Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study aims to investigate the relationships of moderate-to-vigorous physical activity (MVPA) with all-cause and disease-specific mortality. We also investigated how the association between MVPA at leisure time (LT-MVPA) and health outcomes differs at different MVPA at work (WT-MVPA) levels. METHODS: The 81,601 community-dwelling Japanese persons aged 50-79 years who responded to a questionnaire in 2000-2003 were followed until 2018. Cox proportional hazard model was used to examine the association of total MVPA with risks of all-cause, cancer, heart disease, stroke and respiratory disease mortality. Then, we compared the mortality risk according to the tertile of LT-MVPA, stratified by the tertile of WT-MVPA. RESULTS: During the 15.1 years of average follow-up, 16,951 deaths were identified. Even total MVPA below the recommended volume (i.e., 0.1-1.49 METs-h/day) was associated with 11% to 24% reductions in all-cause (hazard ratio [HR]: 0.89, 95% confidence interval [CI]: 0.82-0.96) and heart disease mortality (HR:0.76, CI: 0.61-0.94), compared to no MVPA at all. The further reduced risks were seen in MVPA up to 10 METs-h/day. The inverse association between LT-MVPA and mortality risks was more evident at lower WT-MVPA, which WT-MVPA was also inversely associated with the risks. CONCLUSIONS: Health benefits were observed at low levels of MVPA and up to 10 METs-h/day although the fine threshold for excessive MVPA was not clear. LT-MVPA had distinct health benefits especially for persons with lower WT-MVPA.

DOI： 10.1249/MSS.0000000000003331

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jadohealth.2023.08.037

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.jiph.2023.08.013

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Objectives In Japan, schools of public health (SPH) have engaged in professional education focusing on five core disciplines: epidemiology, biostatistics, social and behavioral science, health policy and management, and occupational and environmental health. However, empirical information is lacking regarding the current state of this education and its associated challenges in Japan. In this article, we showcase this issue, using the master of public health (MPH) course at Teikyo University Graduate School of Public Health (Teikyo SPH) as an example.Methods We summarized the current objectives and classes required to complete the MPH course at Teikyo SPH, using the course guideline published in 2022. Current issues and possible future directions in the course were summarized based on the opinions of Teikyo SPH faculty members.Results For epidemiology, lectures and exercises were designed to focus on how to formulating public health issues, collecting and evaluating data, and causal inference. Issues related to the design included ensuring that students had the necessary skills to apply epidemiology to emerging issues, and catching the course up with evolving techniques. For biostatistics, lectures and exercise classes focused on understanding data and statistics, as well as performing analyses. Issues included the understanding of theories, setting the course level, and a lack of appropriate education materials for emerging analytical methods. For social and behavioral science, lectures and exercise classes focused on understanding human behaviors and actions for problem solving. Issues included learning various behavioral theories in a limited timeframe, the gap between the lectures and various needs, and nurturing professionals who had the skills to perform in practical settings. For health policy and management, lectures, exercise classes, and practical training classes focused on identifying and solving problems in the community and around the world, and on integrating the disparate viewpoints of health economics and policy. Issues included few alumni who actually found work globally, a lack of students working in local or central administrations, and insufficient perspectives on rational/economic thinking and macro-economic transitions. For occupational and environmental health, lectures, exercise classes, and practical training classes focused on learning the occupational and environmental impacts of public health issues, and their countermeasures. Challenges included enriching the topics with regard to advanced technologies, environmental health, and socially vulnerable populations.Conclusion Through these reflections on MPH education at Teikyo SPH, the following recommendations are considered essential in order to prepare improvements to the program: reorganizing the curriculum to meet the needs of the day, accepting students with various backgrounds, addressing the increasing knowledge and skills that need to be acquired by the students, and enhancing the powers of professors to implement changes.

DOI： 10.11236/jph.23-007

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Authorship：Last author  

DOI： 10.24804/ree.2302

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Current pandemic prompted a surge in the television (TV) news watching. However, its influence is poorly understood. In Japan, wide show, a major genre of soft news TV programs, broadcasted COVID-19 for long hours, and was pointed out that it broadcasted COVID-19 sensationally, arousing fear and anxiety, and that it criticized individuals gathering in closed places. Thus, wide show may promote preventive behaviors but also produce fear or anxiety and aggressiveness towards others not engaging in preventive behaviors. We examined this issue using large-scale nationwide data. METHODS: We analyzed the cross-sectional data of 25,482 individuals from the Japan COVID-19 and Society Internet Survey conducted in 2020. Participants reported the type of COVID-19 information sources including TV news and wide show, and their trustworthiness. We calculated multivariable-adjusted prevalence ratios (PRs) of engaging in recommended preventive behaviors strictly (defined as always engaging in hand washing, mask wearing, and attempting to keep physical distancing) and alerting others not engaging in preventive behaviors, respectively. RESULTS: About 72.4% of the participants obtained information from TV news with reliance, while corresponding values were 50.3% for wide show. Overall, 32.8% engaged in recommended preventive behaviors strictly, and 9.6% alerted others. Watching wide show both with and without reliance were significantly associated with alerting others (adjusted PRs: 1.48 and 1.34, respectively) but not associated with preventive behaviors. Watching TV news was neither associated with strict preventive behaviors nor alerting others. CONCLUSION: Watching TV news and wide show was not associated with strict preventive behaviors; watching wide show was associated with only alerting others. Although causality is unclear, actions may be needed for TV stations broadcasting wide show to understand own influences on society in a timely manner amid the health emergencies.

DOI： 10.1371/journal.pone.0284371

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Language：Japanese  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2337/dc22-1267

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We examined the prospective associations of changes in lifestyle behaviors before/during the COVID-19 pandemic, namely physical activity and screen time, with mental health. Furthermore, the impacts of physical activity and screen time on mental health during the pandemic were examined cross-sectionally. METHODS: A two-wave longitudinal study was conducted among 2423 children and adolescents in Shanghai, China. Lifestyle behavior variables (physical activity and screen time) and psychological variables (depressive symptoms, anxiety, and stress) were measured using a self-reported questionnaire in January and March 2020. A series of multivariable logistic regressions were performed to examine the associations between changes in lifestyle behaviors in two waves and psychological problems. The combined associations of physical activity and screen time with psychological problems were also explored using the second wave data. RESULTS: Compared to students with persistently short screen time before and during the COVID-19 pandemic, those with prolonged screen time (OR = 1·36 for depression, OR = 1·48 for anxiety) and those with persistently long screen time (OR = 1·70 for depression, OR = 2·13 for anxiety) reported a higher risk of psychological symptoms. The association between changes in physical activity and psychological symptoms was not statistically significant after adjustment for demographic factors, socioeconomic status, and screen time. During the COVID-19 pandemic, engaging in longer screen time (OR = 1·44 for depression, OR = 1·55 for anxiety) was associated with worsened psychological conditions, while engaging in increased physical activity (OR = 0·58 for depression, OR = 0·66 for anxiety) was associated with better psychological conditions. CONCLUSIONS: Our study suggests that promoting physical activity and limiting leisure screen time during the COVID-19 pandemic are important to prevent and mitigate psychological problems in children and adolescents. Therefore, effective interventions targeting lifestyle behaviors are needed to protect children and adolescents' physical and mental health.

DOI： 10.1186/s12966-022-01327-8

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Authorship：Last author,　Corresponding author   Language：English  

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While late chronotype and greater social jetlag have been associated with poor dietary behavior among the general population, these associations have not been investigated among workers, who struggle to align their sleep timings with work schedules. We aimed to explore the cross-sectional association of social jetlag and a late chronotype with adherence to a healthy diet among Japanese workers. Participants were 1,435 non-shift workers (18-78 years) who attended a nutritional survey. Social jetlag was defined as the difference in the midpoint of sleep times between weekdays and weekends, while chronotype was estimated using the mid-sleep time on weekends that was corrected with sleep debt on weekdays. We calculated the adherence score of the Japanese Food Guide Spinning Top (JFGST) - healthy diet guidelines for Japanese. Multivariable linear regression analyses were used to calculate the adjusted means and 95% confidence intervals (CI) for adherence scores of social jetlag and chronotype. We found that greater social jetlag was associated with a lower JFGST score. The multivariable-adjusted mean (95% CI) of JFGST scores were 39.7 (39.1-40.2), 38.7 (37.9-39.6), and 38.1 (36.6-39.7) for <1 hour, 1 to <2 hours, and ≥2 hours of social jetlag, respectively (P-trend = 0.02). Workers with late chronotypes had significantly lower adherence scores on JFGST [36.3 (34.7-37.8); P-trend = 0.002]. Results suggest that a late chronotype and social jetlag are inversely associated with adherence to a healthy diet among Japanese workers.

DOI： 10.1080/07420528.2022.2079519

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Objective Although volunteer activities of providing meals have been conducted as measures to prevent isolation and loneliness and to secure meals, evidence is lacking regarding how to implement such activities. In this study, we describe the activities process at a community cafeteria located within a housing complex and operated by resident volunteers during the COVID-19 pandemic to provide inexpensive meals. We also report the preliminary results of the impact of such activities on the residents.Method This case study was conducted at the community cafeteria Tate Kitchen 'Sakura' located within a Tokyo housing complex with a high ageing population. We collected data on the cafeteria activities during February to May, 2020. The data sources were daily activity records of the cafeteria, dialogues between volunteers and residents, and photos of activities. We qualitatively assessed the effects of the activities on the residents by classifying interviews with ten users and six volunteer staff based on the Kawakita Jiro (KJ) method.Results During the observation period, regular meetings were held among board members and volunteers, and operations of the cafeteria were verified and modified by referring to the COVID-19 prevention guide for citizens, advice from health professionals, and residents' opinions. It was determined that activities would continue without cessation; the cafeteria, managed mainly by volunteers under the food hygiene control system required for commercial restaurants, was open five days a week to maintain food security and ensure the health of the residents. The number of meals sold at the cafeteria was halved in May (n = 2,149) as a result of the modification in operations. However, the number of meals delivered to each household increased from March because of increased demand. Qualitative analyses using KJ method showed that users perceived that these continued activities were effective in securing food, maintaining social interaction and promoting health, and health promotion, while volunteers perceived that the activities were effective in promoting social interaction and health.Conclusion The resident volunteers continually confirmed their commitment to the principle of protecting food security and health within the community. They continued to operate the cafeteria by referring to available information on COVID-19 preventive measures, adopting the COVID-19 preventive measures, and involving all stakeholders. Qualitative analyses suggested that these continued efforts were useful for securing food and supporting health of the residents, looking after one other, and maintaining ties among residents.

DOI： 10.11236/jph.21-097

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Authorship：Lead author,　Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

AIMS: It is well known that healthy lifestyles measured at one time-point are inversely associated with diabetes risk. The impact of transitions in combined lifestyles in real settings remains unknown. MATERIALS AND METHODS: The trajectory patterns of combined lifestyles over three years were identified using group-based trajectory modeling in 26,647 adults in Japan. Two types of indices (not having the unhealthy lifestyle [easy goal] and having healthiest lifestyles [challenging goal]) were developed using five lifestyle factors: smoking, alcohol consumption, exercise, sleep duration, and body weight control. This index was calculated using the yearly total score (0-5; higher score indicated healthier lifestyles). Diabetes was defined by high plasma glucose level, high hemoglobin A1c level, and self-report. RESULTS: Five trajectory patterns were identified for each index and it was shown that healthier patterns are associated with a lower risk of type 2 diabetes during 6.6 years of average follow-up. For example, with a challenging-goal, compared with a persistently very unhealthy pattern, the adjusted hazard ratios (95% confidence intervals) were 0.65 (0.59, 0.73), 0.50 (0.39, 0.64), 0.43 (0.38, 0.48), and 0.33 (0.27, 0.41) for 'persistently unhealthy', 'improved from unhealthy to moderately healthy', 'persistently moderately healthy', and 'persistently mostly healthy' patterns, respectively. CONCLUSIONS: Our data reinforce the importance of improving and maintaining health-related lifestyles to prevent diabetes.

DOI： 10.1111/jdi.13713

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

AIMS: Data are limited regarding how shift work is linked to the development of type 2 diabetes, especially among workers at high risk of diabetes. We examined the risk of diabetes according to shift-work conditions over several years among Japanese adults. METHODS: This prospective study enrolled 17,515 workers (age 40-78 years). Shift work was self-reported at annual health examinations over time from 2004 to 2017 and categorized as shift workers or non-shift workers. Diabetes was defined as fasting plasma glucose, random glucose, HbA1c, and self-reported use of antidiabetic medications. The association of shift work and diabetes was quantified using Cox regression. RESULTS: During a follow-up of 8.1 years in median, 2071 incident cases of diabetes were documented. Compared with non-shift work, shift work showed a significantly elevated hazard ratios of developing diabetes. Shift work showed a 19% (95% confidence intervals: 3-37%) higher hazard ratios for diabetes, after adjustment for demographic-, cardiometabolic-, and work-related factors. Further adjustment for lifestyle factors and body mass index did not materially change this association (a 16% increase; 95% confidence intervals, 1-34%). This relationship was replicated among workers with prediabetes. CONCLUSIONS: Engaging in shift work may increase the risk of developing diabetes independently of lifestyle factors and body mass index, even among prediabetic workers.

DOI： 10.1007/s00592-021-01770-2

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/ggi.14274

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Metabolic syndrome (MetS) has been associated with various chronic diseases which may lead to long-term sickness absence (LTSA), but there is lacking information on the direct association between MetS and LTSA. The present study aimed to investigate the all-cause and cause-specific associations between MetS and the risk of medically-certified LTSA among Japanese workers. METHOD: We recruited 67,403 workers (57,276 men and 10,127 women), aged 20-59 years, of 13 companies in Japan, during their health check-ups in 2011 (11 companies) and 2014 (2 companies), and followed them up for LTSA events (≥ 30 consecutive days) until March 31, 2020. MetS was defined according to the Joint Interim Statement. A Cox proportional hazards regression model was used to estimate hazard ratio (HR) and its 95% confidence interval (CI) for LTSA associated with MetS and its components. RESULTS: During 408,324 person-years of follow-up, 2,915 workers experienced LTSA. The adjusted HR for all-cause LTSA was 1.54 (95% CI, 1.41-1.68) among those with vs without MetS. In cause-specific analysis, HRs associated with MetS significantly increased for LTSA due to overall physical disorders (1.76), cardiovascular diseases (3.16), diseases of the musculoskeletal system and connective tissue (2.01), cancers (1.24), obesity-related cancers (1.35), mental, behavioral and neurodevelopmental disorders (1.28), reaction to severe stress and adjustment disorders (1.46) and external causes (1.46). The number of MetS components were also significantly associated with increased LTSA risk. CONCLUSION: MetS was associated with an increase in the risk of LTSA due to various diseases among Japanese workers.

DOI： 10.2188/jea.JE20210185

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)  

Background Municipalities in Japan are responsible for supporting community activities, which are important for social ties and community health. However, there is sparse evidence about the information on community activities provided by municipalities.
Methods We performed a content analysis of the webpages provided from May 25 to July 14, 2020 on the websites of all 62 municipalities in Tokyo. We coded the data with respect to the followings: resuming community activities after the first state of emergency was lifted in May 2020; information that would show similar tendencies to community activities; information that could have affected community activities; and factors that could have influenced providing information on community activities. We analyzed the data by sender (mayor vs. other).
Results We identified messages from the 46 mayors; none of them mentioned community activities. Thirty mayors explained about reopening community facilities and 23 announced control measures, such as avoiding the three Cs. Approximately 90% of the mayors provided messages about perceiving COVID-19 risk; however, none referred to the negative health impacts of self-quarantine. Overall, tendencies of the information provided by other than the mayors were relatively similar to those by mayors. Only two cities provided information about resuming community activities after the state of emergency was lifted.
Conclusion The present data suggest that nearly all of municipalities provided no information about community activities after lifting the first state of emergency.

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Increased visit-to-visit variability (VVV) of blood pressure, which is calculated based on several readings, has been suggested to be a significant predictor of cardiovascular events and mortality, independent of mean blood pressure. This study examined associations between the VVV of systolic blood pressure (SBP) measured annually and cardiovascular disease (CVD) events among 72,617 Japanese subjects. Data were obtained from the Japan Epidemiology Collaboration on Occupational Health Study, which is an ongoing epidemiological survey of workers in Japan. VVV was calculated as the coefficient of variation of SBP readings from 2008 to 2011; information on fatal and nonfatal CVD events was collected from registries of specific outcomes between April 2012 and March 2019. A Cox proportional hazards model was applied to investigate associations after adjusting for mean SBP between 2008 and 2011 and covariates. During the 7-year follow-up period, there were 63 CVD fatalities and 314 CVD events (combining fatal and nonfatal events). The results showed that a one-standard deviation increase in VVV was associated with a significant increase in the risk of CVD mortality (hazard ratio [HR] = 1.42; 95% confidence interval [CI] = 1.32-1.54); those in the highest tertile had a 3.20 times (95% CI = 1.26-8.17) higher risk of CVD mortality than those in the lowest tertile. We found less pronounced associations regarding CVD events (HR = 1.08, 95% CI = 1.02-1.15). In conclusion, VVV was significantly associated with CVD mortality in our Japanese working population.

DOI： 10.1038/s41440-021-00654-w

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Physical activity has been linked to a lower risk of chronic kidney disease (CKD); however, evidence on the relationship between domain-specific physical activity and CKD is scarce. This study aimed to examine the risk of CKD in relation to leisure-time, occupational, and commuting physical activities in a large occupational cohort in Japan. Participants were 17,331 workers (20-65 years old) without CKD and were followed-up for a maximum period of 13 years. Incident CKD was defined as an estimated glomerular filtration rate of < 60 mL/min/1.73 m2 and/or proteinuria determined using the dipstick test. The Cox proportional hazards models were used to examine the associations. During 147,752 person-years of follow-up, 4013 participants developed CKD. Workers who were standing or walking at work and those who were fairly active at work had adjusted hazard ratios of 0.88 (95% confidence interval 0.86-0.96) and 0.89 (95% confidence interval 0.78-1.02), respectively, for developing CKD than sedentary workers. Leisure-time physical activity and walking for commute were not associated with CKD risk. Our findings suggest that occupational, but not leisure-time and commuting physical activities, is associated with a lower CKD risk.

DOI： 10.1038/s41598-021-91525-4

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.24804/ree.2016

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：American Diabetes Association  

OBJECTIVE: Prediabetes has been suggested to increase risk for death; however, the definitions of prediabetes that can predict death remain elusive. We prospectively investigated the association of multiple definitions of prediabetes with the risk of death from all causes, cardiovascular disease (CVD), and cancer in Japanese workers. RESEARCH DESIGN AND METHODS: The study included 62,785 workers who underwent a health checkup in 2010 or 2011 and were followed up for death from 2012 to March 2019. Prediabetes was defined according to fasting plasma glucose (FPG) or glycated hemoglobin (HbA1c) values or a combination of both using the American Diabetes Association (ADA) or World Health Organization (WHO)/International Expert Committee (IEC) criteria. The Cox proportional hazards regression model was used to investigate the associations. RESULTS: Over a 7-year follow-up, 229 deaths were documented. Compared with normoglycemia, prediabetes defined according to ADA criteria was associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.53; 95% CI 1.12-2.09) and death due to cancer (HR 2.37; 95% CI 1.45-3.89) but not with death due to CVD. The results were materially unchanged when prediabetes was defined according to ADA FPG, ADA HbA1c, WHO FPG, or combined WHO/IEC criteria. Diabetes was associated with the risk of all-cause, CVD, and cancer deaths. CONCLUSIONS: In a cohort of Japanese workers, FPG- and HbA1c-defined prediabetes, according to ADA or WHO/IEC, were associated with a significantly increased risk of death from all causes and cancer but not CVD.

DOI： 10.2337/dc20-1213

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Other Link： https://syndication.highwire.org/content/doi/10.2337/dc20-1213

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Although previous research has focused on the association between long working hours and several mental health outcomes, little is known about the association in relation to mental health-related sickness absence, which is a measure of productive loss. We aimed to investigate the association between overtime work and the incidence of long-term sickness absence due to mental disorders. METHODS: Data came from the Japan Epidemiology Collaboration on Occupational Health Study (J-ECOH). A total of 47,422 subjects were followed-up in the period between April 2012 and March 2017. Information on long-term sickness absence (LTSA) was obtained via a study-specific registry. Baseline information was obtained at an annual health checkup in 2011; overtime working hours were categorized into <45; 45-79; 80-99; and ≥100 hours/month. RESULTS: During a total follow-up period of 211,443 person-years, 536 people took LTSA due to mental disorders. A Cox proportional hazards model was revealed that compared to those with less than 45 hours/month of overtime work, those with 45-79 hours/month were at a lower risk of LTSA due to mental health problems (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.55-0.72) while those with overtime work of ≥100 hours/month had a 2.11 times (95%CI = 1.10-4.07) higher risk of LTSA due to mental health problems. CONCLUSION: Engaging in excessive overtime work was linked with a higher risk of LTSA due to mental health problems while the lower risk observed among individuals working 45-79 hours/month of overtime work might have been due to a healthy worker effect.

DOI： 10.2188/jea.JE20200382

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

<title>Abstract</title>
<sec>
<title>Background</title>
Few studies have investigated the association between tobacco smoking and sick leave (SL) in Japan.


</sec>
<sec>
<title>Methods</title>
We followed 70 896 workers aged 20–59 years (60 133 males, 10 763 females) between April 2012 and March 2017. A Cox proportional hazards model was used to investigate the associations between smoking (smoking status and intensity) and long-term SL (ie, SL lasting ≥30 consecutive days). Cause-specific analyses were also conducted.


</sec>
<sec>
<title>Results</title>
A total of 1777 people took long-term SL during a follow-up of 307 749 person years. Compared with never-smokers, current smokers were at a higher risk of long-term SL (hazard ratio [HR] = 1.32; 95% confidence interval [CI] = 1.19 to 1.48). Cause-specific analyses revealed that current smoking was associated with a higher risk of SL due to all physical disorders (HR = 1.44, 95% CI = 1.22 to 1.69), cancer (HR = 1.49, 95% CI = 1.10 to 2.01), cardiovascular disease (CVD; HR = 2.16, 95% CI = 1.31 to 3.55), and injuries/external causes (HR = 1.83, 95% CI = 1.31 to 2.58). Former smokers were at a higher risk of SL due to cancer at a borderline significance level (HR = 1.38, 95% CI = 0.99 to 1.92). Low-intensity smoking (ie, 1–10 cigarettes smoked per day) was associated with all-cause SL, SL due to CVD, and SL due to injuries/external causes compared with never-smokers.


</sec>
<sec>
<title>Conclusion</title>
In a large cohort of working-age Japanese, smoking was associated with a greater risk of long-term SL. Greater effort is needed to mitigate disease burden associated with smoking at workplace in Japan.


</sec>
<sec>
<title>Implications</title>
Our study contributes to the literature on the association between smoking and SL in several ways. First, the study was conducted among a Japanese working population. While the association has been extensively studied in Western setting, few attempts have been made elsewhere. Second, cause-specific analyses were undertaken in our study. Third, we paid attention to the effect of low-intensity smoking on SL given that there is growing evidence of an elevated health risk associated with low-intensity smoking.


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DOI： 10.1093/ntr/ntz204

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Other Link： http://academic.oup.com/ntr/article-pdf/23/1/135/35504408/ntz204.pdf

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Consumption of soft drinks has become a serious public health issue worldwide. However, prospective evidence is limited regarding the relationship between soft drink consumption and depression, especially in Asia. The aim of this study was to investigate the prospective association between soft drink consumption and the development of depressive symptoms. METHODS: We evaluated an occupational cohort of 935 adults in Japan (2012-2016), who were free from depressive symptoms at baseline and attended a 3-y follow-up assessment. Soft drink consumption was assessed using a self-administered diet history questionnaire. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from multivariate logistic regression analysis controlling for sociodemographic, lifestyle, dietary, and occupational covariates. RESULTS: Over the 3-y study period, 16.9% (158 cases) of the study participants reported depressive symptoms. Higher soft drink consumption was associated with higher odds of depressive symptoms. The multivariable-adjusted OR was 1.91 (95% CI, 1.11-3.29; Ptrend = 0.015) when comparing soft drink consumption of ≥4 cups/wk with consumption of <1 cup/wk. CONCLUSION: The present results suggested that greater consumption of soft drinks would increase the likelihood of exhibiting depressive symptoms.

DOI： 10.1016/j.nut.2020.110860

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Society for Occupational Health  

DOI： 10.1539/eohp.2020-0012-cm

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Language：Japanese   Publisher：日本行動医学会  

根拠に基づいた医療や健康政策を推進するために求められるのが、ヒト集団を対象とした研究による成果である。ただし、集団から得られたデータであれば無条件にすべてが信じるに足る根拠となるわけではなく、その質や、原因と結果の関連の強さの程度などを慎重に吟味して活用するスキルが求められる。このスキルと密接に関係する学問が疫学と生物統計学である。疫学は、人々の健康・生命に関して説得力のあるメッセージを発信するために、効率性なども踏まえながらより高い質のデータを集団から得るための研究デザインを示す学問である。一方の生物統計学はそうした研究から得られたデータに対して統計手法を適用することで客観的な数値としてメッセージを示すことに長けた学問である。また、生物統計学はそのままでは問題のあるデータをうまく処理して活用するためにも必須の学問である。本稿では、集団のデータ解析を行う際の考え方の基礎と実際について、ヒト集団を対象とした主な(疫学)研究デザインとデータ解析手法を中心に取り上げながら概観する(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

BACKGROUND & AIMS: To investigate trajectories of body mass index (BMI) and waist circumference (WC) among prediabetic people who progressed to diabetes, people who remained with prediabetes, and those who returned to normoglycemia. METHODS: We used data from 22,945 prediabetic people who received an annual health checkup for up to eight years. The development of diabetes was defined using the American Diabetes Association criteria. People who did not progress to diabetes during the observation period were classified as 'remained with prediabetes' or 'returned to normoglycemia', based on their last health checkup data. Trajectories of BMI and WC were evaluated using linear mixed models for repeated measures, with adjustment for a wide range of covariates. RESULTS: During the study period, 2972 people progressed to diabetes, 4706 returned to normoglycemia, and 15,267 remained with prediabetes. People who progressed to diabetes had a larger increase in mean BMI from 7 years to 1 year prior to diagnosis, which was about three times that of people who remained with prediabetes (annual change rate, 0.20 [95% confidence interval; 0.15 to 0.24] vs 0.06 [0.04 to 0.08] kg/m2 per year, P < 0.001), regardless of their BMI levels at the initial health checkup. Among people who returned to normoglycemia, mean BMI remained almost the same over time (-0.04 [-0.09 to 0.002] kg/m2 per year), except for those with obesity (-0.16 [-0.28 to -0.05] kg/m2 per year). As for WC, the annual change rate among people who developed diabetes was about 7 times that of people who remained with prediabetes (0.38 [0.32 to 0.45] vs 0.05 [0.03 to 0.08] cm per year, P < 0.001). We also observed a constant mean WC over time among people who had no central obesity and later returned to normoglycemia (-0.02 [-0.06 to 0.03] cm per year), and an annual decrease in mean WC among those who had central obesity and later returned to normoglycemia (-0.40 [-0.47 to -0.32] cm per year). CONCLUSIONS: Our study provides strong evidence that avoiding weight gain could help prediabetic people minimize the risk of developing diabetes, regardless of whether they are obese. Losing weight could help obese people restore normoglycemia from a prediabetic state, whereas maintaining current weight may help nonobese people return to normoglycemia.

DOI： 10.1016/j.clnu.2019.12.023

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)  

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Society for Occupational Health  

DOI： 10.1539/sangyoeisei.2019-015-c

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In occupational settings, smokers may take quitting smoking seriously if they experienced long-term sick leave due to cancer or cardiovascular disease (CVD). However, no study has elucidated the smoking cessation rate after long-term sick leave. We examined the smoking cessation rate after long-term sick leave due to cancer and CVD in Japan. We followed 23 survivors who experienced long-term sick leave due to cancer and 39 survivors who experienced long-term sick leave due to CVD who reported smoking at the last health exam before the leave. Their smoking habits before and after the leave were self-reported. Logistic regression was used to calculate adjusted smoking cessation rates. Smoking cessation rate after long-term sick leave due to cancer was approximately 70% and that due to CVD exceeded 80%. The adjusted smoking cessation rate was 67.6% (95% confidence interval [CI]: 47.0, 88.2) for cancer and 80.7% (95% CI: 67.7, 93.8) for CVD. Smoking cessation rate after a longer duration of sick leave (≥60 d) tended to increase for both CVD and cancer. Although any definite conclusion cannot be drawn, the data suggest that smoking cessation rate after long-term sick leave due to CVD is slightly higher than that for cancer.

DOI： 10.2486/indhealth.2019-0136

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Language：Japanese   Publisher：(公社)日本産業衛生学会  

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Objective: To examine whether the cross-sectional association of leisure-time physical activity and walking during commuting to work with depressive symptoms depends on the level of work-related physical activity among Japanese workers. Methods: Participants were 2024 workers aged 19-69 years in two manufacturing companies in Japan. Leisure-time physical activity and walking during commuting to work were ascertained via a self-administered questionnaire. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. The odds ratio (OR) of depressive symptoms (CES-D score ≥16) was estimated by using multiple logistic regression with adjustment for covariates. Results: Leisure-time physical activity was inversely associated with depressive symptoms; multivariable-adjusted ORs (95% confidence intervals) of having depressive symptoms for leisure-time physical activity were 1.00 (reference), 0.85 (0.64, 1.12), 0.69 (0.51, 0.94), and 0.59 (0.44, 0.80) for 0, >0 to <3.0, 3.0 to <10.0, and ≥10.0 MET-h/wk, respectively (P for trend <.001). This inverse trend for leisure-time physical activity was clearer among individuals who had low physical activity at workplace (less than 7.0 MET-h/d). For walking to work, such an inverse association was not observed. Conclusion: Leisure-time physical activity was associated with fewer depressive symptoms, especially in workers with low work-related physical activity.

DOI： 10.1002/1348-9585.12120

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BACKGROUND & AIMS: Oxidative stress has been suggested to play an important role in the pathophysiology of depression, and a diet high in antioxidants may improve mood. However, studies addressing this issue are scarce. The aim of this cohort study was to investigate the prospective association between dietary non-enzymatic antioxidant capacity (NEAC) in overall diet and depressive symptoms in Japanese employees. Additionally, we examined the association separated by dietary NEAC sources. METHOD: Participants were 911 workers without depressive symptoms at baseline and participated in 3-y follow-up survey. Dietary NEAC was determined from a database of NEAC measurements obtained by ferric reducing antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC). Dietary NEAC was calculated by multiplying the estimated NEAC values with the consumed amount and summing up those values. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to estimate odds ratios of depressive symptoms according to overall NEAC and separately from foods and beverages. RESULTS: At 3-y follow-up, 153 (16.8%) workers were newly identified as having depressive symptom. No significant associations were found between higher level of overall dietary NEAC and decreased risk of depressive symptoms after adjustment for potential confounders (overall: FRAP, P for trend = 0.19 and ORAC, P for trend = 0.20). Likewise, neither higher dietary NEAC from foods nor beverages were related with lower depressive symptoms. CONCLUSION: Our findings did not support an inverse association between dietary NEAC and the risk of depressive symptoms in Japanese workers.

DOI： 10.1016/j.clnesp.2020.01.010

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

The coronavirus disease 2019 (COVID-19) has spread rapidly across the globe, presenting severe challenges to societies. Gaining a better understanding of patient demographics is essential to develop measures to counteract such spreading. In this context, from a viewpoint of occupational health, we analyzed the publicly available data on patients diagnosed with COVID-19 in Tokyo, which reported the highest number of cases in Japan. A total of 243 cases aged 20 years or older (excluding students) were recorded between January 14 and March 27, 2020. Of 233 cases excluding 10 cases of the first cluster, 162 were men and 176 were of working age (20 to 69 years). Of 203 cases with valid information on employment status, 151 (74%) were workers: 114 employees, 31 self-employed, and 6 medical staff. Of the working patients, the majority were male: 72% in employed and 87% in self-employed. These data suggest the importance of occupational health in controlling the spread of COVID-19. In April 2020, a state of emergency was declared in response to a surge in the number of cases, especially in metropolitan areas. A working schedule associated with lower risks of infection, including telework and flexible working hours, should be rigorously promoted to minimize human-to-human contact. Such policies, along with the implementation of effective measures to protect essential workers from infection, overwork, and stigma, would ensure the smooth running of society amidst the present crisis.

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OBJECTIVE: In contrast to the association between excess weight and sickness absence (SA), the association in relation to underweight has been under-researched. This study aimed to examine the effects of BMI at both extremes of its distribution on SA. METHODS: Data came from the Japan Epidemiology Collaboration on Occupational Health study of 77,760 workers aged 20 to 59 years (66,166 males, 11,594 females). Information was collected on medically certified long-term SA (LTSA) (i.e., SA lasting ≥ 30 consecutive days) from April 2012 to March 2017. A sex-specific Cox proportional hazards model was used to investigate the associations. RESULTS: Among males, both obesity (hazard ratio [HR] = 1.81, 95% CI: 1.50-2.17) and underweight (HR = 1.56, 95% CI: 1.23-1.96) were significantly associated with LTSA compared with normal weight. This U-shaped association between BMI categories and LTSA was observed both for mental and physical disorders. Among females, an elevated risk was observed among those with overweight (HR = 1.54, 95% CI: 1.16-2.05). CONCLUSIONS: In a cohort of the Japanese working-age population, both obesity and underweight were associated with a greater risk of LTSA in males. Future research should not overlook the excess risk of LTSA associated with underweight.

DOI： 10.1002/oby.22703

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It was highlighted that in the original article [1] the selection process was not described clearly enough to avoid confusion under the heading of the Target of Outcomes in the Methods section.

DOI： 10.1186/s12889-019-8096-z

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OBJECTIVES: We aimed to compare the association of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with risk of cardiovascular disease (CVD) among middle-aged working Japanese men. METHODS: A nested case-control study was performed among middle-aged male employees who underwent periodic health checkup. A total of 241 CVD cases were identified and matched individually on age, gender, and worksite with 1205 controls. Data on BMI, WC, WHtR, smoking, hypertension, diabetes, and dyslipidemia collected at 4 years before the event/index date were retrieved. Associations between BMI, WC, WHtR, and CVD risk were assessed by using conditional logistic regression models. RESULTS: The strength of the association of BMI, WC, and WHtR with CVD risk was similar. The smoking-adjusted odds ratio (95% confidence interval) for CVD was 1.60 (1.38-1.85), 1.53 (1.33-1.78), and 1.56 (1.35-1.81) for a 1 SD unit increase in BMI, WC, and WHtR respectively. After further adjustment for hypertension, diabetes, and dyslipidemia, these associations were attenuated but remained statistically significant. CONCLUSIONS: Measures of general (BMI) and abdominal (WC and WHtR) obesity were similarly associated with CVD in middle-aged Japanese men.

DOI： 10.1002/1348-9585.12098

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OBJECTIVE: The present study aimed to estimate cumulative incidence of overweight and obesity and describe 5-year longitudinal changes in body mass index (BMI) in a large occupational cohort in Japan. METHODS: Participants were 55 229 Japanese employees, who were aged 20-59 years and attended at all subsequent annual health check-ups between 2009 and 2014. Mixed model analysis was performed to examine the effects of age and cohort by gender on BMI change, with age as a random variable. Cumulative incidence of overweight (23.0≤ BMI <27.5 kg/m2 ) and obesity (BMI ≥27.5 kg/m2 ) was calculated. Logistic regression analysis was used to estimate odds ratios for the incidence of overweight and obesity according to age group. RESULTS: The incidence of overweight and obesity was approximately double in men (28.3% and 6.7%, respectively) compared to women (14.3% and 3.9%, respectively).The incidence of obesity decreased with age in men, but did not differ according to age in women (P for trend: .02 and .89, respectively). Among overweight participants, the incidence of obesity was higher in women (18.9%) than men (14.5%) and decreased with advancing age (P for trend: <.001 in men and .003 in women). Mean BMI was higher in men than women in all age groups throughout the period. Younger cohorts tended to have a higher BMI change compared with older cohorts. CONCLUSIONS: In this Japanese occupational cohort, transition from overweight to obesity is higher in women than men, and the more recent cohorts had a higher change in mean BMI than the older cohorts.

DOI： 10.1002/1348-9585.12095

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STUDY OBJECTIVES: Social jetlag, a mismatch between biological and social timing, has been reported to be associated with depressive symptoms among general population. However, evidence on this association is lacking among non-shift workers, who are under pressure to adapt themselves to a work schedule. We investigated the cross-sectional association of social jetlag with depressive symptoms among Japanese non-shift workers. METHODS: This study included 1,404 employees, aged 18-78 years, who completed a study questionnaire at a periodic health checkup. Social jetlag was calculated as the absolute value of the difference in the midpoint of sleep times between weekdays and weekends. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression was used to estimate the odds ratio (OR) with adjustments for potential confounders including diet and chronotype. RESULTS: Of the study participants, 63.5%, 28.4%, and 8.1% had less than 1 hour, 1 to less than 2 hours, and at least 2 hours of social jetlag, respectively. Greater social jetlag was significantly associated with an increased likelihood of having depressive symptoms. The multivariable-adjusted OR (95% confidence interval) were 1.30 (0.95 to 1.78) and 2.14 (1.26-3.62) for 1 to less than 2 hour and at least 2 hours compared to less than 1 hour of social jetlag. The association between social jetlag and depressive symptoms appeared to be linear, according to restricted cubic spline regression. CONCLUSION: Results suggest that greater social jetlag is associated with an increased likelihood of having depressive symptoms among non-shift workers.

DOI： 10.1093/sleep/zsz204

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OBJECTIVES: To investigate the association between a healthy lifestyle index (HLI) (i.e., a composite score comprising multiple lifestyle factors) and hypertension among community adults living in Sri Lanka. METHODS: The present study used baseline information of a cluster randomized controlled trial among 456 adults aged 27-65 years in a semi-urban community in Colombo, Sri Lanka. The HLI was constructed by summing a number of low-risk lifestyle factors: low body mass index, sufficient physical activity, non-smoking, low alcohol consumption, and sufficient fruit and vegetable consumption. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or the use of antihypertensive medication. A logistic regression model was used to investigate the association between the HLI (low: 0-2; middle: 3; high: 4-5) and hypertension. RESULTS: A total of 178 (39%) participants were hypertensive. Compared with the low HLI group, multivariate-adjusted odds ratios (95% confidence intervals) of hypertension were 0.72 (0.44-1.19) and 0.28 (0.15-0.54) for the middle and high HLI groups, respectively (p-trend <0.001). CONCLUSIONS: The present study provides essential evidence on an inverse association between adherence to healthy lifestyles and hypertension.

DOI： 10.1371/journal.pone.0226773

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OBJECTIVE: To investigate the association between suicide death and serum cholesterol levels as measured at times close to suicide death. METHODS: We conducted a nested case-control study of 41 cases of suicide deaths and 205 matched controls with serum total cholesterol (TC) levels till 3 years before suicide death in a large cohort of Japanese workers. RESULTS: Individuals in the lowest versus highest tertile/predefined category of TC in a Japanese working population had a three- to four-fold greater risk of suicide death. Each 10 mg/dl decrement of average TC was associated with an 18% increased chance of suicide death (95% confidence interval, 2-35%). Similar results were found for TC levels at each year. CONCLUSION: These results suggest that a low serum TC level in recent past is associated with an increased risk of suicide death.

DOI： 10.1017/neu.2019.26

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AIMS/INTRODUCTION: We examined a prospective association between serum creatinine levels and diabetes. MATERIALS AND METHODS: The present study included 31,343 male workers without diabetes, and aged between 20 and 64 years at baseline. We calculated the cumulative average of their serum creatinine over the study period. We defined diabetes as either glycated hemoglobin levels ≥6.5%, random glucose levels ≥200 mg/dL, fasting glucose levels ≥126 mg/dL or receiving antidiabetic treatment. Cox proportional hazards regression analysis was carried out to estimate the hazard ratio (HR) and 95% confidence interval (CI). RESULTS: With a median observation of 7.7 years, 2,509 participants developed diabetes. After adjusting for age, smoking, body mass index, hypertension and dyslipidemia, lower cumulative average serum creatinine levels were related to a greater diabetes risk: HRs were 1.56 (95% CI 1.35-1.82), 1.22 (1.09-1.35) and 1.06 (0.96-1.17) for the participants with serum creatinine <0.70, 0.70-0.79 and 0.80-0.89 mg/dL, respectively, compared with those with 0.90-1.20 mg/dL (P for trend <0.001). The serum creatinine-diabetes association was more pronounced among older adults (serum creatinine <0.70 vs 0.90-1.20 mg/dL, HR 1.66, 95% CI 1.37-2.00) than younger adults (HR 1.32, 95% CI 1.02-1.71; P for interaction by age group = 0.001). CONCLUSIONS: Low serum creatinine is associated with an increased risk of diabetes. Screening serum creatinine levels can be used to identify those who are at high risk of diabetes.

DOI： 10.1111/jdi.13024

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INTRODUCTION: The effect of weight gain following smoking cessation on cardiovascular risks is unclear. We aimed to prospectively investigate the association of weight gain following smoking cessation with the trajectory of estimated risks of coronary heart disease (CHD). METHODS: In a cohort of 18 562 Japanese male employees aged 30-64 years and initially free of cardiovascular diseases, participants were exclusively grouped into sustained smokers, quitters with weight gain (body weight increase ≥ 5%), quitters without weight gain (body weight increase < 5% or weight loss), and never smokers. Global 10-year CHD risk was annually estimated by using a well-validated prediction model for the Japanese population. Linear mixed models and piecewise linear mixed models were used to compare changes in the estimated 10-year CHD risk by smoking status and weight change following smoking cessation. RESULTS: During a maximum of 8-year follow-up, both quitters with and without weight gain had a substantially decreased level of estimated 10-year CHD risk after quitting smoking, compared with sustained smokers (all p for mean differences < 0.001). The estimated 10-year CHD risk within the first year after cessation decreased more rapidly in quitters without weight gain than in quitters with weight gain (change rate [95% confidence interval, CI] -0.90 [-1.04 to -0.75] vs. -0.40 [-0.60 to -0.19] % per year, p < 0.0001). Thereafter, the estimated 10-year CHD risk in both groups increased at similar rates (change rate [95% CI] -0.07 [-0.21 to 0.07] vs. 0.11 [-0.09 to 0.30] % per year, p = 0.16, from year 1 to year 2; and 0.10 [0.05 to 0.15] vs. 0.11 [0.04 to 0.18] % per year, p = 0.80, from year 2 to year 8). CONCLUSIONS: In this population of middle-aged, Japanese male workers, smoking cessation greatly reduces the estimated 10-year risk of CHD. However, weight gain weakens the beneficial effect of quitting smoking in a temporary and limited fashion. IMPLICATIONS: To our knowledge, the present study is the first to examine the effect of weight gain following smoking cessation on the trajectory of the absolute risk of CHD. Our data imply that the benefits of cessation for reducing the absolute risk of CHD outweigh the potential risk increase due to weight gain, and suggest that in order to maximize the beneficial effects of quitting smoking, interventions to control post-cessation weight gain might be warranted.

DOI： 10.1093/ntr/ntz165

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BACKGROUND: Mobilising non-professional health workers has been successful in improving community health, but the effectiveness of an education program targeting youths in a community-based approach remains unclear. The objective of this study was to investigate the effect of an intervention with youth on cardiovascular disease risk factors of community adults. METHODS: A 12-month cluster randomised trial was conducted in a semi-urban area of Colombo in Sri Lanka. Facilitators trained youth club members aged 15-29 years to assess cardiovascular disease risk factors and take actions in the community to address relevant issues. The control group received no intervention. Body weight and blood pressure as primary outcomes and lifestyle of adults as secondary outcomes were measured pre- and post-intervention. Multilevel linear and logistic regressions were used to assess the effects of the intervention on changes in continuous and binary outcomes, respectively, from baseline to endpoint. RESULTS: Of 512 participants at baseline, 483 completed the final assessment after the intervention. Regarding primary outcomes, the intervention group showed a significantly greater decrease in body weight after intervention than the control group. The mean (95% confidence interval) difference of body weight change for intervention versus control group was - 2.83 kg (- 3.31, - 2.35). There was no statistically significant difference in blood pressure between the two groups. Turning to the secondary outcomes, in diet, the intervention group had a higher probability of consuming at least one serving/day of fruits (p = 0.02) and a lower probability of consuming snacks twice/day or more (p < 0.001) than the control group. CONCLUSIONS: An intervention employing youths as change agents was effective in lowering body weight among community adults in Sri Lanka. TRIAL REGISTRATION: Trial registration number: SLCTR/2017/002 , Name of registry: Sri Lanka Clinical Trials Registry, Date of registration: 19th January 2017, Date of enrolment of the first participant to the trial: 1st February 2017.

DOI： 10.1186/s12889-019-7142-1

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DOI： 10.1093/ije/dyz074

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Language：Japanese   Publisher：(公社)日本産業衛生学会  

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Amino acids have emerged as novel biomarkers for predicting type 2 diabetes (T2D), but the epidemiologic data linking circulating amino acid profiles with T2D are sparse in Asian populations. We conducted a nested case-control study within a cohort of 4,754 nondiabetic Japanese employees who attended a comprehensive health checkup in 2008-2009 and agreed to provide blood samples. During a 5-year follow-up, incident T2D cases were ascertained based on plasma glucose, glycated hemoglobin, and self-report. Two controls matched to each case on sex, age, and the date of serum sampling were randomly selected by using density sampling, resulting in 284 cases and 560 controls with amino acid measures. High concentrations of valine, leucine, isoleucine, phenylalanine, tyrosine, alanine, glutamate, ornithine, and lysine were associated with an increased risk of incident T2D, in a linear manner. High glutamine concentrations were associated with a decreased risk of incident T2D. Further adjustment for the homeostasis model assessment of insulin resistance attenuated these associations. Overall, these amino acids may be novel useful biomarkers in the identification of people at risk of T2D before overt symptoms. Insulin resistance may account for or mediate the relationship between these amino acids and risk of incident T2D.

DOI： 10.1038/s41598-019-43431-z

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Language：Japanese   Publisher：(公社)日本産業衛生学会  

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INTRODUCTION: We aimed to determine the prospective association of smoking status, smoking intensity, and smoking cessation with the risk of hearing loss in a large Japanese cohort. METHODS: The cohort study included 50195 employees, who were aged 20-64 years and free of hearing loss at baseline. Participants were followed up for a maximum of 8 years. Pure-tone audiometric testing was performed annually to identify hearing loss at 1 and 4 kHz. Cox proportional hazards regression models were used to investigate the association between smoking and hearing loss. RESULTS: During follow-up, 3532 individuals developed high-frequency hearing loss, and 1575 developed low-frequency hearing loss. The hazard ratio (HR) associated with current smokers was 1.6 (95% confidence interval [CI] = 1.5 to 1.7) and 1.2 (95% CI = 1.1 to 1.4) for high- and low-frequency hearing loss, respectively, as compared with never smokers. The risk of high- and low-frequency hearing loss increased with the number of cigarettes smoked per day (both p for trend <.001). The HR associated with former smokers was 1.2 (95% CI = 1.1 to 1.3) and 0.9 (95% CI = 0.8 to 1.1) for high- and low-frequency hearing loss, respectively. The analysis by quitting years showed a decline in risk of hearing loss after quitting smoking, even among those who quitted less than 5 years before baseline. CONCLUSIONS: Smoking is associated with increased risk of hearing loss, especially at the high frequency, in a dose-response manner. The excess risk of hearing loss associated with smoking disappears in a relatively short period after quitting. IMPLICATIONS: The prospective association between smoking and hearing loss has not been well studied. To the best of our knowledge, our study is the largest to date investigating the association between smoking and incident hearing loss. Our results indicate that smoking is associated with increased risk of hearing loss in a dose-response manner. Quitting smoking virtually eliminates the excess risk of hearing loss, even among quitters with short duration of cessation. These results suggest that smoking may be a causal factor for hearing loss, although further research would be required to confirm this. If so, this would emphasize the need for tobacco control to prevent or delay the development of hearing loss.

DOI： 10.1093/ntr/nty026

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Breakfast consumption has been suggested to influence mood, but prospective evidence on this issue is limited. We prospectively investigated the association between the frequency of breakfast consumption and the risk of depressive symptoms in Japanese employees. Participants were 716 employees aged 19-68 years who were free from depressive symptoms and mental disorders at baseline and who attended the 3-year follow-up survey. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. The frequency of breakfast consumption was categorized into "daily", "5-6 times/week", "3-4 times/week", "1-2 times/week", or "≤1 times/week". Logistic regression was used to estimate odds ratios of depressive symptoms according to breakfast consumption adjusted for dietary and lifestyle factors. Participants who consumed breakfast ≤1 times/week had an increased risk of depressive symptoms compared to those who ate breakfast every day, even after adjusting for other dietary factors (multivariable-adjusted odds ratio 2.92; 95% confidence interval, 1.37-6.22) The risk of depressive symptoms tended to increase with decreasing frequency of breakfast consumption (P for trend = 0.02). The omission of breakfast is related to increased risk of depressive symptoms among Japanese employees, independently of other dietary and non-dietary factors.

DOI： 10.1016/j.psychres.2019.01.069

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DOI： 10.2188/jea.JE20180184

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Language：Japanese   Publishing type：Research paper (scientific journal)  

© 2019 Life Science Publishing Co. Ltd. All rights reserved. Objectives In pharmaceutical industry, the medical affairs (MA) department engage in the activities for creation of evidence, which consist of various designs. Thus, traditional knowledge and skills are insufficient for evidence creation in MA department. This survey was aimed to clarify key skills for evidence creation and to evaluate factors to contribute medical care through valid clinical evidence. Methods We sent questionnaires to 70 pharmaceutical companies subscribing to the Japan Pharmaceutical Manufacturers' Association, and collected anonymously. Result The responses were obtained from 34 companies (48.6%). All 34 companies set up MA department, and conducted evidence creation in MA department. The average number of research areas was 4.5 areas. The most important skills for evidence creation was the highly ethical mind. The design of clinical studies, biostatistics and knowledge of public health were also considered as important skills for evidence creation. Needs for epidemiology and biostatistics in public health were great, and need for the 10 competency regions in public health was consistently high. Needs for 10 competency regions in public health and internationality were significantly related to the number of research areas. Conclusions In this survey, all company set up MA department, and engaged in evidence creation. The various skills including the highly ethical mind and the design of clinical studies were needed for evidence creation. In terms of public health, epidemiology, biostatistics and competency were regarded as key skills for evidence creation.

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OBJECTIVE: Social jetlag, ie, the mismatch between biological and social timing, has been suggested to induce obesity and cardiometabolic abnormalities. Yet, no study has currently linked social jetlag to metabolic syndrome (MetS) among Asians. The aim of this study was to investigate the cross-sectional association of social jetlag with MetS in a Japanese working population. METHODS: Participants were 1164 employees, aged 18-78 years, who completed a health survey at a periodic checkup. Social jetlag was calculated as the difference in hours of midpoint of sleep times between weekdays and weekends. MetS was defined according to the Joint Interim Statement criteria. Multivariable logistic regression was used to examine the association between social jetlag and MetS with adjustment for potential confounding variables. RESULTS: Greater social jetlag was significantly associated with an increased likelihood of having MetS. The multivariable adjusted odds ratio (95% confidence intervals) for ≥2 h of social jetlag was 1.92 (1.01-3.67) compared to those with <1 h of social jetlag. Of the components of MetS, greater social jetlag was significantly associated with an increased likelihood of having high waist circumference; the multivariable adjusted odds ratio (95% confidence intervals) for ≥2 h of social jetlag was 2.26 (1.33-3.84) compared to those with <1 h of social jetlag. CONCLUSION: Social jetlag may be associated with an increased likelihood of having MetS among non-shift workers.

DOI： 10.1016/j.sleep.2018.07.003

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BACKGROUND: We estimated the cumulative risk of type 2 diabetes from age 30 to 65 years in a large working population in Japan. METHODS: We used data from the Japan Epidemiology Collaboration on Occupational Health Study. Participants (46,065 men and 7,763 women) were aged 30-59 years, free of diabetes at baseline, and followed up for a maximum of 7 years. Incident type 2 diabetes was defined based on fasting and casual glucose, glycated hemoglobin, and current medical treatment for type 2 diabetes. We calculated the sex-specific cumulative risk of type 2 diabetes using the Practical Incidence Estimator macro, which was created to produce several estimates of disease incidence for prospective cohort studies based on a modified Kaplan-Meier method. RESULTS: During 274,349 person-years of follow-up, 3,587 individuals (3,339 men and 248 women) developed type 2 diabetes. The cumulative risk was 34.7% (95% confidence interval, 33.1-36.3%) for men and 18.6% (95% confidence interval, 15.5-21.7%) for women. In BMI-stratified analysis, obese (BMI ≥30 kg/m2) and overweight (BMI 25-29.9 kg/m2) men and women had a much higher cumulative risk of type 2 diabetes (obese: 77.3% for men and 64.8% for women; overweight: 49.1% and 35.7%, respectively) than those with BMI <25 kg/m2 (26.2% and 13.4% for men and women, respectively). CONCLUSIONS: The present data highlight the public health burden of type 2 diabetes in the working population. There is a need for effective programs for weight management and type 2 diabetes screening, especially for young obese employees, to prevent or delay the development of type 2 diabetes.

DOI： 10.2188/jea.JE20170093

PubMed

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BACKGROUND AND AIMS: We aimed to examine the risk of cardiovascular disease (CVD) with persistent prediabetes during the last four years prior to a CVD event in a large occupational cohort in Japan. METHODS: We performed a nested case-control study using data from the Japan Epidemiology Collaboration on Occupational Health Study. A total of 197 registered cases of CVD were identified and matched individually with 985 controls according to age, sex, and worksite. Prediabetes was defined as fasting plasma glucose 100-125 mg/dL and/or HbA1c 5.7-6.4%. Persistent prediabetes was defined as having prediabetes at years one and four prior to the onset/index date; persistent normoglycemia was similarly defined. Associations between prediabetes and CVD risk were assessed using conditional logistic regression models. RESULTS: Compared with people with persistent normoglycemia over the four years prior to the onset/index date, the unadjusted odds ratio (95% confidence interval) for CVD was 2.88 (1.56, 5.32) for people with persistent prediabetes. After adjusting for BMI, smoking, hypertension, and dyslipidemia assessed four years before the onset/index date, the association was slightly attenuated to an OR (95% confidence interval) of 2.62 (1.31, 5.25). Prediabetes assessed at single time points was also associated with an elevated risk of CVD, with multivariable-adjusted odds ratio (95% confidence interval) of 1.72 (1.12, 2.64) and 2.13 (1.32, 3.43) for prediabetes at one and four years prior to the onset/index date, respectively. CONCLUSIONS: Prediabetes is associated with an increased risk of CVD. Identification and management of prediabetes are important for the prevention of CVD.

DOI： 10.1016/j.atherosclerosis.2018.09.004

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OBJECTIVE: To investigate associations of work-related stressors and their changes over time with the risk of developing metabolic syndrome (MetS) among Japanese manufacturing workers. METHODS: Participants were 1,040 employees aged 19 to 68 years who were free from MetS at baseline and completed the three year-interval follow-up survey. MetS was defined according to the Joint Interim Statement. Work-related stressors (job strain, job demands, job control, and worksite social support) were assessed based on the Job Content Questionnaire and were split into two categories (low and high) by the median value at each survey. Multivariable logistic regression was performed to investigate the associations of baseline work-related stressors and their changes over time with the incidence of MetS. RESULTS: Three years later, 61 workers developed MetS. Higher job demands at baseline were significantly associated with a lower risk of MetS (adjusted odds ratio 0.46, 95% confidential interval: 0.24, 0.89). In the analyses of the changes in stressors over time, those whose job demands changed from low to high showed significantly higher risk of MetS (adjusted odds ratio 3.27, 95% confidential interval: 1.46, 7.34), compared with those who reported low job demands in both surveys. CONCLUSIONS: Results suggest that an increase in job demands over time, but not higher job demands at baseline, is associated with increased risk of MetS.

DOI： 10.1539/joh.2017-0298-OA

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OBJECTIVES: The aim of this study was to determine whether haemoglobin A1c (HbA1c) level is associated with the incidence of hearing impairment accounting for smoking status and diabetic condition at baseline. METHODS: Participants were 131 689 men and 71 286 women aged 30-65 years and free of hearing impairment at baseline (2008) who attended Japanese occupational annual health check-ups from 2008 to 2015. We defined low-frequency hearing impairment at a hearing threshold >30 dB at 1 kHz and high frequency at >40 dB at 4 kHz in the better ear in pure-tone audiometric tests. HbA1c was categorised into seven categories. The association between HbA1c and hearing impairment was assessed using the Cox proportional hazards model. RESULTS: On 5 years mean follow-up, high HbA1c was associated with high-frequency hearing impairment. In non-smokers, HbA1c≥8.0% was associated with high-frequency hearing impairment, with a multivariable HR (95% CI) compared with HbA1c 5.0%-5.4% of 1.46 (1.10 to 1.94) in men and 2.15 (1.13 to 4.10) in women. There was no significant association between HbA1c and hearing impairment in smokers. A J-shaped association between HbA1c and high-frequency hearing impairment was observed for participants with diabetes at baseline. HbA1c was not associated with low-frequency hearing impairment among any participants. CONCLUSIONS: HbA1c ≥8.0% of non-smokers and ≥7.3% of participants with diabetes was associated with high-frequency hearing impairment. These findings indicate that appropriate glycaemic control may prevent diabetic-related hearing impairment.

DOI： 10.1136/bmjopen-2018-023220

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AIMS/INTRODUCTION: We previously developed a 3-year diabetes risk score in the working population. The objective of the present study was to develop and validate flexible risk models that can predict the risk of diabetes for any arbitrary time-point during 7 years. MATERIALS AND METHODS: The participants were 46,198 Japanese employees aged 30-59 years, without diabetes at baseline and with a maximum follow-up period of 8 years. Incident diabetes was defined according to the American Diabetes Association criteria. With routine health checkup data (age, sex, abdominal obesity, body mass index, smoking status, hypertension status, dyslipidemia, glycated hemoglobin and fasting plasma glucose), we developed non-invasive and invasive risk models based on the Cox proportional hazards regression model among a random two-thirds of the participants, and used another one-third for validation. RESULTS: The range of the area under the receiver operating characteristic curve increased from 0.73 (95% confidence interval 0.72-0.74) for the non-invasive prediction model to 0.89 (95% confidence interval 0.89-0.90) for the invasive prediction model containing dyslipidemia, glycated hemoglobin and fasting plasma glucose. The invasive models showed improved integrated discrimination and reclassification performance, as compared with the non-invasive model. Calibration appeared good between the predicted and observed risks. These models performed well in the validation cohort. CONCLUSIONS: The present non-invasive and invasive models for the prediction of diabetes risk up to 7 years showed fair and excellent performance, respectively. The invasive models can be used to identify high-risk individuals, who would benefit greatly from lifestyle modification for the prevention or delay of diabetes.

DOI： 10.1111/jdi.12809

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J-GLOBAL

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

Objective: We explored the association of 3-year adherence to a dietary pattern based on nutrients that may be related to mood with the development of depressive symptoms in Japanese employees. Methods: Participants were 903 employees free from depressive symptoms at baseline and who attended the 3-year follow-up. Participants with depressive symptoms were defined as those with a score ≥16 on the Center for Epidemiologic Studies Depression Scale. Dietary patterns were derived using reduced-rank regression at baseline and at the 3-year follow-up survey using a validated, self-administered diet history questionnaire. Based on changes in dietary pattern scores between baseline and follow-up surveys, participants were categorized into four groups: Maintained high scores, improved scores, decreased scores, and maintained low scores. Logistic regression was used to estimate odds ratios of depressive symptoms according to changes in dietary pattern scores. Results: Maintaining high or improving adherence to a diet rich in vegetables, mushrooms, seaweeds, soybean products, green tea, potatoes, fruits, and fish and low in rice over 3 y was associated with a decreased risk of depressive symptoms. The multivariable-adjusted odds ratio (95% confidence intervals) of developing depressive symptoms for maintained high scores versus maintained low scores was 0.57 (0.35–0.93) and for improved scores versus maintained low scores was 0.54 (0.29–1.01). The association with the severe depressive status was more pronounced. Conclusion: Maintaining high or improving adherence to a dietary pattern derived by reduced-rank regression is associated with a lower risk of depression among Japanese employees.

DOI： 10.1016/j.nut.2017.10.023

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Ltd  

Background &amp
aims: Magnesium may play an important role in cardio-metabolic abnormalities, including type 2 diabetes, but epidemiological evidence linking magnesium status to glucose metabolism is limited among Asians. We cross-sectionally examined the association of dietary and serum magnesium with markers of glucose metabolism among Japanese subjects. Methods: Subjects were 1796 workers, aged 18–78 years, who participated in a health survey. Dietary magnesium intake was assessed with a validated brief diet history questionnaire. Serum magnesium concentrations were measured using an enzymatic method. Multivariable linear regression models were used to estimate means of fasting insulin, fasting plasma glucose, homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of β-cell function (HOMA-β), and glycated hemoglobin (HbA1c), with adjustments made for potential confounding variables. Results: Dietary magnesium was inversely associated with HOMA-IR (Ptrend = 0.01). Multivariable-adjusted means (95% confidence intervals) of HOMA-IR for the lowest to highest quartiles of dietary magnesium were 0.94 (0.89–0.99), 0.92 (0.88–0.97), 0.88 (0.83–0.92), and 0.86 (0.81–0.90). Serum magnesium concentrations were also inversely associated with HOMA-IR (Ptrend = 0.04) and HbA1c (Ptrend &lt
0.01). Multivariable-adjusted means (95% confidence intervals) for the lowest to highest quartiles of serum magnesium were 0.94 (0.90–0.98), 0.87 (0.83–0.91), 0.90 (0.85–0.95), and 0.86 (0.81–0.92) for HOMA-IR and 5.41 (5.36–5.45), 5.33 (5.28–5.37), 5.30 (5.25–5.36), and 5.28 (5.22–5.35) for HbA1c. Excluding subjects with diabetes did not materially change the association between dietary magnesium and HOMA-IR (Ptrend &lt
0.01), while it attenuated the association of serum magnesium with HOMA-IR (Ptrend = 0.27) and HbA1c (Ptrend = 0.15). Conclusions: The present findings suggest that lower dietary magnesium, but not serum magnesium, is associated with IR in apparently healthy adults.

DOI： 10.1016/j.clnesp.2018.01.011

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Epidemiological Association  

<p><b>Background:</b> Data on the effect of physical activity intensity on depression is scarce. We investigated the prospective association between intensity of leisure-time exercise and risk of depressive symptoms among Japanese workers.</p><p><b>Methods:</b> The participants were 29,052 employees (24,653 men and 4,399 women) aged 20 to 64 years without psychiatric disease including depressive symptoms at health checkup in 2006–2007 and were followed up until 2014–2015. Details of leisure-time exercise were ascertained via a questionnaire. Depressive states were assessed using a 13-item questionnaire. Multivariable-adjusted hazard ratio of depressive symptoms was estimated using Cox regression analysis.</p><p><b>Results:</b> During a mean follow-up of 5.8 years with 168,203 person-years, 6,847 workers developed depressive symptoms. Compared with workers who engaged in no exercise during leisure-time (0 MET-hours per week), hazard ratios (95% confidence intervals) associated with >0 to <7.5, 7.5 to <15.0, and ≥15.0 MET-hours of leisure-time exercise were 0.88 (0.82–0.94), 0.85 (0.76–0.94), and 0.78 (0.68–0.88) among workers who engaged in moderate-intensity exercise alone; 0.93 (0.82–1.06), 0.82 (0.68–0.98), and 0.83 (0.71–0.98) among workers who engaged in vigorous-intensity exercise alone; and 0.96 (0.80–1.15), 0.80 (0.67–0.95), and 0.76 (0.66–0.87) among workers who engaged in both moderate- and vigorous-intensity exercise with adjustment for age, sex, lifestyles, work-related and socioeconomic factors, and body mass index. Additional adjustment for baseline depression score attenuated the inverse association, especially among those who engaged in moderate-intensity exercise alone.</p><p><b>Conclusions:</b> The results suggest that vigorous-intensity exercise alone or vigorous-intensity combined with moderate-intensity exercise would prevent depressive symptoms among Japanese workers.</p>

DOI： 10.2188/jea.JE20170009

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BACKGROUND: We investigated the risk of cardiovascular disease (CVD) with duration of metabolic syndrome (MetS) for the past 4 years before the CVD event.Methods and Results:We performed a nested case-control study within the Japan Epidemiology Collaboration on Occupational Health Study. A total of 139 registered cases of CVD and 561 self-reported cases of CVD were identified and matched individually on age, sex, and worksite with 695 and 2,803 controls, respectively. MetS was defined by the Joint Interim Statement definition. The odds ratio (95% confidence interval) for registered CVD was 4.7 (2.9, 7.5) for people with persistent MetS (positive for MetS for ≥3 assessments) and 1.9 (1.1, 3.3) for those with intermittent MetS (positive for MetS for 1-2 assessments), compared with people without MetS during the past 4 years before the event/index date (P for trend <0.001). The corresponding odds ratio for self-reported CVD was 2.7 (2.2, 3.5) and 1.8 (1.4, 2.3) (P for trend <0.001). The association with MetS duration was stronger for myocardial infarction than for other CVD subtypes. Similar results were obtained when using the Japanese MetS criteria. CONCLUSIONS: The risk of CVD increases with increasing MetS duration. These findings contribute to risk stratification and encourage lifestyle modification for people with MetS to minimize their health risk.

DOI： 10.1253/circj.CJ-17-0513

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[This corrects the article DOI: 10.1371/journal.pone.0142779.].

DOI： 10.1371/journal.pone.0199075

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OBJECTIVES: The stress check program has been part of annual employees' health screening since 2015. Employees are recommended, but not obliged, to undergo the stress check offered. This study was designed to examine the factors associated with stress check attendance. METHODS: A total of 31,156 Japanese employees who underwent an annual health examination and a stress check service at an Occupational Health Service Center in 2016 participated in this study. Data from the annual health examination and stress check service included stress check attendance, date of attendance (if implemented), gender, age, workplace industry, number of employees at the workplace, and tobacco and alcohol consumption. Data were analyzed using multiple logistic regression. RESULTS: The mean rate of stress check attendance was 90.8%. A higher rate of stress check attendance was associated with a lower duration from the annual health examination, age ≥30 years, construction and transport industry, and 50-999 employees at the workplace. A lower rate of stress check attendance was associated with medical and welfare industry and ≥1,000 employees at the workplace. CONCLUSIONS: These findings provide insights into developing strategies for improving the rate of stress check attendance. In particular, stress check attendance may improve if the stress check service and annual health examination are conducted simultaneously.

DOI： 10.1265/jjh.73.235

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Background: We prospectively examined the association of diabetes risk with the number of metabolic abnormalities, as well as their combinations, according to the presence or absence of impaired fasting glucose (IFG) in a large-scale Japanese working population.
Methods: Participants included 55,271 workers at 11 companies who received periodic health check-ups between 2008 and 2013. The metabolic syndrome (MetS) components were defined using the 2009 Joint Interim Statement. IFG was defined as fasting plasma glucose 5.6-6.9 mmol/L. Diabetes newly diagnosed after the baseline examination was defined according to the American Diabetes Association criteria. We calculated the hazard ratios (HRs) for diabetes incidence using the Cox proportional hazards model.
Results: During the follow-up period (median 4.95 years), 3183 subjects developed diabetes. In individuals with normal fasting glucose levels, the risk of diabetes increased steadily with the increasing number of MetS components; the multivariable-adjusted HRs for incident diabetes for the number of MetS components were 2.0, 4.3, 7.0, and 10.0 for one, two, three, or four MetS components, respectively, compared with the absence of components. A similar association was observed among individuals with IFG; the corresponding HRs were 17.6, 23.8, 33.9, and 40.7. The combinations that included central obesity appeared to be more strongly associated with diabetes risk than other combinations with the same number of MetS components within the same glucose status.
Conclusions: Our findings indicate that risk stratification of individuals by the presence or absence of IFG and the number of MetS components can detect individuals with a high risk of diabetes. (C) 2017 The Authors. Publishing services by Elsevier B.V. on behalf of The Japan Epidemiological Association.

DOI： 10.1016/j.je.2016.08.015

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER SOC NUTRITION-ASN  

Background: The association between the circulating fatty acid (FA) composition and type 2 diabetes (T2D) has been reported in Western populations, but evidence is scarce among Asian populations, including Japanese, who consume large amounts of fish.
Objective: The objective of the present study was to prospectively examine the association between circulating concentrations of individual FAs and T2D incidence among Japanese adults.
Methods: We conducted a nested case-control study in a cohort of 4754 employees, aged 34-69 y, who attended a comprehensive health checkup in 2008-2009 and donated blood samples for the Hitachi Health Study. During 5 y of follow-up, diabetes was identified on the basis of plasma glucose, glycated hemoglobin, and self-report. Two controls matched to each case by sex, age, and date of checkup were randomly chosen by using density sampling, resulting in 336 cases and 678 controls with FA measurements. GC was used to measure the FA composition in serum phospholipids. Cox proportional hazards regression was used to estimate the HRs and 95% CIs after adjusting for potential confounders. We examined the association of T2D risk with 25 different individual and combinations of FAs.
Results: T2D risk was positively associated with serum dihomo-gamma-linoleic acid concentration (highest compared with the lowest quartile-HR: 1.49; 95% CI: 1.04, 2.11; P-trend = 0.02) and inversely associated with Delta 5-desaturase activity (highest compared with the lowest quartile-HR: 0.72; 95% CI: 0.52, 0.99; P-trend = 0.02), independent of body mass index (BMI). There were also inverse associations between T2D risk with serum total n6 (omega-6) polyunsaturated fatty acids (PUFAs), linoleic acid, and cis-vaccenic acid, but these were attenuated and became nonsignificant after adjustment for BMI. Serum n3 (omega-3) PUFAs and saturated fatty acids (SFAs) were not associated with T2D risk.
Conclusions: T2D risk was associated with circulating concentrations of the n6 PUFA dihomo-gamma-linoleic acid and Delta 5-desaturase activity but not with n3 PUFA or SFA concentrations in Japanese adults.

DOI： 10.3945/jn.117.248997

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

Aims/Introduction: Higher iron storage has been linked to an increased risk of type 2 diabetes, but little is known about the mediator of this association. Here, we prospectively investigated the association between circulating ferritin, a marker of iron storage, and the incidence of type 2 diabetes among Japanese individuals.
Materials and Methods: The participants were 4,754 employees who attended a comprehensive health check-up in 2008-2009 and donated blood for the study. During 5 years of follow up, diabetes was identified based on plasma glucose, glycated hemoglobin and self-report. Two controls matched to each case on sex, age and date of check-up were randomly chosen using density sampling, giving 327 cases and 641 controls with ferritin measurement. Cox proportional hazards regression was used to estimate the hazard ratio while adjusting for a series of potential confounders or mediators.
Results: Elevated serum ferritin levels were associated with a significantly increased risk of type 2 diabetes, with the hazard ratio adjusted for known risk factors in the highest vs lowest quartile of 1.42 (95% confidence interval: 1.03-1.96). This association was unchanged after adjustment for C-reactive protein and adiponectin, but attenuated after adjustment for liver enzyme and insulin resistance (hazard ratio 1.04). The ferritin-diabetes association was confined to non-obese participants.
Conclusions: These results suggest that elevated iron storage is associated with increased risk of type 2 diabetes in normal weight individuals, and that this association is partly mediated through liver dysfunction and resulting insulin resistance.

DOI： 10.1111/jdi.12617

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Objective: Increasing evidence has suggested a protective role of vitamin D on metabolic syndrome (MetS). However, studies addressing this issue are limited in Asia and it remains unclear whether calcium could modify the association. We examined the association of serum 25-hydroxyvitamin D (25(OH)D) status with MetS, and the potential effect modification by calcium intake in a Japanese working population.
Methods: Study subjects were 1790 workers, ages 18 to 69 y, who participated in a health survey at the time of periodic checkup. MetS was defined according to the joint interim statement. Serum 25(OH)D was measured by a protein binding assay. Multilevel logistic regression was used to estimate the odds ratio (OR) with adjustment for potential confounding variables.
Results: An inverse trend was observed between 25(OH)D and MetS. Compared with those with a 25(OH)D of &lt;20 ng/mL, multivariable adjusted OR (95% confidence interval) for MetS was 0.79 (0.55-1.15) and 0.52 (0.25-1.04) for those with a 25(OH)D of 20 to 29 ng/mL and &gt;= 30 ng/mL, respectively (P for trend = 0.051). Similar association was observed in the analysis using quartile categories of 25(OH)D; the OR in the highest quartile of 25(OH)D compared with the lowest quartile was 0.61 (0.36-1.01) (P for trend = 0.046). This association was noted only in older subjects (&gt;= 44 y). The inverse association between serum 25(OH)D and MetS was more pronounced in subjects with high calcium intake. The inverse association between 25(OH)D and MetS appears to be linear according to restricted cubic spline regression. There was inverse, but statistically nonsignificant, associations between 25(OH)D and each component of MetS.
Conclusion: Our results suggest that higher circulating vitamin D is associated with decreased likelihood of having MetS among Japanese adults. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.nut.2016.02.024

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ACADEMIC PRESS INC ELSEVIER SCIENCE  

We prospectively examined diabetes risk in association with a summary measure of degree and duration of weight change. The study participants were 51,777 employees from multiple companies in Japan, who were aged 30-59 years, free of diabetes at baseline, and followed up for 7 years (2008-2015). Exposure was cumulative body mass index (BMI)-years, which was defined as the area of BMI units above or below baseline BMI during follow-up, and was treated as a time-dependent variable in the Cox proportional hazards regression models. During the 263,539 person-years of follow-up, 3465 participants developed diabetes. The adjusted hazard ratio (HR) of diabetes for a 1-unit increase in cumulative BMI-years was 1.11 (95% confidence interval (CI): 1.09, 1.12). The association was more pronounced among overweight (HR = 1.11; 95% CI: 1.08, 1.14) and obese (HR = 1.12; 95% CI: 1.08, 1.15) adults compared with normal-and under-weight (HR = 1.07; 95% CI: 1.03, 1.11) adults (P for interaction of cumulative BMI-years X baseline BMI-group = 0.002). The association of higher cumulative BMI-years with incident diabetes did not substantially differ by metabolic phenotype. The present results emphasize the importance of avoiding additional weight gain over an extended period of time for the prevention of type 2 diabetes, especially among overweight and obese adults, irrespective of metabolic health status. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.ypmed.2016.12.046

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：NATURE PUBLISHING GROUP  

We investigated BMI trajectory patterns before diabetes diagnosis and examined associated changes in visceral adiposity and glucose metabolism. 23,978 non-diabetic Japanese participants (2,789 women) aged 30-64 years were assessed with a mean follow-up of 7.6 years. Diabetes was diagnosed via fasting glucose, HbA1c, and self-report. Latent-class trajectory analyses were performed to identify BMI trajectories. Longitudinal changes in BMI, visceral adiposity, and glucose metabolism were estimated using mixed models. 1,892 individuals developed diabetes. Three distinct BMI trajectories were identified in adults developing and not developing diabetes, respectively. Among adults developing diabetes, 47.3% were classified as "medium BMI" (n = 895), and had increased mean BMI within the obesity category before diagnosis. The "low BMI" group (38.4%, n = 726) had an initial mean BMI of 21.9 kg/m(2), and demonstrated small weight gain. The "high BMI" group (n = 271) were severely obese and showed greater increase in BMI until diagnosis. All groups which developed diabetes showed absolute and/or relative increase in visceral fat and impaired beta-cell compensation for insulin resistance. All groups not developing diabetes showed measured variables were relatively stable during observation. These data suggest that visceral fat gain may induce beta-cell failure in compensation for insulin resistance, resulting in diabetes regardless of obesity level.

DOI： 10.1038/srep43521

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：NATL INST OCCUPATIONAL SAFETY & HEALTH, JAPAN  

Data are limited on the sex-specific prevalence of diseases and their risk factors in middleaged and older workers in Japan. In this cross-sectional study, we investigated the age-and sex-specific prevalence of hypertension, diabetes, dyslipidemia, metabolic syndrome (defined using joint statement criteria), obesity, underweight, abdominal obesity, and smoking among approximately 70,000 to 90,000 Japanese workers (predominantly men) aged 20-69 years in 2014. We also investigated the prevalence of low cardiorespiratory fitness in 2012 and no leisure-time exercise in 2014. In both sexes, the prevalence of lifestyle-related risk factors, including hypertension, diabetes, dyslipidemia, metabolic syndrome, obesity, and abdominal obesity, was increased with aging. In contrast, the prevalence of underweight was decreased with aging. Smoking prevalence exceeded 30% in men regardless of age, whereas the prevalence was around 10% in women of all age groups. Prevalence of no leisure time exercise exceeded 50% among middle-aged and older workers in both sexes. Among workers aged 50-64 years, less than half of men had low fitness, whereas more than half of women had low fitness. Given the high prevalence of lifestyle-related risk factors among middle-aged and older workers, effective strategies to prevent cardiovascular disease in this age group are needed in Japan.

DOI： 10.2486/indhealth.2016-0082

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J-GLOBAL

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Data are limited regarding effect of intensity of leisure-time physical activity on metabolic syndrome. Furthermore, no prospective data are available regarding effect of occupational and commuting physical activity on metabolic syndrome. We compared metabolic syndrome risk by intensity level of leisure-time exercise and by occupational and commuting physical activity in Japanese workers. We followed 22,383 participants, aged 30-64 years, without metabolic syndrome until 2014 March (maximum, 5 years of follow-up). Physical activity was self-reported. Metabolic syndrome was defined by the Joint Statement criteria. We used Cox regression models to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of metabolic syndrome. During a mean follow-up of 4.1 years, 5361 workers developed metabolic syndrome. After adjustment for covariates, compared with engaging in no exercise, the HRs (95 % CIs) for &lt; 7.5, 7.5 to &lt; 16.5, and aeyen16.5 metabolic equivalent hours of exercise per week were 0.99 (0.90, 1.08), 0.99 (0.90, 1.10), and 0.95 (0.83, 1.08), respectively, among individuals engaging in moderate-intensity exercise alone; 0.93 (0.75, 1.14), 0.81 (0.64, 1.02), and 0.84 (0.66, 1.06), among individuals engaging in vigorous-intensity exercise alone; and 0.90 (0.70, 1.17), 0.74 (0.62, 0.89), and 0.81 (0.69, 0.96) among individuals engaging in the two intensities. Higher occupational physical activity was weakly but significantly associated with lower risk of metabolic syndrome. Walking to and from work was not associated with metabolic syndrome. Vigorous-intensity exercise alone or vigorous-intensity combined with moderate-intensity exercise and worksite intervention for physical activity may help prevent metabolic syndrome for Japanese workers.

DOI： 10.1007/s12020-016-0911-z

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Aims
The control of blood glucose levels, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) levels reduces the risk of diabetes complications; however, data are scarce on control status of these factors among workers with diabetes. The present study aimed to estimate the prevalence of participants with diabetes who meet glycated hemoglobin (HbA1c), BP, and LDL-C recommendations, and to investigate correlates of poor glycemic control in a large working population in Japan.
Methods
The Japan Epidemiology Collaboration on Occupational Health (J-ECOH) Study is an ongoing cohort investigation, consisting mainly of employees in large manufacturing companies. We conducted a cross-sectional analysis of 3,070 employees with diabetes (2,854 men and 216 women) aged 20-69 years who attended periodic health examinations. BP was measured and recorded using different company protocols. Risk factor targets were defined using both American Diabetes Association (ADA) guidelines (HbA1c &lt; 7.0%, BP &lt; 140/90 mmHg, and LDL-C &lt; 100 mg/dL) and Japan Diabetes Society (JDS) guidelines (HbA1c &lt; 7.0%, BP &lt; 130/80 mmHg, and LDL-C &lt; 120 mg/dL). Logistic regression models were used to explore correlates of poor glycemic control (defined as HbA1c &gt;= 8.0%).
Results
The percentages of participants who met ADA (and JDS) targets were 44.9%(44.9%) for HbA1c, 76.6% (36.3%) for BP, 27.1%(56.2%) for LDL-C, and 11.2%(10.8%) for simultaneous control of all three risk factors. Younger age, obesity, smoking, and uncontrolled dyslipidemia were associated with poor glycemic control. The adjusted odds ratio of poor glycemic control was 0.58 (95% confidence interval, 0.46-0.73) for participants with treated but uncontrolled hypertension, and 0.47 (0.33-0.66) for participants with treated and controlled hypertension, as compared with participants without hypertension. There was no significant difference in HbA1c levels between participants with treated but uncontrolled hypertension and those with treated and controlled hypertension.
Conclusion
Data from a large working population, predominantly composed of men, suggest that achievement of HbA1c, BP, and LDL-C targets was less than optimal, especially in younger participants. Uncontrolled dyslipidemia was associated with poor glycemic control. Participants not receiving antihypertensive treatment had higher HbA1c levels.

DOI： 10.1371/journal.pone.0159071

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Objective: Working long hours is a potential health hazard. Although self-reporting of working hours in various time frames has been used in epidemiologic studies, its validity is unclear. The objective of this study was to examine the validity and reproducibility of self reported working hours among Japanese male employees. Methods: The participants were 164 male employees of four large-scale companies in Japan. For validity, the Spearman correlation between self-reported working hours in the second survey and the working hours recorded by the company was calculated for the following four time frames: daily working hours, monthly overtime working hours in the last month, average overtime working hours in the last 3 months, and the frequency of long working months (&gt;= 5 h/month) within the last 12 months. For reproducibility, the intraclass correlation between the first (September 2013) and second surveys (December 2013) was calculated for each of the four time frames. Results : The Spearman correlations between self reported working hours and those based on company records were 0.74, 0.81, 0.85, and 0.89 for daily, monthly, 3-monthly, and yearly time periods, respectively. The intraclass correlations for self-reported working hours between the two questionnaire surveys were 0.63, 0.66, 0.73, and 0.87 for the respective time frames. Conclusions: The results of the present study among Japanese male employees suggest that the validity of self-reported working hours is high for all four time frames, whereas the reproducibility is moderate to high.

DOI： 10.1539/joh.15-0260-OA

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Objective: Dietary fiber may play a favorable role in mood through gut microbiota, but epidemiologic evidence linking mood to dietary fiber intake is scarce in free-living populations. We investigated cross-sectionally the associations of dietary intakes of total, soluble, insoluble, and sources of fiber with depressive symptoms among Japanese workers.
Methods: Participants were 1977 employees ages 19-69 y. Dietary intake was assessed via a validated, brief self-administered diet history questionnaire. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to estimate odds ratios of depressive symptoms adjusted for a range of dietary and non-dietary potential confounders.
Results: Dietary fiber intake from vegetables and fruits was significantly inversely associated with depressive symptoms. The multivariable-adjusted odds ratios (95% confidence intervals) for the lowest through the highest tertile of vegetable and fruit fiber were 1.00 (reference), 0.80 (0.60-1.05), and 0.65 (0.45-0.95), respectively (P for trend = 0.03). Dietary intake of total, soluble, insoluble, and cereal fiber was not associated with depressive symptoms.
Conclusions: Higher dietary fiber intake from vegetables and fruits may be associated with lower likelihood of having depressive symptoms. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.nut.2015.11.014

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Language：Japanese   Publisher：(公社)日本産業衛生学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CHURCHILL LIVINGSTONE  

Background & aims: Acid-base imbalance has been suggested to play an important role in certain cardio-metabolic abnormalities, including type 2 diabetes; however, epidemiological evidence linking dietary acid load to glucose metabolism is lacking. We examined the association of dietary acid load with markers of insulin resistance (IR), insulin secretion, and blood glucose status among Japanese workers.
Methods: The study subjects were 1732 workers, aged 19-69 years, who completed a health survey at a periodic checkup. Dietary intake was assessed using a validated brief diet history questionnaire. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores were derived from nutrient intake. A multilevel linear regression model was used to estimate the means of fasting insulin, fasting plasma glucose, homeostatic model assessment of IR (HOMA-IR) score, homeostatic model assessment of P-cell function (HOMA-beta) score and glycated hemoglobin (HbAlc) level with adjustment for potential confounding variables.
Results: PRAL was positively associated with HOMA-IR score (P-trend = 0.045); the multivariable-adjusted means (95% confidence intervals) for the HOMA-IR scores for the lowest through the highest quartiles of PRAL were 0.88 (0.82-0.94), 0.92 (0.86-0.98), 0.92 (0.86-0.98), and 0.94 (0.88-1.01). A similar association was observed between NEAP and HOMA-IR scores (P-trend = 0.03). In the stratified analyses, these positive associations were confined to subjects with lower BMIs (&lt;23 kg/m(2)) (P-trend = 0.03 and 0.01 for PRAL and NEAP, respectively). NEAP score was positively associated with HOMA-beta score (P-trend = 0.03). Dietary acid load score was not appreciably associated with fasting glucose or HbA1c levels.
Conclusions: The present findings suggest that high dietary acid load is associated with IR among apparently healthy adults. (C) 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

DOI： 10.1016/j.clnu.2015.03.008

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Background: We sought to establish the optimal waist circumference (WC) cut-off point for predicting diabetes mellitus (DM) and to compare the predictive ability of the metabolic syndrome (MetS) criteria of the Joint Interim Statement (JIS) and the Japanese Committee of the Criteria for MetS (JCCMS) for DM in Japanese.
Methods: Participants of the Japan Epidemiology Collaboration on Occupational Health Study, who were aged 20-69 years and free of DM at baseline (n = 54,980), were followed-up for a maximum of 6 years. Time-dependent receiver operating characteristic analysis was used to determine the optimal cut-off points of WC for predicting DM. Time-dependent sensitivity, specificity, and positive and negative predictive values for the prediction of DM were compared between the JIS and JCCMS MetS criteria.
Results: During 234,926 person-years of follow-up, 3180 individuals developed DM. Receiver operating characteristic analysis suggested that the most suitable cut-off point of WC for predicting incident DM was 85 cm for men and 80 cm for women. MetS was associated with 3-4 times increased hazard for developing DM in men and 7-9 times in women. Of the MetS criteria tested, the JIS criteria using our proposed WC cut-off points (85 cm for men and 80 cm for women) had the highest sensitivity (54.5 % for men and 43.5 % for women) for predicting DM. The sensitivity and specificity of the JCCMS MetS criteria were similar to 37.7 and 98.9 %, respectively.
Conclusion: Data from the present large cohort of workers suggest that WC cut-offs of 85 cm for men and 80 cm for women may be appropriate for predicting DM for Japanese. The JIS criteria can detect more people who later develop DM than does the JCCMS criteria.

DOI： 10.1186/s12889-016-2856-9

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Aims/IntroductionMuscle strength training has been suggested to improve glucose metabolism; however, epidemiological evidence regarding strength training's effects on diabetes risk is scarce. We prospectively examined the association between strength training and the risk of type2 diabetes in Japanese men and women.
Materials and MethodsThe sample included health checkups on 26,630 Japanese male and female workers aged 30-64years without diabetes at baseline. Weekly time spent on strength training was elicited using a self-reported questionnaire. Type2 diabetes was diagnosed based on hemoglobin A1c, fasting glucose, random plasma glucose and self-report in an annual health checkup. Hazard ratio (HR) and its 95% confidence interval (CI) for incident diabetes was estimated using a Cox proportional hazards model.
ResultsDuring a mean follow up of 5.2years with 139,748person-years, 1,770 individuals developed diabetes. Age- and sex-adjusted HR for diabetes was 0.58 (95% CI 0.42-0.79) in those who engaged in strength training compared with those who engaged in no strength training. After further adjusting for potential confounders, the corresponding HR was 0.66 (95% CI 0.48-0.90). Additional adjustment for body mass index did not materially change the result; the HR was 0.70 (95% CI 0.51-0.96). The association was more pronounced in individuals aged 50years or older than those aged &lt;50years, although the difference in the association by age was not significant.
ConclusionsThese results suggest that engagement in strength training could help to reduce the risk of type 2 diabetes in a Japanese working population.

DOI： 10.1111/jdi.12347

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Objective
Risk models and scores have been developed to predict incidence of type 2 diabetes in Western populations, but their performance may differ when applied to non-Western populations. We developed and validated a risk score for predicting 3-year incidence of type 2 diabetes in a Japanese population.
Methods
Participants were 37,416 men and women, aged 30 or older, who received periodic health checkup in 2008-2009 in eight companies. Diabetes was defined as fasting plasma glucose (FPG) &gt;= 126 mg/dl, random plasma glucose &gt;= 200 mg/dl, glycated hemoglobin (HbA1c) &gt;= 6.5%, or receiving medical treatment for diabetes. Risk scores on non-invasive and invasive models including FPG and HbA1c were developed using logistic regression in a derivation cohort and validated in the remaining cohort.
Results
The area under the curve (AUC) for the non-invasive model including age, sex, body mass index, waist circumference, hypertension, and smoking status was 0.717 (95% CI, 0.703-0.731). In the invasive model in which both FPG and HbA1c were added to the non-invasive model, AUC was increased to 0.893 (95% CI, 0.883-0.902). When the risk scores were applied to the validation cohort, AUCs (95% CI) for the non-invasive and invasive model were 0.734 (0.715-0.753) and 0.882 (0.868-0.895), respectively. Participants with a non-invasive score of &gt;= 15 and invasive score of &gt;= 19 were projected to have &gt;20% and &gt;50% risk, respectively, of developing type 2 diabetes within 3 years.
Conclusions
The simple risk score of the non-invasive model might be useful for predicting incident type 2 diabetes, and its predictive performance may be markedly improved by incorporating FPG and HbA1c.

DOI： 10.1371/journal.pone.0142779

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Background: Physical activity has been suggested to reduce the risk of type 2 diabetes. However, evidence is limited regarding whether vigorous-intensity activity yields the same benefits in preventing type 2 diabetes compared with an equivalent dose of moderate-intensity activity as well as other type of physical activity. We examined the risk of type 2 diabetes associated with exercise intensity during leisure and occupational and commuting physical activity among Japanese individuals.
Methods: Participants included 26,628 workers (23,207 men and 3,421 women) aged 30 to 64 years without diabetes at baseline. There was 6 years of follow-up maximum. Leisure-time exercise, occupational physical activity, and duration of walking to and from work were self-reported. Diabetes was diagnosed by using HbA(1c), fasting or random blood glucose, and self-report. We used Cox regression analysis to estimate the hazard ratio (HR) and the 95 % confidence interval (CI) of incident diabetes.
Results: During a mean follow-up of 5.2 years, 1,770 participants developed type 2 diabetes. Compared with individuals who engaged in no exercise, the HRs (95 % CIs) for &lt;7.5, 7.5 to &lt;15.0, and &gt;= 15.0 MET-hours per week of exercise were 0.94 (0.81, 1.08), 1.07 (0.88, 1.30), and 0.90 (0.67, 1.21), respectively, among individuals who engaged in moderate-intensity exercise alone; 0.68 (0.44, 1.06), 0.86 (0.54, 1.34), and 0.89 (0.56, 1.41), respectively, among individuals who engaged in vigorous-intensity exercise alone; and 0.70 (0.44, 1.11), 0.57 (0.37, 0.90), and 0.76 (0.52, 1.11), respectively, among individuals who engaged in the two intensities, with adjustments for potential confounders and the total volume of exercise. Occupational physical activity and walking to and from work were not associated with diabetes.
Conclusions: The results suggest that vigorous-intensity exercise can reduce the risk of type 2 diabetes among Japanese workers.

DOI： 10.1186/s12889-015-2362-5

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Background: Leisure-time physical activity is associated with a lower risk of depression. However, the precise shape of the dose-response relationship remains elusive, and evidence is scarce regarding other domains of activity. We prospectively investigated associations of physical activity during leisure, work, and commuting with risk of depressive symptoms in Japanese workers.
Methods: We conducted a cohort study of 29 082 Japanese workers aged 20-64 years without psychiatric disease (including depressive symptoms) at baseline with a maximum 5-year follow-up. Physical activity was self-reported. Depressive symptoms were assessed by 13 self-report questions on subjective symptoms. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for incidence of depressive symptoms were calculated using Cox regression analysis.
Results: During a mean follow-up of 4.7 years, 6177 developed depressive symptoms. Leisure exercise showed a U-shaped association with risk of depressive symptoms adjusting for potential confounders. Additional adjustment for baseline depression scores attenuated the association, but it remained statistically significant (P for trend = 0.037). Compared with individuals who engaged in sedentary work, the HR (95 % CI) was 0.86 (0.81, 0.92) for individuals who stand or walk during work and 0.90 (0.82, 0.99) for those who are fairly active at work. However, the association disappeared after adjusting for baseline depression scores. Walking to and from work was not associated with depressive symptoms.
Conclusions: The findings suggest that leisure-time exercise has a U-shaped relation with depressive symptoms in Japanese workers. Health-enhancing physical activity intervention may be needed for individuals who engage in sedentary work.

DOI： 10.1186/s12966-015-0283-4

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

Depression has been linked to the overall diet using both exploratory and pre-defined methods. However, neither of these methods incorporates specific knowledge on nutrient-disease associations. The aim of the present study was to empirically identify dietary patterns using reduced rank regression and to examine their relations to depressive symptoms. Participants were 2006 Japanese employees aged 19-69 years. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Diet was assessed using a validated, self-administered diet history questionnaire. Dietary patterns were extracted by reduced rank regression with 6 depression-related nutrients as response variables. Logistic regression was used to estimate odds ratios of depressive symptoms adjusted for potential confounders. A dietary pattern characterized by a high intake of vegetables, mushrooms, seaweeds, soybean products, green tea, potatoes, fruits, and small fish with bones and a low intake of rice was associated with fewer depressive symptoms. The multivariable-adjusted odds ratios of having depressive symptoms were 0.62 (95% confidence interval, 0.48-0.81) in the highest versus lowest tertiles of dietary score. Results suggest that adherence to a diet rich in vegetables, fruits, and typical Japanese foods, including mushrooms, seaweeds, soybean products, and green tea, is associated with a lower probability of having depressive symptoms. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.psychres.2015.07.033

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Language：English   Publisher：PUBLIC LIBRARY SCIENCE  

DOI： 10.1371/journal.pone.0137039

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Aims
To examine the association of smoking status, smoking intensity, and smoking cessation with the risk of type 2 diabetes (T2D) using a large database.
Methods
The present study included 53,930 Japanese employees, aged 15 to 83 years, who received health check-up and did not have diabetes at baseline. Diabetes was defined as fasting plasma glucose &gt;= 126 mg/dl, random plasma glucose &gt;= 200 mg/dl, HbA1c &gt;= 6.5% (&gt;= 48 mmol/mol), or receiving medication for diabetes. Cox proportional-hazards regression models were used to investigate the association between smoking and the risk of diabetes.
Results
During 3.9 years of median follow-up, 2,441 (4.5%) individuals developed T2D. The multi-variable-adjusted hazard ratios (95% CI) for diabetes were 1 (reference), 1.16 (1.04 to 1.30) and 1.34 (1.22 to 1.48) for never smokers, former smokers, and current smokers, respectively. Diabetes risk increased with increasing numbers of cigarette consumption among current smokers (P for trend &lt;0.001). Although the relative risk of diabetes was greater among subjects with lower BMIs (&lt;23 kg/m(2)), attributable risk was greater in subjects with higher BMIs (&gt;= 23 kg/m(2)). Compared with individuals who had never smoked, former smokers who quit less than 5 years, 5 to 9 years, and 10 years or more exhibited hazards ratios for diabetes of 1.36 (1.14 to 1.62), 1.23 (1.01 to 1.51), and 1.02 (0.85 to 1.23), respectively.
Conclusions
Results suggest that cigarette smoking is associated with an increased risk of T2D, which may decrease to the level of a never smoker after 10 years of smoking cessation.

DOI： 10.1371/journal.pone.0132166

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Objective: Although intake of minerals has been suggested to be beneficial against depression, epidemiologic data from free-living settings are limited. The aim of this study was to determine the cross-sectional associations between the intake of magnesium, calcium, iron, and zinc and the prevalence of depressive symptoms in Japanese employees.
Methods: Participants were 1792 men and 214 women ages 19 to 69 y. Dietary intake was assessed using a validated, brief self-administered diet history questionnaire. Participants with depressive symptoms were defined as those with a scale score of &gt;= 16 on the Center for Epidemiologic Studies Depression Scale.
Results: The prevalence of depressive symptoms was 27.8%. Intakes of magnesium, calcium, iron, and zinc were inversely associated with the prevalence of depressive symptoms. The multivariate adjusted odds ratios (95% confidence interval) of having depressive symptoms were 0.63 (0.44-0.91), 0.64 (0.47-0.88), 0.59 (0.40-0.87), and 0.63 (0.45-0.87) in the highest versus lowest tertiles of magnesium, calcium, iron, and zinc, respectively.
Conclusion: Results suggest that higher dietary intake of magnesium, calcium, iron, and zinc is associated with lower prevalence of depressive symptoms in Japanese employees. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.nut.2014.11.002

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：NATURE PUBLISHING GROUP  

BACKGROUND/OBJECTIVES: Although adipokines and insulin resistance are known to be correlated with body fatness, it is unclear whether they are independently related to weight gain experience. We examined the associations of serum adipokines and marker of insulin resistance with past weight gain during adulthood by taking the degree of attained body mass index (BMI) level into consideration.
SUBJECTS/METHODS: Subjects were 399 Japanese municipal employees, aged &gt;= 30 years, who participated in a health survey. Serum adipokines were measured using a Luminex suspension bead-based multiplexed array. Weight change during adulthood was calculated as the difference between measured current weight and recalled weight at the age of 20 years. Multiple regression was performed to calculate mean adipokine levels and homeostasis model assessment of insulin resistance (HOMA-IR) according to weight gain (&lt;5 kg, 5-9.9 kg, or &gt;= 10 kg) with adjustment for current BMI.
RESULTS: Weight gain from the age of 20 years was significantly and positively associated with leptin levels even after adjustment for current BMI (P for trend &lt;0.001), whereas it was significantly and inversely associated with adiponectin levels in a BMI-adjusted model among subjects aged &gt;= 40 years (P for trend = 0.03). Weight gain was associated with HOMA-IR in a BMI-unadjusted model (P for trend &lt;0.001), but this association was largely attenuated after adjustment for BMI. Resistin, plasminogen activator inhibitor-1 and visfatin were not associated with past weight gain.
CONCLUSIONS: Results suggest that a large weight gain during adulthood is associated with higher leptin and lower adiponectin levels independently of the degree of attained BMI level.

DOI： 10.1038/ejcn.2014.257

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER HEIDELBERG  

Coffee and green tea consumption may be associated with circulating adipokines, but data are inconsistent, scarce or lacking. We examined the association of coffee and green tea consumption with serum adiponectin, leptin, visfatin, resistin and plasminogen activator inhibitor-1 (PAI-1) among a Japanese working population.
The authors analyzed data (n = 509) from a cross-sectional survey among Japanese workers aged 20-68 years. Serum adipokines were measured using a Luminex suspension bead-based multiplexed array. Coffee and green tea consumption was assessed using a validated diet history questionnaire, and caffeine consumption from these beverages was estimated. Multiple regression analysis was performed with adjustment for potential confounding variables.
Coffee consumption was significantly, inversely associated with leptin and PAI-1 (P for trend = 0.007 and 0.02, respectively); compared with subjects consuming &lt; 1 cup per day, those consuming a parts per thousand yen4 cups per day had 13 and 10 % lower means of leptin and PAI-1, respectively. Similar associations were observed for caffeine consumption (P for trend = 0.02 for both leptin and PAI-1). Additionally, we noted a significant positive association between coffee consumption and adiponectin in men (P for trend = 0.046), but not in women (P for trend = 0.43, P for interaction = 0.11). Moreover, there was a positive association between coffee consumption and resistin in current male smokers (P for trend = 0.01), but not in male non-smokers (P for trend = 0.35, P for interaction = 0.11). Green tea consumption was not associated with any adipokine.
Higher consumption of coffee and caffeine but not green tea was associated with lower serum levels of leptin and PAI-1 in Japanese adults.

DOI： 10.1007/s00394-014-0701-4

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Language：Japanese   Publisher：産業医学振興財団  

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Background: Accumulating evidence suggests a protective role of vitamin D against mood disorders; however, epidemiologic studies are scarce in working populations.
Objective: We investigated cross-sectionally the association of serum vitamin D status and depressive symptoms among Japanese workers.
Methods: Participants were 1786 employees (9% women), aged 19-69 y, who received health check-ups and participated in a nutrition and health survey. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured with the use of a competitive protein binding assay. Depressive symptoms were assessed by using the Center for Epidemiologic Studies Depression (CES-D) scale. Logistic regression was used to estimate ORs with adjustment for potential confounding variables including dietary factors.
Results: Overall, 92% of study participants had suboptimal vitamin D status [25(OH)D &lt; 30 mu g/L]. Depressive symptoms were inversely associated with 25(OH) D. Compared with those with a 25(OH)D concentration of &lt;20 mu g/L, multivariable-adjusted ORs (95% CIs) for depressive symptoms (CES-D scale score &gt;= 16) were 0.75 (0.59, 0.95) and 0.66 (0.41, 1.06) for those with a 25(OH) D concentration of 20-29 mu g/L and &gt;= 30 mu g/L, respectively (P-trend = 0.01). After further adjustment for leisure-time physical activity and shift work (factors closely related to photo-initiated vitamin D production), the OR (95% CI) for the highest category of 25(OH)D was 0.70 (0.43, 1.14). The association between 25(OH)D and depressive symptoms appears to be linear, according to restricted cubic spline regression.
Conclusion: Results suggest that lower concentrations of circulating vitamin D are associated with increased likelihood of having depressive symptoms among apparently healthy workers.

DOI： 10.3945/jn.114.204115

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Objective: Experimental studies have shown that some nutrients are involved in initiating and maintaining sleep, but epidemiological evidence on overall dietary patterns and insomnia is scarce. We investigated the relationship between dietary patterns and sleep symptoms in a Japanese working population.
Methods: The participants were 2025 workers, aged 18-70 years, who participated in a health survey during a periodic checkup in 2012 and 2013. Dietary intake was assessed with a self-administered diet history questionnaire. Dietary patterns were extracted by principal component analysis on the basis of the energy-adjusted intake of 52 food and beverage items. Sleep duration, difficulty initiating and maintaining sleep, and poor quality of sleep were self-reported. Logistic regression was used to estimate the odds ratios of each sleep symptom according to quartile categories of each dietary pattern with adjustment for potential confounding variables.
Results: We identified three major dietary patterns. A healthy pattern, characterized by a high intake of vegetables, mushrooms, potatoes, seaweeds, soy products, and eggs, was associated with a decreased prevalence of difficulty initiating sleep once or more a week (P for trend = 0.03); the multivariate adjusted odds ratio in the highest quartile of this score compared with the lowest was 0.75 (95% CI: 0.570.99). This association persisted after the exclusion of individuals with severe depressive symptoms. However, there was no significant association with difficulty initiating sleep at least three times a week.
Conclusions: Our findings suggest that a healthy dietary pattern may be associated with difficulty initiating sleep at least once a week. (C) 2014 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.sleep.2014.09.017

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Objective: Acid-base status has been suggested to influence blood pressure, but there is a paucity of epidemiologic evidence linking dietary acid load to hypertension. We examined cross-sectionally the association between dietary acid load and hypertension in a Japanese working population.
Methods: Data were derived from health surveys from 2028 employees, ages 18 to 70 y, in two workplaces in Japan. A validated brief diet history questionnaire was used to assess diet. Two measures were used to characterize dietary acid load: potential renal acid load and estimated net endogenous acid production, which were derived from nutrient intakes. Multilevel logistic regression was used to examine the association between dietary acid load and hypertension with adjustment of potential confounding variables.
Results: High dietary acid load was suggestively associated with increased prevalence of hypertension. The multivariable adjusted odds ratios (95% confidence interval) of hypertension for the lowest through highest tertiles of net endogenous acid production were 1.00 (reference), 1.07 (0.80-1.42), and 1.33 (0.998-1.78), respectively (P for trend = 0.053). This positive association was statistically significant among normal-weight (body mass index &lt;23 kg/m(2); P for trend = 0.03) and non-shift workers (P for trend = 0.04). Similar positive associations were observed between potential renal acid load and hypertension.
Conclusions: The present findings suggest that high dietary acid load may be associated with increased prevalence of hypertension among those who were normal weight and non-shift workers. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.nut.2014.07.007

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This study was aimed to examine the cross-sectional association of protein, carbohydrate, and fat intake with depressive symptoms among 1794 Japanese male workers aged 18-69 years who participated in a health survey. Dietary intake was assessed with a validated self-administered diet history questionnaire. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Odds ratio of depressive symptoms (CES-D scale of &gt;= 16) was estimated by using multiple logistic regression with adjustment for covariates including folate, vitamin B6, vitamin B12, polyunsaturated fatty acid, magnesium, and iron intake. Multivariable-adjusted odds ratio of depressive symptoms for the highest quartile of protein intake was 26%, albeit not statistically significant, lower compared with the lowest. The inverse association was more evident when a cutoff value of CES-D score &gt;= 19 was used. The multivariable-adjusted odds ratios (95% confidence intervals) for the highest through lowest quartile of protein intake were 1.00 (reference), 0.69 (0.47-1.01), 0.69 (0.44-1.09), and 0.58 (031-1.06) (P for trend=0.096). Neither carbohydrate nor fat intake was associated with depressive symptoms. Our findings suggest that low protein intake may be associated with higher prevalence of depressive symptoms in Japanese male workers. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.psychres.2014.08.026

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INFORMA HEALTHCARE  

Long working hours have been associated with an increased risk of cardiovascular disease, but its relationship with hypertension remains unclear. The objective of this study is to examine the relationship between overtime and presence of hypertension using data from a large-scale multi-company study in Japan. Participants were 52 365 workers of four companies that provided both health-checkup data and self-reported data on overtime worked. Hypertension was defined as systolic blood pressure &gt;= 140 mmHg, diastolic blood pressure &gt;= 90 mmHg, and/or the use of antihypertensive drug. Logistic regression analysis was performed to determine the odds ratio for hypertension for each category of overtime work (&lt;45, 45-79, 80-99 or &gt;= 100 h/month) with adjustments for age, sex, company, smoking status and body mass index. The prevalence of hypertension tended to decrease with increasing overtime work: 17.5, 12.0, 11.1 and 9.1% for the shortest (&lt;45 h/month) through the longest overtime category (&gt;= 100 h/month). The age-, sex- and company-adjusted odds ratios (95% confidence interval) were 1.00 (reference), 0.81 (0.75-0.86), 0.73 (0.62-0.86), 0.58 (0.44-0.76), respectively (p for linear trend &lt;0.001). In a sub-cohort, the inverse association remained statistically significant after an additional adjustment for other potential confounders. Results of the present large-scale study among Japanese workers suggest an inverse association between overtime work and presence of hypertension.

DOI： 10.3109/07420528.2014.957298

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

Aims: Few studies have examined the prevalence of diabetes using glycated hemoglobin (HbA1c), a newly recommended diagnostic test. We examined the prevalence of diabetes and pre-diabetes using both HbA1c and fasting plasma glucose (FPG) and their associations with risk factors for type 2 diabetes in a large-scale Japanese working population.
Methods: Participants were 47,172 men and 8280 women aged 20-69 years who received periodic health checkup in nine companies which participated in the Japan Epidemiology Collaboration on Occupational Health study. Participants were categorized into diabetes (HbA1c &gt;= 6.5% (&gt;= 48 mmol/mol), FPG &gt;= 126 mg/dl (&gt;= 7.0 mmol/L), or medication for diabetes), pre-diabetes (HbA1c 6.0-6.4% (42-46 mmol/mol) or FPG 110-125 mg/dl (6.1-6.9 mmol/L) among those without diabetes), and normal glucose regulation.
Results: The prevalence of diabetes was 8.0% and 3.3% in men and women, respectively. Of individuals with diabetes, approximately 80% were defined by HbA1c &gt;= 6.5% (&gt;= 48 mmol/mol) criterion. The prevalence of pre-diabetes was 14.1% in men and 9.2% in women. Prevalence of these glucose abnormalities increased with advancing age, especially during mid-40s and 50s. Higher body mass index and waist circumference, hypertension, dyslipidemia, and current smoking were each associated with higher prevalence of diabetes in both men and women.
Conclusions: Using HbA1c and FPG criteria or current medication, one in 13 men and one in 30 women had diabetes in the present Japanese working population. Interventions targeted for those in an early stage of impaired glucose metabolism would be required to prevent diabetes. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.diabres.2014.07.013

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Background: Leptin and ghrelin have been implicated in the pathogenesis of major depression. However, evidence is lacking among apparently healthy people. This study examined the relationship of these appetite hormones to depressive symptoms in a Japanese working population.
Methods: A cross-sectional study was conducted in 2009 among 497 Japanese employees (287 men and 210 women) aged 20-68 years. Fasting serum leptin and ghrelin levels were measured using a Luminex suspension bead-based multiplexed array. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Logistic regression analysis was performed to estimate odds ratio (OR) and 95% confidence interval (CI) for depressive symptoms with adjustment for potential confounders.
Results: The prevalence of depressive symptoms (CES-D &gt;= 16) was 26.5% and 33.3% among men and women, respectively. Women in the middle and highest tertiles of leptin levels showed lower odds for depressive symptoms compared with those in the lowest level, although the trend association was not statistically significant (P-trend = 0.14). Higher ghrelin levels were associated with increased odds for depressive symptoms in women (P-trend = 0.02). The multivariable adjusted OR (95% CI) of having depressive symptoms for the lowest through highest tertiles of ghrelin levels were 1.00 (reference), 1.71 (0.76 - 3.86), and 2.69 (1.16 - 6.28), respectively. Neither leptin nor ghrelin was associated with depressive symptoms in men.
Conclusions: Results suggest that lower leptin and higher ghrelin levels may be related to higher prevalence of depressive status among Japanese women.

DOI： 10.1186/1471-244X-14-203

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Language：English   Publisher：AMER DIABETES ASSOC  

DOI： 10.2337/dc14-0535

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Objective: Existing evidence is limited on what extent fitness can counterbalance type 2 diabetes mellitus (T2DM) risk associated with obesity. We investigated the joint association of weight status and estimated VO 2max, a marker of fitness, with the risk of developing T2DM among Japanese men using haemoglobin A1c and fasting glucose criterion. Methods: The present study included 3,523 male employees aged 18-61 years without diabetes who provided health check-up and fitness data in Japan in 2003-2005. We calculated hazard ratios and 95% confidence intervals for incident diabetes using the Cox regression model. Results: During a mean follow-up of 6.0 years, 199 men developed diabetes. Multivariable-adjusted hazard ratios (95% confidence interval) of diabetes were 1.00 (reference), 1.44 (1.01-2.07), and 1.48 (1.03-2.13) for the highest through the lowest tertile of fitness (P for trend = 0.04). Additional adjustment for body mass index largely attenuated the association of fitness with diabetes. Joint analysis showed that adjusted hazard ratios of diabetes were 1.00, 1.32, 2.94, and 1.83 in normal weight high-fit men, normal weight low-fit men, overweight high-fit men, and overweight low-fit men, respectively. Conclusion: The results suggest that weight control is more important than fitness in prevention of type 2 diabetes in Japanese men. © 2014 Kuwahara et al.

DOI： 10.1371/journal.pone.0098508

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPANESE CIRCULATION SOC  

Background: Waist-to-height ratio (WHtR) has been suggested as a better screening tool than body mass index (BMI) and waist circumference (WC) for assessing cardiometabolic risk. However, most previous studies did not consider age.
Methods and Results: Participants were 45,618 men and 8,092 women aged 15-84 years who received periodic health checkups in 9 companies in Japan. Clustering of cardiometabolic risk factors was defined by the existence of 2 or more of high blood pressure, hyperglycemia, and dyslipidemia. In both men and women, unadjusted area under the curve (AUC) of the receiver-operating characteristic curve for WHtR in detecting the clustering of cardiometabolic risk factors was significantly higher than that for either BMI or WC; the AUCs for WHtR, BMI, and WC, respectively, were 0.734, 0.705, and 0.717 in men and 0.782, 0.762, and 0.755 in women. After adjustment for age, however, such differences were not observed; the corresponding values were 0.702, 0.701, and 0.696 in men. In women, the age-adjusted AUC for BMI was slightly higher than for other indices (WHtR, 0.721; BMI, 0.726; WC, 0.707).
Conclusions: The screening performance of WHtR for detecting the clustering cardiometabolic risk factors was not superior to that of BMI.

DOI： 10.1253/circj.CJ-13-1067

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Objective: Epidemiologic evidence on long working hour and diabetes has been conflicting. We examined the association between overtime work and prevalence of diabetes among Japanese workers.
Methods: The subjects were 40,861 employees (35,170 men and 5,691 women), aged 16 to 83 years, of 4 companies in Japan. Hours of overtime were assessed using self-reported questionnaires. Diabetes was defined as a fasting plasma glucose &gt;= 126 mg/dl (7.0 mmol/l), hemoglobin A1c &gt;= 6.5% (48 mmol/mol), or current use of anti-diabetic drug. Multiple logistic regression analysis was used to calculate odds ratio of diabetes for each category of overtime.
Results: After adjustment for age, sex, company, smoking, and BMI, there was a suggestion of U-shaped relationship between overtime work and prevalence of diabetes (P for quadratic trend = 0.07). Compared with those who worked,45 hours of overtime per month, the adjusted odds ratios (95% confidence interval) of diabetes were 0.86 (0.77-0.94), 0.69 (0.53-0.89), and 1.03 (0.72-1.46) for those who worked 45-79, 80-99, and &gt;= 100 hours of overtime per month, respectively. In one company (n = 33,807), where other potential confounders including shift work, job position, type of department, alcohol consumption, sleep duration, leisure time physical activity, and family history of diabetes was additionally adjusted for, similar result was obtained (P for quadratic trend = 0.05).
Conclusions: Long hours of overtime work may not be associated with increased prevalence of diabetes among Japanese workers.

DOI： 10.1371/journal.pone.0095732

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

BackgroundInfluences of alcohol use on glucose metabolism may depend on alcohol flushing response. We investigated the effect of alcohol flushing response on the associations between alcohol consumption and markers of glucose metabolism in Japanese men and women.
MethodsThe subjects were 979 employees (885 men and 94 women), aged 18 to 69years, of a manufacturing company in Japan. Flushing response and alcohol consumption were determined using a self-administered questionnaire. Homeostasis model assessment-insulin resistance (HOMA-IR) and homeostasis model assessment for -cell function (HOMA-) were computed using fasting plasma glucose and insulin. For each group of flushers and nonflushers, multiple regression analysis was used to estimate means of fasting plasma glucose, hemoglobin A1c (HbA1c), and HOMAs for each category of alcohol consumption, with adjustments for potential confounders.
ResultsIn flushers, alcohol consumption was associated with HbA1c levels in a U-shaped manner, with the lowest HbA1c levels being observed at an alcohol consumption level of 23.0 to &lt;34.5g ethanol/d (p for quadratic trend=0.002). In nonflushers, alcohol consumption was linearly and inversely associated with HbA1c levels (p for linear trend=0.001). Decreases in HbA1c were more evident among flushers compared with nonflushers at moderate alcohol consumption levels (p for interaction=0.049). An increase of fasting glucose associated with highest alcohol consumption was observed in both flushers and nonflushers. A statistically significant decrease in HOMA-IR with increasing alcohol consumption was observed in flushers (p for trend=0.007), whereas HOMA-IR levels slightly decreased at higher alcohol consumption in nonflushers. HOMA- similarly decreased with increasing alcohol consumption in both flushers and nonflushers (both p for trend&lt;0.001).
ConclusionsThe results suggest that the alcohol flushing response may improve glucose metabolism and insulin resistance at moderate alcohol use levels in apparently healthy Japanese adults.

DOI： 10.1111/acer.12323

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CAMBRIDGE UNIV PRESS  

Objective: To examine the association between the consumption of green tea, coffee and caffeine and depressive symptoms.
Design: Cross-sectional study. Consumption of green tea and coffee was ascertained with a validated dietary questionnaire and the amount of caffeine intake was estimated from these beverages. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Multiple logistic regression analysis was performed to compute odds ratios and 95 % confidence intervals for depressive symptoms with adjustments for potential confounders.
Setting: Two workplaces in north-eastern Kyushu, Japan, in 2009.
Subjects: A total of 537 men and women aged 20-68 years.
Results: Higher green tea consumption was associated with a lower prevalence of depressive symptoms. Compared with participants consuming &lt;= 1 cup/d, those consuming &gt;= 4 cups green tea/d had a 51 % significantly lower prevalence odds of having depressive symptoms after adjustment for potential confounders, with significant trend association (P for trend = 0.01). Further adjustment for serum folate slightly attenuated the association. Coffee consumption was also inversely associated with depressive symptoms (&gt;= 2 cups/d v. &lt;1 cup/d: OR = 0.61; 95 % CI 0.38, 0.98). Multiple-adjusted odds for depressive symptoms comparing the highest with the lowest quartile of caffeine consumption was OR = 0.57 (95 % CI 0.30, 1.05; P for trend = 0.02).
Conclusions: Results suggest that higher consumption of green tea, coffee and caffeine may confer protection against depression.

DOI： 10.1017/S1368980013000360

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Objective. Higher coffee and green tea consumption has been suggested to decrease risk of type 2 diabetes, but their roles in insulin resistance (IR) and insulin secretion remain unclear. This study examined the association between habitual consumption of these beverages and markers of glucose metabolism in a Japanese working population.
Materials/Methods. Participants were 1440 Japanese employees (1151 men and 289 women) aged 18-69 years. Consumption of coffee and green tea was ascertained via a validated brief diet history questionnaire. Multilevel linear regression was used to estimate means (95% confidence intervals) of fasting insulin, fasting plasma glucose, homeostatic model assessment of IR (HOMA-IR), homeostatic model assessment of 3-cell function (HOMA-beta) and glycated hemoglobin (HbA1c) with adjustment for potential confounding variables.
Results. Coffee consumption was significantly, inversely associated with HOMA-IR (P for trend = 0.03), and the association appeared to be confined to overweight subjects (BMI &gt;= 25 kg/m(2)) (P for trend = 0.01, P for interaction = 0.08). Unexpectedly, green tea consumption was positively associated with HOMA-IR (P for trend = 0.02), though there was no dose-response relationship among daily consumers of green tea. Neither coffee nor green tea consumption was associated with HOMA-beta and HbA1c.
Conclusions. Our findings indicate that coffee consumption may be associated with decreased IR, but not with insulin secretion. The positive association between green tea consumption and IR warrants further investigation. (C) 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.metabol.2013.11.008

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Language：English   Publisher：CAMBRIDGE UNIV PRESS  

DOI： 10.1017/S1368980013002012

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Background &amp
aims: Fatty acid composition in diet and serum has been linked to depression, but the evidence on this issue is limited among Japanese, who consume large amounts of fish rich in n-3 polyunsaturated fatty acids. We examined the association between fatty acid composition in serum and depressive symptoms in Japanese men and women. Methods: The subjects were 496 participants aged 21-67 years in a cross-sectional study. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Free, cholesterol ester, and phospholipid fatty acids in serum were measured by gas-liquid chromatography. Multiple logistic regression was used to assess the association between serum fatty acid and depressive symptoms. Results: A higher free alpha-linolenic acid level was marginally significantly associated with a decreased prevalence of depressive symptoms (CES-D≥16) (P for trend=0.07). When a cut-off of CES-D≥19 was used, the association was strengthened
the multivariable-adjusted odds ratios (95% confidence interval) of depressive symptoms for the lowest through highest tertile of alpha-linolenic acid levels were 1.00 (reference), 0.49 (0.29-0.84), and 0.47 (0.26-0.83), respectively (P for trend=0.007). A higher n-6 PUFA in cholesterol esters and free linoleic acid were also significantly associated with a decreased prevalence of depressive symptoms (CES-D≥19) (P for trend=0.03 and 0.048, respectively). The other polyunsaturated fatty acids including marine-derived n-3 PUFA were not associated with depressive symptoms. Conclusions: Fatty acid composition with high levels of serum alpha-linolenic and linoleic acids might be protectively associated with depressive symptoms in Japanese adults. © 2013.

DOI： 10.1016/j.clnme.2013.12.003

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ PUBLISHING GROUP  

Objectives: To examine the association between self-reported eating rate and metabolic syndrome.
Design: Cross-sectional study.
Setting: Annual health checkup at a health check service centre in Japan.
Participants: A total of 56 865 participants (41 820 male and 15 045 female) who attended a health checkup in 2011 and reported no history of coronary heart disease or stroke.
Main outcome measure: Metabolic syndrome was defined by the joint of interim statement of the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute.
Results: In multiple logistic regression models, eating rate was significantly and positively associated with metabolic syndrome. The multivariable-adjusted ORs (95% CI) for slow, normal and fast were 0.70 (0.62 to 0.79), 1.00 (reference) and 1.61 (1.53 to 1.70), respectively, in men (p for trend &lt;0.001), and 0.74 (0.60 to 0.91), 1.00 (reference) and 1.27 (1.13 to 1.43), respectively, in women (p for trend &lt;0.001). Of metabolic syndrome components, abdominal obesity showed the strongest association with eating rate. The associations of eating rate and metabolic syndrome and its components were largely attenuated after further adjustment for body mass index; however, the association of slow eating with lower odds of high blood pressure (men and women) and hyperglycaemia (men) and that of fast eating with higher odds of lipid abnormality (men) remained statistically significant.
Conclusions: Results suggest that eating rate is associated with the presence of metabolic syndrome and that this association is largely accounted for by the difference in body mass according to eating rate.

DOI： 10.1136/bmjopen-2014-005241

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Objective: Higher vitamin B status has been linked to a lower risk for cancer, but the underlying mechanism remains elusive. The aim of the present study was to examine the association of pyridoxal, folate, and homocysteine (Hcy) with urinary 8-hydroxydeoxyguanosine (8-OHdG), a marker of oxidative DNA damage.
Methods: The participants were 500 employees (293 men and 207 women), ages 21 to 66 y, of two municipal offices in Japan. Serum pyridoxal and Hcy concentrations were measured using high-performance liquid chromatography (HPLC) method, and serum folate concentrations were measured using chemiluminescent immunoassay. Urinary 8-OHdG concentrations were measured using HPLC method. Multiple regression was used to estimate means of 8-OHdG for each tertile of pyridoxal, folate, and Hcy with adjustment for potential confounders.
Results: In multivariate analysis, 8-OHdG concentration was inversely associated with pyridoxal concentration in men (P for trend = 0.045) but not in women. The association in men was confined to non-smokers (P for trend = 0.033) or those who consumed no or &lt; 20 g/d of ethanol (P for trend = 0.048). 8-OHdG concentrations were not appreciably associated with folate and Hcy concentrations.
Conclusion: The results suggest that vitamin B-6, but not folate and homocysteine, plays a role against oxidative DNA damage in Japanese men. (c) 2013 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.nut.2013.03.014

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：NATURE PUBLISHING GROUP  

BACKGROUND/OBJECTIVES: Vitamin B6 is suggested to have a protective role against depression. However, the association between vitamin B6 intake and depression remains inconclusive, and few studies have examined the relationship between circulating vitamin B6 concentrations and depressive symptoms. Here, we investigated the cross-sectional and prospective associations between serum pyridoxal concentrations and depressive symptoms among Japanese workers.
SUBJECTS/METHODS: Participants were 422 municipal employees (aged 21-67 years) who participated in a baseline survey in 2006 for cross-sectional analysis, and 210 subjects without depressive symptoms at baseline (2006) who completed both baseline and follow-up (2009) surveys for prospective analysis. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Logistic regression analysis was used to estimate the odds ratio of depressive symptoms (CES-D scale of &gt;= 19) according to tertile of serum pyridoxal with adjustment for potential confounding variables.
RESULTS: In the cross-sectional analysis, serum pyridoxal concentrations were significantly associated with a decreased prevalence of depressive symptoms (P for trend = 0.03); the multivariable-adjusted odds ratio of depressive symptoms for the highest tertile of pyridoxal was 0.54 (95% confidence interval 0.30-0.96) compared with the lowest tertile. In longitudinal analyses, higher serum pyridoxal concentrations at baseline were associated with a trend toward reduced depressive symptoms after 3 years; the multivariable-adjusted odds ratio of depressive symptoms for the highest versus the lowest tertile of pyridoxal concentration was 0.55 (95% confidence interval 0.13-2.32).
CONCLUSIONS: A higher vitamin B6 status may be associated with a decreased risk of depressive symptoms in Japanese.

DOI： 10.1038/ejcn.2013.115

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: Supplementation studies have suggested a role of n-3 polyunsaturated fatty acids (PUFAs) in homocysteine metabolism, but the evidence is limited and inconsistent among studies that measured blood levels of n-3 and n-6 PUFAs. We examined the association between blood levels of PUFAs and homocysteine in Japanese men and women.
Methods: The subjects were 496 employees (290 men and 206 women) of 2 municipal offices in Japan. Fatty acid composition in serum phospholipids and cholesterol ester (CE) was measured using gas-liquid chromatography. Multiple regression was used to calculate means of homocysteine concentrations according to PUFA tertile with adjustment for potential confounders.
Results: Serum homocysteine concentration decreased with increasing levels of total n-3 PUFA, eicosapentaenoic acid and docosahexaenoic acid (DHA) in serum phospholipids and CE with adjustment for age, sex and workplace. However, only DHA in serum phospholipids remained statistically significant after additional adjustment for other potential confounders including serum folate (P-trend = 0.04). N-6 PUFAs were not significantly associated with homocysteine concentrations.
Conclusions: Higher proportion of DHA in serum phospholipids may be associated with lower homocysteine concentrations in Japanese men and women.

DOI： 10.1186/1743-7075-10-41

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Language：Japanese   Publisher：(公社)日本産業衛生学会  

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Fatty acid has been suggested to be involved in development of diabetes. However, its association is unclear among Japanese populations, which consume large amounts of fish rich in n-3 polyunsaturated fatty acids. The present cross-sectional study examined the association of individual dietary fatty acids and dietary fatty acid patterns with abnormal glucose metabolism among 1065 Japanese employees, aged 18-69 years. Impaired glucose metabolism is defined if a person has a history of diabetes, current use of anti-diabetic drug, fasting plasma glucose of 110 mg/dl (&gt;= 6.1 mmol/L) or greater, or hemoglobin A1C of 6.0% (&gt;= 42 mmol/mol) or greater. Dietary intake was assessed with a self-administered diet history questionnaire. Dietary fatty acid patterns were extracted by principal component analysis. Odds ratios of impaired glucose metabolism according to tertile categories of each fatty acids and dietary fatty acid patterns were estimated using logistic regression with adjustment for potential confounding variables. A higher intake of polyunsaturated fatty acid, n-6 fatty acid, linoleic acid, and oleic acid were significantly associated with a decreased prevalence of impaired glucose metabolism (P for trend = 0.03, 0.01, 0.02, and 0.04, respectively). Alpha-linolenic acid was marginally significantly associated with a decreased prevalence of impaired glucose metabolism (P for trend = 0.12). Of three fatty acid patterns identified, a higher plant oil pattern score, which characterized by high intake of alpha-linolenic acid, linoleic acid, and oleic acid, was associated with a decreased prevalence of impaired glucose metabolism (P for trend = 0.03). No association was observed for other patterns. In conclusion, plant source fatty acids might be protectively associated with development of diabetes in Japanese adults.

DOI： 10.1371/journal.pone.0064758

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Language：Japanese   Publisher：(公社)日本小児保健協会  

本研究においては、中学生を対象として、ゲームやテレビの使用状況と、生活習慣や精神・身体症状、および保護者の把握状況との関連について検討した。兵庫県A市内の全中学校の中学1年生、2年生、3年生計1,165名とその保護者を対象に、ゲーム・テレビの使用時間、生活習慣、精神・身体症状に関する質問紙調査を行った。その結果、ゲームやテレビの使用時間と生活習慣や精神・身体症状との間に関連性がみられた。また、ゲームやテレビの使用時間や精神・身体症状について保護者と子どもとの間での回答の一致性は低く、ゲームの使用時間が長い場合や精神・身体症状がある場合に回答が不一致である割合が高かった。以上より、情報機器の使用に関しては、本人だけでなく、保護者の把握状況も関連している可能性もあり、今後の詳細な検討が必要である。(著者抄録)

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Language：Japanese   Publisher：(公社)日本小児保健協会  

本研究においては、小学生を対象として、ゲームの使用状況とゲームに対する意識、および精神・身体症状や家族・友人との関連について検討した。兵庫県A市内の全13小学校の4年生、5年生、6年生計1,323名を対象に、ゲームの使用時間、ゲームに対する意識、生活習慣、精神・身体症状に関する質問紙調査を行った。その結果、ゲームの使用時間が長い者はゲームに対して消極的な印象を持つものが少なく、生活習慣の乱れや精神・身体症状を持つ者や行動が消極的な者が多かった。以上の結果より、ゲームに対する意識は、ゲームの使用時間に影響を与える一因であることが示唆された。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

The aim of this study was to determine the effects of the single intake of a high-energy and high-fat meal, of that of a moderate-energy and high-carbohydrate meal, and of fasting, which are major global eating patterns involving the combination of various levels of energy and nutrients, on heart rate variability in healthy young males. Participants were assigned to three groups: the high-energy and high-fat meal group, the moderate-energy and high-carbohydrate meal group, and the fasting group (no meal) in a randomized crossover design. The R-R intervals were continuously recorded before and after meals. Physiological and psychological data were obtained before and 30, 60, 90, and 120 min after meal intake. The main results were: (1) decreased sympathetic modulation of the heart and increased parasympathetic modulation of the heart in the fasting group, indicated by an unchanged heart rate, a decreased lowfrequency/high-frequency ratio, and increased high-frequency power of heart rate variability in the fasting group; (2) cardiac sympathetic activation or parasympathetic withdrawal after the intake of either a high-energy and high-fat meal or a moderate-energy and high-carbohydrate meal, indicated by increases in the heart rate and the lowfrequency/high-frequency ratio of heart rate variability, and a decrease in the high-frequency power of heart rate variability in both the high-energy and high-fat meal group and the moderate-energy and high-carbohydrate meal group; and (3) the high-energy and high-fat meal group and the moderate-energy and high-carbohydrate meal group showed similar movement in physiological and psychological measurements after the meal intake. In conclusion, the intake of the high-energy and high-fat meal and the moderate-energy and high-carbohydrate meal similarly activated sympathetic modulation of the heart, whereas fasting suppressed sympathetic modulation of the heart compared with the other two eating groups in healthy young males. I Physiol Anthropol 30(6): 223-231, 2011 http://www.jstage.jst.go.jp/browse/jpa2 [DOI: 10.2114/jpa2.30.223]

DOI： 10.2114/jpa2.30.223

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Language：Japanese   Publisher：緒方医学化学研究所医学生物学速報会  

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本研究の目的は、温冷交互浴に対する血行動態反応の影響を検討することである。8名の大学生(男性6名、女性2名)が単回浴(12℃、18℃、24℃、30℃、36℃、42℃の)、繰り返しの温浴(42℃)、温冷交互浴(18℃と42℃)の3つの実験に参加した。単回浴では、心拍が42℃の温浴で上昇し、血圧と末梢血管抵抗が36℃と42℃の温浴で減少した。繰り返しの温浴では、心拍が上昇し、血圧および末梢血管抵抗が減少した。温冷交互浴では、全ての指標が変動しながら推移していた。心拍は温浴のフェーズで上昇し、冷浴のフェーズで減少していた。血圧及び末梢血管抵抗は温浴のフェーズで減少し、冷浴のフェーズで上昇していた。結論として、繰り返しの温浴では、心拍が上昇あるいは血圧や末梢血管抵抗が減少といった一貫した動きを示していたのに対し、温冷交互浴においては、各測定指標は変動的な動きを示し、一貫した上昇あるいは減少傾向は示さなかった。(著者抄録)

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Other Link： http://search.jamas.or.jp/link/ui/2009331798

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

J-GLOBAL

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Language：English  

CiNii Books

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (other)  

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Language：Japanese   Publisher：(公財)産業医学振興財団  

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Language：Japanese   Publishing type：Book review, literature introduction, etc.  

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Language：Japanese   Publisher：(公社)日本産業衛生学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

Web of Science

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：日本公衆衛生学会  

J-GLOBAL

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：(公社)日本産業衛生学会  

J-GLOBAL

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Language：Japanese   Publisher：(公社)日本産業衛生学会  

J-GLOBAL

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Event date： 2021.12

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2021.9

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2021.9

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Event date： 2021.9

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Event date： 2020.10

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Event date： 2020.9

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Event date： 2019.10

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Event date： 2014.1

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Event date： 2011.10

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Event date： 2010.10

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Event date： 2010.10

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Event date： 2010.10

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Event date： 2009.10

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Language：English   Presentation type：Symposium, workshop panel (public)  

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Language：Japanese   Presentation type：Poster presentation  

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Language：Japanese   Presentation type：Oral presentation (general)  

Country：Japan  

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Language：Japanese   Presentation type：Poster presentation  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese  

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