Human leukocyte antigen class II DRB1*1302 allele protects against cervical cancer: At which step of multistage carcinogenesis?

We investigated the role of human leukocyte antigen (HLA) class II alleles in multistage cervical carcinogenesis. Cross-sectional analysis for HLA association with cervical cancer included 1253 Japanese women: normal cytology (NL, n = 341), cervical intraepithelial neoplasia grade 1 (CIN1, n = 505), CIN grade 2 or 3 (CIN2/3, n = 96), or invasive cervical cancer (ICC, n = 311). The HLA class II allele frequencies were compared by Fisher's exact test or the χ(2) -test. The Bonferroni adjustment corrected for multiple comparisons. Among the study subjects, 454 women with low-grade squamous intraepithelial lesion cytology were prospectively monitored by cytology and colposcopy every 3-4 months to analyze cumulative risk of CIN3 within the next 10 years in relation to HLA class II alleles. HLA class II DRB1*1302 allele frequency was similar between women with NL (11.7%) and CIN1 (11.9%), but significantly decreased to 5.2% for CIN2/3 and 5.8% for ICC (P = 0.0003). Correction for multiple testing did not change this finding. In women with low-grade squamous intraepithelial lesion cytology, the cumulative risk of CIN3 diagnosed within 10 years was significantly reduced among DRB1*1302-positive women (3.2% vs. 23.7%, P = 0.03). In conclusion, the two different types of analysis in this single study showed the protective effect of the DRB1*1302 allele against progression from CIN1 to CIN2/3.

Association between carotenoids and outcome of cervical intraepithelial neoplasia: a prospective cohort study

BACKGROUND

It has been suggested that micronutrients such as alpha-tocopherol, retinol, lutein, cryptoxanthin, lycopene, and alpha- and beta-carotene may help in the prevention of cervical cancer. Our aim was to investigate whether serum concentrations and/or dietary intake of micronutrients influence the regression or progression of low-grade cervical abnormalities.

METHODS

In a prospective cohort study of 391 patients with cervical intraepithelial neoplasia (CIN) grade 1-2 lesions, we measured serum micronutrient concentrations in addition to a self-administered questionnaire about dietary intake. We evaluated the hazard ratio (HR) adjusted for CIN grade, human papillomavirus genotype, total energy intake and smoking status.

RESULTS

In non-smoking regression subjects, regression was significantly associated with serum levels of zeaxanthin/lutein (HR 1.25, 0.78-2.01, p = 0.024). This benefit was abolished in current smokers. Regression was inhibited by high serum levels of alpha-tocopherol in smokers (p = 0.042). In progression subjects, a significant protective effect against progression to CIN3 was observed in individuals with a medium level of serum beta-carotene [HR 0.28, 95 % confidence interval (CI) 0.11-0.71, p = 0.007), although any protective effect from a higher level of serum beta-carotene was weaker or abolished (HR 0.52, 95 % CI 0.24-1.13, p = 0.098). Increasing beta-carotene intake did not show a protective effect (HR 2.30, 95 % CI 0.97-5.42, p = 0.058).

CONCLUSIONS

Measurements of serum levels of carotenoids suggest that regression is modulated by smoking status. Maintaining a medium serum level of beta-carotene has a protective effect for progression; however, carotene intake is not correlated with serum levels of carotenoids.

Japan's national tuberculosis control strategies with economic considerations

We made a bibliographic search for Japanese and non-Japanese literature on tuberculosis control programs to study the current public health policies for tuberculosis control in Japan especially in regard to cost-effectiveness. Then, we compared the Japanese, strategies for tuberculosis control with those in other countries including the United States, and those recommended by World Health Organization (WHO). The current trend of tuberculosis incidence in the Japanese community demonstrates major differences from the situation that had prompted installation of tuberculosis control measures several decades ago. The tuberculosis control measures should be targeted to the elderly people (over 65 years old) because of the following three aspects. (1) A continuing decline of tuberculosis in the young Japanese population, particularly children who might attain benefits from BCG immunization; (2) The enhancement of the prevalence among the elderly people who are not covered by a uniform national surveillance strategy; (3) Cost-ineffectiveness of Mass Miniature Radiography (MMR) being used as a means to screen for tuberculosis. The cost-effectiveness issue must be considered more seriously, and the WHO recommendations especially in regard with the DOTS (directly-observed treatment, short course) strategy need to be incorporated more effectively into the national program since the incidence of drug resistant tuberculosis in Japan has been recently increasing. Finally, we propose to limit BCG immunization further and to discontinue annual MMR in the young population, and instead to develop effective strategies of both active and passive case finding in the elderly through public and community health services.

Do neutralizing antibody responses generated by human papillomavirus infections favor a better outcome of low-grade cervical lesions?

To determine the role of neutralizing antibody generated by human papillomavirus (HPV) infections, baseline levels of serum neutralizing antibodies directed against HPV 16 and cervical HPV DNA were determined in 242 unvaccinated women with low-grade cervical abnormalities, who were then monitored by cytology and colposcopy every 4 months. In women infected with HPV 16 (n = 42), abnormal cytology persisted longer in those positive for HPV 16-specific neutralizing antibodies at baseline (median time to cytological regression: 23.8 vs. 7.2 months). Progression to cervical precancer (cervical intraepithelial neoplasia grade 3) within 5 years occurred only among women carrying HPV 16-specific neutralizing antibodies (P = 0.03, log-rank test). In women infected with types other than HPV 16 (n = 200), detection of HPV 16-specific neutralizing antibodies was not correlated with disease outcome. In conclusion, development of specific neutralizing antibodies following natural HPV 16 infection did not favor a better outcome of low-grade cervical lesions induced by HPV 16 or by other types; rather, detection of neutralizing antibodies generated by current infection may reflect viral persistence and thus help identify those who are at high risk of disease progression.

Randomized crossover study of latanoprost and travoprost in eyes with open-angle glaucoma

INTRODUCTION

To compare the intraocular pressure (IOP)-lowering effects of 0.005% latanoprost to that of 0.004% travoprost in eyes with open-angle glaucoma (OAG).

METHODS

Forty-two patients with OAG who received either latanoprost or travoprost every evening for 12 weeks, and then switched to the other medication for another 12 weeks. The IOP measurements were made with a Goldmann applanation tonometer (GAT) at the baseline, and at 1, 3, 4, and 6 months after the treatment. The IOP at the untreated baseline and at the end of each treatment period was measured at 10:00, 12:00, and 16:00 hours. The central corneal thickness (CCT) was measured at each visit using an ultrasonic pachymeter.

RESULTS

The mean baseline IOP was 13.9 ± 2.5 mmHg, and the CCT was 536.7 ± 30.5 μm. Latanoprost reduced the IOP by 2.5 ± 1.7 mmHg and travoprost by 2.6 ± 1.5 mmHg from the baseline (p = 0.6807). The CCT decreased significantly to 531.9 ± 30.3 at 3 months (p = 0.0160) and to 529.4 ± 30.5 μm at 6 months (p = 0.0002) after the therapy. The decrease was significantly greater in eyes after travoprost (p = 0.0049).

CONCLUSIONS

Travoprost has similar effect as latanoprost in reducing the IOP in glaucoma patients with relatively low IOPs. The use of prostaglandin analogs can decrease the CCT, and this change should be considered when the IOPs obtained by GAT are analyzed.

Prevalence of tinnitus in community-dwelling Japanese adults

Background

Several studies have reported the prevalence of tinnitus among general populations; however, most of these studies were conducted in Europe or the United States. We estimated the prevalence of tinnitus among the general adult population in Japan.

Methods

The subjects were participants in the Takayama Study, a population-based cohort study. In 2002, a total of 14 423 adults (6450 men and 7973 women) aged 45 to 79 years responded to a self-administered questionnaire that inquired about history of tinnitus, which was defined as episodes lasting longer than 5 minutes, excluding those occurring immediately after noise exposure. Respondents were also asked about the loudness and severity of tinnitus.

Results

Overall, 11.9% of the subjects reported having tinnitus; the percentage was somewhat higher among men (13.2%) than women (10.8%). The prevalence of tinnitus increased with age in both sexes. Approximately 0.4% of the overall population reported that tinnitus had a severe effect on their ability to lead a normal life. Medical history of hypertension or ischemic heart diseases, use of steroid or antihypertensive medication, and employment as a factory worker or machine operator were associated with tinnitus status in both men and women.

Conclusions

Tinnitus is relatively common in Japan. Although the use of various definitions of tinnitus in different studies makes it difficult to compare prevalence among populations, the present prevalence estimate was similar to those in studies in Europe and the United States.

Tobacco smoking and regression of low-grade cervical abnormalities

The role of tobacco smoking in the multistage carcinogenesis at the cervix is not fully understood because of a paucity of prospective data. To assess the relationship between smoking and spontaneous regression of cervical precursor lesions, a total of 516 women with low-grade squamous intraepithelial lesion (LSIL) were monitored by cytology and colposcopy every 4 months. Probability of LSIL regression within 2 years was analyzed in relation to smoking behaviors, with regression defined as at least two consecutive negative Pap smears and normal colposcopy. Women's age, initial biopsy results, and human papillomavirus (HPV) genotypes were included in the multivariate models for adjustments. Our study subjects included 258 never-smokers and 258 smokers (179 current and 79 former smokers). During a mean follow-up time of 39.8 months, 320 lesions regressed to normal cytology. Probability of regression within 2 years was significantly lower in smokers than in never-smokers (55.0%vs 68.8%, P = 0.004). The risk of LSIL persistence increased with smoking intensity and duration and with younger age at starting smoking (P = 0.003, P < 0.001, and P = 0.03, respectively). Smokers had twice as high a risk of persistent HPV infection compared to never-smokers (odds ratio, 2.50; 95% confidence interval, 1.30-4.81; P = 0.006). In young women, passive smoking since childhood reduced probability of regression within 2 years (56.7%vs 85.9%, P < 0.001). Further adjustments for a wide range of cervical cancer risk factors did not change the findings. In conclusion, tobacco smoking may interfere with regression of cervical precursor lesions. Childhood exposure to second-hand smoke may increase a risk of persistent cervical abnormalities among young women.

Cigarette smoking and other lifestyle factors in relation to the risk of pancreatic cancer death: a prospective cohort study in Japan

OBJECTIVE

To examine the association of smoking and lifestyle factors with pancreatic cancer death in the prospective design.

METHODS

Mortality from pancreatic cancer in regard to smoking, body mass index, physical activity, and alcohol, coffee and green tea intake, was studied in a prospective cohort of 30,826 inhabitants in Takayama, Japan. In 1992, each subject completed a self-administered questionnaire on demographic information, smoking, drinking habits, diet, exercise and medical histories. The response rate was 85.3%.

RESULTS

From 1992 to 1999, 33 men and 19 women died due to pancreatic cancer. Hazard ratios and 95% confidence intervals were determined using Cox proportional hazards models. Women who were defined as current smokers at baseline had significant and increased risk of pancreatic cancer death after adjustment for age, body mass index and history of diabetes mellitus (Hazard ratio: 4.77, 95% confidence intervals: 1.58-14.4). There were significant positive associations of pancreatic cancer death with the years of smoking and the number of cigarettes consumed daily in women in a dose-dependent manner. Current smokers indicated a non-significant risk increase in men (Hazard ratio: 3.81, 95% confidence intervals: 0.88-16.6). Body mass index, physical activity, and alcohol, coffee and green tea intake were not significantly associated with pancreatic cancer death.

CONCLUSIONS

These data suggested that smoking increases the risk of death from pancreatic cancer in Japanese women.

Dietary glycemic index, glycemic load, and intake of carbohydrate and rice in relation to risk of mortality from stroke and its subtypes in Japanese men and women

We assessed the relationship of the dietary glycemic index (GI), glycemic load (GL), and intake of carbohydrate and rice, and risk of mortality from stroke and its subtypes. The cohort consisted of 12,561 men and 15,301 women residing in Takayama, Japan, in 1992. At the baseline, a food frequency questionnaire was administered; and the dietary GI, GL, and intake of carbohydrates and rice were estimated. Deaths from stroke occurring in the cohort were prospectively noted until 1999 with data from the office of the National Vital Statistics. The risk of mortality from stroke was assessed with a Cox proportional hazard model after adjusting for age; body mass index; smoking status; physical activity; history of hypertension; education; and intake of total energy, alcohol, dietary fiber, salt, and total fat. The risk of stroke subtypes was assessed in the age-adjusted model. The hazard ratios of total stroke comparing the highest vs the lowest quartiles of the dietary GI were 0.78 (95% confidence interval [CI], 0.41-1.47) with P(trend) = .50 in men and 2.09 (95% CI, 1.01-4.31) with P(trend) = .10 in women. Among women, the association was also significant with the risk of ischemic stroke (hazard ratio = 2.45; 95% CI, 1.01-5.92; P(trend) = .03); and a significant positive trend was also observed between dietary GL and mortality from hemorrhagic stroke (P(trend) = .05). The current study implies that diets with a high dietary GI increase the risk of mortality from stroke among Japanese women.

Predicting the progression of cervical precursor lesions by human papillomavirus genotyping: a prospective cohort study

Only a subset of cervical precursor lesions progress to cervical cancer and because of the lack of the predictive markers, it cannot be ascertained which lesions will progress or not. To estimate the risk of disease progression associated with human papillomavirus (HPV) genotypes, we followed 570 Japanese women with cytological LSIL (low-grade squamous intraepithelial lesion) and histological CIN (cervical intraepithelial neoplasia) grade 1-2 lesions (479 CIN 1; 91 CIN 2) at 3 to 4 month intervals for a mean follow-up period of 39.1 months. At entry, we detected HPV DNA in cervical samples by polymerase chain reaction-based methodology. Over the period of follow-up period, 46 lesions progressed to CIN 3 while 362 regressed to normal cytology. Women with multiple HPV infections were more likely to have persistent lesions (hazard ratio [HR] for regression, 0.65; 95% confidence interval [CI], 0.42-1.02; p = 0.07); however, multiple infections did not increase the risk of progression (HR for progression, 1.04; 95% CI, 0.37-2.94; p = 0.94). After adjusting for CIN grade and women's age, HRs for progression to CIN 3 (vs. women with low-risk types or negative for HPV DNA) varied markedly by HPV genotype: type 16 (11.1, 95% CI: 1.39-88.3); 18 (14.1, 0.65-306); 31 (24.7, 2.51-243); 33 (20.3, 1.78-231); 35 (13.7, 0.75-251); 52 (11.6, 1.45-93.3); 58 (8.85, 1.01-77.6); other high-risk types (4.04, 0.47-34.7). HPV 45 was not detected in our study subjects. The cumulative probability of CIN 3 within 5 years was 20.5% for HPV 16, 18, 31, 33, 35, 52 and 58; 6.0% for other high-risk types; 1.7% for low-risk types (p = 0.0001). In conclusion, type-specific HPV testing for women with LSIL/CIN 1-2 lesions is useful for identifying populations at increased or decreased risk of disease progression.

Cigarette smoking and the adult onset of bronchial asthma in Japanese men and women

BACKGROUND

Although smoking is a well-known risk factor for the onset of airway diseases, the associations between smoking and asthma are inconsistent.

OBJECTIVE

To examine the relationship of smoking in adulthood with the occurrence of asthma in Japanese individuals.

METHODS

A total of 6,674 men and 8,301 women from a population-based cohort in Takayama, Japan, participated in this prospective study. Information on smoking was collected via a baseline questionnaire in 1992. In 2002, development of asthma and the time of physician diagnosis were reported.

RESULTS

During 10-year follow-up, 105 men and 92 women reported the onset of physician-diagnosed asthma. Among men, compared with never smokers, current smokers at baseline had a significantly increased risk of asthma after adjustment for covariates (hazard ratio [HR], 2.79; 95% confidence interval [CI], 1.18-6.55), whereas women with a current or former history of smoking were at an increased but not significant risk of asthma (HR, 1.18; 95% CI, 0.58-2.38). An approximately 2- to 5-fold increased risk of asthma was observed in men who smoked for more than 30 years or more than 21 cigarettes daily, with a nonsignificant linear trend, but there was no dose-response relationship in current-smoking women. Ever-smoking women with husbands who were ever smokers had a higher risk of asthma (HR, 2.02; 95% CI, 0.72-5.65) than never-smoking women with husbands who had never smoked either.

CONCLUSION

These data suggest that smoking increases the risk of asthma onset in men.

Rationality/anti-emotionality personality and dietary habits in a community population in Japan

Background

There are no strong and consistent predictors of dietary habits although some associations have been shown with psychological factors. The purpose of the present study was to examine the relationships between the rationality and anti-emotionality (R/A) personality and dietary consumption in a Japanese community.

Methods

The Takayama study is a community-based cohort study on diet and cancer in Gifu, Japan, and was initiated on September 1, 1992. Cross-sectional analyses were conducted on dietary and lifestyle data. The consumption of 169 food and beverage items was measured along with portion size by using a food frequency questionnaire. Questions regarding the R/A-personality scale and lifestyle habits were included in the questionnaire. The participants were 28077 adults (13082 males and 14995 females) aged 35 years and over.

Results

Both males and females with high R/A-personality scores (i.e., high degree of rational thought and emotional repression) consumed more soy products, green and yellow vegetables, other vegetables, and seaweed than the other participants. Males with high R/A-personality scores drank fewer alcoholic beverages, and females with high scores were found to snack less on sweet and salty foods than the other participants. Males with high R/A-personality scores showed higher consumption of meat and dairy products, and females with high scores showed higher consumption of fish, shellfish, and eggs than those with low R/A-personality scores.

Conclusion

The R/A-personality scale may differentiate dietary habits in males and females in a Japanese community.

Soy isoflavone intake is not associated with the development of cedar pollinosis in adults

Although soy isoflavone has been suggested to have both immune-enhancing and immune-suppressive effects, the effects of soy isoflavone intake on allergic disorders are unclear. A cross-sectional study indicated that a high intake of soy isoflavone is associated with a decreased risk of allergic rhinitis. We aimed to prospectively examine the relationship between soy isoflavone intake and risk of cedar pollinosis, the most common seasonal allergic rhinitis in Japan. The study was conducted in a population-based cohort of Japanese men and women. Each subject's usual diet, including soy isoflavone intake, was determined with the use of a validated FFQ in 1992. In 2002, a total of 11,229 persons who were 35-69 y old and had no history of cancer or allergic diseases at the baseline responded to a follow-up questionnaire asking about 4 symptoms related to cedar pollinosis. Cox hazard regression model was used to determine the association between soy isoflavone intake and the risk of cedar pollinosis. During the 10-y follow-up, 931 of these subjects reported that they had cedar pollinosis. There was no significant association between soy isoflavone intake and risk of cedar pollinosis in men and women after controlling for covariates. For the highest compared with the lowest quartile of soy isoflavone intake, hazard ratios were 1.07 (95% CI: 0.81-1.42) in men and 0.89 (95% CI: 0.68-1.15) in women. These data did not support an association between soy isoflavone intake and risk of cedar pollinosis.

Smoking and risk of cedar pollinosis in Japanese men and women

BACKGROUND

Pollinosis induced by the cedar pollen antigen is the most common seasonal allergic reaction in Japan. We aimed to examine the relationship between smoking and risk of cedar pollinosis in a population-based cohort of the Japanese.

METHODS

Study subjects were 12,221 men and women from the Takayama Study cohort who were 35-69 years old at enrollment in 1992. A follow-up survey in 2002 was used to obtain information about four symptoms related to cedar pollinosis.

RESULTS

A total of 1,000 subjects had cedar pollinosis during the 10-year follow-up. As compared with those who had never smoked, current smokers at the baseline were at a significantly decreased risk of cedar pollinosis after controlling for covariates in men (hazard ratio [HR]: 0.64, 95% CI: 0.50-0.83) as well as in women (HR: 0.64, 95% CI: 0.47-0.88). There was a significant dose-response relationship between the risk of cedar pollinosis and the number of cigarettes smoked each day as well as with the number of years an individual had smoked. A significant risk reduction was observed among men and women who had continued to smoke cigarettes during the follow-up period in comparison with those who had never smoked. There was no risk increase for former smokers at the baseline as well as for those who quit smoking during the follow-up.

CONCLUSIONS

Some components of tobacco may protect against cedar pollinosis. Our finding could provide clues about therapeutic strategies for protection against cedar pollinosis.

Fruit and vegetable intake and mortality from cardiovascular disease are inversely associated in Japanese women but not in men

Some epidemiological studies undertaken in Western countries have demonstrated that high intake of fruit and vegetables results in decreased risk of cardiovascular disease (CVD). The objective of this study was to examine the hypothesis that high intake of fruit and vegetables lowers CVD mortality in a population-based cohort of Japanese subjects. In 1992, fruit and vegetable intake was assessed in 13,355 men and 15,724 women in Takayama, Gifu, Japan using a validated FFQ. During the follow-up (1992-99), 200 men and 184 women died from CVD. For women, the highest quartile of vegetable intake compared with the lowest was marginally significant and inversely associated with CVD mortality after adjusting for total energy, age, and nondietary and dietary covariates [hazard ratio (HR) = 0.62; 95% CI, 0.36-1.08; P-trend = 0.007]. An inverse trend with borderline significance was also observed in fruit intake, excluding CVD deaths in the first 2 y of this study, after adjusting for the above-mentioned covariates (HR = 0.83; 95% CI, 0.51-1.34; P-trend = 0.10). In men, CVD death was not associated with fruit (HR = 1.16; 95% Cl, 0.77-1.74; P-trend = 0.61) and vegetable (HR = 0.81, 95% CI: 0.49-1.34; P-trend = 0.47) intake. These data suggest that higher intake of vegetables is associated with reduced risk of death from CVD for women.

Causal attributions to epidemiological risk factors and their associations to later psychological adjustment among Japanese breast cancer patients

GOALS

The objective of this study was to evaluate the causal attributions for breast cancer and their association with the subsequent psychological adjustment.

MATERIALS AND METHODS

Sixty-three Japanese patients newly diagnosed with breast cancer were asked by an interviewer about risk factors and explanations for the etiology of breast cancer using a four-point scale. The General Health Questionnaire (GHQ-28) and the Center for Epidemiologic Studies Depression Scale (CES-D) were administered about 2 months later to measure psychological adjustment to the illness. The relationship between each causal attribution and measure of psychological adjustment was assessed with the Spearman rank correlation after adjusting for potential confounders (age, marital status, cancer stage at diagnosis, time between the day of diagnosis and follow-up, and physical symptoms at the follow-up).

MAIN RESULTS

Attributions to several explanations, including "stress" and "personal characteristics," were positively associated with the GHQ-28 measures. Of the attributions to risk factors, "body size" was significantly inversely (r = -0.29) associated and "never having children" was insignificantly and highly inversely (r = -0.77) associated with the GHQ-28 measures, indicating better adjustment to the illness. On the other hand, the attribution to "tobacco" was significantly and positively associated with the GHQ-28 measures (r = 0.34), indicating that the attributions antagonized adjustment to the illness.

CONCLUSION

The current study indicates that forming causal attributions influences the adjustment to the illness in Japanese breast cancer patients and attributions to certain risk factors for breast cancer may contribute to better adjustment.

Self-reported diabetes mellitus and risk of mortality from all causes, cardiovascular disease, and cancer in Takayama: a population-based prospective cohort study in Japan

BACKGROUND

Diabetes mellitus has been reported to be a major risk factor for cardiovascular disease (CVD), and higher risk of CVD among women than that among men has been observed in many studies. Further, the association of diabetes with increasing risk of cancer has also been reported. Well-designed studies conducted among men and women in the general Japanese population remain scarce.

METHODS

Our cohort consisted of 13355 men and 15724 women residing in Takayama, Japan, in 1992. At the baseline, the subjects reported diabetes in a questionnaire. Any deaths occurring in the cohort until 1999 were noted by using data from the Office of the National Vital Statistics. The risk of mortality was separately assessed for men and women by using a Cox proportional hazard model after adjusting for age; smoking status; body mass index (BMI); physical activity; years of education; history of hypertension; and intake of total energy, vegetables, fat, and alcohol.

RESULTS

Diabetes significantly increased the risk of mortality from all causes [hazard ratio (HR): 1.35, 95% confidence interval (CI): 1.11-1.64] and from coronary heart disease (CHD) (HR: 2.96, 95% CI: 1.59-5.50) among men, and that from all causes (HR: 1.74, 95% CI: 1.34-2.26) and cancer (HR: 1.88, 95% CI: 1.16-3.05) among women. Diabetes was not significantly associated with mortality from CHD among women.

CONCLUSION

The findings suggest that diabetes increases the risk of mortality from CVD among men and that from cancer among women. The absence of increased risk of mortality from CHD among women may suggest a particular pattern in the Japanese population.

Prospective cohort study of body mass index in adolescence and death from stomach cancer in Japan

We investigated the association between body mass index (BMI) values and the risk of death from stomach cancer later in life. From 1992 to 2000, 28 443 participants (13 211 men and 15 232 women) were followed, and 129 deaths from stomach cancer (86 men and 43 women) occurred. BMI (BMI at the baseline) and BMI(20y) (BMI at age 20 years) were obtained by questionnaire at the beginning of the study. Men in the middle and highest tertiles of BMI(20y) had a higher risk of death from stomach cancer than those in the lowest tertile (after controlling for covariates, hazard ratio [HR] = 2.73 with 95% confidence interval [CI] 1.26-5.89 for the middle tertile; HR = 2.15 with 95% CI 0.97-4.73 for the highest tertile), although there was no significant trend (P = 0.30). Likewise, women in the middle and highest tertiles of BMI(20y) had an increased risk of death from stomach cancer (HR = 5.17 with 95% CI 1.50-17.87 for the middle tertile; HR = 4.22 with 95% CI 1.18-15.05 for the highest tertile; P for trend = 0.05). The analysis of BMI at the baseline did not show a significant relationship with the risk of death from stomach cancer. These results suggest that a high BMI(20y) is associated with an increased risk of death from stomach cancer.

Sodium Intake and Risk of Death From Stroke in Japanese Men and Women

Background and Purpose— Despite the evidence for a positive association of dietary salt and blood pressure, the few prospective studies that have assessed the association between dietary salt and stroke have reported inconsistent results. The purpose of this study was to examine the relation between sodium intake and death from stroke in a population-based cohort of Japanese men and women.

Methods— In 1992, usual diet including sodium intake was determined in 13 355 men and 15 724 women in Takayama City, Gifu, with the use of a validated food frequency questionnaire.

Results— There were 269 stroke deaths (137 men and 132 women) between baseline and 1999. In men, the highest compared with the lowest tertile of sodium intake was significantly positively associated with death from total stroke after controlling for covariates (hazard ratio [HR]), 2.33; 95% CI, 1.23 to 4.45). Significantly positive associations were also observed between sodium intake and death from ischemic stroke (HR, 3.22; 95% CI, 1.22 to 8.53) as well as death from intracerebral hemorrhage (HR, 3.85; 95% CI, 1.16 to 12.7). A positive association between sodium intake and death from stroke in women was suggested, although the associations for total stroke and ischemic stroke were of borderline significance (HR, 1.70; 95% CI, 0.96 to 3.02 and HR, 2.10; 95% CI, 0.96 to 4.62, respectively).

Conclusions— These prospective data support the hypothesis that dietary salt increases the risk of death from stroke.

The relationships of a rationality/antiemotionality personality scale to mortalities of cancer and cardiovascular disease in a community population in Japan

OBJECTIVE

Grossarth-Maticek et al. reported that an individual's level on a rationality/antiemotionality (R/A) personality was strongly predictive of cancer, ischemic heart disease and stroke mortality. To investigate the relationships of an individual's level on the R/A personality to cancer and cardiovascular disease mortality in Japan, we conducted a population-based cohort study.

METHOD

A self-administered questionnaire was distributed to 36990 Japanese residents in September 1992. The response rate was 90.3%. Data from 13226 males and 14880 females were analyzed. Dates and causes of death through December 31, 1999 were obtained for deceased participants.

RESULTS

The results from multivariate hazard ratios (HRs) revealed that males scoring in the middle level compared to those scoring in the lower level of the R/A personality scale decreased their risk of death from cancer and cardiovascular diseases after controlling for covariates.

CONCLUSIONS

The level on the R/A personality scale may affect mortality from cancer and cardiovascular diseases differently in Japan.

The impact of changes in marital status on the mortality of elderly Japanese

PURPOSE

To assess the impact of changes in marital status on the mortality of elderly Japanese men and women.

METHODS

In a baseline survey conducted in 1992, 2039 male and 1466 female residents in Takayama City, Gifu, who were married and aged 65 years or over responded to a detailed health and lifestyle questionnaire. Information regarding deaths of subjects and their spouses, the causes of death, and whether the subjects and spouses moved away from the city between 1992 and 1999 was obtained from the National Vital Statistics and the residential registers of the city. A proportional hazard model was used including marital status as time- varying independent variable.

RESULTS

During the study period, six men and two women became separated/divorced and 151 men and 448 women became widowed. Widowhood was not significantly associated with mortality in men. Duration of widowhood was significantly inversely associated with mortality in women (p = 0.04). A significant decreased hazard ratio (=0.40, p = 0.04) was observed for women widowed for 3 years or more.

CONCLUSIONS

We found no evidence indicating that widowed men and women have an increased mortality rate. Instead, the data suggested a decreased mortality rate among long-term widowed women.

Soy and fish oil intake and mortality in a Japanese community

The relation between intake of fish and soy products and subsequent all-cause and cause-specific mortality was examined in a cohort of 13,355 male and 15,724 female residents of Takayama, Gifu, Japan. A diet that included soy and fish intake was assessed in 1992 by using a validated semiquantitative food frequency questionnaire. Over 7 years of follow-up, 2,062 participants (1,163 men and 899 women) died. For men, the highest compared with the lowest quintile of total soy product intake was marginally significantly inversely associated with total mortality after adjustment for total energy and nondietary covariates (hazard ratio = 0.83, 95% confidence interval: 0.69, 1.01; p for trend = 0.07). After adjustment for nondietary covariates, a decreased hazard ratio for the highest compared with the lowest quintile of total soy product intake was also observed for women (hazard ratio = 0.83, 95% confidence interval: 0.68, 1.02; p for trend = 0.04). Additional adjustment for dietary factors significantly associated with total mortality did not attenuate these associations. For women but not for men, n-3 fatty acids from fish were significantly inversely associated with total mortality. Results showed that soy intake may have moderate but beneficial effects on total mortality.

A prospective cohort study of soy product intake and stomach cancer death

The relationship between intake of soy products and death from stomach cancer was examined in a community-based prospective study of Japanese men and women in Takayama, Japan. Over 7 years of follow-up, 121 deaths from stomach cancer (81 men and 40 women) occurred among 30,304 (13,880 men and 16,424 women) participants who were at least 35 years of age. Diet including the intake of soy products and isoflavones was assessed by a validated semiquantitative food-frequency questionnaire at the beginning of the study. In men, the highest compared to the lowest tertile of total soy product intake was significantly inversely associated with death from stomach cancer after controlling for covariates (hazard ratios=0.50; 95% confidence intervals (CIs) 0.26-0.93, P for trend=0.03). Decreased hazard ratios for the highest compared to the lowest tertiles of total soy product intake (hazard ratios=0.49; 95% CI 0.22-1.13) was observed in women, although this association was of marginal significance. These data suggest that soy intake may reduce the risk of death from stomach cancer.

Weight change in relation to natural menopause and other reproductive and behavioral factors in Japanese women

PURPOSE

To evaluate the effect of menopause on weight change in Japanese women.

METHODS

Community-based sample of 828 Japanese women who were premenopausal and aged 40 to 54 years completed a self-administered questionnaire asking information on demographic factors, body size, reproductive history and dietary and behavioral factors in 1992. They responded to a follow-up questionnaire asking weight and menopausal status in 1998.

RESULTS

Women gained weight modestly, on average, 0.17 kg during the 6-year study period. Weight gain was significantly higher in women who remained premenopausal at follow-up than those who had natural menopause during the study period. Weight gain was significantly associated with early menarche in women who had natural menopause and with high parity in women remained premenopausal.

CONCLUSION

Reproductive factors rather than sociodemographic and behavioral factors appeared to be associated with weight change during the perimenopausal period. Onset of menopause may diminish weight gain. In contrast, early menarche and high parity showed relationships with weight gain.

Total and monounsaturated fat intake and serum estrogen concentrations in premenopausal Japanese women

The relationships between fat intake and serum estrone, estradiol, and sex hormone-binding globulin were examined cross-sectionally in 60 premenopausal Japanese women. Blood samples were collected on Day 11 of the menstrual cycle. Intake of fats, classified according to fat type, and other macro- and micronutrients was estimated on the basis of daily diet records from Day 2 through Day 10 of the cycle. Total fat intake was significantly correlated with serum estrone concentration (Spearman r = 0.30, p = 0.02) and marginally significantly correlated with serum estradiol concentration (r = 0.26, p = 0.05) after controlling for age, total energy, and number of days before the next menses. Monounsaturated fat intake was significantly correlated with serum estrone (r = 0.32, p = 0.02) and serum estradiol (r = 0.27, p = 0.045). These data suggest an effect of dietary fat on serum estrogen concentrations.

Relationships between types of fat consumed and serum estrogen and androgen concentrations in Japanese men

The relationships between types of fat consumed and serum concentrations of estrone, estradiol, total and free testosterone, dihydrotestosterone, and sex hormone-binding globulin were examined in 69 Japanese men aged 43-88 years. Diet was assessed by a semiquantitative food frequency questionnaire. Intake of saturated, monounsaturated, and polyunsaturated fats was inversely correlated with serum total testosterone after controlling for age, total energy, body mass index, alcohol intake, and smoking status, but the correlation was statistically significant only for polyunsaturated fat (r = -0.29, p = 0.02). Intakes of eicosapentanoic and docosahexaenoic acids, n-3 fatty acids from fish, were significantly inversely correlated with total testosterone (r = -0.25, p = 0.04 and r = -0.32, p = 0.01, respectively). Serum estrone, estradiol, and free testosterone were not significantly correlated with any type of fat studied. The correlations of total testosterone with n-3 fatty acids from fish remained significant after additional adjustment for the other categories of fat (r = -0.27, p = 0. 03 for eicosapentanoic acid and r = -0.32, p = 0.01 for docosahexaenoic acid), while the correlations with saturated and monounsaturated fats became nearly null after the adjustment.

Soy product intake and premenopausal hysterectomy in a follow-up study of Japanese women

OBJECTIVE

The estrogenicity of dietary soy may increase the risk of diseases, such as uterine leiomyoma and endometriosis, which originate from uterine tissue and are predominant indications for hysterectomy. We sought to determine whether soy product intake is associated with an increased risk of premenopausal hysterectomy.

DESIGN

Prospective cohort study.

SETTING

Takayama City, Gifu, Japan.

SUBJECTS

A cohort of 1172 female residents randomly selected from participants in the Takayama Study who were aged 35-54 and premenopausal at the time they entered the study in 1992.

MEASUREMENTS

Diet including soy product and isoflavone intake was assessed by a validated semiquantitative food frequency questionnaire at baseline. Information on the onset of menopause and hysterectomy were obtained by a follow-up mail questionnaire in 1998.

RESULTS

During the 6 y study period, 31 women underwent premenopausal hysterectomies. The second tertile of isoflavone intake was significantly associated with an decreased risk of premenopausal hysterectomy compared to the lowest tertile of intake after controlling for age and total energy (rate ratio=0.35, 95% confidence interval 0.13-0.97), although the dose-response relationship was not statistically significant.

CONCLUSIONS

It is possible that soy product intake may be inversely associated with diagnoses leading to hysterectomy. Future studies focusing on specific diseases will be required to examine this possibility.

SPONSORSHIP

Grants from the Ministry of Education, Science, Sports and Culture, Japan.

Soy product intake and hot flashes in Japanese women: results from a community-based prospective study

The association between soy product intake and the occurrence of hot flashes was examined in a cohort of 1,106 female residents of Takayama, Gifu, JAPAN: The women were aged 35-54 years and premenopausal at their entry into the study in 1992. Diet, including intake of soy products and isoflavones, was assessed by means of a validated semiquantitative food frequency questionnaire at study entry. A follow-up mail questionnaire asking about experiences of hot flashes was sent in 1998. During the 6 years of the study period, 101 women had new moderate or severe hot flashes according to the Kupperman test of menopausal distress. After data were controlled for age, total energy intake, and menopausal status, hot flashes were significantly inversely associated with consumption of soy products in terms of both total amount (highest tertile of soy product intake (g/day) vs. lowest: hazard ratio = 0.47; 95% confidence interval: 0.28, 0.79; p for trend = 0.005) and isoflavone intake (highest tertile of isoflavone intake (mg/day) vs. lowest: hazard ratio = 0.42; 95% confidence interval: 0.25, 0.72; p for trend = 0.002). These data suggest that consumption of soy products has a protective effect against hot flashes.

Effect of soymilk consumption on serum estrogen and androgen concentrations in Japanese men

Soy consumption has been associated with a reduced risk of prostate cancer. The mechanism for this association may involve the effect of soy on the endocrine system. We conducted a randomized dietary intervention study to determine the effects of soy consumption on serum levels of steroid hormones in men. Thirty-five men were randomly assigned to either a soymilk-supplemented group or a control group. The men in the soy-supplemented group were asked to consume 400 ml of soymilk daily for 8 weeks. The men in the control group maintained their usual diet. Blood samples were obtained just before the initiation of the dietary period and thereafter every two weeks for 12 weeks. Changes in hormone concentrations were analyzed and compared between the two groups using the mixed linear regression model against weeks from the start of the dietary period. The mean (SD) soymilk intake estimated from dietary records during the dietary study period was 342.9 (SD, 74.2) ml in the soymilk-supplemented group. There was a significant difference between the two groups in terms of changes in serum estrone concentrations, which tended to decrease in the soy-supplemented group and increase in the control group over time. None of the other hormones measured (estradiol, total and free-testosterone, or sex hormone-binding globulin) showed any statistical difference between the two groups in terms of patterns of change. The results of the study indicate that soymilk consumption may modify circulating estrone concentrations in men.

Association of diet with the onset of menopause in Japanese women

A prospective study was conducted in Takayama, Gifu, Japan, to evaluate the association between diet and the onset of menopause. A total of 1,130 female residents aged 35-54 years who were premenopausal and completed a validated semiquantitative food frequency questionnaire in 1992 were contacted by mail with a follow-up questionnaire in 1998 to update information on menopause. Onset of menopause was defined as a woman's age at the last menstrual period prior to stopping menstruation for 12 months. During the 6-year study period, 296 women experienced natural menopause. The Cox proportional hazards model was used to estimate hazard ratios of the onset of menopause after controlling for age, total energy, body mass index, years of smoking, and age at which regular menstrual cycle began. The authors found that green and yellow vegetable intake was significantly inversely associated with the 6-year incidence of menopause (hazard ratio = 0.71, 95% confidence interval: 0.54, 0.95 for the highest vs. lowest tertile of intake, p for trend = 0.02). Association of carotene intake with the incidence of menopause was of borderline significance (hazard ratio = 0.78, 95% confidence interval: 0.59, 1.04, p for trend = 0.07).

Hypocholesterolemic effect of soymilk supplementation with usual diet in premenopausal normolipidemic Japanese women

BACKGROUND

The hypocholesterolemic effect of soy protein concentrates on normolipidemic subjects still remains unclear. Our objective is to assess the effect of soymilk supplementation, a whole soy product, with usual diet on serum lipids in normolipidemic subjects.

METHODS

We conducted a randomized controlled trial on 60 premenopausal normolipidemic Japanese women. After excluding 8 subjects whose initial serum concentration of total cholesterol or triacylglycerol was higher than 220 mg/dL (5.69 mmol/L) or 160 mg/dL (1.81 mmol/L), respectively, we encouraged the subjects in the soymilk-supplemented group (n = 27) to consume 400 mL (408 g) of commercial regular soymilk daily during two menstrual cycles. There were no significant differences in variables, including nutrient intake, between the soymilk-supplemented and control (n = 25) groups before the intervention.

RESULTS

After the trial, we observed a significant decrease of 10.9 mg/dL, or 5.3%, in serum concentration of total cholesterol in the soymilk-supplemented group. During the intervention, nutrient intake assessment showed significant increases in nutrient densities of vitamin E, polyunsaturated fatty acids, isoflavones, and P/S ratio and decreases in total energy and nutrient densities of vitamin C and green tea in this group. A statistically significant decrease in serum total cholesterol could still be observed even after excluding the estimated hypocholesterolemic effects of soymilk's polyunsaturated fatty acids.

CONCLUSIONS

Our results suggest the hypocholesterolemic effect of soymilk, a traditional whole soy product, in Asian countries in normolipidemic subjects.

Eysenck's personality and tobacco/nicotine dependence in male ever-smokers in Japan

To examine the relationship between Eysenck's personality traits and tobacco/nicotine dependence in a male population, a random sample of 200 male ever-smokers aged 35 or older from a community in Japan were interviewed using the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), which yielded ICD-10, DSM-III-R and DSM-IV diagnoses of tobacco/nicotine dependence. They were also asked to complete the Fagerstrom Tobacco Questionnaire (FTQ) and the short-form Eysenck Personality Questionnaire-Revised. A total of 136 subjects completed both the interview and the questionnaire. Neuroticism scores were significantly higher in those who had lifetime diagnosis of tobacco/nicotine dependence according to ICD-10, DSM-IV, or FTQ criteria than nondependent ever-smokers (p < 0.05). Lie scores were significantly lower in DSM-III-R or DSM-IV tobacco/nicotine dependence than in nondependent ever-smokers (p < 0.05). Multiple logistic regression indicated that neuroticism was significantly associated with a higher risk of ICD-10 tobacco/nicotine dependence (p < 0.05), after controlling for age, education, employment status and smoking behaviors; lie score was significantly associated with a lower risk of DSM-III-R tobacco/nicotine dependence (p < 0.05). It is suggested that neuroticism is associated with a higher risk of tobacco/nicotine dependence in male Japanese ever-smokers. A nonconforming and rebellious attitude or reporting bias represented by higher lie score may be associated with lower rates of tobacco/nicotine dependence.

Rationality/antiemotionality personality and selected chronic diseases in a community population in Japan

OBJECTIVE

To clarify the relationships of the rationality/antiemotionality (R/A) personality with past histories of seven chronic diseases and current smoking habits in a community population in Japan.

METHODS

A questionnaire survey was conducted of all residents aged 35 years old or over (n = 37,287) in Takayama city, Gifu prefecture, Japan; the response rate was 90.3%. Data from 13,091 males and 14,061 females who completed all relevant questions were analyzed. The subjects were asked to complete an 11-item R/A personality scale developed by Grossarth-Maticek et al. (1985). Past histories of seven major chronic diseases and current smoking habit were also asked in the questionnaire.

RESULTS

Among males, the R/A scale score was significantly lower in those who had stroke, diabetes or allergy than in those who did not. Among females, the R/A scale score was significantly lower in those who had stroke, allergy or stomach cancer than in those who did not. Among females, current smokers had significantly lower R/A scores than non-smokers. After controlling for age, smoking and drinking, the R/A score was significantly and negatively associated with stroke among males and females; it was significantly and negatively associated with diabetes and allergy among males.

CONCLUSION

Our findings are contrary to those observed in Yugoslavia and West Germany, and suggest a cultural difference in the relationship between the R/A personality and disease occurrence.

Serum concentrations of carotenoids, alpha-tocopherol, fatty acids, and lipid peroxides among Japanese in Japan, and Japanese and Caucasians in the US

Serum concentrations of carotenoids, alpha-tocopherol, fatty acids, and thiobarbituric acid-reactive substances (TBARS) were measured in 217 Japanese residents of Japan, and in 99 Japanese and 100 Caucasian residents of the US, aged from 50 y to 74 y. In females, serum values of carotenoids such as beta-carotene (BC) and zeaxanthin & lutein (ZL) were highest among Japanese in Japan, followed by Japanese in the US and Caucasians in the US. In males, these values, except for serum BC values, were also highest among Japanese in Japan. Moreover, serum values of n-3 polyunsaturated fatty acids (n-3PUFAs) such as eicosapentaenoic acid and docosahexaenoic acid were significantly higher among Japanese in Japan than among Japanese and Caucasians in the US in both sexes. In contrast, serum values of n-6 polyunsaturated fatty acids such as linoleic acid and arachidonic acid were lowest among Japanese in Japan. For women, serum levels of n-9 unsaturated fatty acids were lowest among Japanese living in Japan. Serum TBARS values were highest among Japanese in Japan, followed by Japanese in the US and Caucasians in the US. A significant positive correlation was observed between serum values of TBARS and n-3 PUFAs among Japanese both in Japan and in the US. Serum TBARS values showed a significant inverse relationship with the serum values of BC and ZL among Japanese in Japan and with those of BC among Japanese in the US. These relationships were not always observed among Caucasians in the US. The results of this study suggest that the high TBARS values among Japanese in Japan may depend in part on lipid peroxidation induced in vitro by n-3PUFAs, while high reduction of lipid peroxidation could be expected among Japanese in Japan with high antioxidants such as BC and ZL. In conclusion, serum levels of nonprovitamin A carotenoids such as ZL may be a useful intake marker of vegetables. Dietary intakes of dark green vegetables and fish rich in n-3PUFAs might be more important in the prevention of some sites of cancer and of ischemic heart disease.

Evaluation of a screening program on reduction of gastric cancer mortality in Japan: preliminary results from a cohort study

BACKGROUND

Systematic population-based screening for gastric cancer is widely spread in Japan. However, the case-control study method has been the main method used to evaluate the effectiveness of the screen ing to reduce gastric cancer mortality in Japan.

METHODS

This article presents a population-based cohort study. A questionnaire about lifestyles and dietary habits was distributed to 36,990 residents in a city of Japan. The response rate to the questionnaire was 92.0%. After ineligible responders had been excluded, 24,134 subjects were classified into screened and un screened groups according to their self-reports of participation in the screening the previous year. We followed them up for 40 months and linked resident death records in the city. We compared mortality from gastric cancer and all other causes between the groups by us ing the Cox proportional hazard model.

RESULTS

The follow-up period was 78,156.6 person-years from September 1992 to December 1995. The multivariate relative risks for gastric cancer death of the screened group in comparison with the unscreened group were 0.72 (95% CI 0.31-1.66) among males and 1.46 (95% CI 0.43-4.90) among females.

CONCLUSION

Although our data are preliminary, we were unable to demonstrate a large contribution of the present screening program to decreasing gastric cancer mortality. Further follow-up is needed to in crease the precision.

Depressive symptoms and occurrence of type 2 diabetes among Japanese men

OBJECTIVE

To examine the relationship between depressive symptoms and the incidence of type 2 diabetes.

RESEARCH DESIGN AND METHODS

In 1984, 2,764 male employees of an electrical company in Japan completed a self-administered questionnaire including the Zung Self-Rating Depression Scale (SDS). They were followed for the next 8 years, and 2,380 (86%) responded to the follow-up survey in 1992. During the follow-up survey, occurrence of type 2 diabetes was diagnosed according to World Health Organization criteria.

RESULTS

A total of 41 cases of type 2 diabetes were identified during the 8-year follow-up survey. After controlling for other known risk factors for type 2 diabetes, a proportional hazard analysis indicated that subjects who had moderate or severe levels of depressive symptoms (> or = 48 on the SDS) at baseline had a 2.3 times higher risk of having type 2 diabetes at the follow-up survey than those who were not depressed (< or = 39 on the SDS) (P < 0.05).

CONCLUSIONS

Depressive symptoms may be associated with the onset of type 2 diabetes.

Overtime, psychosocial working conditions, and occurrence of non-insulin dependent diabetes mellitus in Japanese men

OBJECTIVES

To ascertain the effects of overtime and psychosocial job conditions on the occurrence of non-insulin dependent diabetes mellitus (NIDDM) in Japan.

DESIGN

An eight year prospective cohort study.

SETTING

An electrical company in Japan.

PARTICIPANTS

In 1984, a mailed questionnaire was sent to industrial workers of an electrical company in Japan. After excluding those who had a history of diabetes mellitus or other chronic diseases, 2597 male respondents were prospectively followed up for the succeeding eight years. Data from 2194 (84%) who were completely followed up were analysed. The occurrence of NIDDM during the follow up period was assessed according to the WHO criteria on the basis of an annual screening programme.

MAIN RESULTS

The age adjusted incidence of NIDDM was significantly higher in those who worked overtime more than 50 hours per month than in those who worked 25 hours or less per month (p < 0.05). It was significantly higher in those who worked with new technology at baseline than in those who did not (p < 0.05). Cox's proportional hazard model indicated that those who worked overtime more than 50 hours per month had 3.7 times higher risk of NIDDM after controlling for known risk factors (p < 0.01) and those who worked with new technology had 2.4 times higher risk of NIDDM (p < 0.05).

CONCLUSIONS

It is suggested that longer overtime and use of new technology are risk factors of NIDDM in Japanese men.

Development of a screening questionnaire for tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV

A 10-item questionnaire (the Tobacco Dependence Screener; TDS) for screening of tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV was newly developed. The reliability and validity were assessed in three samples of smokers in Japan. A total of 58 male smokers completed the TDS and the Fagerstrom Tolerance Questionnaire (FTQ), and they were interviewed using the World Health Organization's Composite International Diagnostic Interview (Sample 1). A total of 118 male and 36 female smoking outpatients completed the TDS and the FTQ and provided a breath sample for carbon monoxide measurement (Sample 2). A total of 194 male smokers joined a health education program using a health risk appraisal (HRA) and reported their smoking status and completed the TDS 6 months after receiving the HRA results (Sample 3). The Cronbach's alpha coefficients for the TDS ranged from .74 to .81 among the samples, whereas those for the FTQ ranged from .41 to .64. Receiver operator characteristic analyses indicated that the TDS had a better screening performance for ICD-10, DSM-III-R, and DSM-IV diagnoses than did the FFQ. The TDS score significantly and positively correlated with the severity of the diagnoses, the carbon monoxide levels, number of cigarettes smoked per day, and years of smoking. The TDS score was significantly lower in those who quit smoking than in those who did not quit smoking after the HRA. It is suggested that the TDS is a reliable and useful screening questionnaire for tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV.

Validity and reproducibility of a quantitative food frequency questionnaire for a cohort study in Japan

BACKGROUND

A self-administered quantitative food frequency questionnaire (Qx) was developed for a population-based cohort study on cancer in Takayama, Japan.

METHODS

The Qx was tested among 58 male and 59 female volunteers. Average daily nutrient intakes for the previous year calculated from the Qx were compared with those from 3-day food records and four 24-h recalls. The Qx was also validated among 37 volunteers by comparing the nutrient intakes calculated from the Qx with 12 1-day food records during a year. We also calculated the intra-class correlation coefficients for various nutrients between the Qx and the second Qx administered by the same volunteers 1 year after the first survey.

RESULTS

Pearson correlation coefficients between total energy from the Qx and 3-day records were 0.38 for men and 0.25 for women and those between the Qx and 24-h recalls were 0.19 and -0.02 for men and women, respectively. Correlations between the several nutrients from the Qx and 3-day records ranged from 0.2 to 0.5 for both men and women. These correlations after energy adjustment ranged from 0.2 to 0.6 for men and from 0.1 to 0.7 for women. In general, the correlations for various nutrients between the Qx and 12 1-day records were higher than those described above. The intra-class correlation coefficients ranged from 0.46 to 0.78 in men and from 0.36 to 0.67, except for vitamin C in women. When the information on portion size was excluded, almost all of the above indices showed somewhat lower figures.

CONCLUSION

These results suggest that our food frequency questionnaire with portion size information can be used to estimate nutrient intakes of each individual.

Effect of soymilk consumption on serum estrogen concentrations in premenopausal Japanese women

BACKGROUND

Estrogens have been implicated in the development of breast cancer. Preliminary evidence suggests that consumption of soy products, which contain isoflavones (phytoestrogens), can reduce serum estrogen levels. Our purpose was to determine the effect of soy consumption on serum estrogen levels in premenopausal women by use of a dietary intervention approach.

METHODS

Premenopausal Japanese women were randomly assigned to receive either a soymilk-supplemented diet (n = 31) or a normal (control) diet (n = 29). The women in the soymilk-supplemented group were asked to consume about 400 mL of soymilk (containing about 109 mg of isoflavones) daily during a study period that involved three consecutive menstrual cycles. Follicular-phase blood samples were to be obtained in the menstrual cycles preceding (cycle 1) and following (cycle 3) the 2-month dietary intervention. All statistical tests were two-sided.

RESULTS

At the end of the study period, estrone and estradiol levels were decreased by 23% and 27%, respectively, in the soymilk-supplemented group and were increased by 0.6% and 4%, respectively, in the control group. The changes for each hormone between the two groups were not statistically significantly different. In the soymilk-supplemented group, menstrual cycle length was increased by nearly 2 days, and, in the control group, it was decreased by approximately 1 day, a difference that was not statistically significant. A subgroup analysis restricted to subjects who provided follicular-phase blood samples on the same day or 1 day apart in menstrual cycles 1 and 3 showed a reduction in serum estrone levels in the soymilk-supplemented group that was of borderline statistical significance (P = .07 for change in serum estrone level in soymilk-supplemented group versus control group).

CONCLUSION

Much larger studies will be required to confirm the ability of soy products to reduce serum estrogen levels.

Association of dehydroepiandrosterone sulfate with serum HDL-cholesterol concentrations in post-menopausal Japanese women

OBJECTIVES

Positive association between serum dehydroepiandrosterone sulfate (DHEAS) and high-density lipoprotein (HDL) cholesterol has been observed in men but not women. We aimed to examine the cross-sectional relationships of DHEAS, estradiol (E2), and sex hormone-binding globulin (SHBG) to serum lipid concentrations in post-menopausal Japanese women.

METHODS

A total of 56 post-menopausal Japanese women were derived from female residents in Takayama City in Japan. The information on body size, disease history, reproductive history, diet, and physical activity were obtained by a self-administered questionnaire.

RESULTS

DHEAS was significantly and positively correlated with HDL-cholesterol after controlling for age and body mass index (BMI) (r = 0.28). There was no correlation between DHEAS and total-cholesterol (r = -0.02). E2 was not significantly correlated with total- and HDL-cholesterol and triglyceride. However, SHBG-unbound E2 was significantly positively correlated with HDL-cholesterol (r = 0.34) and negatively correlated with triglyceride (r = -0.27) after controlling for age and BMI. SHBG was negatively correlated with triglyceride, although the correlation was not statistically significant (r = -0.22).

CONCLUSION

These data suggest favorable effect of DHEAS as well as E2 and SHBG on lipid profile in Japanese post-menopausal women.

Effects of passive smoking on serum levels of carotenoids and alpha-tocopherol

To evaluate the effects of passive smoking identified by urine cotinine on serum carotenoids and alpha-tocopherol, we categorized 124 residents in a rural city of Japan into 4 groups by their urine cotinine/creatinine (Cot/Cr) ratio (u.d. (undetectable); low (0-50 ng/mg); moderate (50-120 ng/mg); high (> 120 ng/mg)) and compared the serum carotenoids and alpha-tocopherol levels among these groups. We identified passive smoking by low Cot/Cr ratio level. After controlling on related factors, men with low Cot/Cr ratio showed significantly lower serum zeaxanthin/lutein levels than men with u.d. Cot/Cr ratio. The difference was still marginally significant after excluding self-reported current smokers from the low Cot/Cr group. It is suggested that low level exposure to tobacco smoke, which has been reported to be equivalent to that for passive smokers, could be associated with decreased serum zeaxanthin/lutein levels in men.

Life-time prevalence and risk factors of tobacco/nicotine dependence in male ever-smokers in Japan

To estimate the life-time prevalence rate of tobacco/nicotine dependence and demographic variables and smoking habits associated with the disorder in male ever-smokers in Japan.

DESIGN

A cross-sectional community-based interview study.

SETTING

Takayama city, Gifu Prefecture, Japan.

PARTICIPANTS

A total of 170 male ever-smokers aged 35 years or older selected randomly from a community in Japan were interviewed. The response rate was 85%.

MEASUREMENTS

The WHO Composite International Diagnostic Interview (CIDI) was used to make diagnoses of tobacco/nicotine dependence according t ICD-10, DSM-III-R and DSM-IV. The Fagerstrom Tolerance Questionnaire (FTQ) was also administered and those who had a FTQ score of 7 or above were identified.

FINDINGS

The life-time prevalence rates of tobacco/nicotine dependence in male ever-smokers were 42%, 26% and 32% according to ICD-10, DSM-III-R and DSM-IV criteria, respectively; 19% had a FTQ score of 7 or above. The ICD-10 diagnosis was significantly and negatively associated with quitting smoking (p < 0.05). Multiple logistic regression analyses indicated that number of cigarettes per day when they smoked the most was significantly associated with higher life-time risks of the disorder according to DSM-III-R, DSM-IV and Fagerstrom's classification (p < 0.05). The length of cigarette smoked was associated with higher life-time risks of ICD-10 and DSM-IV diagnoses, and years of smoking were associated with higher life-time risks of ICD-10, DSM-III-R and DSM-IV diagnoses (p < 0.05). Younger birth cohorts had higher cumulative rates of the disorder according to DSM-IV (p for trend < 0.05).

CONCLUSIONS

Life-time prevalence rates of tobacco/nicotine dependence according to ICD-10, DSM-III-R and DSM-IV in male ever-smokers in Japan were within the range of rates reported in previous US studies; rates of FTQ score of 7 or above were lower. Fagerstrom scores and diagnostic criteria appear to reflect different aspects of dependence.

Association of diet and other lifestyle with onset of menopause in Japanese women

OBJECTIVES

To evaluate the cross-sectional relationships of dietary and other lifestyle variables to menopause.

METHODS

A total of 4186 female residents aged 45-55 in Takayama City, Japan, responded to a self-administered questionnaire (the response rate was 89.3%). Diet in the past year was assessed by semiquantitative food frequency questionnaire. Using the logistic regression model, associations between study variables and menopausal status were estimated in terms of odds ratio (OR).

RESULTS

Nulliparity and lower relative weight were significantly associated with menopause after controlling for age (P < 0.05). The association of smoking with menopause was marginally significant after controlling for age (P = 0.06). Higher intakes of fat, cholesterol, and coffee were inversely and significantly associated with later menopause after controlling for age, total energy, parity, menarche age, and relative weight (ORs for the highest tertiles of fat, cholesterol and coffee intakes were 0.78, 0.79, and 0.70, respectively, P < 0.05). The highest tertiles of calcium and soy product intakes were significantly associated with menopause after controlling for the covariates (ORs = 1.25 and 1.42, respectively, P < 0.05), but postmenopausal women who had menopause at later age showed higher calcium intake than those who had menopause at early age.

CONCLUSION

Dietary factors appear to be associated with onset of menopause.

[Environmental factors possibly associated with onset of senile dementia]

Factors associated with senile dementia have not been clarified, and factors, especially those in the living environment which seem to have a close link to the dementia need to be analysed. We conducted a case-control study targeting patients within the jurisdiction of Nagahama Public Health Center in Shiga and Hikone city, who are diagnosed to have senile dementia of the Vascular type, senile dementia of the Alzheimer type, and senile dementia of the Mixed type, and compared them to age matched controls. The outcome of the study by Matched pair analysis (McNemar's test) before the onset of the senile dementia were as follows. 1 The factors related to senile dementia of the vascular type were: Previous histories (Matched Odds Ratio (MOR): 8.0 p < 0.05), disturbance of the lower limbs (MOR = 8.0 p < 0.05). Environmental factors were: strong preference for sweets (MOR = 8.0 p < 0.05 female), smoking (MOR = 3.7 p < 0.10), lower utilization of health care (MOR = 3.3 p < 0.10), such as periodic medical check (MOR = 0/6 p < 0.10), sleep (MOR = 0/5 p < 0.10), less commitment to hobbies (MOR = 2.6 p < 0.10), such as handicrafts (MOR = 0/5 p < 0.10) etc, less intercourse with relatives (MOR = 0/9 p < 0.01), not living together with children's family (MOR = 0.20 p < 0.05 female), and death (MOR = 8/0 p < 0.05) or hospitalization (MOR = 9.0 p < 0.05) of a family member. 2 The factors related to senile dementia of the Alzheimer type and the Mixed type were: some previous histories (MOR = 8.0 p < 0.05), less disturbance of gait (MOR = 0/5 p < 0.10). Environmental factors were: lower utilization of health care, such as periodic medical check (MOR = 0.18 p < 0.05), and lower participation in exercise (MOR = 0/5 p < 0.10) etc, less association with neighbors (MOR = 0.11 p < 0.05), less participation in community activities (MOR = 0.11 p < 0.05), not living together with children's family (MOR = 0/8 p < 0.05), relocation (MOR = 5/0 p < 0.10) and retirement (MOR = 5/0 p < 0.10).

Decreased serum total cholesterol concentration is associated with high intake of soy products in Japanese men and women

The relationship between soy product intake and serum total cholesterol concentration was examined in 1242 men and 3596 women who participated in an annual health check-up program in Takayama City, Japan, provided by the municipality in 1992. The intake of soy products and various foods and nutrients was assessed by a semiquantitative food-frequency questionnaire. Blood samples were collected from fasting subjects to measure the serum total cholesterol concentration. A significant trend (P for trend = 0. 0001) was observed for decreasing total cholesterol concentration with an increasing intake of soy products in men after controlling for age, smoking status and intake of total energy, total protein and total fat. This negative trend (P for trend = 0.0001) was also noted in women after controlling for age, menopausal status, body mass index and intake of total energy and vitamin C. An additional adjustment for physical activity, coffee and tea consumption, and intake of cholesterol, carbohydrates, fiber and vitamin E did not change the results. These data suggest a role for soy products in human cholesterol homeostasis.