological study suggests that the traditional Japanese dietary pattern might improve SDGs except Fresh water.

Effects of acute resistance exercise on exhaled nitric oxide levels in non-asthmatic male

Fractional nitric oxide (FeNO) is an index of eosinophilic airway inflammation. However, the effect of acute resistance exercise on FeNO is not completely known, in non-asthmatics. In this study, we aimed to assess the effects of acute resistance exercise on FeNO levels in non-asthmatics. Ten participants completed both exercise and control sessions. The resistance exercise routine consisted of three sets of 10 repetitions, each at 75 % of the one-repetition maximum, including vertical chest press, lateral pull-down, leg press, leg extension, and abdominal exercises. Additionally, FeNO levels and respiratory impedance were measured, and blood samples were collected from each participant at baseline, immediately after exercise (post), and 30 min after exercise (post 30). At baseline, post, and post 30, the FeNO levels did not significantly differ between the exercise and control sessions (17.1 ± 4.7 vs. 18.5 ± 3.8 vs. 16.9 ± 3.8 ppb, respectively) and exercise sessions (16.6 ± 3.4 vs. 19.3 ± 7.6 vs. 18.3 ± 5.6 ppb, respectively). Therefore, acute resistance exercise lasting approximately 30 min did not exert an impact on FeNO levels.

Global Association between Traditional Japanese Diet Score and All-Cause, Cardiovascular Disease, and Total Cancer Mortality: A Cross-Sectional and Longitudinal Ecological Study

OBJECTIVE

Studies conducted on Japanese people have suggested that a traditional Japanese diet contributes to good health, longevity, and protection against several non-communicable diseases. However, it is unknown whether traditional Japanese dietary patterns are associated with all-cause mortality, cardiovascular disease, and cancer mortality globally. The purpose of this cross-sectional and longitudinal ecological study is to clarify the global association between the traditional Japanese diet score (TJDS) and all-cause, cardiovascular disease, and total cancer mortality.

METHODS

Data on food supply and all-cause mortality, cardiovascular disease mortality, total cancer mortality, and covariables by country were obtained from a relevant internationally available database. TJDS by country was calculated from eight food groups and the total score ranged from -8 to 8, with higher scores indicating greater adherence to a traditional Japanese diet. We evaluated the cross-sectional and 10-year longitudinal association between TJDS and all-cause, cardiovascular disease, and total cancer mortality using 2009 as the baseline in 142 countries with populations of more than one million. A cross-sectional analysis and a longitudinal analysis were performed using three general linear models or three linear mixed models with different covariables.

RESULTS

In cross-sectional models controlled for fully-adjusted covariables, TJDS was negatively associated with all-cause mortality (β ± standard error; -43.819 ± 11.741, p < 0.001), cardiovascular disease mortality (-22.395 ± 4.638, p < 0.001), and total cancer mortality (-3.893 ± 1.048, p < 0.001). In 10-year longitudinal models controlled for fully-adjusted covariables, TJDS was significantly negatively associated with all-cause mortality (-31.563 ± 7.695, p < 0.001), cardiovascular disease mortality (-16.249 ± 4.054, p < 0.001), and total cancer mortality (-3.499 ± 0.867, p < 0.001).

CONCLUSIONS

This cross-sectional and longitudinal ecological study suggests that the traditional Japanese diet is associated with lower all-cause mortality, cardiovascular disease mortality, and total cancer mortality, worldwide.

The Global Association between Egg Intake and the Incidence and Mortality of Ischemic Heart Disease-An Ecological Study

The relationship between egg consumption and ischemic heart disease (IHD) remains controversial as there is still no clear answer regarding the relationship, with research limited to a few geographical regions. In the current study, we conducted a longitudinal analysis of the association between egg intake and IHD incidence (IHDi) and mortality (IHDd) using 28 years of international data from 1990 to 2018. Egg intake (g/day/capita) by country was obtained from the Global Dietary Database. Age-standard IHDi and IHDd rates per 100,000 subjects in each country were obtained from the 2019 Global Burden of Disease database. The analysis included a total of 142 countries with populations of at least one million, for which all data were available from 1990 to 2018. Eggs are consumed worldwide, and regional differences in consumption are also shown. Utilizing IHDi and IHDd as objective variables and egg intake as an explanatory variable, the analysis was conducted using linear mixed models, which controlled for inter- and intra-country variation from year to year. The results showed a significant negative association between egg intake, and IHDi (-0.253 ± 0.117, p < 0.05) and IHDd (-0.359 ± 0.137, p < 0.05). The analysis was carried out using R 4.0.5. The results suggest that adequate egg intake might suppress IHDi and IHDd on a global scale.

Validation of a dietary balance score in middle-aged and older community-dwelling Japanese

This study assessed the validity of dietary balance scores (DBSs) by investigating the association between DBSs and nutrient adequacy (NA) in two Japanese populations. The participants were 65 community-dwelling Japanese from Tokushima Prefecture and 2,330 community-dwelling Japanese from Aichi Prefecture. Based on food frequency questionnaires or 3-day dietary records, we obtained 18 food groups. The NA score integrates nine beneficial nutrients and two nutrients that should be limited. We calculated four different DBSs: DBS1 consisted of five food groups (score range:0?20), DBS2 consisted of nine food groups (score range:0?36), DBS3 consisted of eight food groups (score range:0?32), and DBS4 consisted of 10 food groups (score range:0?40). Both the Spearman rank correlation coefficient with NA and the area under the receiver operating characteristic curve (AUC-ROC) for the nine beneficial nutrients were then estimated to test the performance of each DBS in predicting nutrient intake. The results showed that DBS1 and DBS4 were positively correlated with NA, while the AUC-ROC showed that DBS4 could moderately discriminate individuals with adequate intake levels of all nine nutrients. These findings suggest DBSs (especially DBS4) are useful in assessing dietary balance in middle-aged and older community-dwelling Japanese. J. Med. Invest. 70 : 377-387, August, 2023.

Indirect impact of the COVID-19 pandemic on the incidence of non-COVID-19 infectious diseases: a region-wide, patient-based database study in Japan

OBJECTIVES

The COVID-19 pandemic has forced people to change many behaviours, including physical distancing, hygiene measures and lifestyles. This study aimed to evaluate the indirect impact of the COVID-19 pandemic on the incidence of non-COVID-19 infections and medical care costs/visits using health insurance claims.

STUDY DESIGN

This was an observational study using patient-based administrative claims covering approximately 800,000 insured persons and their dependents in the Mie Prefecture in Japan.

METHODS

This study identified non-COVID-19 infectious disease incidences, number of outpatient visits and healthcare costs between 2017 and 2021. Each year was divided into quarters. The adjusted incidence rate ratios (IRRs) during the pandemic (January 2020 to September 2021) and during the prepandemic period (January 2017 to December 2019) were determined using Poisson regression.

RESULTS

The adjusted influenza IRRs from April 2020 were close to zero. The incidence of upper respiratory tract infections and bacterial pneumonia was significantly reduced (IRRs range: 0.39-0.73 and 0.43-0.84, respectively). Gastrointestinal and urinary tract infection incidences decreased by approximately 30% and 10%, respectively. In contrast, sexually transmitted infections (STIs), including syphilis, gonococcal infection and Chlamydia trachomatis infection, did not decrease during the pandemic but increased significantly between April and June 2021 (adjusted IRR, 1.37; 95% confidence interval, 1.18-1.60). The adjusted IRRs for outpatient visits and healthcare costs were 0.86-0.93 and 0.91-0.97, respectively.

CONCLUSIONS

In contrast to other infections, STIs did not decrease during the COVID-19 pandemic. The IRR of STIs during the pandemic period is an area of public health concern. Appropriate screening and medical consultations are strongly recommended.

Effect of Omega-3 Polyunsaturated Fatty Acids Intake on Eosinophil Airway Inflammation in University Athletes

Background

Though athletes have a high risk of respiratory disorders, effective prevention has not yet to be identified. Omega-3 (n-3) polyunsaturated fatty acids (PUFA) have some practical anti-inflammatory effects in allergy, and therefore may reduce airway inflammation in athletes. This study aimed to assess whether n-3 PUFA intake affects airway inflammation in university athletes.

Methods

Twenty-three males were divided into three groups: 1) the eosinophilic airway inflammation group (I_PUFA group; fractional exhaled nitric oxide (FeNO ≥ 25 ppb, n = 10); 2) the non-eosinophilic airway inflammation group (N_PUFA group; FeNO < 25 ppb, exhaled carbon dioxide (eCO) ≥ 3.6 ppm, n = 5); and 3) the control group (FeNO < 25 ppb, eCO < 3.6 ppm, n = 8). Participants took supplements containing 260 mg of docosapentaenoic acid and 600 mg of eicosapentaenoic acid (EPA) daily for 3 weeks. Baseline measurements of FeNO, respiratory impedance, respiratory function, dietary intake (food frequency questionnaires), and blood tests were performed. FeNO and respiratory impedance were measured weekly, and the rest were measured after 3 weeks.

Results

There was a significant decrease in FeNO levels from baseline at 2 and 3 weeks in the I_PUFA group (54.7 ± 8.5 ppb vs. 45.1 ± 9.1 and 45.4 ± 7.7 ppb; mean ± standard error (SE), P < 0.05). After 3 weeks, FeNO levels remained unchanged in the N_PUFA and control groups, and respiratory impedance and function remained unchanged in all groups. Blood EPA levels significantly increased in the I_PUFA and N_PUFA groups (I_PUFA, 27.7 ± 16.9 vs. 52.1 ± 12.3 µg/mL; N_PUFA, 20.8 ± 8.7 vs. 70.4 ± 36.1 µg/mL; mean ± standard deviation (SD), P < 0.05). No changes were observed in dietary intake over the 3 weeks.

Conclusions

n-3 PUFA supplementation for 3 weeks reduced airway inflammation in athletes with FeNO levels ≥ 25 ppb.

Association between the Mediterranean Diet Score and Healthy Life Expectancy: A Global Comparative Study

OBJECTIVES

Extending healthy life expectancy (HALE), defined as the average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury, is a common topic worldwide. This study aims to clarify the relationships between the Mediterranean diet score (MDS) and life expectancy (LE) and HALE globally using publicly available international data.

SETTING

Analyses were conducted on 130 countries with populations of 1 million or more for which all data were available. Individual countries were scored from 0 to 9 to indicate adherence to the Mediterranean diet according to the MDS scoring method. The supply of vegetables, legumes, fruits and nuts, cereals, fish, and olive oil per 1,000 kcal per country was calculated based on the Food and Agriculture Organization Corporate Statistical Database, with a score of 1 for above the median and 0 for below. The same method was used to calculate scores of presumed detrimental components (meat and dairy), with consumption below the median given a value of 1, and consumption above the median given a value of 0. For ethanol, a score of 1 was given for 10g to 50 g of consumption. We investigated the cross-sectional associations between the MDS and LE and HALE at birth in 2009, and the longitudinal associations between the MDS in 2009 and LE and HALE between 2009 and 2019, controlling for covariates at baseline using linear mixed models.

RESULTS

In the cross-sectional analysis, the MDS was significantly positively associated with LE (β=0.906 [95% confidence interval, 0.065-1.747], p=0.037) and HALE (β=0.875 [0.207-1.544], p=0.011) after controlling for all covariates. The longitudinal analysis also revealed significantly positive associations between the MDS and LE (0.621 [0.063-1.178], p=0.030) and HALE (0.694 [0.227-1.161], p=0.004) after controlling for all covariates.

CONCLUSION

The present study, based on an analysis using 10 years of international data, showed that countries with a higher MDS showed a positive association with HALE.

Intake of isoflavones reduces the risk of all-cause mortality in middle-aged Japanese

BACKGROUND/OBJECTIVES

To clarify the effects of intake of legumes and isoflavones on all-cause mortality in middle-aged and older Japanese.

SUBJECT/METHODS

The subjects were 2136 randomly chosen community-dwelling Japanese men and women aged 40-79 years who participated in a first-wave survey (1997-2000; baseline). The subjects were followed from baseline to December 31, 2017 (mean period of 16.6 ± 4.2 years). Intake of legumes, soybeans, and isoflavones at baseline was assessed using a 3-day dietary record with photographs. The relationships of intake amounts of legumes and isoflavones to mortality were assessed using Cox proportional hazards regression controlling for age, sex, education, employment, body mass index, smoking habits, medical histories, drinking, and energy intake.

RESULTS

There were 491 deaths during the follow-up period. We found inverse associations of the intake of total soy products and intake of each of the isoflavones with all-cause mortality (p for trend < 0.05) in subjects aged < 60 years: the multivariate-adjusted hazard ratios (95% confidence intervals) for all-cause mortality in the highest intake group (third tertile) of total soy products and total isoflavones were 0.32 (0.13-0.78) and 0.35 (0.17-0.73), respectively, compared with the reference group (first tertile). In contrast, there were no significant associations of intake amounts of legumes, soybeans, and isoflavones with all-cause mortality in subjects aged 60 years or older.

CONCLUSIONS

The findings suggest that a higher intake of isoflavones might decrease the risk of all-cause mortality, especially in middle-aged Japanese.

213Traditional Japanese Diet Score and healthy life expectancy - a longitudinal global study

Background

Traditional Japanese diets are considered to be health and longevity. We created a Traditional Japanese Diet Score (TJDS) and investigated the relationship between the TJDS and healthy life expectancy (HALE) longitudinally using global database.

Methods

Average food (g/day/capita) and energy supply (kcal/day/capita) by countries were identified by the Food and Agriculture Organization of the United Nations Statistics Division database. The sum of characterizing traditional Japanese foods supply (beneficial food components in Japanese diet; rice, fish, soybeans, vegetables, eggs, seaweeds, food components not use so much in Japanese diet; wheat, milk, and red meat) were divided as tertile (beneficial food components;-1, 0, 1, not use so much food components; 1, 0, -1). HALE values by country were derived from the Global Burden of Disease 2017 database. The longitudinal effects of TJDS on the rate of change in HALE from 1990 to 2013 were evaluated using a generalized mixed-effect model (GLMM), which takes into account the dependence of repeated observations within countries. The interaction between TJDS and survey year was applied to access the effects on HALE. This study covered 137 countries with populations of 1 million or greater.

Results

Longitudinal analysis controlled for covariates showed that smooth term of the interaction between TJDS and survey year was significant (p &lt; 0.001). The TJDS was negative associated with HALE in 1990, and in 1991, but positive associated after 2002.

Conclusions

The relationship between the TJDS as a healthy eating style and HALE is getting stronger since the 21st century.

Key messages

Well-balanced eating habits of traditional Japanese diets is supports healthy life expectancy.

265Global diabetes trends and associated socioeconomic, lifestyle and health indicators from 1990 to 2017

Background

This longitudinal ecological study was conducted to determine the global trends in the age-standardised prevalence of type 2 diabetes mellitus (T2DM) and its association with socioeconomic, lifestyle and health indicators.

Methods

Data pertaining to the age-standardised prevalence of T2DM (rates per 100,000) and socioeconomic, lifestyle and health indicators were obtained from several international databases. Data available from 1990 to 2017 for 139 countries with populations of 1 million or greater were analysed, followed by estimation of slopes for T2DM prevalence in each country. The longitudinal association between T2DM and the standardised variables of socioeconomic, lifestyle and health indicators was fitted using a generalised linear mixed-effects model with random intercept for each country and random slope for year.

Results

The country-specific age-standardised prevalence of T2DM decreased significantly in 9 countries, remained unchanged in 11 countries and increased significantly in 119 countries. The estimated standardised effect of age-standardised education for T2DM was the largest at − 524.5 (SE; 109.9), followed by − 514.8 (SE; 95.6) for physical activity and 398.8 (SE; 45.8) for body mass index (BMI) (P &lt; 0.0001 for all).

Conclusions

The factors strongly associated with global T2DM prevalence and trends were years of education, followed by physical activity and BMI. This study also provides a basis for investigating public health approaches to control the increase in global T2DM prevalence.

Key messages

The promotion of policies that reduce international educational disparities may have the potential to reduce the global increase in the number of patients with T2DM.

169Folic acid intake and dementia - a 27-year global longitudinal study

Background

Folate deficiency increases serum homocysteine and may cause cognitive impairment. However, there have been no international longitudinal studies that examined the association between folic acid intake and dementia. We investigated the longitudinal association between folate intake and the prevalence of dementia using global data during 27 years.

Methods

Prevalence of Alzheimer’s disease and other dementias and folic acid intake by country were obtained from the Global Burden of Disease (GBD) 2017 database. The longitudinal associations between folic acid intake and prevalence of dementia was examined using linear mixed effect model during 27 years from 1990 to 2017 in 151countries with populations of 1 million or greater. The effects of folic acid, year and interaction of folic acid and year were estimated controlling for covariates including socio-economic variables and life-style variables.

Results

Fixed effects of folic acid was highly significant (mean and SE; -33.1±7.1, p &lt; 0.001) and interaction of folic acid and survey year was also significant (0.90±0.13, p &lt; 0.001). Slope of folic acid for dementia prevalence was significant in 1990 and the slope has decreased with the year and has become not significant after 2011.

Conclusions

Folic acid was associated with the prevalence of dementia, but weakened over the years.

Key messages

Although folic acid intake has been associated with the of dementia, the risk of dementia may be increasingly related to factors other than nutrition.

64Traditional Japanese Diet Score and cancer incidence and mortality - a 23-year longitudinal global study

Background

Traditional Japanese diets are considered to be one cause of Japanese health and longevity. We created a Traditional Japanese Diet Score (TJDS) and investigated the relationship between the TJDS and cancer during more than 20 years using global database.

Methods

Total cancer incidence and mortality by country were identified from the Global Burden of Disease 2017 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations database. The TJDS by country was calculated from nine food groups, the higher scores mean the more adherence to traditional Japanese diet. That is beneficial food groups (rice, fish, soybeans, vegetables, eggs, seaweed) gave positive points to high supply amount, and food groups not commonly used in the Japanese diet (wheat, milk, and red meat) gave minus points to high supply amount. The longitudinal associations between the TJDS and cancer incidence and mortality controlled for covariates were examined during 23 years from 1990 to 2013. The country covered by this study was 139 countries with populations of 1 million or greater.

Results

The TJDS was negatively associated with cancer incidence and mortality longitudinally in a linear mixed-effect model controlled for covariates.

Conclusions

These results suggest that greater adherence with the TJDS supressed cancer incidence and mortality worldwide.

Key messages

Well-balanced eating habits like traditional Japanese diets is important for suppressing cancer.

Global relationship between Mediterranean diet and the incidence and mortality of ischaemic heart disease

BACKGROUND

The purpose of this study was to clarify the global relationship between the Mediterranean diet score (MDS) and country-wise incidence and mortality of ischaemic heart disease (IHD) using an international database.

METHODS

We used population data from a global longitudinal database covering 137 countries with a population of over one million. MDS were evaluated based on the total score of the nine foods that comprise the Mediterranean diet. The incidence and mortality of IHD by country was derived from the Global Burden of Disease (GBD) database. Average food (g/day/capita) and energy supply (kcal/day/capita) by country, excluding loss between production and household, were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. Data from the GBD database were used for body mass index, current smoking rates, physical activity, years of education and percentage of the Muslim population. We identified the percentage of the population over 65 years of age (aging rate) and gross domestic product per capita (US$/capita) using the World Bank database. A linear mixed-effect model was used for evaluating the effects of MDS on incidence and mortality of IHD controlled for socioeconomic and lifestyle variables.

RESULTS

Analysis showed that MDS was significantly associated with IHD incidence after controlling for covariates (-1.01 ± 0.27, P < 0.001). Similarly, there was a significant association between MDS and IHD-related mortality after controlling for covariates (-0.73 ± 0.34, P < 0.05).

CONCLUSION

Analysis of 27 years of data suggests that a Mediterranean diet might have a preventive effect on IHD.

Trends in age-standardised prevalence of type 2 diabetes mellitus according to country from 1990 to 2017 and their association with socioeconomic, lifestyle and health indicators: An ecological study

Background

There is a need for global public health strategies to effectively curb the ever-growing global diabetes population. This longitudinal ecological study was conducted to elucidate the country-specific trends of the age-standardised prevalence of type 2 diabetes mellitus (T2DM) and their association with socioeconomic, lifestyle and health indicators.

Methods

Data pertaining to the age-standardised prevalence of T2DM (rates per 100 000) and socioeconomic, lifestyle and health indicators were obtained from several international databases. Data available from 1990 to 2017 for 139 countries with populations of 1 million or greater were analysed, followed by estimation of slopes for T2DM prevalence in each country. The longitudinal association between T2DM and the standardised variables of socioeconomic, lifestyle and health indicators was fitted using a generalised linear mixed-effects model with random intercept for each country and random slope for year.

Results

The country-specific age-standardised prevalence of T2DM decreased significantly in 9 countries, remained unchanged in 11 countries and increased significantly in 119 countries. The estimated standardised effect of age-standardised education for T2DM was the largest at −524.5 (SE; 109.9), followed by −514.8 (SE; 95.6) for physical activity and 398.8 (SE; 45.8) for body mass index (BMI) (P < 0.0001 for all).

Conclusions

The factors largely associated with global T2DM prevalence and trends were years of education, followed by physical activity and BMI. This study also provides basic resources for examining public health approaches to curb the increase in global T2DM prevalence.

A longitudinal association between the traditional Japanese diet score and incidence and mortality of breast cancer-an ecological study

BACKGROUND

The traditional Japanese diet is considered one of the important factors of health and longevity in Japanese people. Breast cancer is the most common cancer among women in the world. However, the association between the traditional Japanese diet and breast cancer is unclear. The purpose of this study was to investigate the longitudinal association between the traditional Japanese diet score (TJDS) with the incidence and mortality of breast cancer in an ecological study.

METHODS

Food supply and breast cancer incidence and mortality by country were obtained from an international database. TJDS by country was calculated from nine food groups and the total score ranged from -9 to 9, with higher scores indicating greater adherence to a traditional Japanese diet. Longitudinal associations of interaction between TJDS and fiscal year on breast cancer incidence and mortality were investigated in 139 countries with populations of 1 million or greater. The longitudinal analysis was evaluated using four linear mixed-effect models with different adjustment covariables.

RESULTS

Many countries with high scores on TJDS had lower distributions of breast cancer incidence and mortality in 1990-2017. Longitudinal analysis using a linear mixed-effect model controlled for socio-economic and lifestyle covariables showed that the interaction between TJDS and fiscal year was significantly associated with incidence of breast cancer (-0.453 ± 0.138, p < 0.01) and mortality of breast cancer (-0.455 ± 0.135, p < 0.001).

CONCLUSIONS

This longitudinal analysis suggested that a traditional Japanese diet has been associated with lower breast cancer incidence and mortality worldwide in recent years.

Roles of cytokines and T cells in the pathogenesis of myasthenia gravis

Myasthenia gravis (MG) is characterized by muscle weakness and fatigue caused by the presence of autoantibodies against the acetylcholine receptor (AChR) or the muscle-specific tyrosine kinase (MuSK). Activated T, B and plasma cells, as well as cytokines, play important roles in the production of pathogenic autoantibodies and the induction of inflammation at the neuromuscular junction in MG. Many studies have focused on the role of cytokines and lymphocytes in anti-AChR antibody-positive MG. Chronic inflammation mediated by T helper type 17 (Th17) cells, the promotion of autoantibody production from B cells and plasma cells by follicular Th (Tfh) cells and the activation of the immune response by dysfunction of regulatory T (T_reg ) cells may contribute to the exacerbation of the MG pathogenesis. In fact, an increased number of Th17 cells and Tfh cells and dysfunction of T_reg cells have been reported in patients with anti-AChR antibody-positive MG; moreover, the number of these cells was correlated with clinical parameters in patients with MG. Regarding cytokines, interleukin (IL)-17; a Th17-related cytokine, IL-21 (a Tfh-related cytokine), the B-cell-activating factor (BAFF; a B cell-related cytokine) and a proliferation-inducing ligand (APRIL; a B cell-related cytokine) have been reported to be up-regulated and associated with clinical parameters of MG. This review focuses on the current understanding of the involvement of cytokines and lymphocytes in the immunological pathogenesis of MG, which may lead to the development of novel therapies for this disease in the near future.

A bolus of saline injection leads to increase in coronary flow based on the viscosity reduction effect: the mechanism of saline induced Pd/Pa ratio

Background

In conjunction with fractional flow reserve (FFR), our previous study has shown the accuracy and utility of saline induced Pd/Pa ratio (SPR) for the assessment of myocardial ischemia. However, the potential mechanism how saline injection leads to increase in coronary flow remains speculative.

Purpose

This study aimed to clarify the underlying mechanism of SPR by using swine models.

Methods

The study was conducted in four swine models, and bolus of 25°C saline, 40°C saline, and 25°C dextran was injected at rates of 40mL/5sec through a catheter inserted into the superior mesenteric artery. Its peripheral arterioles were observed and recorded by a digital microscope, and transit time of each fluid and a luminal diameter of arterioles before and after injection were measured.

Results

The result from arterioles diameters of pre- and post-injection (0.049±0.016mm vs. 0.050±0.016mm; P=0.636) indicated that luminal diameters remained unchanged regardless of fluid administration. The transit time of 25°C saline was significantly shorter than 25°C dextran (3.19±0.68sec vs. 6.15±1.19sec; P&lt;0.0001). Although the result showed no significance, the transit time of 40°C saline with lower viscosity was shorten compared to 25°C saline (3.1±0.43sec vs. 3.65±0.46sec; P=0.088).

Conclusions

Compared to 25°C dextran (viscosity of 4.991mPa·s) having the same viscosity as 37°C whole blood, 25°C saline (viscosity of 1.012mPa·s) caused increasing to double the intravascular flow volume without dilating arterioles. The results strongly suggested that the potential mechanism of SPR was viscosity reduction effect. Combined with FFR which is based on vasodilation-mediated hyperemia, these findings may contribute to clarifying the pathophysiology and especially the microcirculation in coronary artery diseases.

Funding Acknowledgement

Type of funding source: None

The developing mechanism of atherosclerotic lesion in coronary side branch on the ventricular free wall differs by the location of lesion

Background

The effective treating method of coronary side branch lesions such as ostial stenosis or thin arteries has not been established. On the other hand, tortuous side branch rarely has stenotic lesions.

Purpose

We focused on coronary side branches on the ventricular free wall, and examined coronary risk factors and bending and stretching motion of branch which can contribute to the development of atherosclerotic lesion.

Methods

In elective and first-time coronary angiograms, we included side branches on the ventricular free wall (&gt;2mm in diameter) and excluded previously treated ones. Study A; we divided arteries into proximal, middle, and distal segment, and examined the presence of tortuosity and stenotic lesions exceeding 50% diameter stenosis (DS) for each segment. A score of 1 was assigned to tortuous segment, and 0 to non-tortuous one. Study B; we included stenotic lesion (&gt;50% DS) in side branch ostium and excluded those extended across main coronary arteries. Relation between lesions and patients' characteristics was examined.

Results

Study A; in 1,828 side branches from 472 patients, middle and distal segments had significantly higher tortuosity score than proximal (0.68, 0.78 vs. 0.34; p&lt;0.0001). On the contrary, proximal segments had more stenotic lesions except ostial stenosis (230 vs. 69, 5; p&lt;0.0001). Study B; in 1,740 side branches from 465 patients, 122 ostial stenotic lesions were found (7.0%). Multivariate logistic regression analysis revealed diabetes mellitus and age as independent contributors to development of ostial stenosis (Table).

Conclusions

Side branch stenosis developed less frequently in middle and distal segments, where stronger ventricular wall motion reinforces bending and stretching motion and tortuosity of arteries. This fact indicates that those characteristics may prevent developing atherosclerosis through increasing shear stress. On the other hand, diabetes mellitus strongly contributes to the development of ostial stenosis. Thus, the developing mechanism of atherosclerotic lesion in side branch on the ventricular free wall differs by the location of lesion.

Funding Acknowledgement

Type of funding source: None

Pathological Features of Persistent Atrial Standstill Syndrome in Three Dogs

The hearts of three dogs, clinically diagnosed as having persistent atrial standstill syndrome (PAS), were studied post mortem. The most significant gross findings in the hearts of all three dogs were dilatation and marked reduction in the thickness of both atrial walls. Histopathologically, all three had widespread progressive loss of the atrial myocardium with replacement by fatty or fibrofatty tissue, consistent with atrial myopathy. The lesion mainly affected the upper half of both atria and was more severe in the epimyocardium and midmyocardium than in the endomyocardium. On the basis of these observations, it is proposed that the atrial myopathy commences in the upper regions of both atria and progresses downwards, as has been demonstrated electrophysiologically in PAS in humans, and extends from the epicardium towards the endocardium.

Understanding the impact of gamma irradiation of epoxy titania nanocomposites on surface and bulk charge characteristics

Epoxy titania nanocomposites were prepared under optimum process conditions through shear mixing of titania nanoparticles in to epoxy resin, for its potential application as insulant in nuclear power plants and space applications. The complex intrinsic nature of properties, its characteristic variation due to ageing of nanocomposite insulating material upon its continuous exposure to gamma irradiation, and their charge trap and space charge characteristics are explored. Surface potential variation studies were carried out under DC voltage. In the present study, the charge trap performance was assessed under switching impulse voltage. It is observed that surface potential decay and shallow trap formation are high with gamma irradiated specimen. In addition, the potential decay is high under switching impulse voltage compared to DC voltage. Also, the trap depth formed is less under switching impulse voltage compared to DC voltage and it is high under negative DC voltage. The space charge analysis through Pulsed electro acoustic (PEA) studies has shown increase in accumulation of space charge and enhancement of electric field with increase in dosage of gamma-irradiation. Polarity reversal tests have revealed that the electric field enhancement is high before reversal of polarity, irrespective of level of gamma irradiation dosage. The direct correlation between characteristic variation in trap depth values with the gamma irradiated specimen and its contact angle was observed.

Cubic Rashba Effect in the Surface Spin Structure of Rare-Earth Ternary Materials

Spin-orbit interaction and structure inversion asymmetry in combination with magnetic ordering is a promising route to novel materials with highly mobile spin-polarized carriers at the surface. Spin-resolved measurements of the photoemission current from the Si-terminated surface of the antiferromagnet TbRh_{2}Si_{2} and their analysis within an ab initio one-step theory unveil an unusual triple winding of the electron spin along the fourfold-symmetric constant energy contours of the surface states. A two-band k·p model is presented that yields the triple winding as a cubic Rashba effect. The curious in-plane spin-momentum locking is remarkably robust and remains intact across a paramagnetic-antiferromagnetic transition in spite of spin-orbit interaction on Rh atoms being considerably weaker than the out-of-plane exchange field due to the Tb 4f moments.

Individual response of humans to ionising radiation: governing factors and importance for radiological protection

Tissue reactions and stochastic effects after exposure to ionising radiation are variable between individuals but the factors and mechanisms governing individual responses are not well understood. Individual responses can be measured at different levels of biological organization and using different endpoints following varying doses of radiation, including: cancers, non-cancer diseases and mortality in the whole organism; normal tissue reactions after exposures; and, cellular endpoints such as chromosomal damage and molecular alterations. There is no doubt that many factors influence the responses of people to radiation to different degrees. In addition to the obvious general factors of radiation quality, dose, dose rate and the tissue (sub)volume irradiated, recognized and potential determining factors include age, sex, life style (e.g., smoking, diet, possibly body mass index), environmental factors, genetics and epigenetics, stochastic distribution of cellular events, and systemic comorbidities such as diabetes or viral infections. Genetic factors are commonly thought to be a substantial contributor to individual response to radiation. Apart from a small number of rare monogenic diseases such as ataxia telangiectasia, the inheritance of an abnormally responsive phenotype among a population of healthy individuals does not follow a classical Mendelian inheritance pattern. Rather it is considered to be a multi-factorial, complex trait.

＜Editors' Choice＞ Association between green tea intake and risk of cognitive decline, considering glycated hemoglobin level, in older Japanese adults: the NILS-LSA study

Positive and negative associations with risk of cognitive decline have been reported for glycated hemoglobin (HbA1c) level and green tea (GT) intake, respectively. This study aimed to assess whether the reduction in the risk of cognitive decline with GT intake depended on HbA1c level. The participants were aged ≥60 years at baseline in the cohort study, wherein examinations were conducted biennially from 2000 to 2012. Subjects (n=1,304) who had no cognitive decline during the first survey and who had participated in the follow-up survey at least once were included. The follow-up end point was the first screening time point for cognitive decline (Mini-Mental State Examination score <27) or the last survey participation. With reference to the Japanese Diabetes Society guideline, the cut-off points for HbA1c level were set at 5.6%, 6.0%, and 6.5%, and lower and higher groups were assigned for each cut-off point. In a multiple Cox proportional hazard model, an interaction between GT intake and HbA1c groups for cognitive decline was observed only at HbA1c 6.0% (P-value for interaction [with Bonferroni's correction] <0.05/3). Lower risks of cognitive decline were found for the HbA1c ≥5.6%, ≥6.0%, and <6.5% groups (hazard ratios: 0.59, 0.34, and 0.77; 95% confidence intervals: 0.41-0.88, 0.19-0.61, and 0.56-1.08 for "≥4 times a day" vs. "<once a day" GT intake, respectively; P-value for trend: 0.06, <0.01, and 0.09, respectively). With respect to blood glucose level, our cohort study showed non-uniformly reduced risk of cognitive decline with GT intake among older Japanese adults.

Effects of Mild Orthostatic Stimulation on Cerebral Pulsatile Hemodynamics

The augmented cerebral hemodynamic pulsatility could lead to the elevated risk of cerebrovascular disease. To determine the impact of an acute orthostatic challenge on a pulsatile component of cerebral hemodynamics, mild lower body negative pressure (LBNP, -30 mmHg) was applied to 29 men. Middle cerebral artery blood flow velocity (MCAv) was measured by transcranial Doppler technique. Stroke volume (SV) was estimated by the Modelflow method with adjustment by the Doppler ultrasound-measured SV at rest. SV, peak and pulsatile MCAv, and pulsatility index were significantly lower during the LBNP stimulation than those at the baseline (e.g., supine resting) (P < 0.05 for all), whereas mean arterial pressure and mean MCAv remained unchanged. The change in SV with the LBNP stimulation significantly correlated with corresponding changes in peak and pulsatile MCAv (r = 0.617, P < 0.001; r = 0.413, P = 0.026, respectively). These results suggest that pulsatile components of cerebrovascular hemodynamics are dampened during the transient period of orthostatic challenge (as simulated using LBNP) when compared to supine rest, and which is partly due to the modified SV.

Surgical approaches for condylar fractures related to facial nerve injury: deep versus superficial dissection

The aim of this study was to investigate the probability of facial nerve injury (FNI) in the treatment of condylar neck and subcondylar fractures (CN/SCFs) with percutaneous approaches and to identify factors predicting FNI. The data of 80 patients with 87 CN/SCFs were evaluated retrospectively. The primary outcome was FNI occurrence. The predictor variables were age, sex, aetiology, alcohol consumption, fracture site and pattern (dislocation or not), concomitant fractures, time interval to surgery, surgeon experience, plate type, and the dual classification of percutaneous approaches. The approaches were classified based on whether subcutaneous dissection traversed the marginal mandibular branch (MMB) deeply (deep group: submandibular and retroparotid approaches) or superficially (superficial group: transparotid, transmasseteric anteroparotid (TMAP), and high cervical-TMAP approaches). Twenty-two patients (27.5%) suffered FNI, of whom two in the deep group had permanent paralysis of the MMB. In the multivariate logistic regression model, deeply traversing surgery approaches (odds ratio 12.4, P=0.025) and the presence of a dislocated fracture (odds ratio 6.66, P=0.012) were associated with an increased risk of FNI. These results suggest that percutaneous approaches in the superficial group should be recommended for the treatment of CN/SCFs to reduce the risk of FNI.

Frequency and risk factors of thoracic metastases and optimisation of the use of cross-sectional chest imaging in follow-up patients with cervical cancer

AIM

To optimise cross-sectional chest imaging usage by identifying frequency and risk factors associated with thoracic metastases in cervical cancer patients after initial definitive treatment.

MATERIALS AND METHODS

This study, conducted during 2004-2015, examined 361 consecutive patients with histopathologically proven cervical carcinoma with at least 1 year of follow-up. Electronic medical records and all available imaging modes were used to record and assess patient and tumour characteristics and timing of thoracic metastases. Associations with these characteristics and thoracic metastases were assessed using univariate and multivariable Cox proportional hazards modelling.

RESULTS

Of the 361 patients, 31 developed thoracic metastases. Multivariate regression results showed that adeno/adenosquamous carcinomas (hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.06 to 5.72), other histology (HR, 5.61; 95% CI, 1.81 to 17.42), high International Federation of Gynaecology and Obstetrics (FIGO) stage (HR, 2.84; 95% CI, 1.09 to 7.37), and presence of initial intra-abdominal lymph node metastases (HR, 2.46; 95% CI, 1.02 to 5.90) were associated significantly and independently with thoracic metastases. The second analysis among the subgroup of surgical treatment identified intermediate-high risk classification of recurrence (HR, 5.12; 95% CI, 1.14 to 22.94), high FIGO stage (HR, 2.73; 95% CI, 1.05 to 7.13), and other histology (HR, 11.51; 95% CI, 3.66 to 36.19) as independent predictors of thoracic metastases. Two of the 361 and 2/313 patients with thoracic metastases who did not correspond to the conditions above were in the respective evaluation groups.

CONCLUSION

Assessment of negative prognostic factors for thoracic metastases might contribute to reduced need for chest cross-sectional chest computed tomography examinations.

Traditional Japanese Diet Score - Association with Obesity, Incidence of Ischemic Heart Disease, and Healthy Life Expectancy in a Global Comparative Study

OBJECTIVES

We created a Traditional Japanese Diet Score (TJDS), and to clarify the relationship between TJDS and obesity, ischemic heart disease (IHD), and healthy life expectancy (HALE).

DESIGN

Ecological study.

SETTING

Food (g/day/capita) and energy (kcal/day/capita) supply was determined using the Food and Agriculture Organization of the United Nations Statistics Division database. The sum of characteristic traditional Japanese foods (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, eggs, and seaweeds; food components rarely used in the Japanese diet: wheat, milk, and red meat) was divided as tertiles (beneficial food components: -1, 0, 1; rarely used food components: 1, 0, -1). Obesity rate was determined using the World Health Organization database. Incidence of IHD, HALE and smoking rate were determined using the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 database. Gross domestic product per capita, percentage of population > 65 years old, and health expenditure were determined using the World Bank database. Education years were obtained from the United Nations Educational, Scientific and Cultural Organization Institute for Statistics. Associations between TJDS and obesity, IHD and HALE were examined in 132 countries with a population of 1 million or greater using a general linear model controlled for co-variables.

RESULTS

TJDS was distributed from -6 to 7. TJDS was inversely correlated to obesity (β±SE; -0.70±0.19, p<0.001), IHD (-19.4±4.3, p<0.001), and positively correlated to HALE (0.40±0.14, p<0.01).

CONCLUSIONS

TJDS is a good indicator of a healthy diet, and applies to preventing obesity, IHD and extending HALE.

Relationship between the administration of nicardipine hydrochloride and the development of delirium in patients on mechanical ventilation

A history of hypertension is a known risk factor for delirium in patients in intensive care units, but the effect of antihypertensive agents on delirium development is unclear. Nicardipine, a calcium channel blocker, is widely used in ICU as a treatment agent for hypertensive emergency. This study investigated the relationship between the administration of nicardipine hydrochloride and delirium development in patients under mechanical ventilation. We conducted a medical chart review of 103 patients, who were divided into two groups according to the use of nicardipine hydrochloride. The prevalence of delirium was compared with respect to factors such as age, sex, laboratory data, and medical history, by multivariate analysis. 21 patients (20.4 %) were treated with nicardipine hydrochloride in 103 patients. The treatment and non-treatment groups differed significantly in age (72 vs. 65 years) and history of high blood pressure (57% vs. 11%). Multivariate analysis revealed that patients in the treatment group developed delirium significantly less often than those in the non-treatment group (19% vs. 48%). These results suggested that treatment of high blood pressure with nicardipine hydrochloride is a possible method for preventing the development of delirium.

Soy food and isoflavone intake reduces the risk of cognitive impairment in elderly Japanese women

Data were derived from the National Institute for Longevity Sciences-Longitudinal Study of Aging. Subjects comprised 403 men and 373 women aged 60-81 years at baseline who participated in the follow-up study at least once. Bean, soy product and soy isoflavone intake was assessed using a 3-day dietary record at baseline. Cognitive function was assessed by the Mini-Mental State Examination (MMSE). MMSE scores of ≤23 were used to define cognitive impairment. The relationship between bean, soy product and soy isoflavone intake and cognitive impairment was assessed using a generalized estimating equation. Multivariate-adjusted odds ratios (95% confidence intervals) for cognitive impairment with a 1 s.d. increase in total bean, total soybean and total soy isoflavone intakes were 0.48 (0.28-0.81; p = 0.006), 0.51 (0.32-0.83; p = 0.007), and 0.55 (0.32-0.93; p = 0.026), respectively, in women. Total soybean and soy isoflavone intake might decrease the risk of cognitive impairment in elderly Japanese women.

Primary cardiac lymphoma in a 10-week-old dog

A 10-week-old miniature dachshund presented with acute onset of weakness. Electrocardiography showed sustained ventricular tachycardia, and thoracic and abdominal radiography revealed pleural and peritoneal effusion. Echocardiography revealed severely hypokinetic left and right ventricles. Thoracocentesis and abdominocentesis and subsequent transfer to an oxygen chamber yielded no clinical improvement, and the dog died about 1 hr after admission. Gross examination of a longitudinal section through the entire heart revealed poorly demarcated focal or patchy areas of grayish-white tissue infiltrating extensively into the myocardium. Histologically, these lesions were consistent with infiltrative proliferation of neoplastic lymphoid cells. Immunohistochemical staining confirmed the diagnosis of primary cardiac lymphoma (PCL) of T-cell origin. There have been no previous reports of such young dogs with PCL.

Dietary diversity and healthy life expectancy-an international comparative study

BACKGROUND/OBJECTIVES

The prolongation of healthy life expectancy (HALE) is a core issue of health policy in many countries. The purpose of this study is to clarify the relationship between dietary diversity and HALE using international databases.

MATERIALS/METHODS

HALE data by country were derived from the Global Burden of Disease (GBD) 2015 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country, excluding loss between production and household, were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. Each food was sorted across 12 food groups, and dietary diversity was obtained from food groups using the Quantitative Index for Dietary Diversity (QUANTIDD). The cross-sectional and longitudinal associations between QUANTIDD and HALE were examined in the countries with populations of one million or greater.

RESULTS

Cross-sectional analysis showed that HALE was significantly associated with QUANTIDD (β = 99.9 ± 11.4, p < 0.001) in the single regression model and in the multiple regression model controlled for covariates (β = 36.4 ± 11.3, p = 0.002). Longitudinal analysis showed that HALE increased with QUANTIDD during the 15-year study period (β = 46.4 ± 5.1, p < 0.001), and this association was also significant when controlled for covariates (β = 39.7 ± 5.1, p < 0.001). Longitudinal association of QUANTIDD with the percentage difference between life expectancy and HALE controlled for covariates was significantly negative (β = - 1.3 ± 0.5, p = 0.011).

CONCLUSIONS

After controlling for socioeconomic indicators, longer healthy life is enjoyed by populations of countries with greater dietary diversity.

Impact of Short-Term Training Camp on Aortic Blood Pressure in Collegiate Endurance Runners

To investigate the influence of short-term vigorous endurance training on aortic blood pressure (BP), pulse wave analysis was performed in 36 highly trained elite collegiate endurance runners before and after a 7-day intense training camp. Subjects participated three training sessions per day, which mainly consisted of long distance running and sprint training to reach the daily target distance of 26 km. After the camp, they were divided into two groups based on whether the target training was achieved. Aortic systolic BP, pulse pressure, and tension-time index (TTI, a surrogate index of the myocardial oxygen demand) were significantly elevated after the camp in the accomplished group but not in the unaccomplished group, whereas the brachial BP remained unchanged in both groups. The average daily training distance was significantly correlated with the changes in aortic systolic BP (r = 0.608, p = 0.0002), pulse pressure (r = 0.415, p = 0.016), and TTI (r = 0.438, p = 0.011). These results suggest that aortic BP is affected by a short-term vigorous training camp even in highly trained elite endurance athletes presumably due to a greater training volume compared to usual.

Circadian Rhythm Estimation by Core Body Temperature Filtered with Simultaneously Recorded Physiological Data

In field measurements, monitoring of core body temperature is influenced by physical activities; therefore, the estimation of circadian rhythm from the data may not be exact. The purpose of this study is to design a core body temperature filter in order to reduce artifacts induced by physical activities using simultaneously recorded physiological data such as heart rate data.

The effects of physical activities on core body temperature and heart rate are assessed through three experiments. Based on the above knowledge, a core body temperature filter was designed. The filter removes part of rectal temperature data as artifact when heart rate rises above a predetermined threshold. As a result, most of the spike-like noise was removed and the filtered temperature data showed sinusoidal variation more than the unfiltered data. The mesor of the estimated rhythm significantly decreased. This filtering method can provide more precise information about circadian rhythm, especially in field measurements.