Objective: To determine whether or not the breast milk feeding has a role in the prevalence of atopic dermatitis among children. Methods: The target population of the study was all children participating in health check-up program for 3-year-old children in 60 municipalities locating 10 selected prefectures during designated 2 months between October and December 1997. Using a questionnaire, information on nutrition in infants (breast milk only, bottled milk only, or mixed), parity, mothers' age at birth, and a history of atopic dermatitis was obtained. Besides, data on potential confounding factors were obtained. Results: Questionnaires from 3856 children (81.6% of those who were to participate in the programs, and 96.4% of children who participated them) were analyzed. After the adjustment for all potential confounding factors using unconditional logistic models, the risk of atopic dermatitis was slightly higher among children with breast milk (odds ratio [OR]= 1.16 with 95% confidence interval [CI] 0.96-1.40). Mothers' age at birth (OR for those who were more than 30 years or older in comparison with those who were younger than 30 years = 1.15; 95% CI, 0.96-1.37) and those with second or later parity orders (OR=1.14, 95% CI;0.95-1.35) showed odds ratios that were higher than unity without statistical significance. Conclusion: Breast milk elevates the risk of atopic dermatitis slightly without statistical significance; the risk may be, however, higher in children in second or later parity orders. J Epidemiol, 2000 ; 10 : 74-78

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This study was the first nationwide population-based study to estimate the prevalence rates of sleep disturbance and hypnotic medication use in the general Japanese adult population. In 1997, 2, 800 Japanese adults aged 20 years and over were randomly selected from the 1995 Census and 1, 871 were examined using the Pittsburgh Sleep Quality Index. The respective estimated overall prevalences of insomnia (INS), difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), poor perceived quality of sleep (PQS) and hypnotic medication use (HMU) were 17.3%, 8.6%, 12.9%, 17.8%, and 3.5% in males and 21.5%, 12.6%, 16.2%, 20.2% and 5.4% in females. Among males, DIS (OR=2.76) and PQS (OR=2.12) were associated with never having married. DMS was associated with being 60 years and older (OR=2.68) or divorced/separated (OR=3.74). Among females, DMS was associated with being widowed (OR=1.65), unemployed (OR=1.60), 40 to 59 years old (OR=0.57) or never having married (OR=0.39). DIS was associated with being widowed (OR=1.67) or unemployed (OR=1.58). HMU was associated with advancing age (OR=8.26-10.7), being widowed (OR=2.12) or never having married (OR=2.84). PQS was associated with advancing age (OR=0.63-0.50). Our study showed sleep disturbance and hypnotic medication use were prevalent among Japanese adults and some sociodemographic factors contributed to them. J Epidemiol, 2000 ; 10 : 79-86

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A population-based cohort study was conducted to assess the relationship between total mortality and self-reported sleep patterns as regards not only to sleep duration but also subjective sleep quality. A total of 5, 322 inhabitants in Gifu Prefecture, Japan, completed a selfadministered questionnaire on health status and lifestyles including habitual sleep patterns, and were followed-up for an average of 11.9 years. Relative risks were computed by using Cox proportional hazards models. Both longer and shorter sleep, compared to 7-8 hour-sleep, was related to significantly increased risk of total mortality in males (relative risk [RR] for g"10 hours = 1.94, and RR for <7 hour = 1.90), but not in females. Females complaining of poor awakening state experienced a higher mortality risk compared to those who woke up normally (RR: 1.97). Males who usually fell asleep easily showed a marginally lower mortality risk compared to those who fell asleep normally (RR: 0.70). Female users of sleeping pills were at an elevated risk (RR: 1.89). These findings were almost unchanged after adjustment for sleep duration and other confounders. Poor self-reported quality of sleep seemed to be associated with an increased risk of mortality independently of sleep duration. J Epidemiol, 2000 ; 10 : 87-93

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A population-based cohort study was conducted to assess the relationship between total mortality and self-reported sleep patterns as regards not only to sleep duration but also subjective sleep quality. A total of 5, 322 inhabitants in Gifu Prefecture, Japan, completed a selfadministered questionnaire on health status and lifestyles including habitual sleep patterns, and were followed-up for an average of 11.9 years. Relative risks were computed by using Cox proportional hazards models. Both longer and shorter sleep, compared to 7-8 hour-sleep, was related to significantly increased risk of total mortality in males (relative risk [RR] for g"10 hours = 1.94, and RR for <7 hour = 1.90), but not in females. Females complaining of poor awakening state experienced a higher mortality risk compared to those who woke up normally (RR: 1.97). Males who usually fell asleep easily showed a marginally lower mortality risk compared to those who fell asleep normally (RR: 0.70). Female users of sleeping pills were at an elevated risk (RR: 1.89). These findings were almost unchanged after adjustment for sleep duration and other confounders. Poor self-reported quality of sleep seemed to be associated with an increased risk of mortality independently of sleep duration. J Epidemiol, 2000 ; 10 : 87-93

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We examined the data from 530 subjects enrolled in a survey on the prevalence of diabetes in a Japanese-Brazilian population aged 40-79 years. Past self-reported and current weight values were analysed. Student t test was used to compare anthropometric measures between subjects with and without disturbance of glucose tolerance (DGT), hypertension and dyslipidemia. Point and interval estimates of the weight at 20 years-, ageand sex-adjusted odds ratios (OR) were obtained by logistic regression analysis to evaluate the relationship between these diseases and the percent weight gain. Subjects with DGT, hypertension or dyslipidemia tended to have higher BMI during adulthood and to gain more weight in a shorter interval of time. Also, they presented higher waist-to-hip ratio and plasma glucose and worse lipid profile. OR were consistent with associations between chronic diseases and percent weight gain. Trend test of OR indicated that the risk of developing DGT alone or combined with hypertension and abdominal obesity increased 2% and 15% by percent unit of gained weight, respectively, as compared with those subjects with stable weight. Weight gain and the rate by which this occurs during lifetime may confer increased risk of chronic diseases. We suggested that preventive measures against obesity, i.e. the maintenance of healthy body weight lifelong, are necessary to minimize the occurrence of these diseases, also among migrant populations such as the JapaneseBrazilians. J Epidemiol, 2000; 10: 103-110

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We evaluated dietary habits as risk factor for glucose intolerance in a high risk population of Japanese-Brazilians enrolled in a study on the prevalence of diabetes (DM). Based on oral glucose tolerance test and WHO criteria, 331 had normal tolerance (NGT), 88 impaired tolerance (IGT) and 83 had type 2 DM (51 self-reported, 32 newly diagnosed diabetics). Clinical, laboratory and dietary data, assessed by food frequency questionnaire (FFQ), were compared between the NGT group and another composed of IGT and newly diagnosed DM (disturbed glucose tolerance or DGT group). Associations of total energy intake and nutrient intakes with glucose intolerance were analyzed by logistic regression. Also, subjects with NGT and DGT entered into separate models of multiple linear regression including BMI as the dependent variable, and total energy intake or each nutrient as independent variables. DGT group showed higher waist-to-hip ratio, blood pressure, plasma glucose and insulin levels and worse lipid profile. Total energy intake, macronutrients, fibers, alcohol and saturated fat intakes did not differ between groups; DGT was not associated with any nutrient intake in multivariate analyses. BMI of the subjects with DGT but not with NGT was associated with protein and cholesterol intakes in linear regression analysis. Our findings did not support an association between nutritional factors and glucose intolerance even in subjects who are unaware of their DGT, using FFQ to reflect current habits. However, we suggest that protein and cholesterol intakes may be markers of increased BMI. Despite assuming that obesity and insulin resistance precedes DM, FFQ may not be useful in the assessment of unfavorable dietary patterns among subjects at risk for glucose intolerance, such as JapaneseBrazilians with elevated BMI. J Epidemiol, 2000 ; 10 : 111-117

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To examine the reliability and construct validity of the Japanese version of the Anger Expression Scale among four Japanese communities, and to examine distributions of anger expression scores according to sex, age, occupation, and community, we performed a crosssectional study among 1, 802 men and 3, 229 women aged 20-70 in four geographic populations in 1995-97. We handed a self-administered questionnaire, which was selected from the Spielberger Anger Expression Scale, to the participants in the risk factor surveys and measured anger-in and anger-out as the anger expression scale. These scales had high internal consistency (Cronbach's alpha coefficient was 0.97-0.98 for anger-out and 0.77-0.86 for angerin) and were of almost the same structure as the original. The Pearson correlation coefficients for the anger expression scale examined in 1995 and 1996 were 0.69 for anger-out and 0.57 for anger-in (both p<0.001). The mean scores of both anger-out and anger-in were inversely associated with age. The mean anger-out score was higher for men than for women (p<0.001), whereas the mean anger-in score did not vary significantly between the sexes. Furthermore, the mean scores of anger-out and anger-in varied among populations and occupational groups. The present study suggests that the Japanese version of the selected Anger Expression Scale is an acceptable scale for evaluating anger expression among Japanese. J Epidemiol, 2000; 10: 118-123

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The reference value of erythrocyte sedimentation rate (ESR) should be established for a population concerned because it is influenced by many local conditions. It has not yet been determined in healthy children of Bangladesh. This study was done to determine the reference value of ESR in Bangladeshi children. ESR was determined in a sample of 413 'healthy' primary school students (259 boys and 154 girls, mean age 8.7 years). Ninety-five percent of them had ESR S0 30 mm (Westergren 1 h). Our findings suggest that ESR value >30 mm (Westergren 1 h) should be considered high in Bangladeshi primary school children. J Epidemiol, 2000 ; 10 : 124-126

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Biological effects of dietary isoflavones, such as daidzein and genistein are of interest in preventive medicine. We estimated the dietary intake of isoflavones from dietary records and compared the values with the plasma concentrations and urinary excretions in Japanese middleaged women. The dietary intake of daidzein and genistein was 64.6 and 111.6μ mol/day/capita (16.4 and 30.1 mg/day/capita), respectively. The isoflavones intake was mostly attributable to tofu, natto and miso. The median of plasma daidzein and genistein concentration was 72.46 and 206.09 nmol/L, respectively. The median of urinary excretion was 20.54μ mol/day for daidzein, 10.79 for genistein, 15.74 for equol and 1.64 for O-desmethylangolensin (0-DMA). Equol and 0DMA were excreted by 50 % and 84 % of all participants, respectively. Equol metabolizers were significantly lower the plasma and urinary daidzein and urinary O-DMA. The dietary intake of daidzein and genistein after the adjustment for total energy intake was significantly correlated with the urinary excretion (r=0.365 for daidzein and r=0.346 for genistein) and plasma concentration (r=0.335 for daidzein and r=0.429 for genistein). The plasma concentration of isoflavones was also significantly correlated with the urinary excretion. We conclude that in epidemiological studies measurements of plasma concentration or urinary excretion of these isoflavones are useful biomarkers of dietary intake and important for studies on their relation to human health. J Epidemiol, 2000 ; 10 : 127-135

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