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Watanabe H, Minagawa Y, Suzuki I, Kitamura K, Watanabe Y, Kabasawa K, Platonova K, Hinata A, Nakamura K. Secular changes in bone mineral density of adult Japanese women from 1995 to 2013. Fukushima J Med Sci 2021; 67:128-134. [PMID: 34744088 PMCID: PMC8784192 DOI: 10.5387/fms.2021-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/14/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Secular changes in hip fracture incidence have been reported in the last few decades in Japan, but whether long-term bone mineral density (BMD) is also changing is unclear. This study aimed to determine whether BMD of Japanese women has changed over time. METHODS Subjects were 10,649 adult women who underwent BMD measurement in a health check-up population in Niigata, Japan, between 1995 and 2013. BMD of the distal, non-dominant forearm was measured by dual-energy X-ray absorptiometry. Demographic information and BMI were also obtained. Secular trends were determined by linear regression analysis. RESULTS BMD of subjects in their 40's decreased significantly in the age-adjusted model (P for trend=0.0162), but not in the age- and BMI-adjusted model (P for trend=0.2171). BMD of subjects in their 50's decreased marginally in the age-adjusted model (P for trend=0.0535), but not in the age- and BMI-adjusted model (P for trend=0.6601). BMDs of subjects in their 30's and 60's did not significantly change, while BMIs of subjects in their 40's-60's decreased significantly. CONCLUSIONS A secular decrease in BMD, partly attributed to decreases in BMI, was observed in middle-aged Japanese women from 1995 to 2013. Measures to help maintain suitable BMI will be necessary to prevent a decrease in BMD among women.
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Affiliation(s)
- Hiroaki Watanabe
- Department of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
- Department of Clinical Engineering and Medical Technology, Niigata University of Health and Welfare
| | | | | | - Kaori Kitamura
- Department of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Yumi Watanabe
- Department of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Keiko Kabasawa
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Kseniia Platonova
- Department of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Aya Hinata
- Department of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Kazutoshi Nakamura
- Department of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
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Yamaji T, Iwasaki M, Sawada N, Shimazu T, Inoue M, Tsugane S. Fat mass and obesity-associated gene polymorphisms, pre-diagnostic plasma adipokine levels and the risk of colorectal cancer: The Japan Public Health Center-based Prospective Study. PLoS One 2020; 15:e0229005. [PMID: 32053666 PMCID: PMC7017986 DOI: 10.1371/journal.pone.0229005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/28/2020] [Indexed: 12/27/2022] Open
Abstract
Although their functional outcomes remain largely unknown, single nucleotide polymorphisms (SNPs) in the fat mass and obesity-associated gene (FTO) may interact with adipokines, especially leptin and adiponectin, to modify the risk of colorectal cancer. We conducted a prospective study of 375 colorectal cancer cases and 750 matched controls to examine the effects of SNPs in the FTO, either alone or in interaction with pre-diagnostic plasma adipokine levels. Using a conditional logistic regression model, we obtained odds ratios (ORs) and their 95% confidence intervals (CIs) of colorectal cancer. Seven SNPs in strong linkage disequilibrium demonstrated a similarly positive association with colorectal cancer, and most evidently for rs1558902, rs8050136, rs3751812, and rs9939609 (Ptrend = 0.02). Of interest, we observed a statistically significant interaction of rs8050136 with plasma total adiponectin levels (Pinteraction = 0.03). Compared to non-carriers in the lowest quintile of plasma total adiponectin, A allele carriers in the same quintile showed a considerably elevated risk of colorectal cancer, with a body mass index-adjusted OR of 2.54 (95% CI, 1.36-4.75). This investigation of the interaction between SNPs in the FTO and pre-diagnostic plasma adipokine levels has revealed the importance of both genetic and hormonal factors associated with adiposity in colorectal carcinogenesis.
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Affiliation(s)
- Taiki Yamaji
- Epidemiology and Prevention Group, National Cancer Center, Tokyo, Japan
- * E-mail:
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, National Cancer Center, Tokyo, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, National Cancer Center, Tokyo, Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Group, National Cancer Center, Tokyo, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
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3
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Inoue M, Sawada N, Goto A, Shimazu T, Yamaji T, Iwasaki M, Tsugane S. High-Negative Anti–Helicobacter pylori IgG Antibody Titers and Long-Term Risk of Gastric Cancer: Results from a Large-Scale Population-Based Cohort Study in Japan. Cancer Epidemiol Biomarkers Prev 2019; 29:420-426. [DOI: 10.1158/1055-9965.epi-19-0993] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/04/2019] [Accepted: 12/03/2019] [Indexed: 01/11/2023] Open
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Effect heterogeneity and variable selection for standardizing causal effects to a target population. Eur J Epidemiol 2019; 34:1119-1129. [PMID: 31655945 DOI: 10.1007/s10654-019-00571-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 10/11/2019] [Indexed: 12/14/2022]
Abstract
The participants in randomized trials and other studies used for causal inference are often not representative of the populations seen by clinical decision-makers. To account for differences between populations, researchers may consider standardizing results to a target population. We discuss several different types of homogeneity conditions that are relevant for standardization: Homogeneity of effect measures, homogeneity of counterfactual outcome state transition parameters, and homogeneity of counterfactual distributions. Each of these conditions can be used to show that a particular standardization procedure will result in an unbiased estimate of the effect in the target population, given assumptions about the relevant scientific context. We compare and contrast the homogeneity conditions, in particular their implications for selection of covariates for standardization and their implications for how to compute the standardized causal effect in the target population. While some of the recently developed counterfactual approaches to generalizability rely upon homogeneity conditions that avoid many of the problems associated with traditional approaches, they often require adjustment for a large (and possibly unfeasible) set of covariates.
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Abe SK, Saito E, Sawada N, Tsugane S, Ito H, Lin Y, Tamakoshi A, Sado J, Kitamura Y, Sugawara Y, Tsuji I, Nagata C, Sadakane A, Shimazu T, Mizoue T, Matsuo K, Naito M, Tanaka K, Inoue M. Green tea consumption and mortality in Japanese men and women: a pooled analysis of eight population-based cohort studies in Japan. Eur J Epidemiol 2019; 34:917-926. [DOI: 10.1007/s10654-019-00545-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/27/2019] [Indexed: 12/31/2022]
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Yuwaki K, Shimazu T, Yamagiwa Y, Inoue M, Goto A, Yamaji T, Iwasaki M, Sawada N, Tsugane S. Association between serum liver enzymes and all-cause mortality: The Japan Public Health Center-based Prospective Study. Liver Int 2019; 39:1566-1576. [PMID: 30566759 DOI: 10.1111/liv.14030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND & AIMS The association of serum liver enzyme levels with all-cause mortality in individuals without hepatitis B virus or hepatitis C virus infection is inconsistent. We aimed to investigate all-cause and non-liver disease mortality according to levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) stratified by hepatitis virus infection status in a Japanese cohort. METHODS Participants were 7243 men and 13 513 women aged 40-69 years at the baseline survey in 1993-1994. Multivariate-adjusted hazard ratios of death from the baseline health check-up to December 2012 were calculated with a Cox proportional hazards model controlling for potential confounding factors. RESULTS During follow-up, 2235 deaths in men and 1901 deaths in women were identified. All serum liver enzymes were associated with all-cause mortality in each sex and hepatitis virus infection status. In participants without infection, those with more than twice the upper level of normal (ULN), which was defined as 30 IU/L for AST and ALT and 50 IU/L for GGT, had a higher risk of non-liver disease mortality compared to those below the ULN (HR 1.69; 95% confidence interval 1.13-2.53, 1.49; 1.02-2.18, 1.39; 1.11-1.73, 1.72; 1.08-2.74 and 1.72; 1.10-2.69 for AST, ALT, and GGT in men and AST and GGT in women, respectively), except for ALT in women. CONCLUSIONS In participants without hepatitis virus infection, serum liver enzyme levels were positively associated with all-cause mortality. Similar associations were also found for non-liver disease mortality.
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Affiliation(s)
- Keiichi Yuwaki
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Underwriting and Medical Department, The Dai-ichi Life Insurance Company, Limited, Tokyo, Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Yoko Yamagiwa
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Atsushi Goto
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
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Ikeda A, Iso H, Yamagishi K, Iwasaki M, Yamaji T, Miura T, Sawada N, Inoue M, Tsugane S. Plasma tea catechins and risk of cardiovascular disease in middle-aged Japanese subjects: The JPHC study. Atherosclerosis 2018; 277:90-97. [PMID: 30176569 DOI: 10.1016/j.atherosclerosis.2018.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/03/2018] [Accepted: 08/16/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Although a potential benefit of drinking green tea has been suggested to reduce the development of cardiovascular disease, no study has investigated the relationship between plasma tea catechin and risk of cardiovascular disease. METHODS A prospective, nested case-control study was conducted to examine the association between plasma tea catechin and risk of stroke and coronary heart disease (CHD) in a cohort of 29,876 men and women aged 40-69 years without history of heart disease, stroke or cancer. Participants completed a survey and donated blood samples between 1990 and 1994, and were followed-up through 2008. A total of 1132 stroke cases and 209 CHD cases, matched 1:1 to controls (n = 1132) for stroke and 1:2 to controls (n = 418) for CHD, were included in the analysis. RESULTS We found no significant association between plasma tea catechin and the incidence of stroke or CHD in either men or women. However, we found that high plasma levels of epigallocatechin gallate (EGCG) were associated with reduced risk of stroke in non-smoking men; the adjusted odds ratio (95% CI) for the highest vs. non-detectable levels was 0.53 (0.29-0.98). The respective OR in male smokers was 1.23 (0.75-2.16). A significant interaction by smoking status was found for the highest vs. non-detected plasma EGCG in relation to stroke (p-for-interaction: p = 0.09). CONCLUSIONS Plasma tea catechin was not associated with reduced risks of either stroke or CHD, while a protective effect of certain tea catechin on stroke risk is suggested for male non-smokers.
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Affiliation(s)
- Ai Ikeda
- Department of Public Health, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Tsutomu Miura
- Department of Health and Nutrition, Faculty of Human Life Studies, Jin-ai University, Fukui, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
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An Out-of-Pocket Cost Removal Intervention on Fecal Occult Blood Test Attendance. Am J Prev Med 2017; 53:e51-e62. [PMID: 28236518 DOI: 10.1016/j.amepre.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/14/2016] [Accepted: 01/05/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To date, no comparative study has assessed the impact of a cost-removal intervention on fecal occult blood testing (FOBT). In 2012, the Japanese government introduced a nationwide project to remove out-of-pocket costs for FOBT. The study objective was to evaluate the differential impact of the intervention on FOBT attendance in the total population and various subgroups. METHODS This study analyzed 309,103 people in national, repeated cross-sectional studies, observed pre- and post-intervention (2010 and 2013), using covariate-adjusted difference-in-differences estimates to compare intervention and no-intervention groups. The outcome measure was uptake of FOBT attendance resulting from the intervention. Stratified analyses were conducted according to sociodemographic and health-related characteristics. RESULTS The intervention was associated with significantly positive uptake of FOBT in both genders, but the impact was greater in women than men: 6.7% (95% CI=5.2, 8.1) for women and 2.7% (95% CI=1.1, 4.3) for men in the covariate-adjusted models. Post-intervention, attendance increased in almost all subgroups in women. However, among men, some socially advantaged subgroups, such as high expenditure, high education, and public officers, showed no effect. Some subgroups such as current smokers and less than high school education were identified as hard-to-reach populations that may be less sensitive to the intervention, irrespective of gender. CONCLUSIONS This is the first comparative study of cost-removal intervention for uptake of FOBT. The intervention may increase FOBT attendance. However, the size of the effect is not great, especially in men, and differential effects occurred across subgroups including gender and socioeconomic differences.
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Flather M, Delahunty N, Collinson J. Generalizing results of randomized trials to clinical practice: reliability and cautions. Clin Trials 2016; 3:508-12. [PMID: 17170034 DOI: 10.1177/1740774506073464] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BackgroundWell designed randomized controlled trials provide reliable evidence of treatment effects, but there is no consensus on how best to apply these results to clinical practice. The main concerns are that populations enrolled in trials are more selected than those treated in a clinical setting, and whether the treatment effects observed in trials will also be observed in clinical practice. MethodsAn informal literature review was undertaken to find studies analysing the issue of generalizing trial results (external validity) to clinical practice. ResultsMost of the studies focused on differences in patients characteristics (age, gender, severity of disease, concomitant treatments and so on) between the clinical trial population and a ‘real world’ clinical population. None provided good evidence of a reduction in the treatment effect in the trial compared to what might happen in clinical practice for simple pharmacological treatments. However complex treatments like surgery or percutaneous interventional procedures, had a greater potential for variation. Extrapolating treatments to different health care settings from the trial can result in important variations in treatment effects. ConclusionsComplex therapies need careful consideration before they can be applied routinely from trials into practice, and applying results from one health care environment to a different one should be carried out with caution. Generalizing results from well conducted trials to clinical practice can mostly be carried out with confidence, especially for simple therapies with good evidence of benefit.
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Affiliation(s)
- Marcus Flather
- Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London, UK.
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Charvat H, Sasazuki S, Inoue M, Iwasaki M, Sawada N, Shimazu T, Yamaji T, Tsugane S. Prediction of the 10-year probability of gastric cancer occurrence in the Japanese population: the JPHC study cohort II. Int J Cancer 2015. [PMID: 26219435 DOI: 10.1002/ijc.29705] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Gastric cancer is a particularly important issue in Japan, where incidence rates are among the highest observed. In this work, we provide a risk prediction model allowing the estimation of the 10-year cumulative probability of gastric cancer occurrence. The study population consisted of 19,028 individuals from the Japanese Public Health Center cohort II who were followed-up from 1993 to 2009. A parametric survival model was used to assess the impact on the probability of gastric cancer of clinical and lifestyle-related risk factors in combination with serum anti-Helicobacter pylori antibody titres and pepsinogen I and pepsinogen II levels. Based on the resulting model, cumulative probability estimates were calculated and a simple risk scoring system was developed. A total of 412 cases of gastric cancer occurred during 270,854 person-years of follow-up. The final model included (besides the biological markers) age, gender, smoking status, family history of gastric cancer and consumption of highly salted food. The developed prediction model showed good predictive performance in terms of discrimination (optimism-corrected c-index: 0.768) and calibration (Nam and d'Agostino's χ(2) test: 14.78; p values = 0.06). Estimates of the 10-year probability of gastric cancer occurrence ranged from 0.04% (0.02, 0.1) to 14.87% (8.96, 24.14) for men and from 0.03% (0.02, 0.07) to 4.91% (2.71, 8.81) for women. In conclusion, we developed a risk prediction model for gastric cancer that combines clinical and biological markers. It might prompt individuals to modify their lifestyle habits, attend regular check-up visits or participate in screening programmes.
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Affiliation(s)
- Hadrien Charvat
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Shizuka Sasazuki
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,AXA Department of Health and Human Security, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
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Iwasaki M. Commentary: Factors associated with non-participation in cohort studies emphasize the need to generalize the results with care. J Epidemiol 2015; 25:89-90. [PMID: 25721068 PMCID: PMC4310868 DOI: 10.2188/jea.je20140269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Motoki Iwasaki
- Division of Epidemiology, Research Center for Cancer Prevention and Screening, National Cancer Center
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12
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Michikawa T, Inoue M, Sawada N, Tanaka Y, Yamaji T, Iwasaki M, Shimazu T, Sasazuki S, Mizokami M, Tsugane S. Plasma isoflavones and risk of primary liver cancer in Japanese women and men with hepatitis virus infection: a nested case-control study. Cancer Epidemiol Biomarkers Prev 2014; 24:532-7. [PMID: 25542831 DOI: 10.1158/1055-9965.epi-14-1118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evidence suggests that estrogen plays a preventive role in primary liver cancer development, and it might be thought that isoflavones, which are structurally similar to estrogens and bind to estrogen receptors, are associated with the risk of liver cancer. We investigated this suspected association by measuring plasma concentrations of isoflavones in a nested case-control study of a population-based prospective cohort in Japan. METHODS From 18,628 target participants ages 40 to 69 years who returned the baseline questionnaire and provided blood samples, we selected those with either hepatitis B or hepatitis C virus infection at baseline (n = 1,544). Among these, 90 (28 women and 62 men) were newly diagnosed with primary liver cancer from 1993 through 2006; they were matched with 175 controls (54 women and 121 men). Plasma concentrations of isoflavones (genistein, daidzein, glycitein, and equol) were measured using triple quadrupole tandem liquid chromatography-mass spectrometry. The ORs of liver cancer development based on plasma concentrations were estimated with a conditional logistic regression model. RESULTS Basically, distributions of plasma isoflavone concentrations did not differ between the cases and controls. No statistically significant associations of genistein, daidzein, glycitein, and equol with primary liver cancer risk were found in either women or men. CONCLUSIONS In middle-aged Japanese women and men with hepatitis virus infection, plasma isoflavones were unassociated with the occurrence of primary liver cancer. IMPACT The role of isoflavones in liver carcinogenesis merits further study using both biomarkers and data on dietary intake of isoflavones. Cancer Epidemiol Biomarkers Prev; 24(3); 532-7. ©2014 AACR.
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Affiliation(s)
- Takehiro Michikawa
- Environmental Epidemiology Section, Center for Environmental Health Sciences, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan. Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan. Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Norie Sawada
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Yasuhito Tanaka
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Shizuka Sasazuki
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Masashi Mizokami
- The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
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Kato M, Takahashi Y, Matsushita Y, Mizoue T, Inoue M, Kadowaki T, Tsugane S, Noda M. Diabetes mellitus defined by hemoglobin A1c value: Risk characterization for incidence among Japanese subjects in the JPHC Diabetes Study. J Diabetes Investig 2014; 2:359-65. [PMID: 24843514 PMCID: PMC4019303 DOI: 10.1111/j.2040-1124.2011.00119.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
UNLABELLED Aims/Introduction: Although several risk factors for type 2 diabetes have been identified, most of them have been identified in studies on Western populations, and they should be evaluated in a Japanese population. In 2010, new diagnostic criteria for diabetes mellitus using hemoglobin A1c (HbA1c) were released and its use in epidemiological studies has many advantages. The aim of the present study was to evaluate risk factors for type 2 diabetes defined based on HbA1c values in a Japanese population. MATERIALS AND METHODS A total of 9223 subjects (3076 men and 6147 women) were followed up for 5 years. Diabetes was defined based on self-report or HbA1c value. Risk factors for diabetes were evaluated as odds ratios adjusted for potential confounding factors by logistic regression. RESULTS During the 5-year follow-up period, we documented 518 incident cases of diabetes (232 men and 286 women). Of the 518 incident cases, 310 cases were diagnosed by HbA1c alone. Among the men, age, smoking (both past smoking and current smoking) and family history of diabetes significantly increased the risk of diabetes. Among the women, body mass index, family history of diabetes and hypertension significantly increased the risk of diabetes. These results did not change markedly after adjustment for the baseline HbA1c values, and the baseline HbA1c value itself was a significant risk factor for diabetes mellitus. CONCLUSIONS Known risk factors for diabetes established in Western populations also increased the risk of diabetes in a Japanese population defined on the basis of HbA1c values. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00119.x, 2011).
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Affiliation(s)
- Masayuki Kato
- Japan Foundation for the Promotion of International Medical Research Cooperation
| | | | - Yumi Matsushita
- Department of Epidemiology and International Health, Research Institute, National Center for Global Health and Medicine
| | - Tetsuya Mizoue
- Department of Epidemiology and International Health, Research Institute, National Center for Global Health and Medicine
| | - Manami Inoue
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center
| | - Takashi Kadowaki
- Department of Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center
| | - Mitsuhiko Noda
- Department of Diabetes and Metabolic Medicine, Center Hospital
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Saida T, Fukushima W, Ohfuji S, Kondo K, Matsunaga I, Hirota Y. Effect modification of body mass index and body fat percentage on fatty liver disease in a Japanese population. J Gastroenterol Hepatol 2014; 29:128-36. [PMID: 23980616 DOI: 10.1111/jgh.12377] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM No previous study has performed multivariate analysis of the risk factors of fatty liver disease (FL), focusing on the effect of weight gain of ≥ 10 kg since the age of 20, and no analysis model exists that simultaneously evaluates body mass index (BMI) and body fat percentage (BFP) as adjustment variables. METHODS To investigate these, we collected anthropometric data from health checkups, and conducted a cross-sectional study (targeting 1851 males and 1259 females aged 30 years or over). RESULTS Regardless of sex, weight gain of ≥10 kg since the age of 20 was positively associated with FL. Our stratified analysis of BFP into two categories, to evaluate the interaction between BMI and BFP in FL, indicated an approximately fivefold increase in the odds ratio in the male group with high BMI and BFP values compared to those with low BMI and BFP values, with a synergy index of 1.77 > 1. On the other hand, females demonstrated no significant additive interaction, with a synergy index of 0.49 < 1. CONCLUSIONS We revealed that weight gain ≥ 10 kg since the age of 20 is significantly associated with FL regardless of sex. In addition, by performing a synergy index (S), we showed that the additive interaction between BMI and BFP in FL differs according to gender.
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Affiliation(s)
- Tomomi Saida
- Department of Radiology, Nishinarachuo Hospital, Nara City, Nara, Japan
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15
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Michikawa T, Inoue M, Sawada N, Sasazuki S, Tanaka Y, Iwasaki M, Shimazu T, Yamaji T, Mizokami M, Tsugane S. Plasma levels of adiponectin and primary liver cancer risk in middle-aged Japanese adults with hepatitis virus infection: a nested case-control study. Cancer Epidemiol Biomarkers Prev 2013; 22:2250-7. [PMID: 24045928 DOI: 10.1158/1055-9965.epi-13-0363] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Excess body weight is an independent risk factor for primary liver cancer, and the role of adiponectin in the pathogenesis of obesity-related malignancies is a focus of research interest. Few prospective studies have examined the association between circulating adiponectin and liver cancer risk, so we investigated this association in a nested case-control study of a population-based prospective cohort in Japan. METHODS From 18,628 target participants of ages 40 to 69 years who returned the baseline questionnaire and provided blood samples, we selected those with either hepatitis B or C virus infection at baseline (n = 1,544). Among these, 90 were newly diagnosed with primary liver cancer from 1993 through 2006, and matched to 177 controls. The ORs of liver cancer development based on plasma levels of adiponectin were estimated with a conditional logistic regression model. RESULTS Median values of total and high-molecular-weight (HMW) adiponectin tended to be higher in the patients with liver cancer, and plasma levels of adiponectin were positively associated with liver cancer risk. Body mass index- and diabetes-adjusted ORs for the highest tertile of total and HMW adiponectin levels versus the lowest were 3.30 [95% confidence interval (CI), 1.45-7.53; Ptrend < 0.01] and 3.41 (95% CI, 1.50-7.73; Ptrend < 0.01), respectively. There was no effect modification by body mass index and diabetes. CONCLUSIONS Higher plasma adiponectin levels were associated with an increased risk of primary liver cancer in middle-aged Japanese adults with hepatitis virus infection. IMPACT Circulating adiponectin levels may be a risk marker for primary liver cancer.
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Affiliation(s)
- Takehiro Michikawa
- Authors' Affiliations: Environmental Epidemiology Section, Center for Environmental Health Sciences, National Institute for Environmental Studies, Tsukuba, Ibaraki; Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center; Graduate School of Medicine, The University of Tokyo, Tokyo; Department of Virology & Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya; and The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
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Ikeda A, Iso H, Sasazuki S, Inoue M, Tsugane S. The combination of Helicobacter pylori- and cytotoxin-associated gene-A seropositivity in relation to the risk of myocardial infarction in middle-aged Japanese: The Japan Public Health Center-based study. Atherosclerosis 2013; 230:67-72. [PMID: 23958254 DOI: 10.1016/j.atherosclerosis.2013.06.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 06/04/2013] [Accepted: 06/17/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Limited evidence is available concerning the impact of the combination of Helicobacter pylori- (H. pylori) and cytotoxin-associated gene-A (CagA)-positivity on the risk of myocardial infarction (MI) and stroke, particularly in Asian populations, in which the prevalence of H. pylori infection is high. METHODS A prospective, nested case-control study was conducted to examine the association between H. pylori and CagA and risk of MI and stroke within a cohort of 29,876 men and women aged 40-69 years with no history of heart disease, stroke or cancer. Participants completed a risk factor survey and donated blood samples between 1990 and 1994. Systematic cardiovascular surveillance was performed through 2002. One control for each stroke case and two controls for each MI case were matched by sex, age, date of blood sampling, time since last meal and study location. RESULTS During the follow-up period, there were 600 strokes and 106 MIs. H. pylori-IgG positivity was not associated with the risk of MI, while CagA positivity tended to be associated with it (OR = 1.72, 95%CI: 0.91-3.26, p = 0.10). We found no association between H. pylori or CagA and risk of stroke. CONCLUSIONS H. pylori infection was not significantly associated with risk of MI and stroke among middle-aged Japanese. However, CagA positivity tended to be associated with MI.
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Affiliation(s)
- Ai Ikeda
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Chuo-ku, Tokyo, Japan
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17
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Tabuchi T, Hoshino T, Nakayama T, Ito Y, Ioka A, Miyashiro I, Tsukuma H. Does removal of out-of-pocket costs for cervical and breast cancer screening work? A quasi-experimental study to evaluate the impact on attendance, attendance inequality and average cost per uptake of a Japanese government intervention. Int J Cancer 2013; 133:972-83. [DOI: 10.1002/ijc.28095] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 01/28/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Takahiro Tabuchi
- Center for Cancer Control and Statistics; Osaka Medical Center for Cancer and Cardiovascular Diseases; Osaka; Japan
| | | | - Tomio Nakayama
- Center for Cancer Control and Statistics; Osaka Medical Center for Cancer and Cardiovascular Diseases; Osaka; Japan
| | - Yuri Ito
- Center for Cancer Control and Statistics; Osaka Medical Center for Cancer and Cardiovascular Diseases; Osaka; Japan
| | - Akiko Ioka
- Center for Cancer Control and Statistics; Osaka Medical Center for Cancer and Cardiovascular Diseases; Osaka; Japan
| | - Isao Miyashiro
- Center for Cancer Control and Statistics; Osaka Medical Center for Cancer and Cardiovascular Diseases; Osaka; Japan
| | - Hideaki Tsukuma
- Center for Cancer Control and Statistics; Osaka Medical Center for Cancer and Cardiovascular Diseases; Osaka; Japan
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Iso H, Noda H, Ikeda A, Yamagishi K, Inoue M, Iwasaki M, Tsugane S. The Impact of C-Reactive Protein on Risk of Stroke, Stroke Subtypes, and Ischemic Heart Disease in Middle-Aged Japanese: the Japan Public Health Center-Based Study. J Atheroscler Thromb 2012. [DOI: 10.5551/jat.11999] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Driscoll T. Epidemiological aspects of studying work-related musculoskeletal disorders. Best Pract Res Clin Rheumatol 2011; 25:3-13. [DOI: 10.1016/j.berh.2011.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Sawada N, Iwasaki M, Inoue M, Sasazuki S, Yamaji T, Shimazu T, Tsugane S. Plasma testosterone and sex hormone-binding globulin concentrations and the risk of prostate cancer among Japanese men: a nested case-control study. Cancer Sci 2010; 101:2652-7. [PMID: 20942896 PMCID: PMC11158937 DOI: 10.1111/j.1349-7006.2010.01721.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Sex hormones, particularly androgens, have been implicated in prostate carcinogenesis. Overall, however, prospective studies have reported no association between circulating levels of sex hormones and the risk of prostate cancer. However, despite the possible difference in the effects of hormones on prostate cancer risk by stage, age, body mass index (BMI) and isoflavones, evidence for these is sparse. Moreover, few studies have been conducted in Asian populations, who are relatively lean and have high isoflavone consumption. We examined the hypothesis that plasma concentrations of circulating testosterone and sex hormone-binding globulin (SHBG) are associated with the risk of prostate cancer in a case-control study nested in the Japan Public Health Center-based Prospective Study. Concentrations of total testosterone and SHBG were measured in plasma samples from 201 patients with prostate cancer and 402 matched control participants, and concentrations of free testosterone were calculated. No overall association between the plasma levels of any hormone and total prostate cancer was observed. Odds ratios (95% confidence interval [CI]) in the highest versus lowest group were 0.71 (95% CI = 0.36-1.41, Ptrend = 0.43) for total testosterone, 0.70 (95% CI = 0.39-1.27, Ptrend = 0.08) for free testosterone and 1.38 (95% CI = 0.69-2.77, Ptrend = 0.23) for SHBG. When stratified by cancer stage, age, BMI and plasma isoflavone level, free testosterone was inversely associated with localized cancers and equol producers, while SHBG was associated with an increased risk of prostate cancer in younger men. In conclusion, in this nested case-control study, concentrations of circulating total testosterone, free testosterone or SHBG were not strongly associated with a risk for total prostate cancer.
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Affiliation(s)
- Norie Sawada
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.
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21
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Participation in health check-ups and mortality using propensity score matched cohort analyses. Prev Med 2010; 51:397-402. [PMID: 20828583 DOI: 10.1016/j.ypmed.2010.08.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 08/24/2010] [Accepted: 08/30/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE All Japanese aged ≥40 years are eligible for free annual health check-ups including blood pressure and cholesterol measurements. It is well known that health check-up screenees are more likely to have healthy lifestyles and better health conditions than non-screenees. Therefore, controlling these factors is required to investigate whether screenees have a lower mortality risk than non-screenees independent of their lifestyles or health conditions. METHODS We followed 48,775 Japanese National Health Insurance beneficiaries aged 40-79 years since 1994 for 11 years. We used Cox proportional hazard models adjusted for possible confounding factors. We also performed propensity for use of the health check-up matched cohort analyses. RESULTS Compared to non-screenees, multiple-adjusted hazard ratios (95% confidence intervals) for all-cause and cardiovascular disease mortality among screenees were 0.74 (0.62-0.88) and 0.65 (0.44-0.95) for men and 0.69 (0.52-0.91) and 0.61 (0.36-1.04) for women, respectively. These relations were also observed when we used propensity matched cohort analyses. CONCLUSION This is the first study to show that mortality rates are lower among screenees than non-screenees in Japanese health check-ups when propensity matched cohort analyses were used for adjusting confounding factors. Further prospective studies, including randomized controlled trials, are required to confirm whether screening lowers mortality.
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Plasma tea polyphenol levels and subsequent risk of breast cancer among Japanese women: a nested case–control study. Breast Cancer Res Treat 2010; 124:827-34. [DOI: 10.1007/s10549-010-0916-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 04/22/2010] [Indexed: 11/26/2022]
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23
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Sawada N, Iwasaki M, Inoue M, Itoh H, Sasazuki S, Yamaji T, Shimazu T, Tsugane S. Plasma organochlorines and subsequent risk of prostate cancer in Japanese men: a nested case-control study. ENVIRONMENTAL HEALTH PERSPECTIVES 2010; 118:659-65. [PMID: 20435560 PMCID: PMC2866682 DOI: 10.1289/ehp.0901214] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 12/17/2009] [Indexed: 05/04/2023]
Abstract
BACKGROUND Although accumulating evidence suggests that exposure to organochlorine pesticides and polychlorinated biphenyls (PCBs) may contribute to the development of prostate cancer, few investigations have used biological samples to classify exposure to specific organochlorines. To our knowledge, this is the first prospective study to investigate the association between blood levels of organochlorines and prostate cancer risk. METHODS We conducted a nested case-control study using data from the Japan Public Health Center-based Prospective (JPHC) Study. A total of 14,203 men 40-69 years old who returned the baseline questionnaire and who provided blood samples were followed from 1990 to 2005. Using a mean follow-up period of 12.8 years, we identified 201 participants who were newly diagnosed with prostate cancer. Two matched controls for each case were selected from the cohort. We used a conditional logistic regression model to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for prostate cancer in relation to plasma levels of nine organochlorines: PCBs, dichlorodiphenyltrichloroethane (DDT), hexachlorobenzene (HCB), beta-hexachlorocyclohexane (beta-HCH), trans- and cis-nonachlor, oxychlordane, and mirex. RESULTS No statistically significant association with total prostate cancer was seen for any plasma organochlorine, although we did observe an insignificant inverse association for plasma HCB and beta-HCH. Total PCB in plasma was also inversely associated with advanced prostate cancer but without statistical significance. CONCLUSION Our results suggest that no overall association exists between prostate cancer and organochlorines at the levels measured in our study population.
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Affiliation(s)
- Norie Sawada
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.
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Impact of metabolic factors on subsequent cancer risk: results from a large-scale population-based cohort study in Japan. Eur J Cancer Prev 2009; 18:240-7. [PMID: 19491612 DOI: 10.1097/cej.0b013e3283240460] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The impact of metabolic factors, which are major risk factors for cardiovascular disease, on total cancer risk has not been clarified. We prospectively examined whether metabolic factors and their aggregates predict the subsequent occurrence of total and major sites of cancer in the Japan Public Health Center-based Prospective Study. A total of 27 724 participants (9548 men and 18 176 women) aged 40-69 years participating in a questionnaire and health checkup survey in 1993-1995 were followed for total cancer incidence through 2004. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated for metabolic factors and for two criteria of their aggregates (three or more than three factors and two or more than two additional factors in addition to being overweight) with a Cox proportional hazards model to control for potential confounding factors. In both sexes, the presence of metabolic factors in the aggregate did not predict subsequent occurrence of cancer as a whole. By site, a significant increase in risk was observed for male liver cancer [HR = 1.73, CI = 1.03-2.91 (three or more than three factors); HR = 1.99, CI = 1.11-3.58 (two or more than two additional factors in addition to being overweight)], and female pancreatic cancer [HR = 1.99, CI = 1.00-3.96 (two or more than two additional factors in addition to being overweight)]. For other sites, positive associations were observed only for specific metabolic factors, that is, high triglycerides and male colon cancer (HR = 1.71, CI = 1.11-2.62), and obesity and female breast cancer (HR = 1.75, CI = 1.21-2.55). Metabolic factors in the aggregate may have little impact on total cancer risk in the Japanese population, although the association between specific components and specific cancers suggests an etiologic link between them.
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Kurahashi N, Inoue M, Iwasaki M, Tanaka Y, Mizokami M, Tsugane S. Isoflavone consumption and subsequent risk of hepatocellular carcinoma in a population-based prospective cohort of Japanese men and women. Int J Cancer 2009; 124:1644-9. [PMID: 19089922 DOI: 10.1002/ijc.24121] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The incidence of hepatocellular carcinoma (HCC) is much higher in men than in women. Several experiment and epidemiological studies have suggested that estrogen might play an inhibitory role in the development of HCC. Because isoflavones have a similar structure as 17beta-estradiol and appear to have an anti-estrogenic effect in women and estrogenic effect in men, we hypothesized that the effect of isoflavones on HCC differs by sex. We investigated the association between isoflavones (genistein and daidzein) and soy products and HCC in Japan in a population-based prospective study in 19,998 Japanese (7,215 men and 12,783 women) aged 40-69 years. During 11.8 years of follow-up, 101 subjects (69 men and 32 women) were newly diagnosed with HCC. Case patients were grouped according to consumption of isoflavones and soy products and stratified by hepatitis virus infection. Hazard ratios (HRs) and 95% confidence intervals (CIs) for HCC were calculated by Cox proportional-hazards modeling. In women, genistein and daidzein were dose-dependently associated with an increased risk of HCC, with multivariable HRs for the highest versus lowest tertile of 3.19 (95%CI = 1.13-9.00, p(trend) = 0.03) and 3.90 (95% CI = 1.30-11.69, p(trend) = 0.01), respectively. No association between isoflavones and HCC was observed in men. These results persisted when analysis was restricted to subjects positive for either or both hepatitis C and B virus. In conclusion, isoflavone consumption may be associated with an increased risk of HCC in women. Women with hepatitis virus infection may be advised to abstain from isoflavone consumption. Further studies are warranted to confirm these findings.
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Affiliation(s)
- Norie Kurahashi
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.
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Ikeda A, Iso H, Yamagishi K, Inoue M, Tsugane S. Blood pressure and the risk of stroke, cardiovascular disease, and all-cause mortality among Japanese: the JPHC Study. Am J Hypertens 2009; 22:273-80. [PMID: 19229210 DOI: 10.1038/ajh.2008.356] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Little is known about the influence of blood pressure (BP) on cardiovascular disease (CVD) outcomes among Asian populations. METHODS We examined population attributable fractions (PAFs) and hazard ratios (HRs) associated with BP in relation to stroke and coronary heart disease (CHD) incident and mortality within a cohort of 33,372 Japanese men and women aged 40-69 years, free of prior diagnosis of cancer and CVD. The BP was classified based on modified criteria of the 2003 European Society of Hypertension-European Society of Cardiology guidelines. A total of 943 stroke events, 182 CHD events, 262 stroke deaths, and 120 CHD deaths occurred between the baseline questionnaire (1990-1994) and the end of follow-up in 31 December 2003. RESULTS BP levels were linearly associated with incidence and mortality of CVD in men and women. According to the PAF estimation, the elimination of normal to severe hypertension would prevent 64% of stroke incidence in men and 50% in women; 67% of stroke mortality in men and 29% in women; and 38% of total CVD mortality in men and 36% in women. The PAF estimate for total stroke incidence was the highest for mild hypertension, and lower for moderate to severe hypertension in both sexes. CONCLUSIONS The contributions of normal BP, high normal BP, and mild hypertension to the occurrence of stroke events were greater than those made by moderate and severe hypertension, highlighting the importance of primary prevention and of treatment for low-to-moderate degrees of hypertension.
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Affiliation(s)
- A Cecile J W Janssens
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Saito I, Iso H, Kokubo Y, Inoue M, Tsugane S. Metabolic Syndrome and All-Cause and Cardiovascular Disease Mortality Japan Public Health Center-Based Prospective (JPHC) Study. Circ J 2009; 73:878-84. [DOI: 10.1253/circj.cj-08-1025] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Isao Saito
- Department of Public Health, Social Medicine and Medical Informatics, Ehime University Graduate School of Medicine
| | - Hiroyasu Iso
- Department of Social and Environmental Medicine, Division of Preventive and Environmental Medicine, Graduate School of Medicine, Osaka University
| | | | - Manami Inoue
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center
| | - Shoichiro Tsugane
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center
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Inoue M, Kurahashi N, Iwasaki M, Tanaka Y, Mizokami M, Noda M, Tsugane S. Metabolic factors and subsequent risk of hepatocellular carcinoma by hepatitis virus infection status: a large-scale population-based cohort study of Japanese men and women (JPHC Study Cohort II). Cancer Causes Control 2008; 20:741-50. [PMID: 19115074 DOI: 10.1007/s10552-008-9287-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 12/10/2008] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The association between metabolic factors and hepatocellular carcinoma (HCC) has not been well clarified. We prospectively examined whether metabolic factors predicts the subsequent risk of HCC in the Japan Public Health Center-based Prospective Study Cohort II, in consideration of hepatitis virus infection status. METHODS A total of 17,590 subjects aged 40-69 participating in a questionnaire and health checkup survey during 1993-1994 were followed for incidence of HCC through 2006. A total of 102 cases of HCC were newly documented. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for metabolic factors controlling for potential confounding factors. RESULTS The presence of metabolic factors in the aggregate was associated with a significantly increased risk of HCC, especially with hepatitis virus infection. HCC was positively associated particularly with high glucose (HR = 1.75, CI = 1.11-2.74) and overweight (HR = 2.22, CI = 1.42-3.48). Results were similar when analyses were limited to subjects with HCV infection. CONCLUSIONS Although metabolic factors in the aggregate may be associated with an increased risk of HCC, the main contributors to this association under HCV infection appear to be overweight and high glucose. Improvement of these factors may be a crucial target in preventing progression to HCC in those with HCV infection.
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Affiliation(s)
- Manami Inoue
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Katanoda K, Marugame T, Saika K, Satoh H, Tajima K, Suzuki T, Tamakoshi A, Tsugane S, Sobue T. Population attributable fraction of mortality associated with tobacco smoking in Japan: a pooled analysis of three large-scale cohort studies. J Epidemiol 2008; 18:251-64. [PMID: 19075498 PMCID: PMC4771610 DOI: 10.2188/jea.je2007429] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 04/23/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Quantitative measures of the burden of tobacco smoking in Asian countries are limited. We estimated the population attributable fraction (PAF) of mortality associated with smoking in Japan, using pooled data from three large-scale cohort studies. METHODS In total, 296,836 participants (140,026 males and 156,810 females) aged 40-79 years underwent baseline surveys during the 1980s and early 1990s. The average follow-up period was 9.6 years. PAFs for all-cause mortality and individual tobacco-related diseases were estimated from smoking prevalence and relative risks. RESULTS The prevalence of current and former smokers was 54.4% and 25.1% for males, and 8.1% and 2.4% for females. The PAF of all-cause mortality was 27.8% [95% confidence interval (CI): 25.2-30.4] for males and 6.7% (95% CI: 5.9-7.5) for females. The PAF of all-cause mortality calculated by summing the disease-specific PAFs was 19.1% (95% CI: 16.0-22.2) for males and 3.6% (95% CI: 3.0-4.2) for females. The estimated number of deaths attributable to smoking in Japan in 2005 was 163,000 for males and 33,000 for females based on the former set of PAFs, and 112,000 for males and 19,000 for females based on the latter set. The leading causes of smoking-attributable deaths were cancer (61% for males and 31% for females), ischemic heart diseases and stroke (23% for males and 51% for females), and chronic obstructive pulmonary diseases and pneumonia (11% for males and 13% for females). CONCLUSION The health burden due to smoking remains heavy among Japanese males. Considering the high prevalence of male current smokers and increasing prevalence of young female current smokers, effective tobacco controls and quantitative assessments of the health burden of smoking need to be continuously implemented in Japan.
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Affiliation(s)
- Kota Katanoda
- Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
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Hofman A. Recent trends in publications in the European Journal of Epidemiology. Eur J Epidemiol 2008; 23:757-60. [PMID: 19039670 DOI: 10.1007/s10654-008-9305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Appropriate epidemiologic methods as a prerequisite for valid study results. Eur J Epidemiol 2008; 23:761-5. [DOI: 10.1007/s10654-008-9299-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 11/04/2008] [Indexed: 11/26/2022]
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Kurahashi N, Iwasaki M, Inoue M, Sasazuki S, Tsugane S. Plasma isoflavones and subsequent risk of prostate cancer in a nested case-control study: the Japan Public Health Center. J Clin Oncol 2008; 26:5923-9. [PMID: 19018085 DOI: 10.1200/jco.2008.16.8807] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The incidence of prostate cancer is much lower in Japanese than Western populations. Given the preventive effects of isoflavones on carcinogenesis in the prostate in many nonhuman studies and the high consumption of isoflavones in Japanese, this low incidence may be partly due to the effects of soy. PATIENTS AND METHODS We conducted a nested case-control study within the Japan Public Health Center-based Prospective Study. A total of 14,203 men aged 40 to 69 years who had returned the baseline questionnaire and provided blood samples were observed from 1990 to 2005. During a mean of 12.8 years of follow-up, 201 newly diagnosed prostate cancers were identified. Two matched controls for each case were selected from the cohort. Conditional logistic regression model was used to estimate the odds ratios (ORs) and 95% CIs for prostate cancer in relation to plasma levels of isoflavone. RESULTS Plasma genistein level tended to be inversely associated with the risk of total prostate cancer. Although plasma daidzein showed no association, the highest tertile for plasma equol, a metabolite of daidzein, was significantly associated with a decreased risk of total prostate cancer (OR = 0.60; 95% CI, 0.36 to 0.99; P(trend) = .04). These inverse associations were strengthened after analysis was confined to localized cases, with ORs in the highest group of plasma genistein and equol compared with the lowest of 0.54 (95% CI, 0.29 to 1.01; P(trend) = .03) and 0.43 (95% CI, 0.22 to 0.82; P(trend) = .02), respectively. Plasma isoflavone levels were not statistically significantly associated with the risk of advanced prostate cancer. CONCLUSION Isoflavones may prevent the development of prostate cancer.
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Affiliation(s)
- Norie Kurahashi
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji Chuo-ku Tokyo 104-0045 Japan.
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Iwasaki M, Inoue M, Otani T, Sasazuki S, Kurahashi N, Miura T, Yamamoto S, Tsugane S. Plasma Isoflavone Level and Subsequent Risk of Breast Cancer Among Japanese Women: A Nested Case-Control Study From the Japan Public Health Center-Based Prospective Study Group. J Clin Oncol 2008; 26:1677-83. [DOI: 10.1200/jco.2007.13.9964] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Because they have large variations in consumption, Asian countries are suitable settings for studies of the effect of relatively high-dose isoflavone intake on breast cancer risk. Nevertheless, no prospective study from Asia has assessed blood or urine levels as biomarkers of isoflavone intake. Patients and Methods A total of 24,226 women ages 40 to 69 years in the Japan Public Health Center–based prospective study who responded to the baseline questionnaire and provided blood in 1990 to 1995 were observed to December 2002. During a mean 10.6 years of follow-up, 144 patients newly diagnosed with breast cancer were identified. Two matched controls for each patient were selected from the cohort. Isoflavone levels were assessed by plasma level and food frequency questionnaire, and the odds ratio of breast cancer according to isoflavone level was estimated using a conditional logistic regression model. Results We found a statistically significant inverse association between plasma genistein and risk of breast cancer, but no association for plasma daidzein. Adjusted odds ratios for the highest versus lowest quartile of plasma level were 0.34 for genistein (95% CI, 0.16 to 0.74; P for trend, .02) and 0.71 for daidzein (95% CI, 0.35 to 1.44; P for trend, .54). Median plasma genistein values in the control group were 31.9 ng/mL for the lowest and 353.9 ng/mL for the highest quartile groups. Regarding dietary intake of isoflavones, nonsignificant inverse associations were observed for both genistein and daidzein. Conclusion This nested case-control study found an inverse association between plasma genistein and the risk of breast cancer in Japan.
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Affiliation(s)
- Motoki Iwasaki
- From the Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center; Department of Sport and Exercise Nutrition, School of Physical Education, Sendai University; and the Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Manami Inoue
- From the Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center; Department of Sport and Exercise Nutrition, School of Physical Education, Sendai University; and the Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Tetsuya Otani
- From the Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center; Department of Sport and Exercise Nutrition, School of Physical Education, Sendai University; and the Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Shizuka Sasazuki
- From the Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center; Department of Sport and Exercise Nutrition, School of Physical Education, Sendai University; and the Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Norie Kurahashi
- From the Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center; Department of Sport and Exercise Nutrition, School of Physical Education, Sendai University; and the Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Tsutomu Miura
- From the Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center; Department of Sport and Exercise Nutrition, School of Physical Education, Sendai University; and the Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Seiichiro Yamamoto
- From the Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center; Department of Sport and Exercise Nutrition, School of Physical Education, Sendai University; and the Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- From the Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center; Department of Sport and Exercise Nutrition, School of Physical Education, Sendai University; and the Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
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