Prevalence of dysphagia in patients after orthopedic surgery

OBJECTIVES

Oropharyngeal dysphagia is one of the most prevalent health complications in older adults. The prevalence of postoperative dysphagia is expected to rise with the increasing number of older patients undergoing orthopedic surgery; however, the specific prevalence and contributing factors remain unclear. This scoping review aimed to identify the prevalence and factors related to postoperative dysphagia in older orthopedic patients.

METHODS

This review included studies published up to September 2022 on postoperative patients aged ≥ 60 years who underwent orthopedic surgery. We searched MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, and Ichushi-Web.

RESULTS

In total, 21 of the 2158 identified studies were reviewed. The studies were classified into the three categories according to the surgical site: cervical spine disease (n = 12), hip fracture (n = 7), and others (n = 2). The estimated dysphagia prevalence rates [95 % confidence interval] of cervical spine disease, hip fractures, and others were 16 % [8-27], 32 % [15-54], and 6 % [4-8], respectively. Factors related to postoperative dysphagia included cervical alignment in cervical spine disease, being older within the cohort, preoperative health status, malnutrition, and sarcopenia in hip fractures.

CONCLUSIONS

The prevalence of postoperative dysphagia after orthopedic surgery was highest for hip fractures, followed by cervical spine and others. These results suggest non-neurogenic dysphagia in older patients undergoing orthopedic surgery and indicate that sarcopenia may contribute to postoperative dysphagia in this population. Therefore, further research should clarify the trajectory of postoperative dysphagia and the effectiveness of rehabilitation for postoperative dysphagia after orthopedic surgery.

Traditional japanese diet score and the sustainable development goals by a global comparative ecological study

BACKGROUND

Reducing the environmental impact of the food supply is important for achieving Sustainable Development Goals (SDGs) worldwide. Previously, we developed the Traditional Japanese Diet Score (TJDS) and reported in a global ecological study that the Japanese diet is associated with reducing obesity and extending healthy life expectancy etc. We then examined the relationship between the TJDS and environmental indicators.

METHODS

The average food (g/day/capita) and energy supplies (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. The TJDS was calculated from eight food groups (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, and eggs; food components that are relatively unused in the traditional Japanese diet: wheat, milk, and red meat) by country using tertiles, and calculated the total score from - 8 to 8, with higher scores meaning greater adherence to the TJDS. We used Land Use (m2), Greenhouse gas (GHG) emissions 2007/2013 (kg CO2eq), Acidifying emissions (g SO2eq), Eutrophying emissions (g PO43- eq), Freshwater (L), and water use (L) per food weight by Poore et al. as the environmental indicators and multiplied these indicators by each country's average food supply. We evaluated the cross-sectional and longitudinal associations between the TJDS and environmental indicators from 2010 to 2020. This study included 151 countries with populations ≥ 1 million.

RESULTS

Land use (β ± standard error; -0.623 ± 0.161, p < 0.001), GHG 2007 (-0.149 ± 0.057, p < 0.05), GHG 2013 (-0.183 ± 0.066, p < 0.01), Acidifying (-1.111 ± 0.369, p < 0.01), and Water use (-405.903 ± 101.416, p < 0.001) were negatively associated with TJDS, and Freshwater (45.116 ± 7.866, p < 0.001) was positively associated with TJDS after controlling for energy supply and latitude in 2010. In the longitudinal analysis, Land Use (β ± standard error; -0.116 ± 0.027, p < 0.001), GHG 2007 (-0.040 ± 0.010, p < 0.001), GHG 2013 (-0.048 ± 0.011, p < 0.001), Acidifying (-0.280 ± 0.064, p < 0.001), Eutrophying (-0.132 ± 0.062, p < 0.05), and Water use (-118.246 ± 22.826, p < 0.001) were negatively associated with TJDS after controlling for confounders.

CONCLUSIONS

This ecological study suggests that the traditional Japanese dietary pattern might improve SDGs except Fresh water.

Association of resting energy expenditure with phase angle in hospitalized older patients: a cross-sectional analysis

BACKGROUND/OBJECTIVES

Resting energy expenditure (REE) constitutes the largest component of total energy expenditure and undergoes an age-related decline that is unexplained by decreased fat-free mass. Phase angle (PhA) is a cellular health indicator that is possibly associated with REE. We investigated the association of REE and PhA in hospitalized older adults.

SUBJECTS/METHODS

This single-center, cross-sectional analysis utilized the baseline data from a prospective longitudinal study and included 131 eligible patients aged ≥70 years. The REE was measured using indirect calorimetry, and PhA and body composition were assessed using bioelectrical impedance. The association between REE, PhA, and body composition was examined, and REE was compared using previously reported PhA cutoff values.

RESULTS

In this cohort with a mean (±standard deviation) age of 87.4 (±7.0) years, 34.4% of the participants were men. REE and PhA correlated strongly (r: 0.562, p < 0.001) and significantly after adjusting for age and sex (r: 0.433, p < 0.001). Multivariate analysis showed a significant independent association between REE and PhA and skeletal muscle mass (standardized β [95% CI]; 28.072 [2.188-53.956], p = 0.035) without any significant interaction between PhA and age on REE. The low PhA group had a significantly lower REE (kcal/day; 890 [856-925] vs. 1077 [1033-1122], p < 0.001), and this remained significant after adjusting for age, sex, and skeletal muscle mass index.

CONCLUSIONS

PhA is associated with REE in older adults. Adjusting REE calculation algorithms based on PhA values and correcting predicted REE according to PhA may aid in determining more accurate energy requirements.

Association between Japanese Diet Adherence and Muscle Weakness in Japanese Adults Aged ≥50 Years: Findings from the JSTAR Cohort Study

Japanese diet adherence has been inversely correlated with muscle weakness. In this study, we aimed to validate that association. Longitudinal data from 1699 individuals aged ≥50 years (mean age 62.5 ± 6.9 years, 50.4% female) at two time points (2007 and 2011) were used. Participants without muscle weakness from several regions in Japan were included. The 12-component revised Japanese Diet Index (rJDI12) classified by tertiles assessed adherence to the Japanese dietary pattern. Muscle weakness was defined as a handgrip strength of ˂18 kg for females and ˂28 kg for males based on the Asian Working Group for Sarcopenia criteria 2019. A multivariate logistic approach was used to determine the relationship between rJDI12 tertile and the occurrence of muscle weakness by calculating the odds ratio (OR) and its 95% confidence interval (95% CI) throughout the observation period. Muscle weakness was negatively correlated with the highest rJDI12 tertile (OR [95% CI] 0.891 [0.814, 0.973] for T3). This association was consistent in sensitivity analyses with multiple imputations of missing values. Closely following the Japanese dietary pattern appears to reduce the occurrence of muscle weakness among the aging population in this study, suggesting it may prevent frailty and sarcopenia in the aging population.

New prediction equations for resting energy expenditure in older hospitalized patients: Development and validation

OBJECTIVES

Accurate resting energy expenditure (REE) prediction is needed to prevent over- or underfeeding in older hospitalized patients. However, few validated REE prediction Equations are known for such patients. Therefore, this study aimed to develop new REE prediction Equations and evaluate their validity.

METHODS

This single-center, cross-sectional study enrolled 134 patients ages ≥70 y. For holdout validation, patients were randomized in a 3:1 ratio; for the development data set, a new Equation was developed according to the measured REE using indirect calorimetry. The new and existing Equations were compared using the validation data set.

RESULTS

Mean patient age was 87.4 ± 6.9 y, and 34.3% were male. Two Equations were developed in multivariable regression models: Equation 1: REE (kcal/day) = 313.582 + Height (cm) × 3.973 + Body weight (kg) × 5.332 - Age (y) × 5.474 - (0 if male; 1 if female) × 20.012 + Calf circumference (cm) × 12.174; and Equation 2: REE (kcal/day) = 594.819 + Height (cm) × 3.760 + Body weight (kg) × 8.888 - Age (y) × 6.298 - (0 if male; 1 if female) × 16.396. The mean relative bias (95% CI) with measured REE as a reference had a small bias for Equations 1 and 2 (-0.1 [-4.1 to 3.9]% and -0.2 [-4.4 to 4.1]%, respectively); however, the Harris-Benedict, Food and Agriculture Organization of the United Nations/World Health Organization/United Nations University, Ganpule, and body weight × 20 Equations had larger biases (-6.2 [-10.3 to -2.0]%; 5.3 [1.3 to 9.3]%; -13.9 [-18.6 to -9.3]%; and -11.6 [-16.1 to -7.1]%, respectively).

CONCLUSIONS

New prediction Equations using height, body weight, age, sex, and calf circumference improve REE prediction accuracy in older hospitalized patients.

Diagnosis and prevalence of sarcopenic obesity in patients with colorectal cancer: A scoping review

BACKGROUND & AIMS

Sarcopenic obesity (SO) is associated with worse outcomes in patients with colorectal cancer (CRC); however, the diagnostic methods and prevalence of SO vary among studies. Therefore, we conducted this scoping review to investigate the diagnosis of SO in CRC, identify the associated problems, and determine its prevalence.

METHODS

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. A literature search was performed by two independent reviewers on studies that diagnosed SO in CRC using the MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, and Ichushi-Web (in Japanese) databases. Observational, longitudinal, cross-sectional, and clinical trials written in English or Japanese as of July 2022 were included. Studies that did not define SO were excluded from the analysis. The study protocol was pre-registered in Figshare.

RESULTS

In total, 670 studies were identified, 22 of which were included. Eighteen studies used sarcopenia in combination with obesity to diagnose SO. Sarcopenia was mainly diagnosed using skeletal muscle mass index (SMI), and only one combined with grip strength or gait speed. Obesity was diagnosed based on the body mass index (BMI; n = 11), followed by visceral fat area (VFA; n = 5). The overall prevalence of SO in patients with CRC was 15% (95%CI, 11-21%). The prevalence of SO in surgical resection and colorectal cancer liver metastases was 18% (95%CI, 12-25%) and 11% (95%CI, 3-36%), respectively.

CONCLUSIONS

SO in patients with CRC was mainly diagnosed based on a combination of SMI and BMI, and muscle strength and body composition were rarely evaluated. The prevalence of SO was approximately 15%, depending on the diagnostic methods used. Since SO in patients with CRC is associated with poor prognosis, further research on diagnostic methods for the early detection of SO and its clinical outcomes is needed.

Global Association between Traditional Japanese Diet Score and All-Cause, Cardiovascular Disease, and Total Cancer Mortality: A Cross-Sectional and Longitudinal Ecological Study

OBJECTIVE

Studies conducted on Japanese people have suggested that a traditional Japanese diet contributes to good health, longevity, and protection against several non-communicable diseases. However, it is unknown whether traditional Japanese dietary patterns are associated with all-cause mortality, cardiovascular disease, and cancer mortality globally. The purpose of this cross-sectional and longitudinal ecological study is to clarify the global association between the traditional Japanese diet score (TJDS) and all-cause, cardiovascular disease, and total cancer mortality.

METHODS

Data on food supply and all-cause mortality, cardiovascular disease mortality, total cancer mortality, and covariables by country were obtained from a relevant internationally available database. TJDS by country was calculated from eight food groups and the total score ranged from -8 to 8, with higher scores indicating greater adherence to a traditional Japanese diet. We evaluated the cross-sectional and 10-year longitudinal association between TJDS and all-cause, cardiovascular disease, and total cancer mortality using 2009 as the baseline in 142 countries with populations of more than one million. A cross-sectional analysis and a longitudinal analysis were performed using three general linear models or three linear mixed models with different covariables.

RESULTS

In cross-sectional models controlled for fully-adjusted covariables, TJDS was negatively associated with all-cause mortality (β ± standard error; -43.819 ± 11.741, p < 0.001), cardiovascular disease mortality (-22.395 ± 4.638, p < 0.001), and total cancer mortality (-3.893 ± 1.048, p < 0.001). In 10-year longitudinal models controlled for fully-adjusted covariables, TJDS was significantly negatively associated with all-cause mortality (-31.563 ± 7.695, p < 0.001), cardiovascular disease mortality (-16.249 ± 4.054, p < 0.001), and total cancer mortality (-3.499 ± 0.867, p < 0.001).

CONCLUSIONS

This cross-sectional and longitudinal ecological study suggests that the traditional Japanese diet is associated with lower all-cause mortality, cardiovascular disease mortality, and total cancer mortality, worldwide.

The Global Association between Egg Intake and the Incidence and Mortality of Ischemic Heart Disease-An Ecological Study

The relationship between egg consumption and ischemic heart disease (IHD) remains controversial as there is still no clear answer regarding the relationship, with research limited to a few geographical regions. In the current study, we conducted a longitudinal analysis of the association between egg intake and IHD incidence (IHDi) and mortality (IHDd) using 28 years of international data from 1990 to 2018. Egg intake (g/day/capita) by country was obtained from the Global Dietary Database. Age-standard IHDi and IHDd rates per 100,000 subjects in each country were obtained from the 2019 Global Burden of Disease database. The analysis included a total of 142 countries with populations of at least one million, for which all data were available from 1990 to 2018. Eggs are consumed worldwide, and regional differences in consumption are also shown. Utilizing IHDi and IHDd as objective variables and egg intake as an explanatory variable, the analysis was conducted using linear mixed models, which controlled for inter- and intra-country variation from year to year. The results showed a significant negative association between egg intake, and IHDi (-0.253 ± 0.117, p < 0.05) and IHDd (-0.359 ± 0.137, p < 0.05). The analysis was carried out using R 4.0.5. The results suggest that adequate egg intake might suppress IHDi and IHDd on a global scale.

Trajectories of the Prevalence of Sarcopenia in the Pre- and Post-Stroke Periods: A Systematic Review

Interventions for stroke-related sarcopenia in patients with stroke are needed, but the details of the target population are unclear. This systematic review aimed to identify trajectories of the prevalence of sarcopenia in the pre- and post-stroke periods and to determine the diagnostic criteria used in patients with stroke. We searched for literature in six databases: MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and Ichushi-web (in Japanese). We included 1627 studies in the primary screening, and 35 studies were finally included. Of the 35 studies, 32 (91.4%) included Asian patients, and the criteria of the Asian Working Group for Sarcopenia was mainly used as the diagnostic criteria. Nineteen studies used muscle strength and muscle mass to diagnose sarcopenia, whereas a full assessment, including physical performance, was performed in five studies. The estimated prevalences of sarcopenia in pre-stroke, within 10 days of stroke, and from 10 days to 1 month after stroke were 15.8%, 29.5%, and 51.6%, respectively. Sarcopenia increased by approximately 15% from pre-stroke to 10 days, and increased by approximately 20% from 10 days to 1 month. Healthcare providers should note that the prevalence of sarcopenia increases during the acute phase in patients with stroke.

Resting Energy Expenditure in Older Inpatients: A Comparison of Prediction Equations and Measurements

Determining energy requirements are an important component of nutritional support for patients with malnutrition; however, the validity of prediction equations for resting energy expenditure (REE) is disputed in older hospitalized patients. We aimed to assess the validity of these equations in older hospitalized patients in Japan. This was a single-center, cross-sectional study of 100 patients aged ≥70 years, hospitalized between January 2020 and December 2021. REE was measured using an indirect calorimeter and was compared to the predicted values calculated from five REE prediction equations. The mean (95% confidence interval) measured REE was 968.1 (931.0, 1005.3) kcal/day, and the mean predicted REE was higher for the FAO/WHO/UNU (1014.3 [987.1, 1041.6] kcal/day, p = 0.164) and Schofield (1066.0 [1045.8, 1086.2] kcal/day, p < 0.001) equations and lower for the Harris-Benedict (898.6 [873.1, 924.1] kcal/day, p = 0.011), Ganpule (830.1 [790.3, 869.9] kcal/day, p < 0.001), and body weight (kg) × 20 (857.7 [821.9, 893.5] kcal/day, p < 0.001) equations. In the age group analysis, none of the predicted values were within a 10% error for more than 80% of patients aged 70−89 years and ≥90 years. The five REE prediction equations did not provide accurate estimates. Validated REE prediction equations need to be developed for older hospitalized patients.

Association of Japanese and Mediterranean Dietary Patterns with Muscle Weakness in Japanese Community-Dwelling Middle-Aged and Older Adults: Post Hoc Cross-Sectional Analysis

The association of Japanese and Mediterranean dietary patterns with muscle weakness in middle-aged and older Japanese individuals is unclear. This cross-sectional study investigated the association between Japanese and Mediterranean dietary patterns and muscle weakness in community-dwelling, middle-aged, and older Japanese individuals (enrolled from 2007 to 2011). Based on the dietary consumption information obtained from the brief self-administered diet history questionnaire, we assessed adherence to the Japanese (12-component revised Japanese diet index (rJDI12)) and Mediterranean (alternate Mediterranean diet (aMed) score) dietary patterns. Muscle weakness was defined as handgrip strength <28 and <18 kg for men and women, respectively. Logistic regression was used to ascertain the relationship between dietary pattern and muscle weakness. In our study, with 6031 participants, the Japanese, but not Mediterranean, dietary pattern was inversely associated with muscle weakness (p for trend = 0.031 and 0.242, respectively). In the model adjusted for confounders, including energy intake, the highest quartile of rJDI12 scores (9-12 points), and the rJDI12 scores, entered as continuous variables, showed an independent association (odds ratio (95% CI), 0.703 (0.507-0.974), and 0.933 (0.891-0.977), respectively). Our findings showed that adherence to the Japanese dietary pattern is associated with a low prevalence of muscle weakness.

Association between the Mediterranean Diet Score and Healthy Life Expectancy: A Global Comparative Study

OBJECTIVES

Extending healthy life expectancy (HALE), defined as the average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury, is a common topic worldwide. This study aims to clarify the relationships between the Mediterranean diet score (MDS) and life expectancy (LE) and HALE globally using publicly available international data.

SETTING

Analyses were conducted on 130 countries with populations of 1 million or more for which all data were available. Individual countries were scored from 0 to 9 to indicate adherence to the Mediterranean diet according to the MDS scoring method. The supply of vegetables, legumes, fruits and nuts, cereals, fish, and olive oil per 1,000 kcal per country was calculated based on the Food and Agriculture Organization Corporate Statistical Database, with a score of 1 for above the median and 0 for below. The same method was used to calculate scores of presumed detrimental components (meat and dairy), with consumption below the median given a value of 1, and consumption above the median given a value of 0. For ethanol, a score of 1 was given for 10g to 50 g of consumption. We investigated the cross-sectional associations between the MDS and LE and HALE at birth in 2009, and the longitudinal associations between the MDS in 2009 and LE and HALE between 2009 and 2019, controlling for covariates at baseline using linear mixed models.

RESULTS

In the cross-sectional analysis, the MDS was significantly positively associated with LE (β=0.906 [95% confidence interval, 0.065-1.747], p=0.037) and HALE (β=0.875 [0.207-1.544], p=0.011) after controlling for all covariates. The longitudinal analysis also revealed significantly positive associations between the MDS and LE (0.621 [0.063-1.178], p=0.030) and HALE (0.694 [0.227-1.161], p=0.004) after controlling for all covariates.

CONCLUSION

The present study, based on an analysis using 10 years of international data, showed that countries with a higher MDS showed a positive association with HALE.

213Traditional Japanese Diet Score and healthy life expectancy - a longitudinal global study

Background

Traditional Japanese diets are considered to be health and longevity. We created a Traditional Japanese Diet Score (TJDS) and investigated the relationship between the TJDS and healthy life expectancy (HALE) longitudinally using global database.

Methods

Average food (g/day/capita) and energy supply (kcal/day/capita) by countries were identified by the Food and Agriculture Organization of the United Nations Statistics Division database. The sum of characterizing traditional Japanese foods supply (beneficial food components in Japanese diet; rice, fish, soybeans, vegetables, eggs, seaweeds, food components not use so much in Japanese diet; wheat, milk, and red meat) were divided as tertile (beneficial food components;-1, 0, 1, not use so much food components; 1, 0, -1). HALE values by country were derived from the Global Burden of Disease 2017 database. The longitudinal effects of TJDS on the rate of change in HALE from 1990 to 2013 were evaluated using a generalized mixed-effect model (GLMM), which takes into account the dependence of repeated observations within countries. The interaction between TJDS and survey year was applied to access the effects on HALE. This study covered 137 countries with populations of 1 million or greater.

Results

Longitudinal analysis controlled for covariates showed that smooth term of the interaction between TJDS and survey year was significant (p &lt; 0.001). The TJDS was negative associated with HALE in 1990, and in 1991, but positive associated after 2002.

Conclusions

The relationship between the TJDS as a healthy eating style and HALE is getting stronger since the 21st century.

Key messages

Well-balanced eating habits of traditional Japanese diets is supports healthy life expectancy.

265Global diabetes trends and associated socioeconomic, lifestyle and health indicators from 1990 to 2017

Background

This longitudinal ecological study was conducted to determine the global trends in the age-standardised prevalence of type 2 diabetes mellitus (T2DM) and its association with socioeconomic, lifestyle and health indicators.

Methods

Data pertaining to the age-standardised prevalence of T2DM (rates per 100,000) and socioeconomic, lifestyle and health indicators were obtained from several international databases. Data available from 1990 to 2017 for 139 countries with populations of 1 million or greater were analysed, followed by estimation of slopes for T2DM prevalence in each country. The longitudinal association between T2DM and the standardised variables of socioeconomic, lifestyle and health indicators was fitted using a generalised linear mixed-effects model with random intercept for each country and random slope for year.

Results

The country-specific age-standardised prevalence of T2DM decreased significantly in 9 countries, remained unchanged in 11 countries and increased significantly in 119 countries. The estimated standardised effect of age-standardised education for T2DM was the largest at − 524.5 (SE; 109.9), followed by − 514.8 (SE; 95.6) for physical activity and 398.8 (SE; 45.8) for body mass index (BMI) (P &lt; 0.0001 for all).

Conclusions

The factors strongly associated with global T2DM prevalence and trends were years of education, followed by physical activity and BMI. This study also provides a basis for investigating public health approaches to control the increase in global T2DM prevalence.

Key messages

The promotion of policies that reduce international educational disparities may have the potential to reduce the global increase in the number of patients with T2DM.

169Folic acid intake and dementia - a 27-year global longitudinal study

Background

Folate deficiency increases serum homocysteine and may cause cognitive impairment. However, there have been no international longitudinal studies that examined the association between folic acid intake and dementia. We investigated the longitudinal association between folate intake and the prevalence of dementia using global data during 27 years.

Methods

Prevalence of Alzheimer’s disease and other dementias and folic acid intake by country were obtained from the Global Burden of Disease (GBD) 2017 database. The longitudinal associations between folic acid intake and prevalence of dementia was examined using linear mixed effect model during 27 years from 1990 to 2017 in 151countries with populations of 1 million or greater. The effects of folic acid, year and interaction of folic acid and year were estimated controlling for covariates including socio-economic variables and life-style variables.

Results

Fixed effects of folic acid was highly significant (mean and SE; -33.1±7.1, p &lt; 0.001) and interaction of folic acid and survey year was also significant (0.90±0.13, p &lt; 0.001). Slope of folic acid for dementia prevalence was significant in 1990 and the slope has decreased with the year and has become not significant after 2011.

Conclusions

Folic acid was associated with the prevalence of dementia, but weakened over the years.

Key messages

Although folic acid intake has been associated with the of dementia, the risk of dementia may be increasingly related to factors other than nutrition.

64Traditional Japanese Diet Score and cancer incidence and mortality - a 23-year longitudinal global study

Background

Traditional Japanese diets are considered to be one cause of Japanese health and longevity. We created a Traditional Japanese Diet Score (TJDS) and investigated the relationship between the TJDS and cancer during more than 20 years using global database.

Methods

Total cancer incidence and mortality by country were identified from the Global Burden of Disease 2017 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations database. The TJDS by country was calculated from nine food groups, the higher scores mean the more adherence to traditional Japanese diet. That is beneficial food groups (rice, fish, soybeans, vegetables, eggs, seaweed) gave positive points to high supply amount, and food groups not commonly used in the Japanese diet (wheat, milk, and red meat) gave minus points to high supply amount. The longitudinal associations between the TJDS and cancer incidence and mortality controlled for covariates were examined during 23 years from 1990 to 2013. The country covered by this study was 139 countries with populations of 1 million or greater.

Results

The TJDS was negatively associated with cancer incidence and mortality longitudinally in a linear mixed-effect model controlled for covariates.

Conclusions

These results suggest that greater adherence with the TJDS supressed cancer incidence and mortality worldwide.

Key messages

Well-balanced eating habits like traditional Japanese diets is important for suppressing cancer.

Global relationship between Mediterranean diet and the incidence and mortality of ischaemic heart disease

BACKGROUND

The purpose of this study was to clarify the global relationship between the Mediterranean diet score (MDS) and country-wise incidence and mortality of ischaemic heart disease (IHD) using an international database.

METHODS

We used population data from a global longitudinal database covering 137 countries with a population of over one million. MDS were evaluated based on the total score of the nine foods that comprise the Mediterranean diet. The incidence and mortality of IHD by country was derived from the Global Burden of Disease (GBD) database. Average food (g/day/capita) and energy supply (kcal/day/capita) by country, excluding loss between production and household, were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. Data from the GBD database were used for body mass index, current smoking rates, physical activity, years of education and percentage of the Muslim population. We identified the percentage of the population over 65 years of age (aging rate) and gross domestic product per capita (US$/capita) using the World Bank database. A linear mixed-effect model was used for evaluating the effects of MDS on incidence and mortality of IHD controlled for socioeconomic and lifestyle variables.

RESULTS

Analysis showed that MDS was significantly associated with IHD incidence after controlling for covariates (-1.01 ± 0.27, P < 0.001). Similarly, there was a significant association between MDS and IHD-related mortality after controlling for covariates (-0.73 ± 0.34, P < 0.05).

CONCLUSION

Analysis of 27 years of data suggests that a Mediterranean diet might have a preventive effect on IHD.

Trends in age-standardised prevalence of type 2 diabetes mellitus according to country from 1990 to 2017 and their association with socioeconomic, lifestyle and health indicators: An ecological study

Background

There is a need for global public health strategies to effectively curb the ever-growing global diabetes population. This longitudinal ecological study was conducted to elucidate the country-specific trends of the age-standardised prevalence of type 2 diabetes mellitus (T2DM) and their association with socioeconomic, lifestyle and health indicators.

Methods

Data pertaining to the age-standardised prevalence of T2DM (rates per 100 000) and socioeconomic, lifestyle and health indicators were obtained from several international databases. Data available from 1990 to 2017 for 139 countries with populations of 1 million or greater were analysed, followed by estimation of slopes for T2DM prevalence in each country. The longitudinal association between T2DM and the standardised variables of socioeconomic, lifestyle and health indicators was fitted using a generalised linear mixed-effects model with random intercept for each country and random slope for year.

Results

The country-specific age-standardised prevalence of T2DM decreased significantly in 9 countries, remained unchanged in 11 countries and increased significantly in 119 countries. The estimated standardised effect of age-standardised education for T2DM was the largest at −524.5 (SE; 109.9), followed by −514.8 (SE; 95.6) for physical activity and 398.8 (SE; 45.8) for body mass index (BMI) (P < 0.0001 for all).

Conclusions

The factors largely associated with global T2DM prevalence and trends were years of education, followed by physical activity and BMI. This study also provides basic resources for examining public health approaches to curb the increase in global T2DM prevalence.

A longitudinal association between the traditional Japanese diet score and incidence and mortality of breast cancer-an ecological study

BACKGROUND

The traditional Japanese diet is considered one of the important factors of health and longevity in Japanese people. Breast cancer is the most common cancer among women in the world. However, the association between the traditional Japanese diet and breast cancer is unclear. The purpose of this study was to investigate the longitudinal association between the traditional Japanese diet score (TJDS) with the incidence and mortality of breast cancer in an ecological study.

METHODS

Food supply and breast cancer incidence and mortality by country were obtained from an international database. TJDS by country was calculated from nine food groups and the total score ranged from -9 to 9, with higher scores indicating greater adherence to a traditional Japanese diet. Longitudinal associations of interaction between TJDS and fiscal year on breast cancer incidence and mortality were investigated in 139 countries with populations of 1 million or greater. The longitudinal analysis was evaluated using four linear mixed-effect models with different adjustment covariables.

RESULTS

Many countries with high scores on TJDS had lower distributions of breast cancer incidence and mortality in 1990-2017. Longitudinal analysis using a linear mixed-effect model controlled for socio-economic and lifestyle covariables showed that the interaction between TJDS and fiscal year was significantly associated with incidence of breast cancer (-0.453 ± 0.138, p < 0.01) and mortality of breast cancer (-0.455 ± 0.135, p < 0.001).

CONCLUSIONS

This longitudinal analysis suggested that a traditional Japanese diet has been associated with lower breast cancer incidence and mortality worldwide in recent years.

Traditional Japanese Diet Score - Association with Obesity, Incidence of Ischemic Heart Disease, and Healthy Life Expectancy in a Global Comparative Study

OBJECTIVES

We created a Traditional Japanese Diet Score (TJDS), and to clarify the relationship between TJDS and obesity, ischemic heart disease (IHD), and healthy life expectancy (HALE).

DESIGN

Ecological study.

SETTING

Food (g/day/capita) and energy (kcal/day/capita) supply was determined using the Food and Agriculture Organization of the United Nations Statistics Division database. The sum of characteristic traditional Japanese foods (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, eggs, and seaweeds; food components rarely used in the Japanese diet: wheat, milk, and red meat) was divided as tertiles (beneficial food components: -1, 0, 1; rarely used food components: 1, 0, -1). Obesity rate was determined using the World Health Organization database. Incidence of IHD, HALE and smoking rate were determined using the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 database. Gross domestic product per capita, percentage of population > 65 years old, and health expenditure were determined using the World Bank database. Education years were obtained from the United Nations Educational, Scientific and Cultural Organization Institute for Statistics. Associations between TJDS and obesity, IHD and HALE were examined in 132 countries with a population of 1 million or greater using a general linear model controlled for co-variables.

RESULTS

TJDS was distributed from -6 to 7. TJDS was inversely correlated to obesity (β±SE; -0.70±0.19, p<0.001), IHD (-19.4±4.3, p<0.001), and positively correlated to HALE (0.40±0.14, p<0.01).

CONCLUSIONS

TJDS is a good indicator of a healthy diet, and applies to preventing obesity, IHD and extending HALE.

Dietary diversity and healthy life expectancy-an international comparative study

BACKGROUND/OBJECTIVES

The prolongation of healthy life expectancy (HALE) is a core issue of health policy in many countries. The purpose of this study is to clarify the relationship between dietary diversity and HALE using international databases.

MATERIALS/METHODS

HALE data by country were derived from the Global Burden of Disease (GBD) 2015 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country, excluding loss between production and household, were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. Each food was sorted across 12 food groups, and dietary diversity was obtained from food groups using the Quantitative Index for Dietary Diversity (QUANTIDD). The cross-sectional and longitudinal associations between QUANTIDD and HALE were examined in the countries with populations of one million or greater.

RESULTS

Cross-sectional analysis showed that HALE was significantly associated with QUANTIDD (β = 99.9 ± 11.4, p < 0.001) in the single regression model and in the multiple regression model controlled for covariates (β = 36.4 ± 11.3, p = 0.002). Longitudinal analysis showed that HALE increased with QUANTIDD during the 15-year study period (β = 46.4 ± 5.1, p < 0.001), and this association was also significant when controlled for covariates (β = 39.7 ± 5.1, p < 0.001). Longitudinal association of QUANTIDD with the percentage difference between life expectancy and HALE controlled for covariates was significantly negative (β = - 1.3 ± 0.5, p = 0.011).

CONCLUSIONS

After controlling for socioeconomic indicators, longer healthy life is enjoyed by populations of countries with greater dietary diversity.

Binding of chlorpromazine, phenytoin and aspirin to the erythrocytes and lipoproteins in whole human blood

The quantitative binding of 14C-labelled chlorpromazine, phenytoin or aspirin (at 10 microM) to blood cells and plasma lipoproteins in whole human blood or to the washed erythrocytes in an isotonic protein-free medium has been studied. The fractions of chlorpromazine, phenytoin and aspirin bound to the blood cells in whole blood amounted to about 40, 14 and 2% of the total amount added, and those to the lipoproteins amounted to 7, 2 and 1%, respectively. Their binding to the washed erythrocytes in protein-free medium was 95, 76 and 40%, respectively. Their octanol:water partition coefficients were 214, 170 and less than 0.1, respectively. These results suggest that the amphiphilic drugs with relatively high hydrophobicity may be bound to the blood cells, mainly to erythrocytes, to considerable extents when administered clinically, and also that their binding to plasma lipoproteins may not be negligible.