Fruit and Vegetable Intake and Risk of Disabling Dementia: Japan Public Health Center Disabling Dementia Study.

BACKGROUND: Fruits and vegetables contain abundant amounts of antioxidant vitamins such as vitamin C, α-carotene, and ß-carotene. Few prospective observational studies have investigated the effects of fruit and vegetable intake on the risk of dementia, and the results are inconsistent. OBJECTIVES: Our aim was to examine associations between fruit and vegetable intake and the risk of disabling dementia. METHODS: We conducted a follow-up survey within the Japan Public Health Center-based Prospective Study involving 42,643 individuals aged 50-79 y at baseline (2000-2003). Dietary fruit and vegetable intakes and related antioxidant vitamin intakes (i.e., α-carotene, ß-carotene, and vitamin C) were determined using a food frequency questionnaire. The diagnosis of disabling dementia was made based on the daily living disability status related to dementia under the Japanese long-term care insurance program from 2006 to 2016. Hazard ratios and 95% confidence intervals for disabling dementia were estimated using area-stratified Cox proportional hazard models adjusted for potential confounding factors. RESULTS: A total of 4990 cases of disabling dementia were recorded. We observed an inverse association between total fruit and vegetable intake and the risk of dementia among males and females: the multivariate hazard ratios (95% confidence intervals) for the highest compared with lowest quartiles of intake were 0.87 (0.76, 0.99) (P- trend = 0.05) among males and 0.85 (0.76, 0.94) (P- trend = 0.006) among females. Among antioxidant vitamins, vitamin C intake was inversely associated with the risk of dementia among males and females: the multivariate hazard ratios (95% confidence intervals) for the highest compared with lowest quartiles of intake were 0.71 (0.61, 0.84) (P- trend < 0.001) among males, and 0.76 (0.67, 0.86) (P- trend < 0.001) among females. CONCLUSIONS: Fruit and vegetable intake and dietary intake of vitamin C may contribute to reducing the risk of disabling dementia among males and females.

Medical and exercise consultation use for low back and knee pain among cardiovascular mass screening population: A cross-sectional study.

Low back and knee pain, as major symptoms and early signs of osteoarthritis, have restricted healthy life expectancy, and numerous guidelines have recommended therapeutic exercise as the first-line treatment for chronic pain. Proportions of medical and exercise consultation use for those pain have been unclear, and these may change in the future. We performed a cross-sectional study of 2,954 persons aged over 30 years in 2017 as a part of the Circulatory Risk in Communities Study. A generalized linear model with logit link and 11-year age-group moving averages were used to estimate sex- and age-specific average proportions of lifetime pain, chronic pain, and dysfunctional chronic pain of the low back and knee, and history of medical and exercise consultation use. The medical consultation use increased in the order of lifetime pain, chronic pain, and dysfunctional chronic pain, reaching 69.1 % [65.2, 72.8] in women and 74.9 % [70.3, 79.0] in men for chronic low back pain, and 70.3 % [66.1, 74.2] in women and 55.6 % [49.3, 61.7] in men for chronic knee pain. On the other hand, the exercise consultation use accounted for 36.5 % [32.6, 40.6] in women and 28.8 % [24.4, 33.5] in men for chronic low back pain, and 40.8 % [36.5, 45.2] in women and 20.6 % [16.0, 26.0] in men for chronic knee pain. This survey revealed the differences in the multilayer proportions of medical and exercise consultation use for low back and knee pain in the cardiovascular mass screening, suggesting exercise consultation was less often provided compared to medical consultation.

Sleep duration, its change, and risk of dementia among Japanese: The Japan Public Health Center-based Prospective Study.

OBJECTIVE: Previous findings on the association between sleep duration, changes in sleep duration, and long-term dementia risk were mixed. Thus, we aimed to investigate the association between midlife sleep duration, its change, and dementia. METHODS: We recruited 41,731 Japanese (40-71 years) and documented their habitual sleep duration at baseline (1990-1994) and a 5-year follow-up survey. Changes in sleep duration were calculated as differences between baseline and 5-year measurements. We identified dementia using the Long-Term Care Insurance system (2007-2016). Hazard ratios (HRs) and 95% confidence intervals (CIs) of dementia were calculated using the area-stratified Cox model. RESULTS: During 360,389 person-years, 4621 participants exhibited dementia. The multivariable HRs of dementia compared with 7 h of sleep were 1.13 (95% CI: 0.98-1.30) for 3-5 h, 0.93 (0.85-1.02) for 6 h, 1.06 (0.99-1.14) for 8 h, 1.13 (1.01-1.27) for 9 h, and 1.40 (1.21-1.63) for 10-12 h with a J-shaped fashion (p for linear < 0.001 and quadratic < 0.001). For its change, the HRs compared with no change were 1.02 (0.90-1.16) for decreased ≥2 h, 0.95 (0.88-1.03) for decreased 1 h, 1.00 (0.91-1.09) for increased 1 h, and 1.37 (1.20-1.58) for increased ≥2 h. The positive association for decreased sleep duration was observed in individuals with an initial sleep duration of ≤7 h, but not in those with ≥8 h (p for interaction = 0.007). CONCLUSIONS: Long and increased sleep duration was associated with a higher risk of dementia.

Relation between a history of glaucoma and subjective happiness: the JPHC-Next study.

OBJECTIVE: This population-based, cross-sectional study was performed to investigate the relationship between a history of glaucoma and subjective happiness. METHODS AND ANALYSIS: We conducted a cross-sectional questionnaire-based survey of 92 397 Japanese men and women aged 40-74 who participated in the Japan Public Health Center-based Prospective Study for the Next Generation study. A multivariable logistic regression model was used to estimate the ORs of glaucoma associated with subjective happiness and their two-sided 95% CIs. RESULTS: Among 40 727 men and 51 670 women, 1733 participants (635 men, 1098 women) had a history of glaucoma. The odds of unhappiness in male participants with a history of glaucoma were higher (OR 1.26; 95% CI 1.05 to 1.51) than in female participants (OR 1.05; 95% CI 0.90 to 1.23). In a subgroup analysis stratified by age, among participants with a history of glaucoma, males in the younger group (40-59 years) showed the most robust association with unhappiness (OR 1.40; 95% CI 1.04 to 1.88). CONCLUSIONS: These findings suggest that a history of glaucoma is related with subjective unhappiness, especially in men.

Mushroom intake and risk of incident disabling dementia: the Circulatory Risk in Communities Study (CIRCS).

It is uncertain whether dietary intake of mushrooms rich in dietary fibre and several antioxidants is associated with a lower risk of dementia. We sought to examine prospectively the association between mushroom intake and the risk of disabling dementia. We performed a prospective study involving 3750 people aged 40 to 64 years residing in three communities who participated in an annual cardiovascular risk survey from 1985 to 1999. Cases of incident disabling dementia were surveyed from 1999 to 2020. We calculated the hazard ratios (HR) and 95 % CI for incident total dementia according to mushroom intake among participants with or without a history of stroke. During a mean 16·0 years' follow-up in 3739 eligible participants, 670 people developed disabling dementia. For women, mushroom intake was inversely associated with the risk of total dementia and the association was confined to dementia without a history of stroke. The multivariable HR (95 % CI) for total dementia in women were 0·81 (0·62, 1·06) for mushroom intake of 0·1-14·9 g/d and 0·56 (0·42, 0·75) for mushroom intake above 15·0 g/d (Pfor trend = 0·003) compared with no intake. The corresponding HR (95 % CI) for dementia without a history of stroke were 0·66 (0·47, 0·93) and 0·55 (0·38, 0·79) (Pfor trend = 0·01). In men, no associations were observed between mushroom intake and the risk of disabling dementia. Among Japanese women, dietary mushroom intake was associated with a lower risk of disabling dementia.

Validity of self-reported Helicobacter pylori eradication treatment from questionnaire and interview surveys of the JPHC-NEXT study: comparison with prescription history from insurance claims data.

BACKGROUND: We aimed to evaluate the validity of self-administered questionnaire surveys and face-to-face interview surveys for the detection of Helicobacter pylori eradication therapy. METHODS: Participants were a cohort, aged 40-74 years, living in three different locations of Japan, who took part in the baseline survey (2011-2012) of the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT). Five years after the baseline survey, a questionnaire and interview survey were independently conducted to determine the history of Helicobacter pylori eradication treatment over the 5-year period. Prescription of Helicobacter pylori eradication medications in national insurance claims data from the baseline survey to the 5-year survey was used as a reference standard. RESULTS: In total, 15,760 questionnaire surveys and 8,006 interview surveys were included in the analysis. There were 3,471 respondents to the questionnaire and 2,398 respondents to the interview who reported having received Helicobacter pylori eradication treatment within the past five years. Comparison of the questionnaire survey to national insurance claims data showed a sensitivity of 95.1% (2213/2328), specificity of 90.6% (12174/13432), positive predictive value of 63.8% (2213/3471), negative predictive value of 99.1% (12174/12289), and Cohen's Kappa value of 0.71. Respective values of the interview survey were 94.4% (1694/1795), 88.7% (5507/6211), 70.6% (1694/2398), 98.2% (5507/5608), and 0.74. CONCLUSION: Both the questionnaire and the interview showed high sensitivity, high specificity, and good agreement with the insurance claim prescriptions data. Some participants may have received eradication treatment without going through the public insurance claim database, resulting in a low positive predictive value.

Role of Polyunsaturated Fat in Modifying Cardiovascular Risk Associated With Family History of Cardiovascular Disease: Pooled De Novo Results From 15 Observational Studies.

BACKGROUND: It is unknown whether dietary intake of polyunsaturated fatty acids (PUFA) modifies the cardiovascular disease (CVD) risk associated with a family history of CVD. We assessed interactions between biomarkers of low PUFA intake and a family history in relation to long-term CVD risk in a large consortium. METHODS: Blood and tissue PUFA data from 40 885 CVD-free adults were assessed. PUFA levels ≤25th percentile were considered to reflect low intake of linoleic, alpha-linolenic, and eicosapentaenoic/docosahexaenoic acids (EPA/DHA). Family history was defined as having ≥1 first-degree relative who experienced a CVD event. Relative risks with 95% CI of CVD were estimated using Cox regression and meta-analyzed. Interactions were assessed by analyzing product terms and calculating relative excess risk due to interaction. RESULTS: After multivariable adjustments, a significant interaction between low EPA/DHA and family history was observed (product term pooled RR, 1.09 [95% CI, 1.02-1.16]; P=0.01). The pooled relative risk of CVD associated with the combined exposure to low EPA/DHA, and family history was 1.41 (95% CI, 1.30-1.54), whereas it was 1.25 (95% CI, 1.16-1.33) for family history alone and 1.06 (95% CI, 0.98-1.14) for EPA/DHA alone, compared with those with neither exposure. The relative excess risk due to interaction results indicated no interactions. CONCLUSIONS: A significant interaction between biomarkers of low EPA/DHA intake, but not the other PUFA, and a family history was observed. This novel finding might suggest a need to emphasize the benefit of consuming oily fish for individuals with a family history of CVD.

The effect of age on the relationship between body mass index and risks of incident stroke subtypes: The JPHC study.

OBJECTIVE: The associations between body mass index (BMI) and stroke subtypes, particularly intracerebral hemorrhage, have not been consistent. Such inconsistencies may be due to differences in the age at which BMI was obtained. We examined the possible age modifications in the association between BMI and stroke risk. MATERIALS AND METHODS: We followed 88,754 participants, aged 40-69 years at baseline (1990-1994), of the Japan Public Health Center-based prospective (JPHC) study for stroke incidence. BMI was obtained using self-reported body weight and height, which were categorized using the following cut-off points: 18.5, 21, 23, 25, 27.5, and 30 kg/m2. Time-dependent Cox proportional hazards models that updated BMI and covariates using 5- and 10-year questionnaire responses were used to estimate hazard ratios and 95 % confidence intervals. The analyses were stratified by age group (40-59 and ≥60 years) and the age of the individuals was updated. RESULTS: During the median follow-up period of 19 years, we documented 4,690 strokes, including 2,781 ischemic strokes and 1,358 intracerebral hemorrhages. After adjusting for sex, age, smoking, alcohol consumption, leisure-time physical activity, history of hypertension, dyslipidemia, and diabetes mellitus, we observed a positive linear association between BMI and ischemic stroke (linear trend, p < 0.001) in both age groups (interaction p>0.05). In contrast, a curvilinear association between BMI and intracerebral hemorrhage was observed in both the middle (curvilinear trend, p=0.017) and the older group (curvilinear trend, p=0.098) (interaction p>0.05). CONCLUSION: BMI and stroke associations did not vary significantly with age, although the association may differ according to subtype.

Association between birth weight and prevalence of cardiovascular disease and other lifestyle-related diseases among Japanese population: JPHC-NEXT Study.

BACKGROUND: An association between birth weight and cardiovascular disease (CVD) in adulthood has been observed in many countries; however, only a few studies have been conducted in Asian populations. METHODS: We used data from the baseline survey (2011-2016) of the Japan Public Health Center-based Prospective Study for the Next Generation Cohort, which included 114,105 participants aged 40-74 years. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were calculated from the prevalence of present and past histories of CVD and other lifestyle-related diseases, including hypertension, diabetes, hyperlipidemia, and gout, by birth weight, using Poisson regression. RESULTS: The prevalence of CVD increased with lower birth weight, with the highest prevalence among those with birth weight under 1,500 grams (males 4.6%; females 1.7%) and the lowest one among those with birth weight at or over 4,000g (males 3.7%: females 0.8%). Among 88.653 participants (41,156 males and 47,497 females) with complete data on possible confounders, birth weight under 1,500g was associated with a higher prevalence of CVD (aPR 1.76 [95%CI 1.37-2.26]), hypertension (aPR 1.29 [95%CI 1.17-1.42]), and diabetes (aPR 1.53 [95%CI 1.26-1.86]) when a birth weight of 3,000-3,999 grams was used as the reference. Weaker associations were observed for birth weight of 1500-2499 grams and 2500-2999 grams, while no significant associations were observed for birth weight at or over 4000 g. The association between birth weight and the prevalence of hyperlipidemia was less profound, and no significant association was observed between birth weight and gout. CONCLUSION: Lower birth weight was associated with a higher prevalence of CVD, hypertension, and diabetes in the Japanese population.

Body mass index, weight change in midlife, and dementia incidence: the Japan Public Health Center-based Prospective Study.

INTRODUCTION: Insufficient evidence exists on the sex-specific associations of body mass index (BMI) and weight change through midlife with dementia incidence, especially in Asian populations. METHODS: For 37,414 Japanese residents aged 40 to 59 years, BMIs at baseline (year 1990 or 1993) and 10-year follow-ups were obtained. Weight changes between baseline and 10-year follow-ups were determined. Disabling dementia incidence from 2006 to 2016 was ascertained using long-term care insurance (LTCI) certifications. Hazard ratios (HRs) were computed. RESULTS: Increased dementia risk was observed with obesity at baseline and with underweight at 10-year follow-ups. Weight loss after baseline was at greater risk than weight gain. No sex difference was observed. DISCUSSION: In both sexes, obesity in midlife increased the risk of developing dementia with increasing impacts of weight loss after midlife. A healthy body weight throughout adulthood is beneficial for dementia prevention. Highlights: Obesity in midlife is a risk factor for incident dementia.Weight loss is a bigger risk factor than weight gain in later midlife.Association of BMI and weight change in midlife with dementia does not vary by sex.

Perceived Level of Life Enjoyment and Risk of Developing Disabling Dementia: The Japan Public Health Center-Based Study.

OBJECTIVES: Life enjoyment, linked to the ability to engage pleasurably with one's environment, may be related to the risk of developing dementia. This prospective cohort study examined the association between level of life enjoyment and disabling dementia incidence among Japanese community residents. METHODS: The participants were Japanese, aged 45-74 years old at 5-years follow-up, in the Japan Public Health Center-based Study (N = 38,660). Psychological conditions and other confounding variables were identified through self-administered questionnaires. Incident disabling dementia registered based on the Japan's Long-Term Care Insurance system from 2006 to 2016. Hazard ratios [95% confidence intervals] were assessed using Cox proportional hazards models. RESULTS: Over a median follow-up period of 9.4 years, a total of 4,642 cases of disabling dementia developed. Level of life enjoyment was inversely associated with the risk of disabling dementia: the multivariable hazard ratios were 0.75 [0.67-0.84] (p < .001) and 0.68 [0.59-0.78] (p < .001) with medium and high life enjoyment, respectively, compared to low life enjoyment. Furthermore, the association between greater life enjoyment and low risk for disabling dementia was strongest in the subgroup with low-medium mental stress. In the high mental stress group, this association was evident for poststroke disabling dementia, but not for disabling dementia without a history of stroke. DISCUSSION: A higher level of life enjoyment was associated with a lower risk of disabling dementia, particularly in the low-medium mental stress group. This finding suggests the importance of having life enjoyment by managing mental stress for reducing risk of disabling dementia.

Associations between fatty acid intake and diabetic retinopathy in a Japanese population.

Residents of Chikusei City, aged 40-74 years, underwent systemic and ophthalmological screening, and participants with diabetes were included in this analysis. Dietary intake was assessed using a food frequency questionnaire and calculated as a percentage of the total energy. The presence of diabetic retinopathy (DR) was defined as Early Treatment Diabetic Retinopathy Study levels ≥ 20 in either eye. The association between dietary fatty acid intake and DR has been examined in a cross-sectional study. Among the 647 diabetic participants, 100 had DR. The mean total fat and saturated fatty acid (SFA) intakes were 22.0% and 7.3% of the total energy intake, respectively. After adjusting for potential confounders, the highest quartiles of total fat and SFA intake were positively associated with the presence of DR compared with the lowest quartiles (odds ratios (95% confidence intervals), 2.61 (1.07-6.39), p for trend = 0.025, and 2.40 (1.12-5.17), p for trend = 0.013, respectively). No significant associations were found between DR prevalence and monounsaturated or unsaturated fatty acid intake. These results suggest that a high intake of fat and SFA may affect the development of DR, even in individuals whose total fat intake is generally much lower than that of Westerners.

Self-reported eating habits and dyslipidemia in men aged 20-39 years: the Japan Environment and Children's Study.

BACKGROUND AND AIMS: Unhealthy eating behaviors, including eating fast, eating after satiety, skipping breakfast, and eating out are common among men aged 20-39 years. In this cross-sectional study, we aimed to examine the association between self-reported eating habits and the prevalence of dyslipidemia. METHODS: The participants of this study were 38,233 men aged 20-39 years, whose food consumption frequency related information was collected through a questionnaire. Dyslipidemia was defined as total cholesterol (TC) ≥190 mg/dL, fasting triglyceride (TG) ≥150 mg/dL and non-fasting TG ≥175 mg/dL, high-density lipoprotein cholesterol (HDL-C) <40 mg/dL, low-density lipoprotein cholesterol (LDL-C) ≥140 mg/dL. Odds ratios (ORs) and 95% confidence intervals were calculated relative to healthy eating habits using logistic regression, after adjustment for age, study unit, and other potential confounding factors. RESULTS: Moderate and fast speeds were associated with a higher prevalence of reduced HDL-C (by 27% and 26%, respectively) compared to slow speeds. Eating after satiety was associated with a higher prevalence of elevated TC (by 16%) and elevated TG (by 11%), elevated LDL-C (by 21%). Breakfast eating of 1-4 times/week and <1 time/week were associated with a higher prevalence of elevated TC (by 11% and 16%, respectively) and elevated LDL-C (by 21% and 38%, respectively) compared to that of ≥5 times/week. Eating out of ≥5 times/week was associated with a 13% higher prevalence of elevated TG. CONCLUSIONS: All of four unhealthy eating habits were associated with a higher prevalence of dyslipidemia in men aged 20-39 years.

Risk and population attributable fraction of stroke subtypes in Japan.

BACKGROUND: Associations of major risk factors for stroke with total and each type of stroke as well as subtypes of ischemic stroke and their population attributable fractions had not been examined comprehensively. METHODS: Participants of the Japan Public Health Center-based prospective (JPHC) Study Cohort II without histories of cardiovascular disease and cancer (n=14,797) were followed from 1993 through 2012. Associations of current smoking, hypertension, diabetes, overweight (body mass index ≥ 25 kg/m2), non-high-density lipoprotein cholesterol (non-HDLC) categories, low HDLC (< 40 mg/dL), urine protein, and history of arrhythmia were examined in a mutually-adjusted Cox regression model that included age and sex. Population attributable fraction (PAF) was estimated using the hazard ratios and the prevalence of risk factors among cases. RESULTS: Subjects with hypertension were 1.63 to 1.84 times more likely to develop any type of stroke. Diabetes, low HDLC, current smoking, overweight, urine protein, and arrhythmia were associated with risk of overall and ischemic stroke. Hypertension and urine protein were associated with risk of intracerebral hemorrhage while current smoking, hypertension, and low non-HDLC were associated with subarachnoid hemorrhage. Hypertension alone accounted for more than a quarter of stroke incidence, followed by current smoking and diabetes. High non-HDLC, current smoking, low HDLC, and overweight contributed mostly to large-artery occlusive stroke. Arrhythmia explained 13.2% of embolic stroke. Combined PAFs of all the modifiable risk factors for total, ischemic and large-artery occlusive strokes were 36.7 and 44.5% and 61.5%, respectively. CONCLUSION: Although there are differences according to the subtypes, hypertension could be regarded as the most crucial target for preventing strokes in Japan.

Serum folate and risk of disabling dementia: a community-based nested case-control study.

PURPOSE: The aim of this study was to examine associations between serum folate levels and risk of disabling dementia that required care under the national insurance (disabling dementia). METHODS: We performed a nested case-control study in a community-based cohort, the Circulatory Risk in Communities Study, involving 13,934 Japanese individuals aged 40-84 years at the baseline period of 1984-2005. Serum folate was measured in 578 cases of incident disabling dementia, and in 1,156 controls whose age (±1 years), sex, area of residence, and baseline year were matched with the cases. The diagnosis of disabling dementia was performed by attending physicians under the National Long-Term Care Insurance System in Japan. Conditional odds ratios of disabling dementia according to quintiles of serum folate were calculated using conditional logistic regression models. RESULTS: After a 20.8-year follow-up, serum folate was inversely associated with risk of disabling dementia. The respective multivariable odds ratios (95% CIs) were 0.71 (0.51-0.99), 0.76 (0.54-1.06), 0.70 (0.49-1.00), and 0.62 (0.43-0.90) for persons with the second, third, fourth, and highest quintiles of serum folate as compared with the lowest quintile (P for trend = 0.03). A similar association was observed for dementia with or without stroke. CONCLUSION: In this nested case-control study with a long follow-up, low serum folate levels were associated with an increased risk of disabling dementia among Japanese individuals.

Longitudinal trajectories of smoking status using 25 year annually-updated data and all-cause mortality followed over 30 years: A community-based prospective cohort study.

We aimed to evaluate the long-term risk of smoking for all-cause mortality according to smoking status trajectories using 25-year annually-repeated input, traced by group-based trajectory modeling with an extension to account for non-random participant attrition or truncation due to death. We examined 2682 men and 4317 women aged 40 to 59 years who participated in annual health checks for the community-based prospective cohort study, 1975-1984 enrollment in Japan. The main outcome measure was all-cause mortality (follow-up period: median 30.2 years in men and 32.2 years in women). We traced annual smoking trajectories, stratified by sex and smoking status at baseline. For smokers at baseline, we identified five trajectories in both sexes, with different patterns of smoking cessation (e.g., early quitters and lifelong smokers). We calculated HRs and 95% CI of all-cause mortality using Cox proportional hazards regression modeling adjusted for age, body mass index, alcohol intake, blood pressure category, dyslipidemia and glucose category. Compared with one-time-point-based smokers, trajectory-based lifelong smokers had an increased risk of all-cause mortality; HRs were 1.31 (95% CI, 1.18-1.46) in men and 1.26 (95% CI, 0.91-1.73) in women. Among community residents aged 40 to 59 years, 25-year-trajectory-based lifelong smokers had an approximately 30% increased risk for all-cause mortality compared to one-time-point-based smokers. Risk of all-cause mortality among smokers with earlier cessation varied materially. It is necessary to consider the trajectories of smoking status to clarify the long-term excess risk of smoking.

Childhood secondhand smoke exposure and respiratory disease mortality among never-smokers: the Japan collaborative cohort study for evaluation of cancer risk.

BACKGROUND: The main source of secondhand smoke (SHS) exposure during childhood occurs at home due to close family members who smoke. This study examined the association between childhood SHS exposure and the risk of respiratory disease mortality among non-smoking adults. METHODS: Data from 44 233 never-smoking Japanese men and women aged 40-79 years who participated in the JACC study between 1988 and 1990 were analyzed. The Cox proportional hazards model was used to calculate hazard ratios and 95% confidence intervals of respiratory disease mortality according to the number of smoking family members during childhood. Subdistribution HRs (SHRs) were calculated as a competing risk analysis. RESULTS: A total of 735 deaths from respiratory diseases were documented in a median follow-up of 19.2 years. Living with three or more smoking family members during childhood was associated with a higher risk of respiratory disease mortality in adulthood among women; multivariable SHR compared with participants with no family member smokers during childhood was 1.60 (1.01-2.54) for participants with three or more family members who smoked during their childhood. CONCLUSIONS: SHS exposure from three or more family members during childhood was associated with an increased risk of respiratory disease-related mortality in adulthood.

Television Viewing Time and All-cause and Cardiovascular Disease Mortality Among Japanese Adults with and without a History of Stroke or Myocardial Infarction.

AIMS: We examined the association between television (TV) viewing time and all-cause and cardiovascular disease (CVD) mortality among Japanese adults with and without a history of stroke or myocardial infarction (MI). METHODS: In the Japan Collaborative Cohort Study, 76,572 participants (851 stroke survivors, 1,883 MI survivors, and 73,838 persons without a history of stroke or MI), aged 40-79 years at baseline (1988-1990), completed a lifestyle, diet, and medical history questionnaire, and were followed up regarding mortality until 2009. The Cox proportional hazard model was used to calculate the multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of all-cause and CVD mortality. RESULTS: During the 19.3-year median follow-up period, 17,387 deaths were documented. TV viewing time was positively associated with all-cause and CVD mortality regardless of stroke or MI history. The multivariable-adjusted HRs of all-cause mortality with 95% CIs for TV viewing time of 3-4.9 h, 5-6.9 h, and ≥ 7 h were 1.18 (0.95-1.48), 1.12 (0.86-1.45), and 1.61 (1.12-2.32) for stroke survivors; 0.97 (0.81-1.17), 1.40 (1.12-1.76), and 1.44 (1.02-2.03) for MI survivors; and 1.00 (0.96-1.03), 1.07 (1.01-1.12), and 1.22 (1.11-1.34) for persons without a history of stroke or MI, respectively, compared with ＜3 h. CONCLUSIONS: Prolonged TV viewing time was associated with higher risks of all-cause and CVD mortality in stroke or MI survivors and in persons without a history of them. It may be recommended to reduce sedentary time for stroke or MI survivors, independent of the level of physical activity.

Total protein intake and subsequent risk of chronic kidney disease: the Circulatory Risk in Communities Study.

BACKGROUND: Whether dietary protein intake worsens renal function in the general population has been discussed but not yet determined. We aimed to examine the longitudinal association between dietary protein intake and risk of incident chronic kidney disease (CKD). METHODS: We conducted a 12-year follow-up study with 3,277 Japanese adults (1,150 men and 2,127 women) aged 40-74 years, initially free from CKD, who participated in cardiovascular risk surveys from two Japanese communities under the Circulatory Risk in Communities Study. The development of CKD was defined by the estimated glomerular filtration rate (eGFR) during the follow-up period. Protein intake was measured at baseline by using the brief-type self-administered diet history questionnaire. We estimated sex-, age-, community- and multivariate-adjusted hazard ratios (HR) for incident CKD were calculated using the Cox proportional hazards regression models according to quartiles of percentage of energy (%energy) from protein intake. RESULTS: During 26,422 person-years of follow-up, 300 participants developed CKD (137 men and 163 women). The sex-, age-, and community-adjusted HR (95% confidence interval, CI) for the highest (≥16.9%energy) versus lowest (≤13.4%energy) quartiles of total protein intake was 0.66 (0.48-0.90), p for trend = 0.007. The multivariable HR (95%CI) was 0.72 (0.52-0.99), p for trend = 0.016 after further adjustment for body mass index, smoking status, alcohol drinking status, diastolic blood pressure, antihypertensive medication use, diabetes mellitus, serum total cholesterol levels, cholesterol-lowering medication use, total energy intake, and baseline eGFR. The association did not vary by sex, age, and baseline eGFR. When examining animal and vegetable protein intake separately, the respective multivariable HRs (95%CIs) were 0.77 (0.56-1.08), p for trend = 0.036, and 1.24 (0.89-1.75), p for trend = 0.270. CONCLUSIONS: Higher protein intake, more specifically animal protein intake was associated with a lower risk of CKD.

Risk Factors for Mortality From Aortic Aneurysm and Dissection: Results From a 26-Year Follow-Up of a Community-Based Population.

Background Aortic aneurysm rupture and acute aortic dissection are life-threatening conditions and represent an ever-growing public health challenge. Comprehensive epidemiologic investigations for their risk factors are scant. We aimed to investigate risk factors associated with mortality from aortic diseases through analysis of a community-based Japanese cohort. Methods and Results IPHS (Ibaraki Prefectural Health Study) comprises 95 723 participants who took part in municipal health checkups in 1993. Factors considered for analysis included age, sex, body mass index, blood pressure, serum lipids (high-density lipoprotein [HDL] cholesterol, non-HDL cholesterol, and triglycerides), diabetes, antihypertensive and lipid-lowering drug use, and smoking and drinking habits. Cox proportional hazards models were applied to evaluate the associations between these variables and mortality from aortic diseases. During the median 26-year follow-up, 190 participants died of aortic aneurysm rupture, and 188 died of aortic dissection. An increased multivariable hazard ratio (HR) for mortality from total aortic diseases was observed for high systolic blood pressure (1.61 [1.00-2.59]), diastolic blood pressure (2.95 [1.95-4.48]), high non-HDL cholesterol (1.63 [1.19-2.24]), low HDL cholesterol (1.86 [1.29-2.68]), and heavy (>20 cigarettes/day) smoking habit (2.46 [1.66-3.63]). A lower multivariable HR was observed for diabetes (0.50 [0.28-0.89]). Conclusions Smoking habit, higher systolic blood pressure and diastolic blood pressure levels, higher non-HDL, and lower HDL cholesterol levels were positively associated with mortality from total aortic diseases, whereas diabetes was inversely associated.