Journal of Epidemiology
Online ISSN : 1349-9092
Print ISSN : 0917-5040
ISSN-L : 0917-5040
Volume 27 , Issue 11
Showing 1-7 articles out of 7 articles from the selected issue
Original Articles
  • Mikiko Shibata, Kyoko Kogawa Sato, Shinichiro Uehara, Hideo Koh, Shige ...
    2017 Volume 27 Issue 11 Pages 505-510
    Published: 2017
    Released: October 05, 2017

    Background: We examined prospectively which of the four blood pressure (BP) components (systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], and mean arterial pressure [MAP]) was best in predicting the risk of proteinuria.

    Methods: This prospective study included 9341 non-diabetic Japanese middle-aged men who had no proteinuria and an estimated glomerular filtration rate ≥60 mL/min/1.73 m2 and were not taking antihypertensive medications at entry. Persistent proteinuria was defined if proteinuria was detected two or more times consecutively and persistently at the annual examination until the end of follow-up. We calculated the difference in values of Akaike's information criterion (ΔAIC) in comparison of the BP components-added model to the model without them in a Cox proportional hazards model.

    Results: During the 84,587 person-years follow-up period, we confirmed 151 cases of persistent proteinuria. In multiple-adjusted models that included a single BP component, the hazard ratios for persistent proteinuria for the highest quartile of SBP, PP, and MAP were 3.11 (95% confidence interval [CI], 1.79–5.39), 1.87 (95% CI, 1.18–2.94), and 2.21 (95% CI, 1.33–3.69) compared with the lowest quartile of SBP, PP, and MAP, respectively. The hazard ratio for the highest quartile of DBP was 2.69 (95% CI, 1.65–4.38) compared with the second quartile of DBP. Of all models that included a single BP component, those that included SBP alone or DBP alone had the highest values of ΔAIC (14.0 and 13.1, respectively) in predicting the risk of persistent proteinuria.

    Conclusions: Of all BP components, SBP and DBP were best in predicting the risk of persistent proteinuria in middle-aged Japanese men.

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  • Saigo Baba, Toru Takashima, Miki Hirota, Michihiro Kawashima, Etsuo Ho ...
    2017 Volume 27 Issue 11 Pages 511-515
    Published: 2017
    Released: October 05, 2017

    Background: Insulin resistance has been associated with cytokines, including interleukin-6 and tumor necrosis factor alpha soluble receptor, both of which are elevated in chronic obstructive pulmonary disease (COPD). Few studies have investigated the relationship between pulmonary function tests using spirometry (PFT) and fasting plasma glucose (FPG) or glycated hemoglobin (HbA1c) levels in Japanese participants. The purpose of this study was to clarify the relationship between PFT in Japanese people who had health checkups and their FPG or HbA1c levels. In the context of preventative medicine, we intend to connect early detection of COPD to an index of blood sugar.

    Methods: From August 2013 through March 2014, 1019 participants underwent health checkups. PFT, FPG, and HbA1c measurements were conducted. HbA1c levels were measured according to National Glycohemoglobin Standardization Program guidelines.

    Results: Participants with FPG ≥100 mg/dL and HbA1c ≥5.6% showed a significantly lower forced expiratory volume in 1 s:forced vital capacity ratio (FEV1/FVC) compared to participants with lower FPG and Hb1Ac levels. Prevalence of FEV1/FVC values <70% in PFT differed significantly depending on sex, age, body mass index, FPG, HbA1c, and smoking habits. Age (≥60 years), HbA1c (≥5.6%), and current or former smoking were associated with FEV1/FVC values <70%.

    Conclusion: In Japan, HbA1c levels were higher in participants with FEV1/FVC values <70% in PFT than in those with FEV1/FVC ≥70%. In preventive medicine, PFT by spirometry should be performed in elderly participants with elevated HbA1c levels who are current or former smokers.

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  • Hui-Ju Wen, Lillian Sie, Pen-Hua Su, Chia-Jui Chuang, Hsiao-Yen Chen, ...
    2017 Volume 27 Issue 11 Pages 516-523
    Published: 2017
    Released: October 05, 2017

    Background: Phthalate diesters are commonly used and have been well established as environmental endocrine disruptors. However, few studies have examined their effects on sex steroid hormones in children. We followed children over time to examine the association between pre- and post-natal phthalate exposure and sex steroid hormone levels at 2, 5, 8, and 11 years of age.

    Methods: We recruited 430 pregnant women from central Taiwan from 2000 to 2001 and assessed their children at birth, 2, 5, 8, and 11 years of age. We studies children with at least one measurement for both phthalate and hormone levels during each any of the follow-up time point (n = 193). Estradiol, free testosterone, testosterone, and progesterone were measured from venous blood. Three monoesters of di-2-ethylhexyl phthalate (DEHP), mono-benzyl phthalate, mono-n-butyl phthalate, mono-ethyl phthalate, and mono-methyl phthalate were measured in maternal urine collected during the 3rd trimester and child urine collected at each follow-up point. The sum of mono-2-ethylhexyl phthalate (∑MEHP) was calculated by summing the concentrations of the three DEHP monoesters. Generalized estimating equation regression analysis with repeated measures was used to estimate associations between phthalate metabolites and hormone levels.

    Results: After adjustment for potential confounders, maternal ∑MEHP level was associated with decreased levels of progesterone in girls (β = −0.309 p = 0.001). The child ∑MEHP concentration was associated with decreased levels of progesterone for girls (β = −0.194, p = 0.003) and with decreased levels of free testosterone for boys (β = −0.124, p = 0.004).

    Conclusions: Early-life DEHP exposure may alter sex steroid hormones of children over time, which may pose potential reproductive health risks.

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  • Yuko Tokudome, Keiko Okumura, Yoshiko Kumagai, Hirohiko Hirano, Hunkyu ...
    2017 Volume 27 Issue 11 Pages 524-530
    Published: 2017
    Released: October 05, 2017

    Background: Because few Japanese questionnaires assess the elderly's appetite, there is an urgent need to develop an appetite questionnaire with verified reliability, validity, and reproducibility.

    Methods: We translated and back-translated the Council on Nutrition Appetite Questionnaire (CNAQ), which has eight items, into Japanese (CNAQ-J), as well as the Simplified Nutritional Appetite Questionnaire (SNAQ-J), which includes four CNAQ-J-derived items. Using structural equation modeling, we examined the CNAQ-J structure based on data of 649 Japanese elderly people in 2013, including individuals having a certain degree of cognitive impairment, and we developed the SNAQ for the Japanese elderly (SNAQ-JE) according to an exploratory factor analysis. Confirmatory factor analyses on the appetite questionnaires were conducted to probe fitting to the model. We computed Cronbach's α coefficients and criterion-referenced/-related validity figures examining associations of the three appetite battery scores with body mass index (BMI) values and with nutrition-related questionnaire values. Test–retest reproducibility of appetite tools was scrutinized over an approximately 2-week interval.

    Results: An exploratory factor analysis demonstrated that the CNAQ-J was constructed of one factor (appetite), yielding the SNAQ-JE, which includes four questions derived from the CNAQ-J. The three appetite instruments showed almost equivalent fitting to the model and reproducibility. The CNAQ-J and SNAQ-JE demonstrated satisfactory reliability and significant criterion-referenced/-related validity values, including BMIs, but the SNAQ-J included a low factor-loading item, exhibited less satisfactory reliability and had a non-significant relationship to BMI.

    Conclusions: The CNAQ-J and SNAQ-JE may be applied to assess the appetite of Japanese elderly, including persons with some cognitive impairment.

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  • Jiao Wang, Peymane Adab, Weijia Liu, Yajun Chen, Bai Li, Rong Lin, Wei ...
    2017 Volume 27 Issue 11 Pages 531-537
    Published: 2017
    Released: October 05, 2017

    Background: Short sleep duration has been reported to be associated with obesity in children, but findings are not consistent. Since few studies have examined the relationship between more complex sleep characteristics and obesity, we examined the association between adiposity and self-reported sleep duration, bedtime, and sleep quality in 9–12-year-old Chinese children using multilevel mixed models.

    Methods: 5518 children aged 9–12 years were recruited from 29 randomly selected primary schools in Guangzhou, China in 2014. Standardized questionnaires were used to obtain data to estimate sleep duration on typical weekdays and weekends. Sleep quality data were collected using the Children's Sleep Habits Questionnaire (CSHQ). Trained researchers undertook measurements of weight, height, and waist circumference (WC) for all participating children. Body mass index (BMI) z-scores were derived using the World Health Organization (WHO) child growth reference, and children were classified as overweight or obese using +1 and +2 SD as cut-offs, respectively. Percentage body fat (BF%) was calculated using bioelectrical impedance.

    Results: Longer sleep duration was inversely associated with BMI z-score (β = −0.16, p < 0.05), WC (β = −1.11, p < 0.05) and later bedtime was associated with higher BMI z-score (β = 0.03, p < 0.05), WC (β = 1.72, p < 0.001), and BF% (β = 0.15, p < 0.05) in multivariable multilevel mixed models, after adjustment for age, gender, physical activity, parental education level, and average monthly income. No association was seen between sleep quality and adiposity.

    Conclusion: Shorter sleep duration and later bedtime are associated with higher adiposity indices in early adolescents from southern China.

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  • Takashi Matsunaga, Mariko Naito, Kenji Wakai, Shigekazu Ukawa, Wenjing ...
    2017 Volume 27 Issue 11 Pages 538-545
    Published: 2017
    Released: October 05, 2017

    Background: To clarify the role of physical activity in preventing disability in Japan, we investigated the association between amount of leisure-time physical activity and incidence of disability among the young elderly.

    Methods: In the New Integrated Suburban Seniority Investigation (NISSIN) project conducted from 1996 to 2013, we followed 2888 community-dwelling adults aged 64–65 years with no history of cerebrovascular disease for a median follow-up of 11.6 years. Disabilities were defined as follows based on the classifications of the Japanese long-term care insurance system: 1) support or care levels (support levels 1–2 or care levels 1–5); 2) care levels 2–5; 3) support or care levels with dementia; and 4) care levels 2–5 or death. In addition, we also assessed 5) all-cause mortality.

    Results: After controlling for sociodemographic, lifestyle, and medical factors, male participants reporting an activity level of 18.1 metabolic equivalent (MET)-hours/week (the median among those with activities) or more had 52% less risk of being classified as support or care levels with dementia compared with the no activity group (hazard ratio 0.48; 95% confidence interval, 0.25–0.94). No significant association was found among women between amount of leisure-time physical activity and incidence of disability.

    Conclusion: We identified an inverse dose–response relationship between the amount of leisure-time physical activity and the risk of disability with dementia in men. Therefore, a higher level of physical activity should be recommended to young elderly men to prevent disability with dementia.

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  • Hideko Nakamura, Mieko Nakamura, Eisaku Okada, Toshiyuki Ojima, Katsun ...
    2017 Volume 27 Issue 11 Pages 546-551
    Published: 2017
    Released: October 05, 2017

    Background: Food access is important for maintaining dietary variety, which predicts underweight. The aim of this study was to examine the association of food access and neighbor relationships with eating and underweight.

    Methods: We analyzed cross-sectional data from 102,869 Japanese individuals aged 65 years or older. The perceived availability of food was assessed using the presence or absence of food stores within 1 km of the home. Level of relationships with neighbors was also assessed. The odds ratios (ORs) and 95% confidence intervals (CIs) for infrequent food intake and underweight were determined using logistic regression analysis.

    Results: The proportion of men and women having low access to food was 25–30%. Having low food access (OR 1.18; 95% CI, 1.12–1.25 for men and OR 1.26; 95% CI, 1.19–1.33 for women) and a low level of relationship with neighbors (OR 1.38; 95% CI, 1.31–1.45 for men and OR 1.57; 95% CI, 1.48–1.67 for women) was associated with infrequent intake of fruits and vegetables in both sexes. Association between low food access and infrequent intake of fruits and vegetables was higher among men with low levels of neighbor relationship (OR 1.34; 95% CI, 1.23–1.46) than among men with high levels of relationship (OR 1.10; 95% CI, 1.03–1.18).

    Conclusions: Low perceived availability of food is a risk factor for low dietary variety among older people. Furthermore, high levels of relationship with neighbors may relieve the harmful effect of low food access.

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