Dietary patterns and colorectal cancer risk in Japan: the Ohsaki Cohort Study.

PURPOSE: To evaluate dietary patterns in relation to colorectal cancer risk in Japanese. METHODS: We prospectively assessed the association between dietary patterns among the Japanese and the risk of colorectal cancer. Dietary information was collected from 44,097 Japanese men and women aged 40-79 years without a history of cancer at the baseline in 1994. RESULTS: During 11 years of follow-up, we documented 854 cases of colorectal cancer, which included 554 cases of colon cancer and 323 cases of rectal cancer. Factor analysis (principal component analysis) based on a validated food frequency questionnaire identified three dietary patterns: (1) a Japanese dietary pattern, (2) an "animal food" dietary pattern, and (3) a high-dairy, high-fruit-and-vegetable, low-alcohol (DFA) dietary pattern. After adjustment for potential confounders, the DFA pattern was inversely associated with the risk of colorectal cancer (hazard ratio of the highest quartile vs the lowest, 0.76; 95 % confidence interval 0.60-0.97; p for trend = 0.02). When colon and rectal cancers were separated, the inverse association between the DFA pattern and cancer risk was observed for rectal cancer (p for trend = 0.003), but not for colon cancer (p for trend = 0.43). No apparent association was observed for either the Japanese dietary pattern or the "animal food" dietary pattern. CONCLUSIONS: The DFA dietary pattern was found to be inversely associated with the risk of colorectal cancer. This association was observed for rectal cancer, but not for colon cancer.

Relationships between changes in time spent walking since middle age and incident functional disability.

OBJECTIVE: To examine the relationship between changes in time spent walking since middle age and incident functional disability. METHOD: In 2006, we conducted a prospective cohort study of 7177 disability-free Japanese individuals aged ≥65years who lived in Ohsaki City, Miyagi Prefecture, Japan. Participants were categorized into four groups according to changes in time spent walking based on two questionnaire surveys conducted in 1994 and in 2006. Incident functional disability was retrieved from the public Long-term Care Insurance database, and the subjects were followed up for 5years. The Cox proportional hazards model was used to investigate the association between changes in time spent walking and the risk of incident functional disability. RESULTS: Compared with subjects who remained sedentary, the multivariate-adjusted hazard ratios (95% confidence intervals) were 0.69 (0.49-0.98) among those who became active and 0.64 (0.50-0.82) among those who remained active. These results did not alter when analyses were stratified by gender, age and motor function status. CONCLUSION: An increase in time spent walking among sedentary adults is significantly associated with a lower risk of incident functional disability.

Impact of weight change since age 20 and cardiovascular disease mortality risk: the Ohsaki Cohort Study.

BACKGROUND: It is unclear whether weight change since young adulthood affects the risk of mortality due to cardiovascular disease (CVD). The aim of this study was to investigate weight change since age 20 in relation to the risk of CVD mortality. METHODS AND RESULTS: A total of 41,364 eligible Japanese men and women aged 40-79 years participated in the Ohsaki Cohort Study baseline survey in 1994. Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD mortality were calculated according to weight change since age 20 (loss ≥ 10.0 kg; loss 5.0-9.9 kg; stable [± 4.9 kg]; gain 5.0-9.9 kg; gain ≥ 10.0 kg). During 13.3 years of follow-up, 1,756 participants died of CVD. The association between weight change and CVD mortality was L-shaped in men and U-shaped in women; the multivariate HR (95% CI) for men with weight loss ≥ 10.0 kg was 1.52 (1.25-1.85), and that for women with weight loss ≥ 10.0 kg and weight gain ≥ 10.0 kg was 1.62 (1.25-2.11) and 1.36 (1.09-1.69), respectively. Cross-classification analysis based on body mass index (BMI) at age 20 and weight change tended to be U-shaped, except for men whose BMI had been <25 kg/m(2) at age 20, in which case it was L-shaped. CONCLUSIONS: Weight loss since young adulthood is associated with excess risk of mortality due to CVD in men, while a U-shaped relationship was observed for women.

Association between the disability prevention program "Secondary Preventive Services" and disability incidence among the elderly population: A nationwide longitudinal comparison of Japanese municipalities.

AIM: The aim of the present ecological study was to evaluate the relationship between the rate of participation in Secondary Preventive Services (SPS) and the incidence of disability in Japanese municipalities. METHODS: We used the national statistics data for Long-term Care Insurance (LTCI), because all Japanese people aged ≥65 years are eligible for LTCI services depending on their functional status assessed by a national uniform standard in all municipalities. The disability incidence rate for the 2-year period in 2009-2010 was compared among five different levels of SPS participation in 2006-2008. The primary outcome was the sum total disability incidence rate in LTCI from 2009 to 2010. The outcome was divided according to disability level into three patterns: "all levels (Support Level 1 - Care Level 5)", "mild disability (Care Level ≤1)" and "moderate to severe disability (Care Level ≥2)". RESULTS: There was a significant inverse association between the SPS participation rate and disability incidence rate. Among 1541 municipalities, those in the highest SPS participation rate quintile (≥9.79 per 1000 elderly population) had a lower disability incidence rate for all levels than those in the lowest quintile (<1.86 per 1000 elderly population; absolute rate difference 0.6%; age-adjusted incident rate ratio 0.94; 95% CI 0.89-0.99). This inverse association was observed for mild disability and not for moderate to severe disability. CONCLUSIONS: Municipalities with a higher SPS participation rate have a lower incidence rate of mild disability. SPS could be an effective health policy for containing mild disability incidence among the elderly.

Dietary patterns and incident functional disability in elderly Japanese: the Ohsaki Cohort 2006 study.

BACKGROUND: To date, little is known about the association between dietary pattern and disability in older adults. The present prospective cohort study investigated the association between dietary patterns and incident functional disability. METHODS: Information on food consumption and other lifestyle factors was collected from Japanese older persons aged ≥65 years via a questionnaire. Three dietary patterns (Japanese pattern, animal food pattern, and high dairy pattern) were derived using principal component analysis of the consumption of 39 food and beverage items. Data on functional disability were retrieved from the public Long-term Care Insurance database, in which participants were followed up for 5 years. The Cox model was used to estimate the multivariate-adjusted hazard ratios of incident functional disability. RESULTS: Among 14,260 participants, the 5-year incidence of functional disability was 16.6%. The Japanese pattern score was associated with a lower risk of incident functional disability (hazard ratio of the highest quartile vs the lowest, 0.77; 95% confidence interval: 0.68-0.88; p trend <.001). An animal food pattern and a high dairy pattern tended to have a higher risk of incident functional disability, but not to a significant degree. CONCLUSIONS: In Japanese older persons, the Japanese dietary pattern is associated with a decreased risk of incident functional disability.

Comparative characterization of stromal vascular cells derived from three types of vascular wall and adipose tissue.

Multipotent stem/progenitor cells localize perivascularly in many organs and vessel walls. These tissue-resident stem/progenitor cells differentiate into vascular endothelial cells, pericytes, and other mesenchymal lineages, and participate in physiological maintenance and repair of vasculatures. In this study, we characterized stromal vascular cells obtained through the explant culture method from three different vessel walls in humans: arterial wall (ART; >500 µm in diameter), venous wall (VN; >500 µm in diameter), and small vessels in adipose tissue (SV; arterioles and venules, <100 µm in diameter). These were examined for functionality and compared with adipose-derived stem/stromal cells (ASCs). All stromal vascular cells of different origins presented fibroblast-like morphology and we could not visually discriminate one population from another. Flow cytometry showed that the cultured population heterogeneously expressed a variety of surface antigens associated with stem/progenitor cells, but CD105 was expressed by most cells in all groups, suggesting that the cells generally shared the characteristics of mesenchymal stem cells. Our histological and flow cytometric data suggested that the main population of vessel wall-derived stromal vascular cells were CD34(+)/CD31(-) and came from the tunica adventitia and areola tissue surrounding the adventitia. CD271 (p75NTR) was expressed by the vasa vasorum in the VN adventitia and by a limited population in the adventitia of SV. All three populations differentiated into multiple lineages as did ASCs. ART cells induced the largest quantity of calcium formation in the osteogenic medium, whereas ASCs showed the greatest adipogenic differentiation. SV and VN stromal cells had greater potency for network formation than did ART stromal cells. In conclusion, the three stromal vascular populations exhibited differential functional properties. Our results have clinical implications for vascular diseases such as arterial wall calcification and possible applications to regenerative therapies involving each vessel wall-resident stromal population.

Performance of European system for cardiac operative risk evaluation in Veterans General Hospital Kaohsiung cardiac surgery.

BACKGROUND: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) model is a widely-used risk prediction algorithm for in-hospital or 30-day mortality in adult cardiac surgery patients. Recent studies indicated that EuroSCORE tends to overpredict mortality. The aim of our study is to evaluate the validity of EuroSCORE in Veterans General Hospital Kaohsiung (VGHKS) cardiac surgery including a number of different surgical and risk subgroups. METHODS: From January 2006 to December 2009, 1,240 adult patients who underwent cardiac surgery in VGHKS were included in this study. The study was followed the guidelines of the Ethics Committee of Kaohsiung Veterans General Hospital, Taiwan. Both additive and logistic score of all patients were calculated depending on the formula in the official EuroSCORE website. The entire cohort, different surgical type and risk stratification subgroups were analyzed. Model discrimination was tested by determining the area under receiver operating characteristic (ROC) curve. Model calibration was tested by the Hosmer-Lemeshow chi-square test. Clinical performance of model was assessed by comparing the observed and predicted mortality rates. RESULTS: There were significant differences between the VGHKS and European cardiac surgical populations. The additive score and logistic score for the overall group were 7.16% and 12.88%, respectively. Observed mortality was 10.72% overall, 5.68% for isolated coronary artery bypass grafting (CABG), 4.67% for the mitral valve only and 4.25% for the aortic valve only group. The discriminative ability EuroSCORE was very good in all and various surgical subgroups, with area under the ROC curve from 0.75 to 0.87. The addictive and logistic models of EuroSCORE showed excellent accuracy, 0.839 and 0.845, respectively. Good calibration power was recognized by p value higher than 0.05 for the entire cohort and all subgroups of patients except for isolated CABG. The logistic EuroSCORE model overestimated mortality to different degrees in the various subgroups, indicating that the logistic EuroSCORE needs to be recalibrated by a factor about 0.55 for uncomplicated surgery and low-risk groups, and 0.85 for high-risk patients with original additive score more than six. CONCLUSION: EuroSCORE is simple and easy to use. In the present study, the model demonstrated excellent accuracy in all and various surgical subgroups in VGHKS cardiovascular surgery populations. Good calibration ability in all and different risk categories was identified except for isolated CABG group. Recalibration factors of 0.55 and 0.85 were suggested for the various operative subgroups and risk categories.