Association between shift work in early pregnancy, snacking, and inappropriate weight gain during pregnancy: The Japan Environment and Children's Study.

OBJECTIVES: This study aimed to investigate the relationship between night shifts and snacking behaviors during pregnancy using Japanese maternal-infant longitudinal data from a large-scale study. METHODS: This study used the Japan Environment and Children's Study dataset jecs-ta-20190930, released in October 2019. After simple analysis using analysis of variance and multiple comparisons, crude odds ratios (cOR) and adjusted odds ratios (aORs) were calculated. To evaluate eating habits, we examined habitual fast food and snacks (e.g., potato chips, corn puffs and tortilla chips) consumption, midnight snacks, and regular missing breakfast. RESULTS: There was no significant association between inappropriate weight gain during pregnancy and night shift work in early pregnancy. The aOR for consuming snacks more than once a week after noticing pregnancy for shift workers was 1.34 (95% confidence interval 1.27-1.41; p < 0.001) compared with worker without night shiftwork. The aOR for shift workers consuming fast food more than three times a week during pregnancy was 1.40 (95% confidence interval 0.79-2.33; p > 0.05). CONCLUSIONS: Pregnant night shift workers did not show excessive weight gain but had an increased frequency of consumption of snack foods compared with pregnant dayshift workers.

Association between frequency of going out and mild cognitive impairment in community-dwelling older adults: a pilot study in frailty prevention groups.

BACKGROUND: Clarifying the role of physical limitations in the relationship between frequency of going out and mild cognitive impairment (MCI) may be useful in supporting early detection and prevention of MCI. However, few studies have explored relatively active populations that are continuously active throughout the year. This study aimed to determine the relationship between frequency of going out and MCI among non-homebound older adults who participated in group activities to prevent frailty. METHODS: This prospective cohort study used frequency of going out as the exposure and MCI as the outcome. The Touch Panel-type Dementia Assessment Scale and questionnaires about daily life were completed by 153 community-dwelling older adults aged ≥65 years participating in frailty prevention groups in a rural town. The baseline survey was conducted from December 2017 to March 2018 and analysed cross-sectionally. Follow-up surveys were conducted at 1- and 2-years and analysed longitudinally. RESULTS: Univariate and binomial logistic regression analyses at baseline showed no association between MCI and frequency of going out in older adults with physical limitations. However, there was a significant association in older adults without physical limitations. A binomial logistic regression analysis of the frequency of going out at baseline and cognitive function at the 2-year follow-up showed no association between MCI and frequency of going out in older adults with physical limitations, but there was a significant association in those without physical limitations. CONCLUSION: Our results suggest that frequency of going out may not be a useful indicator of MCI in older adults with physical limitations, although low frequency of going out may be an indicator of MCI in older adults without physical limitations.

Association between prenatal cadmium exposure and child development: The Japan Environment and Children's study.

Cadmium is a heavy metal that can be found in soil, air, food, and water. Cadmium has toxic effects on the kidneys, bones, and respiratory system. Prenatal exposure to cadmium has been found to affect the mental development of children, but inconsistent results have been found in different studies. Therefore, it is unknown that prenatal cadmium exposure associated with child development after birth. To elucidate whether cadmium affect the child development or not, we analyzed nation-wide cohort study data, the Japan Environment and Children's Study. Prenatal cadmium concentrations in blood from mothers in the second or third trimester were determined by inductively coupled plasma mass spectrometry. Child development was evaluated using "Ages and Stages" questionnaires. The association between cadmium and child development were investigated by performing logistic regression analyses, multinomial logistic regression analyses and generalized linear mixed model using the child development parameters as dependent variables and the cadmium concentrations in maternal blood as the independent variable. There were significant associations between the cadmium concentration and child development at 6 months, 1 year, and 1.5 years after birth. However, the effect had disappeared at 2 years after birth or later. The number of developmental delays was positively associated with the cadmium concentration after adjusting individual difference. The results indicate that prenatal exposure affects child development, but the effect decreases with age.

Short- and Long-Term Effects of Drought on Selected Causes of Mortality in Northern Bangladesh.

Drought has exacerbated morbidity and mortality worldwide. Here, a time series study was conducted in northern Bangladesh to evaluate the impact of drought on selected causes of mortality during 2007-2017. Rainfall and temperature data from six meteorological stations were used to analyze drought and non-drought periods and to categorize mild, moderate, severe, and extreme drought based on the 3-month and 12-month Standardized Precipitation Index (SPI) and Standardized Precipitation Evaporation Index (SPEI). A generalized linear model with Poisson regression with log link, a negative binomial with log link, and a zero-inflated Poisson model were used to determine associations between drought severity and mortality. The SPI and SPEI produced slightly different analysis results. Compared with the SPEI, the SPI showed a stronger and more sensitive correlation with mortality. The relative risk for respiratory disease mortality was high, and Saidpur was the most vulnerable area. Health care expenditure was negatively associated with mortality. High temperatures during the drought period were associated with suicide-related mortality in Rajshahi. The impact of drought on mortality differed with small changes in climate. The findings of this study improve our understanding of the differences between the two most used drought indicators and the impact of drought on mortality.

The Effects of Drought Severity and Its Aftereffects on Mortality in Bangladesh.

BACKGROUND: Drought has been a considerable problem for many years in northern Bangladesh. However, the health impacts of drought in this region are not well understood. METHODS: This study analyzed the impact of drought duration and severity on select causes of mortality in northern Bangladesh. Rainfall data from three meteorological stations (Rangpur, Dinajpur and Nilphamari) in northern Bangladesh were used to assess drought and non-drought periods, and the Standardized Precipitation Index was used to categorize mild, moderate, severe, and extreme drought. Mortality data from 2007 to 2017 for the three areas were collected from the Sample Vital Registration System, which is a survey of 1 million people. The generalized linear model with Poisson regression link was used to identify associations between mortality and the drought severity and 1-month preceding SPI. RESULTS: Only severe and extreme drought in the short-term drought periods affected mortality. Long-term drought was not associated with natural cause mortality in Rangpur and Nilphamari. In Dinajpur, mild and moderate drought was associated with circulatory- and respiratory-related mortality. CONCLUSION: The impact of drought on mortality varied by region. This study improves our understanding of how droughts affect specific causes of mortality and will help policy makers to take appropriate measures against drought impacts on selected cause of mortality. Future research will be critical to reduce drought-related risks of health.

The Effect of Minimum and Maximum Air Temperatures in the Summer on Heat Stroke in Japan: A Time-Stratified Case-Crossover Study.

An increase in the global surface temperature and changes in urban morphologies are associated with increased heat stress especially in urban areas. This can be one of the contributing factors underlying an increase in heat strokes. We examined the impact of summer minimum air temperatures, which often represent nighttime temperatures, as well as a maximum temperature on a heat stroke. We collected data from the records of daily ambulance transports for heat strokes and meteorological data for July and August of 2017-2019 in the Tottori Prefecture, Japan. A time-stratified case-crossover design was used to determine the association of maximum/minimum air temperatures and the incidence of heat strokes. We used a logistic regression to identify factors associated with the severity of heat strokes. A total of 1108 cases were identified with 373 (33.7%) calls originating in the home (of these, 59.8% were the age of ≥ 75). A total of 65.8% of cases under the age of 18 were related to exercise. Days with a minimum temperature ≥ 25 °C had an odds ratio (95% confidence interval) of 3.77 (2.19, 6.51) for the incidence of an exercise-related heat stroke (reference: days with a minimum temperature < 23 °C). The odds ratio for a heat stroke occurring at home or for calls for an ambulance to the home was 6.75 (4.47, 10.20). The severity of the heat stroke was associated with older age but not with air temperature. Minimum and maximum air temperatures may be associated with the incidence of heat strokes and in particular the former with non-exertional heat strokes.

Spatiotemporal variation of nitrate concentrations in soil and groundwater of an intensely polluted agricultural area.

Nitrate pollution in groundwater is a serious problem in many parts of the world. However, due to the diffuse and common spatially over-lapping character of potential several non-point pollution sources, it is often difficult to distinguish main nitrate sources responsible for the pollution. For this purpose, we present a novel methodology applied to groundwater for an intensely polluted area. Groundwater samples were collected monthly from April 2017 to March 2018 in Shimabara City, Nagasaki, Japan. Soil samples were collected seasonally at soil surface and 50 cm depth at 10 locations during the same period. Sequential extraction by water and extract agents was performed using calcium phosphate for anions and strontium chloride for cations. Mean nitrate concentration in groundwater close to a livestock waste disposal site (hereinafter called "LWDS") was 14.2 mg L-1, which is exceeding Japanese drinking water standards (10 mg L-1). We used coprostanol concentration, which is a fecal pollution indicator, to identify pollution sources related to livestock waste. For this purpose, we measured coprostanol (5ß) and cholestanol (5α) and then calculated the sterol ratio (5ß/(5ß + 5α)). The ratios for three groundwater sampling sites were 0.28, 0.26, and 0.10, respectively. The sterol ratios indicated no pollution (< 0.3). However, the detection of coprostanol originating from animal and human waste showed that groundwater was clearly affected by this pollution source. Nitrate levels in the soil were relatively high in samples collected close to the LWDS and coprostanol contents were affected by livestock waste. Soil and groundwater nitrate concentrations displayed a complex but strong relationship. Nitrate contents were shown to be transported downstream from source areas in both soil and groundwater.

Plasma Oxytocin Concentrations During and After Gestation in Japanese Pregnant Women Affected by Anxiety Disorder and Endometriosis.

BACKGROUND: Oxytocin has a key role in mother-infant bonding, maternal care, social interaction, and stress-related psychiatric disorders. However, the factors determining oxytocin concentrations during and after pregnancy such as medical history related to nursing or parental behavior are unknown. To elucidate these, we analyzed the relationships between oxytocin concentrations during and after pregnancy, and medical history assessed in the Japan Environment and Children's Study (JECS). METHODS: We then selected the pregnant women with a medical history of anxiety disorder and endometriosis as cases and pregnant women without medical history as controls adjusting the cohort for age and parity for a nested case-control study, after which 162 women remained for analysis. We evaluated 162 pregnant women from JECS using answers provided in a questionnaire and by measuring plasma oxytocin concentration by ELISA during the first (T1) and second (T2) trimesters of pregnancy, and after childbirth (T3). RESULTS: Oxytocin concentration increased in a time dependent manner, consistent with previous reports. There were weak negative correlations between oxytocin concentration at T1 and the mother's age and height, but no correlation with other factors. The mean oxytocin concentrations of pregnant women with a history of an anxiety disorder (n = 7) and endometriosis (n = 13) were significantly lower than those of pregnant women with no such history at T2 and T3. CONCLUSION: These results suggest that oxytocin concentrations during and after pregnancy were affected by a past history of anxiety disorder and endometriosis. This is the first study of the relationship between oxytocin concentration and endometriosis. To elucidate the molecular mechanisms, further study is needed.

Land Cover Classification by Integrating NDVI Time Series and GIS Data to Evaluate Water Circulation in Aso Caldera, Japan.

Grasslands in Aso caldera, Japan, are a type of land cover that is integral for biodiversity, tourist attractions, agriculture, and groundwater recharge. However, the area of grasslands has been decreasing in recent years as a result of natural disasters and changes in social conditions surrounding agriculture. The question of whether the decrease in spring water discharge in Aso caldera is related to the decrease in grasslands remains unanswered. To clarify this relationship, a water circulation model that considers land covers with different hydrological features is needed. In this study, by integrating Normalized Difference Vegetation Index (NDVI) time series and Geographic Information System (GIS) data, we generated land cover maps from the past (in 1981 and 1991) to the present (in 2015 and 2016), before and after the 2016 Kumamoto earthquake, and then for the future (in the 2040s); these maps formed the dataset for building a water circulation model. The results show that the area of grasslands, which are reported to have a higher groundwater recharge rate than that of forests, in 2016 had decreased to 68% of the area in 1981 as a result of afforestation and transformation into forests, as well as landslides induced by the earthquake. The area of grasslands is predicted to further drop to 60% by the 2040s. On the other hand, the area of forests (conifers and hardwoods) in 2016 had increased by 119% relative to that in 1981 because of the transformation of grasslands into forests, although these areas decreased as a result of landslides due to the 2016 Kumamoto earthquake. Quantification of groundwater recharge from grasslands and forests using the land cover maps generated for 1981, 1996, 2015, and 2016 shows that the annual increase in precipitation in these years significantly affected groundwater recharge; these effects were greater than those associated with the type of land cover. Thus, the groundwater recharge increased, despite the decrease in grasslands. However, when constant precipitation was assumed, the groundwater recharge presented a decreasing trend, indicating the importance of maintaining and conserving grasslands from the viewpoint of groundwater conservation.

Adverse obstetrical outcomes for women with endometriosis and adenomyosis: A large cohort of the Japan Environment and Children's Study.

BACKGROUND: Because of the increased number of diagnosed cases of endometriosis or adenomyosis resulting in infertility, many women require assisted reproductive technology (ART) to become pregnant. However, incidences of obstetric complications are increased for women who conceive using ART. There has been no prospective cohort study examining the influence of endometriosis and adenomyosis on obstetric outcomes after adjusting for the confounding influence of ART therapy. OBJECTIVE: This study evaluated the impact of endometriosis and adenomyosis on the incidence of adverse pregnancy outcomes. STUDY DESIGN: Data were obtained from a prospective cohort study, known as the Japan Environment and Children's Study (JECS), of the incidence of obstetric complications for women with endometriosis and adenomyosis. The data of 103,099 pregnancies that resulted in live birth or stillbirth or that were terminated through abortion between February 2011 and July 2014 in Japan were included. RESULTS: Women with endometriosis or adenomyosis were at increased risk for complications during pregnancy compared to those without a medical history of endometriosis (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.23 to 1.41) or adenomyosis (OR, 1.72; 95% CI, 1.37 to 2.16). Our analysis showed that the adjusted ORs for obstetric complications of pregnant women who conceived naturally or after infertility treatment that did not involve ART therapy were 1.26 (CI, 1.17 to 1.35) for pregnant women with a history of endometriosis and 1.52 (CI, 1.19 to 1.94) for those with a history of adenomyosis. CONCLUSIONS: The presence of endometriosis and adenomyosis significantly increased the prevalence of obstetric complications after adjusting for the influence of ART outcomes.

Impact of Maximum Air Temperature on Ambulance Transports Owing to Heat Stroke During Spring and Summer in Tottori Prefecture, Japan: A Time-stratified Case-crossover Analysis.

BACKGROUND: The frequency and intensity of hot weather have increased. In Japan, there have been many studies of the relationship between ambulance transports owing to heat stroke (ATHS) and high air temperature in the summer season. However, there have been very few reports focusing on ATHS in spring. Therefore, we investigated the effect of the maximum air temperature on ATHS not only in summer but also in spring, to help with development of effective measures to prevent heat stroke. METHODS: We obtained daily ATHS and meteorological data from April to September in 2017 in Tottori Prefecture. We used a time-stratified case-crossover method for data analysis. RESULTS: A total 382 cases of ATHS were identified from April to September in 2017 in Tottori. The number of cases was highest in July, followed by August and May. Maximum air temperature was significantly linked to ATHS. The risk of ATHS was increased 1.13 times when maximum air temperature rose by 1°C. In summer, the risk on extremely hot days (maximum air temperature ≥ 35°C) increased by 5.55 times or more compared with that on days below 30 °C (< 30°C). The risk was approximately four times greater on hot days (≥ 30°C and < 35°C) than that on relatively cooler days (< 30°C) during the spring months of April through May. CONCLUSION: Maximum air temperature was significantly linked to ATHS. It is necessary to pay particular attention to heat stroke prevention not only on extremely hot days in summer but also on hot days in the spring.

Erratum for Yokoyama et al., "Skipping Breakfast and Risk of Mortality from Cancer, Circulatory Diseases and All Causes: Findings from the Japan Collaborative Cohort Study".

[This corrects the article on p. 55 in vol. 59, PMID: 27046951.].

Association of plasma free amino acids with hyperuricemia in relation to diabetes mellitus, dyslipidemia, hypertension and metabolic syndrome.

Previous studies demonstrated independent contributions of plasma free amino acids (PFAAs) and high uric acid (UA) concentrations to increased risks of lifestyle-related diseases (LSRDs), but the important associations between these factors and LSRDs remain unknown. We quantified PFAAs and UA amongst Japanese subjects without LSRDs (no-LSRD, n = 2805), and with diabetes mellitus (DM, n = 415), dyslipidemia (n = 3207), hypertension (n = 2736) and metabolic syndrome (MetS, n = 717). The concentrations of most amino acids differed significantly between the subjects with and without hyperuricemia (HU) and also between the no-LSRD and LSRD groups (p < 0.05 to 0.001). After adjustment, the logistic regression analyses revealed that lysine in DM, alanine, proline and tyrosine in dyslipidemia, histidine, lysine and ornithine in hypertension, and lysine and tyrosine in MetS demonstrated significant positive associations with HU among the patients with LSRDs only (p < 0.05 to 0.005). By contrast, arginine, asparagine and threonine showed significant inverse associations with HU in the no-LSRD group only (p < 0.05 to 0.01). For the first time, we provide evidence for distinct patterns of association between PFAAs and HU in LSRDs, and postulate the possibility of interplay between PFAAs and UA in their pathophysiology.

Plasma free amino acid profiles evaluate risk of metabolic syndrome, diabetes, dyslipidemia, and hypertension in a large Asian population.

BACKGROUND: Recently, the association of plasma free amino acid (PFAA) profile and lifestyle-related diseases has been reported. However, few studies have been reported in large Asian populations, about the usefulness of PFAAs for evaluating disease risks. We examined the ability of PFAA profiles to evaluate lifestyle-related diseases in so far the largest Asian population. METHODS: We examined plasma concentrations of 19 amino acids in 8589 Japanese subjects, and determined the association with variables associated with obesity, blood glucose, lipid, and blood pressure. We also evaluated the PFAA indexes that reflect visceral fat obesity and insulin resistance. The contribution of single PFAA level and relevant PFAA indexes was also examined in the risk assessment of lifestyle-related diseases. RESULTS: Of the 19 amino acids, branched-chain amino acids and aromatic amino acids showed association with obesity and lipid variables. The PFAA index related to visceral fat obesity showed relatively higher correlation with variables than that of any PFAA. In the evaluation of lifestyle-related disease risks, the odds ratios of the PFAA index related to visceral fat obesity or insulin resistance with the diseases were higher than most of those of individual amino acid levels even after adjusting for potential confounding factors. The association pattern of the indexes and PFAA with each lifestyle-related disease was distinct. CONCLUSIONS: We confirmed the usefulness of PFAA profiles and indexes as markers for evaluating the risks of lifestyle-related diseases, including diabetes mellitus, metabolic syndrome, dyslipidemia, and hypertension in a large Asian population.

Alteration in plasma free amino acid levels and its association with gout.

BACKGROUND: Studies on the association of plasma-free amino acids with gout are very limited and produced conflicting results. Therefore, we sought to explore and characterize the plasma-free amino acid (PFAA) profile in patients with gout and evaluate its association with the latter. METHODS: Data from a total of 819 subjects (including 34 patients with gout) undergoing an annual health examination program in Shimane, Japan were considered for this study. Venous blood samples were collected from the subjects and concentrations of 19 plasma amino acids were determined by high-performance liquid chromatography-electrospray ionization-mass spectrometry. Student's t-test was applied for comparison of variables between patient and control groups. The relationships between the presence or absence of gout and individual amino acids were investigated by logistic regression analysis controlling for the effects of potential demographic confounders. RESULTS: Among 19 amino acids, the levels of 10 amino acids (alanine, glycine, isoleucine, leucine, methionine, phenylalanine, proline, serine, tryptophan, valine) differed significantly (P < .001 to .05) between the patient and control groups. Univariate logistic regression analysis revealed that plasma levels of alanine, isoleucine, leucine, phenylalanine, tryptophan and valine had significant positive associations (P < .005 to .05) whereas glycine and serine had significant inverse association (P < .05) with gout. CONCLUSIONS: The observed significant changes in PFAA profiles may have important implications for improving our understanding of pathophysiology, diagnosis and prevention of gout. The findings of this study need further confirmation in future large-scale studies involving a larger number of patients with gout.

Skipping Breakfast and Risk of Mortality from Cancer, Circulatory Diseases and All Causes: Findings from the Japan Collaborative Cohort Study.

BACKGROUND: Breakfast eating habits are a dietary pattern marker and appear to be a useful predictor of a healthy lifestyle. Many studies have reported the unhealthy effects of skipping breakfast. However, there are few studies on the association between skipping breakfast and mortality. In the present study, we examined the association between skipping breakfast and mortality from cancer, circulatory diseases and all causes using data from a large-scale cohort study, the Japan Collaborative Cohort Study (JACC) Study. METHODS: A cohort study of 34,128 men and 49,282 women aged 40-79 years was conducted, to explore the association between lifestyle and cancer in Japan. Participants completed a baseline survey during 1988 to 1990 and were followed until the end of 2009. We classified participants into two groups according to dietary habits with respect to eating or skipping breakfast and carried out intergroup comparisons of lifestyle. Multivariate analysis was performed using the Cox proportional hazard regression model. RESULTS: There were 5,768 deaths from cancer and 5,133 cases of death owing to circulatory diseases and 17,112 cases for all causes of mortality during the median 19.4 years follow-up. Skipping breakfast was related to unhealthy lifestyle habits. After adjusting for confounding factors, skipping breakfast significantly increased the risk of mortality from circulatory diseases [hazard ratio (HR) = 1.42] and all causes (HR = 1.43) in men and all causes mortality (HR = 1.34) in women. CONCLUSION: Our findings showed that skipping breakfast is associated with increasing risk of mortality from circulatory diseases and all causes among men and all causes mortality among women in Japan.

Association between feeling upon awakening and use of information technology devices in Japanese children.

BACKGROUND: The objective of this study was to clarify the relationship between feeling upon awakening (FA) and time spent using information technology (IT) devices by children in kindergartens, elementary schools, and junior high schools in Shimane, Japan. METHODS: In October 2008, a self-report survey was distributed to 2075 children in kindergartens (n = 261), elementary schools (n = 1162), and junior high schools (n = 652) in Shimane, Japan. The questionnaire gathered data on sex, school year, feeling upon awakening, and time spent using IT devices after school (television, videos on television, video games, personal computers, and cellular phones). After adjusting for sex and school year, data were analyzed by multivariate logistic regression analysis to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 2030 children completed this survey (response rate, 97.8%). Negative FA was associated with watching television more than 2 hours/day (OR = 1.51, 95% CI = 1.23-1.85), playing video games more than 30 minutes/day (1.50, 1.20-1.87), and using personal computers more than 30 minutes/day (1.35, 1.04-1.75). CONCLUSIONS: Time spent using IT devices affected the FA of children in kindergarten through junior high school. We propose the development of guidelines regarding the appropriate amount of time this population should spend using IT devices.

Association analysis of the NOD2 gene with susceptibility to graft-versus-host disease in a Japanese population.

Members of the nucleotide-binding oligomerization domain (NOD)-like receptor (NLR) family participate in the innate immune system, exerting widespread effects on cytokine secretion, autophagy, and apoptosis. Recent studies in Caucasians revealed the association between mutants of NOD2, a member of the NLR family, and severity of acute graft-versus-host disease (GVHD). NOD2 polymorphism screening has been recommended for donor selection and risk assessment at bone marrow transplantation. To investigate whether NOD2 plays a role in the pathogenesis of GVHD in a Japanese population, we examined DNA from 142 bone marrow transplant patient/donor pairs to detect genetic variation in the NOD2 gene. No genetic variants of NOD2 were associated with the severity of acute GVHD in our patients. However, a weak association between a single nucleotide polymorphism in the NOD2 gene (R471C) and acute myeloid leukemia in the bone marrow patients (p = 0.029, odds ratio 4.08, 95% CI 1.22-13.67) was detected. This polymorphism was not prevalent in 479 Crohn's disease (CD) patients in Japan. These results suggest that, in the Japanese population, unlike the Caucasian, NOD2 is not a major contributor to susceptibility to severe acute GVHD.