Case-control study of green tea consumption and the risk of endometrial endometrioid adenocarcinoma.

OBJECTIVE: To investigate the association between green tea consumption and the risk of endometrial cancer restricted to endometrial endometrioid adenocarcinoma (EEA) using a case-control design in Japan. METHODS: The cases were 152 patients with histopathologically diagnosed EEA, and the controls were 285 healthy women who were matched for age and area of residence with individual cases. The subjects completed a questionnaire regarding health-related lifestyle and reproductive history, and a food frequency questionnaire. Odds ratios (ORs) of EEA for frequency of green tea consumption were calculated by conditional logistic regression analysis. RESULTS: We observed a significant inverse association between green tea consumption and the risk of EEA with a dose-response relationship. The multivariate-adjusted OR of EEA was 0.77 (95% CI: 0.37-1.58) for those in the second quartile of green tea consumption (5-6 cups/week-1 cup/day), 0.61 (0.30-1.23) in the third quartile (2-3 cups/day), and 0.33 (0.15-0.75) in the highest quartile (> or = 4 cups/day), as referenced with those in the lowest quartile (< or = 4 cups/week; p for trend = 0.007). This inverse association was consistently observed regardless of the presence or absence of factors such as obesity and menopause. CONCLUSION: Green tea consumption may be associated with a lower risk of EEA.

Sense of life worth living (ikigai) and mortality in Japan: Ohsaki Study.

OBJECTIVE: To investigate the association between the sense of "life worth living (ikigai)" and the cause-specific mortality risk. The psychological factors play important roles in morbidity and mortality risks. However, the association between the negative psychological factors and the risk of mortality is inconclusive. METHODS: The Ohsaki Study, a prospective cohort study, was initiated on 43,391 Japanese adults. To assess if the subjects found a sense of ikigai, they were asked the question, "Do you have ikigai in your life?" We used Cox regression analysis to calculate the hazard ratio of the all-cause and cause-specific mortality according to the sense of ikigai categories. RESULTS: Over 7 years' follow-up, 3048 of the subjects died. The risk of all-cause mortality was significantly higher among the subjects who did not find a sense of ikigai as compared with that in the subjects who found a sense of ikigai; the multivariate adjusted hazard ratio (95% confidence interval) was 1.5 (1.3-1.7). As for the cause-specific mortality, subjects who did not find a sense of ikigai were significantly associated with an increased risk of cardiovascular disease (1.6; 1.3-2.0) and external cause mortality (1.9; 1.1-3.3), but not of the cancer mortality (1.3; 1.0-1.6). CONCLUSIONS: In this prospective cohort study, subjects who did not find a sense of ikigai were associated with an increased risk of all-cause mortality. The increase in mortality risk was attributable to cardiovascular disease and external causes, but not cancer.

Body mass index and cardiovascular disease mortality in Japan: the Ohsaki Study.

OBJECTIVE: Although there is a clear positive association between obesity and the incidence and severity of cardiovascular disease, the association between underweight and cardiovascular disease is unclear. The objective of this study was to examine the relation between body mass index (BMI) and cardiovascular disease in Japan, where the proportion of the population that is underweight is relatively high. METHOD: A total of 43,916 Japanese adults (21,003 men and 22,913 women) aged 40 to 79 years who had no history of cancer, ischemic heart disease (IHD), or stroke participated in the baseline survey in 1994. Hazard ratios (HR) and their 95% confidence intervals (CIs) for death due to total cardiovascular disease, all strokes, ischemic stroke, hemorrhagic stroke, and IHD were calculated according to BMI by using Cox's proportional hazards regression models. The 22.5-24.9 kg/m(2) BMI category was used as the reference category in all analyses. RESULTS: There were U-shaped associations between BMI and total cardiovascular disease, all stroke, hemorrhagic stroke, and IHD mortality, and a J-shaped association between BMI and ischemic stroke mortality. Participants with a BMI <18.5 kg/m(2) had a significantly increased risk of total cardiovascular disease, all stroke, hemorrhagic stroke, and IHD mortality, and the multivariate HR (95% CI) was 1.62 (1.19-2.19), 1.50 (1.02-2.21), 2.11 (1.07-4.17), 1.83 (1.11-3.01), respectively. CONCLUSION: Underweight was substantially associated with hemorrhagic stroke and IHD mortality in Japan, while obesity was associated with increased risk of total cardiovascular disease mortality and mortality from individual cardiovascular diseases.

[Fish intake and the risk of prostate cancer in Japan: a prospective cohort study].

OBJECTIVE: Fish intake may reduce the risk of prostate cancer. However, the results of previous prospective cohort studies have been inconsistent, and almost all have been undertaken in Western countries, where total fish intake is low. We therefore investigated the association between fish intake and the risk of prostate cancer in a prospective cohort study in Japan. PARTICIPANTS AND METHODS: We delivered a self-administered questionnaire including items on dietary intake (40-item food frequency questionnaire [FFQ]), and various lifestyle habits, between October and December 1994 to all male National Health Insurance (NHI) beneficiaries aged 40-79 years in Japan. Usable questionnaires were returned from 24,895 (94%) of the participants. We divided the participants into quartiles based on their self-reported fish intake. We used the Cox proportional hazards model to estimate the hazard ratio (HR) and 95% confidence interval (CI) of prostate cancer incidence according to fish intake, after adjustment for potential confounders. RESULTS: We identified 95 prostate cancer cases during 7 years of follow-up, to the end of December 2001. An inverse association was observed between fish intake and the risk of prostate cancer. The multivariate HRs (95% CI) of prostate cancer across increasing quartiles of fish intake were 1.00, 0.92 (0.48-1.76), 0.73 (0.42-1.28), and 0.72 (0.40-1.33) (P for trend = 0.23). Among participants aged 40-69 years, the multivariate HRs (95% CI) of prostate cancer across increasing quartiles of fish intake were 1.00, 1.26 (0.51-3.11), 0.86 (0.38-1.94), and 1.01 (0.43-2.34) (P for trend = 0.83). On the other hand, among participants aged 70 years or older, the corresponding multivariate HRs (95% CI) were 1.00, 0.63 (0.23-1.69), 0.60 (0.27-1.30), and 0.44 (0.18-1.11) (P for trend = 0.08). CONCLUSIONS: The risk of prostate cancer tended to decrease among those aged 70 years or older although it was not significant. The relation was not seen in those aged 40-69 years old.

Alcohol consumption and suicide mortality among Japanese men: the Ohsaki Study.

The risk of suicide is well known to be increased among heavy alcohol drinkers. However, whether the risk is increased or decreased among light drinkers is still under debate. We investigated this association in a population-based sample of men in Japan. The Ohsaki Study was a population-based, prospective cohort study among Japanese adults aged from 40 to 79 years. Between October and December, 1994, 22,804 men in Miyagi Prefecture, Japan, completed a questionnaire on various health-related lifestyles, including alcohol drinking. During the subsequent 7 years follow-up, 73 participants committed suicide. We used the Cox proportional hazards regression model to estimate the hazard ratio (HR) for suicide mortality according to the quantity of alcohol consumed daily, with adjustment for potential confounders. There was a statistically significant positive and linear association between the amount of alcohol consumed and the risk of suicide: the multivariate HRs in reference to nondrinkers (95% confidence interval) were 1.2 (0.5-2.7), 1.5 (0.7-3.4), and 2.4 (1.2-4.6) in current drinkers who consumed /=45.6g of alcohol per day, respectively (P-trend=.016). Even after the early death cases were excluded, a significant linear association was observed between alcohol consumption and the risk of suicide, with the risk of suicide also being nonsignificantly higher among the light drinkers than among nondrinkers (multivariate HR=1.7). This prospective cohort study indicated a positive linear association between alcohol consumption and the risk of suicide, and the suicide risk among the light drinkers was not decreased as compared with that in nondrinkers.

Survival prediction of patients with advanced cancer: the predictive accuracy of the model based on biological markers.

To determine whether the addition of biological markers to performance status (PS) and physical symptoms would improve survival prediction among patients with advanced cancer, we developed two prediction models with a scoring system based on 294 consecutive patients with advanced cancer (training set), and then tested its validity on another 93 patients (testing set). We assessed the predictive accuracy of the models using receiver-operating characteristic analysis. Albumin (ALB), lactate dehydrogenase (LDH), and lymphocyte percentage (Lymp%) were significantly and independently associated with survival length. For prediction of 60-day survival, the predictive accuracy of Model 2, based on the above biological markers in addition to PS and symptoms, was significantly better than that of Model 1, based on PS and symptoms alone (area under the curve [AUC] for Model 2, 0.80+/-0.03; AUC for Model 1, 0.69+/-0.04; P<0.001). Addition of ALB, LDH, and Lymp% to PS and physical symptoms improved prediction accuracy, especially for longer survival.

Dietary patterns and cardiovascular disease mortality in Japan: a prospective cohort study.

BACKGROUND: Although ecological observations suggest that the Japanese diet may reduce the risk of cardiovascular disease (CVD), the impact of a Japanese dietary pattern upon mortality due to CVD is unclear. METHODS: We prospectively assessed the association between dietary patterns among the Japanese and CVD mortality. Dietary information was collected from 40 547 Japanese men and women aged 40-79 years without a history of diabetes, stroke, myocardial infarction or cancer at the baseline in 1994. RESULTS: During 7 years of follow-up, 801 participants died of CVD. Factor analysis (principal component) based on a validated food frequency questionnaire identified three dietary patterns: (i) a Japanese dietary pattern highly correlated with soybean products, fish, seaweeds, vegetables, fruits and green tea, (ii) an 'animal food' dietary pattern and (iii) a high-dairy, high-fruit-and-vegetable, low-alcohol (DFA) dietary pattern. The Japanese dietary pattern was related to high sodium intake and high prevalence of hypertension. After adjustment for potential confounders, the Japanese dietary pattern score was associated with a lower risk of CVD mortality (hazard ratio of the highest quartile vs the lowest, 0.73; 95% confidence interval: 0.59-0.90; P for trend = 0.003). The 'animal food' dietary pattern was associated with an increased risk of CVD, but the DFA dietary pattern was not. CONCLUSION: The Japanese dietary pattern was associated with a decreased risk of CVD mortality, despite its relation to sodium intake and hypertension.

Coffee consumption and the risk of colorectal cancer: a prospective cohort study in Japan.

An inverse association between coffee consumption and the risk of colorectal cancer has been reported in several case-control studies, but results from prospective cohort studies have been inconclusive. We conducted a prospective cohort study among a Japanese population to clarify the association between coffee consumption and the risk of colorectal cancer incidence. We used data from the Miyagi Cohort Study for this analysis. Usable self-administered questionnaires about coffee consumption were returned from 22,836 men and 24,769 women, aged 40-64 years, with no previous history of cancer. We used the Cox proportional-hazard regression model to estimate hazard ratios and 95% confidence intervals. During 11.6 years of follow-up (425,303 person-years), we identified 457 cases of colorectal cancer. Coffee consumption was not associated with the incidence of colorectal, colon or rectal cancer. The multivariate-adjusted hazard ratio (95% confidence interval) of colorectal cancer incidence for 3 or more cups of coffee per day as compared with no consumption was 0.95 (0.65-1.39) for men and women (p for trend = 0.55), 0.91 (0.56-1.46) for men (p for trend = 0.53) and 1.16 (0.60-2.23) for women (p for trend = 0.996). Coffee consumption was also not associated with incidence of either proximal or distal colon cancer. We conclude that coffee consumption is not associated with the incidence risk of colorectal cancer in the general population in Japan.

Lower risk of death from gastric cancer among participants of gastric cancer screening in Japan: a population-based cohort study.

OBJECTIVE: This study aimed to investigate the association between gastric cancer screening and mortality from gastric cancer. METHODS: In 1990, 47,605 Japanese subjects were recruited and completed a questionnaire about participation in gastric cancer screening and life-style. We followed up their vital status through December 2001. In this cohort, 41,394 subjects without a history of cancer were allocated to the screened group or the unscreened group according to their response to the question about gastric cancer screening. We estimated the relative risk (RR) of death from gastric cancer, death from any cause except gastric cancer, and incidence of gastric cancer with adjustment for potential confounding variables. RESULTS: The risk of death from gastric cancer among the screened group was significantly lower than that among the unscreened group. The multivariate RR of death from gastric cancer for screened individuals compared with those not screened was 0.54 (95% confidence interval [CI]: 0.38, 0.77). The RR of death from any cause except gastric cancer was 0.83 (95% CI: 0.77, 0.90), and the RR of incidence of gastric cancer was 0.94 (95% CI: 0.79, 1.13). CONCLUSION: Our data suggest that gastric cancer screening or factors associated with it may be associated with lower mortality from gastric cancer.

Alcohol consumption is associated with an increased risk of distal colon and rectal cancer in Japanese men: the Miyagi Cohort Study.

The association between alcohol consumption and the risk of cancer of the proximal or distal colon or rectum remains controversial. We examined this association in a large population-based cohort of Japanese men. In 1990, a self-administered questionnaire on alcohol drinking and other health habits was delivered to 25,279 Japanese men aged 40 to 64 years of age. After exclusion of subjects who gave incomplete responses on alcohol drinking or prevalent cancer cases at the baseline, a total of 21,199 men remained. Of these, 307 men were diagnosed as having colorectal cancer after 11 years of follow-up. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustments made for potential confounders. Compared with never drinkers, past and current drinkers had multivariate HRs of 1.1 (95% CI, 0.6-1.9) and 1.6 (95% CI, 1.1-2.2) for colorectal cancer, respectively. A dose-response relationship with current volume of alcohol drinkers was observed for cancer of the distal colon and rectum, but not for proximal colon. The multivariate HRs for distal colon and rectal cancer among current heavy drinkers (45.6 g or more ethanol per day) as compared with never drinkers were 4.2 (1.6-10.7; p for trend=0.0002) and 1.8 (1.1-3.2; p for trend=0.04), respectively. In contrast, no significant linear association was found for proximal colon cancer (p for trend=0.2). These data indicate that alcohol consumption in Japanese men is associated with a statistically significant increased risk of cancer of the distal colon and rectum, but not cancer of the proximal colon.

Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki study.

CONTEXT: Green tea polyphenols have been extensively studied as cardiovascular disease and cancer chemopreventive agents in vitro and in animal studies. However, the effects of green tea consumption in humans remain unclear. OBJECTIVE: To investigate the associations between green tea consumption and all-cause and cause-specific mortality. DESIGN, SETTING, AND PARTICIPANTS: The Ohsaki National Health Insurance Cohort Study, a population-based, prospective cohort study initiated in 1994 among 40,530 Japanese adults aged 40 to 79 years without history of stroke, coronary heart disease, or cancer at baseline. Participants were followed up for up to 11 years (1995-2005) for all-cause mortality and for up to 7 years (1995-2001) for cause-specific mortality. MAIN OUTCOME MEASURES: Mortality due to cardiovascular disease, cancer, and all causes. RESULTS: Over 11 years of follow-up (follow-up rate, 86.1%), 4209 participants died, and over 7 years of follow-up (follow-up rate, 89.6%), 892 participants died of cardiovascular disease and 1134 participants died of cancer. Green tea consumption was inversely associated with mortality due to all causes and due to cardiovascular disease. The inverse association with all-cause mortality was stronger in women (P = .03 for interaction with sex). In men, the multivariate hazard ratios of mortality due to all causes associated with different green tea consumption frequencies were 1.00 (reference) for less than 1 cup/d, 0.93 (95% confidence interval [CI], 0.83-1.05) for 1 to 2 cups/d, 0.95 (95% CI, 0.85-1.06) for 3 to 4 cups/d, and 0.88 (95% CI, 0.79-0.98) for 5 or more cups/d, respectively (P = .03 for trend). The corresponding data for women were 1.00, 0.98 (95% CI, 0.84-1.15), 0.82 (95% CI, 0.70-0.95), and 0.77 (95% CI, 0.67-0.89), respectively (P<.001 for trend). The inverse association with cardiovascular disease mortality was stronger than that with all-cause mortality. This inverse association was also stronger in women (P = .08 for interaction with sex). In women, the multivariate hazard ratios of cardiovascular disease mortality across increasing green tea consumption categories were 1.00, 0.84 (95% CI, 0.63-1.12), 0.69 (95% CI, 0.52-0.93), and 0.69 (95% CI, 0.53-0.90), respectively (P = .004 for trend). Among the types of cardiovascular disease mortality, the strongest inverse association was observed for stroke mortality. In contrast, the hazard ratios of cancer mortality were not significantly different from 1.00 in all green tea categories compared with the lowest-consumption category. CONCLUSION: Green tea consumption is associated with reduced mortality due to all causes and due to cardiovascular disease but not with reduced mortality due to cancer.

Obesity and depressive symptoms in elderly Japanese: the Tsurugaya Project.

OBJECTIVE: The aim of this study is to examine the association between obesity and depressive symptoms in Japan. METHODS: We conducted a cross-sectional study of 1128 community-dwelling elderly Japanese aged 70 years or older in 2002. We calculated the body mass index [BMI=weight (kg)/height (m)2] from measured weight and height and evaluated depressive symptoms using the 30-item Geriatric Depression Scale (GDS 30), with a cut-off point of 11. RESULTS: In men, no apparent association was observed between BMI and depressive symptoms. An inverse linear trend was observed in women overall, but stratified analysis of chronic medical conditions, such as stroke or cancer, showed an inverse association was evident only among women with the conditions. Among women without these chronic conditions, no apparent association was evident. CONCLUSION: No apparent association was observed in men overall or in apparently healthy women. An inverse trend was observed only in women with chronic medical conditions.

Factors affecting home-measured resting heart rate in the general population: the Ohasama study.

BACKGROUND: We recently demonstrated that a home-measured resting heart rate (HR) can predict cardiovascular disease mortality, and it is possible that the determinants of home HR are different from casual HR. Therefore, clarifying the determinants of home HR should be useful. METHODS: Home HR was obtained using a self-monitored blood pressure (BP) measuring device. The impact of factors including home-measured BP and lifestyle on home HR was examined in 1275 members of the general Japanese population aged > or =40 years. RESULTS: Multivariate linear regression analysis demonstrated that younger age (beta = -0.08, P < or = .01), current smoking (beta = 3.22, P < or = .01), female gender (beta = 2.07, P < or = .01), and sedentary lifestyle (walking for < or =1 h/day) (beta = 2.43, P < or = .01) were determinants of elevated morning home HR. No significant association was observed between home HR and home systolic BP, whereas casual HR was significantly and positively associated with casual systolic BP. The difference between casual and home HR was also significantly and positively associated with the difference between casual and home systolic BP, suggesting that positive association between BP and HR obtained in clinic settings would be a reflection of the so-called white-coat effect. CONCLUSIONS: We observed that, with the exception of BP, most determinants of home HR were consistent with the determinants observed in previous studies using casual HR. These results suggest that reduction of home HR through modification of smoking habit or sedentary lifestyle may have a potential to decrease cardiovascular risk in addition to decreasing in these modifiable risk factor per se.

Modifiable factors for the length of life with disability before death: mortality retrospective study in Japan.

BACKGROUND: Past studies have measured and described the length of life with disability before death, but there has been no study of the relationship between modifiable lifestyle factors and duration of disability. OBJECTIVE: To examine whether there are modifiable factors influencing the length of life with disability before death. METHODS: The study was designed as a retrospective observation of the deceased who had earlier been enrolled in a prospective cohort study. During the follow-up period (1996-1999), we documented 781 deaths among those who were 70-79 years of age at the baseline survey in 1994 (n=10,216). In 2000, we interviewed family members of the deceased about the duration of the subjects' disability before death (n=655). RESULTS: The median duration of disability before death was approximately 6 months. Both higher Body Mass Index (BMI) and shorter time spent walking were significantly associated with an increased risk of long-term disability (more than 6 months). The odds ratios of long-term disability were 1.3 in those with BMI 20-25 and 2.1 in those with BMI>25, compared with BMI<20. The odds ratios of long-term disability were 1.3 in those walking for 0.5-0.9 h/day and 1.7 in those walking for <0.5 h/day, compared with those walking for >1.0 h/day. These relationships were unchanged after stratification for causes of death. CONCLUSION: Weight control and walking in later life may shorten the length of life with disability before death.

Coffee consumption and the risk of primary liver cancer: pooled analysis of two prospective studies in Japan.

Although case-control studies suggested that coffee consumption is associated with a decreased risk of liver cancer, no prospective cohort study has been carried out. To examine the association between coffee consumption and the risk of liver cancer, we conducted a pooled analysis of data available from 2 cohort studies in Japan. A self-administered questionnaire about the frequency of coffee consumption and other health habits was distributed to 22,404 subjects (10,588 men and 11,816 women) in Cohort 1 and 38,703 subjects (18,869 men and 19,834 women) in Cohort 2, aged 40 years or more, with no previous history of cancer. We identified 70 and 47 cases of liver cancer among the subjects in Cohort 1 (9 years of follow-up with 170,640 person-years) and Cohort 2 (7 years of follow-up with 284,948 person-years), respectively. We used Cox proportional hazards regression analysis to estimate the relative risk (RR) and 95% confidence interval (CI) of liver cancer incidence. After adjustment for potential confounders, the pooled RR (95% CI) of drinking coffee never, occasionally and 1 or more cups/day were 1.00 (Reference), 0.71 (0.46-1.09) and 0.58 (0.36-0.96), respectively (p for trend = 0.024). In the subgroup of subjects with a history of liver disease, we found a significant inverse association between coffee consumption and the risk of liver cancer. Our findings support the hypothesis that coffee consumption decreases the risk of liver cancer. Further studies to investigate the role of coffee in prevention of liver cancer among the high-risk population are needed.

Impact of alcohol consumption upon medical care utilization and costs in men: 4-year observation of National Health Insurance beneficiaries in Japan.

AIMS: The purpose of the present study was to examine the association between alcohol consumption and in-patient and out-patient care utilization and its costs, respectively. DESIGN AND PARTICIPANTS: The present data were derived from a 4-year prospective observation of National Health Insurance beneficiaries in rural Japan. A total of 17 497 men aged 40-79 years were analysed, after excluding subjects who at the baseline reported having had at least one of four chronic diseases: stroke, myocardial infarction, liver disease and cancer. Alcohol intake was classified into five groups, not including ex-drinkers: life-long abstainers and ethanol intakes of 1-149 g/week, 150-299 g/week, 300-449 g/week, and > or = 450 g/week. FINDINGS: The hospital days and in-patient care cost showed a U-shaped relationship with alcohol consumption. In-patient cost was highest for those consuming more than 450 g/week [ pound 74.96, 95% confidence interval (CI): 54.39, 95.52] and for life-long abstainers ( pound 69.16, 95% CI: 62.08, 77.83), and lowest for those consuming 150-299 g/week ( pound 51.69, 95% CI: 45.33, 58.04). In-patient use by age specific analysis also showed a U-shape at all ages, and was lowest for those consuming 1-149 g/week in youngest age group. In contrast, the number of physician visits and out-patient cost showed an inverse linear relationships with alcohol consumption. CONCLUSIONS: This study suggests that in-patient use shows a U-shaped curve and out-patient use shows an inverse linear relationship to alcohol consumption.

Obesity and risk of cancer in Japan.

We conducted a population-based prospective cohort study in Japan to examine the relationship between body mass index (BMI) and the risk of incidence of any cancer and of cancer at individual sites. Body mass index was calculated from self-administered body weight and height at baseline. Relative risks (RR) and 95% confidence intervals (CI) were calculated in multivariate proportional-hazards models. Among 27,539 persons (15,054 women and 12,485 men) aged 40 years or older who were free of cancer at enrollment in 1984, 1,672 (668 women and 1,004 men) developed cancer during 9 years of follow-up. In women, after adjustment for potential confounders, the RR of all cancers associated with different BMI, relative to a BMI of 18.5-24.9, were 1.04 (95% CI = 0.85-1.27) for BMI = 25.0-27.4, 1.29 (1.00-1.68) for BMI = 27.5-29.9 and 1.47 (1.06-2.05) for BMI >/=30.0 (p for trend = 0.007). Higher BMI was also significantly associated with higher risk of cancers of the colorectum, breast (postmenopausal), endometrium and gallbladder in women. In men, we observed significantly increased all-cancer risk among only never-smokers. Overweight and obesity could account for 4.5% (all subjects) or 6.2% (never-smokers) of the risk of any cancer in women and -0.2% (all subjects) or 3.7% (never-smokers) in men. The value for women was within the range among women reported from Western populations (3.2%-8.8%). Our data demonstrate that excess weight is a major cancer risk among Japanese women.

Joint impact of health risks on health care charges: 7-year follow-up of National Health Insurance beneficiaries in Japan (the Ohsaki Study).

BACKGROUND: The objective of this study was to examine the joint impact of modifiable health-risk factors such as smoking, obesity, and physical inactivity on direct health care charges. METHOD: We conducted a population-based prospective cohort study, with follow-up from 1995 to 2001. The participants were Japanese National Health Insurance (NHI) beneficiaries (26,110 men and women aged 40-79 years). RESULTS: 'No risk' group defined as never-smoking, body mass index (BMI) 20.0-24.9 kg/m(2), and walking for >/=1 h/day had mean health care charges of 171.6 dollars after adjustment for potential confounders. Compared with this group, the presence of smoking (SM; ever-smoking) alone, obesity alone (OB; BMI >/=25.0 kg/m(2)), or physical inactivity (PI; walking for <1 h/day) alone were associated with a 8.3%, 7.1%, or 8.0% increase in health care charges, respectively. The combinations of the risks of SM and OB, SM and PI, OB and PI, and SM and OB and PI were associated with a 11.7%, 31.4%, 16.4%, and 42.6% increase in charges, respectively. CONCLUSION: Interventions to improve modifiable health-risk factors may be a cost-effective approach for reducing health care charges as well as improving people's health.

Increased plasma 8-isoprostane levels in hypertensive subjects: the Tsurugaya Project.

To examine the relationship between 8-isoprostane and blood pressure, we measured plasma 8-isoprostane concentration and home blood pressure levels in an elderly Japanese population. Our study population comprised 569 subjects aged 70 years and over who were not receiving antihypertensive medication. On the basis of their blood pressure values, the participants were classified into three groups: normotensive (home blood pressure <135/85 mmHg), hypertensive (home blood pressure 135/85-160/90 mmHg), and severely hypertensive (home blood pressure > or =160/90 mmHg). The mean plasma 8-isoprostane level in the severely hypertensive group (21.1+/-5.2 pg/ml) was significantly higher than that in the normotensive (20.2+/-4.9 pg/ml) or hypertensive (19.7+/-5.1 pg/ml) group, and this result was unchanged when we adjusted for possible confounding factors such as age, sex, use of vitamin A, C or E supplements, smoking status, drinking status, body mass index, use of non-steroidal anti-inflammatory drugs, history of diabetes, hypercholesterolemia, home heart rate and serum creatinine level. Thus, the level of plasma 8-isoprostane appears to be elevated in older subjects with severe hypertension.

[A survey regarding the implementation of cancer screening among municipalities in Japan].

OBJECTIVE: The objective of this study was to conduct a survey regarding implementation of cancer screening in all municipalities in Japan. METHODS: In February 2003, we sent out a questionnaire regarding cancer screening to all 3,242 municipalities in Japan. RESULTS: A total of 2,342 municipalities (72.2%) completed and returned the questionnaire. In the year 2002, the percentages of municipalities which implemented each cancer screening were 49.4% for breast cancer using mammography, 33.7% for prostate cancer, 20.3% for cervical cancer for women younger than 30 years old, 5.7% for lung cancer using helical CT, 5.0% for gastric cancer using the PG method and 4.8% for ovarian cancer. CONCLUSIONS: Screening for breast cancer using mammography, as recommended by the 4-th plan for Health Services for the Aged, was implemented by less than half of the municipalities. Parameters, including eligible age group, target group, and method, widely differed among the municipalities. A standardized system for cancer screening programs should be recommended.