Details of a Researcher - Miyagawa, Naoko

Papers - Miyagawa, Naoko

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Associations of Nutrient Patterns with the Prevalence of Metabolic Syndrome: Results from the Baseline Data of the Japan Multi-Institutional Collaborative Cohort Study.

Yuki Iwasaki, Kokichi Arisawa, Sakurako Katsuura-Kamano, Hirokazu Uemura, Mineko Tsukamoto, Yuka Kadomatsu, Rieko Okada, Asahi Hishida, Keitaro Tanaka, Megumi Hara, Toshiro Takezaki, Keiichi Shimatani, Etsuko Ozaki, Teruhide Koyama, Sadao Suzuki, Hiroko Nakagawa-Senda, Kiyonori Kuriki, Naoko Miyagawa, Aya Kadota, Hiroaki Ikezaki, Norihiro Furusyo, Isao Oze, Hidemi Ito, Haruo Mikami, Yohko Nakamura, Kenji Wakai

Nutrients (Nutrients) 11 ( 5 ) 990 - 990 2019.05

Research paper (scientific journal), Joint Work, Accepted

: The association between nutrient patterns and metabolic syndrome (MetS) has not been examined in a Japanese population. A cross-sectional study was performed on 30,108 participants (aged 35-69 years) in the baseline survey of the Japan Multi-Institutional Collaborative Cohort Study. Dietary intake was assessed using a 46-item food frequency questionnaire. MetS was diagnosed according to the Joint Interim Statement Criteria of 2009, using body mass index instead of waist circumference. Factor analysis was applied to energy-adjusted intake of 21 nutrients, and three nutrient patterns were extracted: Factor 1 (fiber, potassium and vitamins pattern); Factor 2 (fats and fat-soluble vitamins pattern); and Factor 3 (saturated fatty acids, calcium and vitamin B2 pattern). In multiple logistic regression analysis adjusted for sex, age, and other potential confounders, Factor 1 scores were associated with a significantly reduced odds ratio (OR) of MetS and all five components. Factor 2 scores were associated with significantly increased prevalence of MetS, obesity, and high blood pressure. Factor 3 scores were significantly associated with lower OR of MetS, high blood pressure, high serum triglycerides and low HDL cholesterol levels. Analysis of nutrient patterns may be useful to assess the overall quality of diet and its association with MetS.

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Factors associated with intra-individual visit-to-visit variability of blood pressure in four countries: the INTERMAP study.

Takashima N, Ohkubo T, Miura K, Okayama A, Okuda N, Nakagawa H, Saito S, Sakata K, Choudhury SR, Miyagawa N, Chan Q, Zhao L, Elliott P, Ueshima H, Stamler J, INTERMAP Study Group

Journal of human hypertension (Journal of Human Hypertension) 33 ( 3 ) 229 - 236 2019.03

Research paper (scientific journal), Joint Work, Accepted, ISSN 09509240

Several studies demonstrated that visit-to-visit variability of blood pressure (BP) predicted future events of total death, stroke and cardiovascular disease. Little is known about factors associated with visit-to-visit BP variability in different countries. We recruited participants aged 40-59 years from four countries (Japan, the People's Republic of China [PRC], the United Kingdom [UK] and the United States [US]). At each study visit, BP was measured twice by trained observers using random zero sphygmomanometers after five minutes resting. We defined visit-to-visit BP variability as variation independent of mean (VIM) by using average systolic BP of 1st and 2nd measurement across four study visits. Data on 4680 men and women were analyzed. Mean ± standard deviation of VIM values among participants in Japan, the PRC, the UK and the US were 5.44 ± 2.88, 6.85 ± 3.49, 5.65 ± 2.81 and 5.84 ± 3.01, respectively; VIM value in the PRC participants was significantly higher. Sensitivity analyses among participants without antihypertensive treatment or past history of cardiovascular disease yielded similar results. Higher VIM value was associated with older age, female gender, lower pulse rate and urinary sodium excretion and use of antihypertensive agents such as angiotensin converting enzyme inhibitors, beta blockers and calcium channel blockers. The difference of visit-to-visit BP variability between PRC and other countries remained significant after adjustment for possible confounding factors. In this large international study across four countries, visit-to-visit BP variability in the PRC was higher than in the other three countries. Reproducibility and mechanisms of these findings remain to be elucidated.

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Having few remaining teeth is associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese individuals: findings from the NIPPON DATA2010.

Nakamura M, Ojima T, Nagahata T, Kondo I, Ninomiya T, Yoshita K, Arai Y, Ohkubo T, Murakami K, Nishi N, Murakami Y, Takashima N, Okuda N, Kadota A, Miyagawa N, Kondo K, Okamura T, Ueshima H, Okayama A, Miura K, NIPPON DATA, Research Group

Environmental health and preventive medicine (Environmental Health and Preventive Medicine) 24 ( 1 ) 1 - 1 2019.01

Research paper (scientific journal), Joint Work, Accepted, ISSN 1342078X

BACKGROUND: Oral health is thought to be associated with diet quality, and socioeconomic status (SES) affects both oral health and diet. The aim of this study was to investigate the association between the number of teeth and dietary intake as well as nutritional biomarker, considering the subjects' SES. METHODS: We conducted a cross-sectional analysis of data from 2049 individuals aged ≥ 50 years from the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010. The number of remaining teeth was categorized into age-specific quartiles (Q1 to Q4). We assessed the adjusted means and 95% confidence intervals for dietary variables by the number of teeth using analysis of covariance. Stratified analyses by SES were also conducted. RESULTS: The intake of grain products was 31 g higher, and those of vegetables and meat were 30 g and 8 g lower, respectively, in Q1 (fewer teeth) than in Q4 (more teeth). Carbohydrate intake was higher whereas protein, minerals (potassium, magnesium, and zinc), vitamins (vitamins A, E, B1, B6, β-carotene, and folic acid), and dietary fiber intakes were lower among individuals with fewer teeth. Adjusted mean serum albumin levels were low in Q1. The associations between the number of teeth and dietary intake were more evident in individuals with a low SES. CONCLUSIONS: Having few remaining teeth was associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese adults, and these associations were more evident in individuals with low SES.

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Association of Work Situation With Cardiovascular Disease Mortality Risk Among Working-Age Japanese Men - A 20-Year Follow-up of NIPPON DATA90.

Okuda N, Kadota A, Nishi N, Miura K, Ohkubo T, Miyagawa N, Satoh A, Kita Y, Hayakawa T, Takashima N, Fujiyoshi A, Okayama A, Okamura T, Ueshima H, NIPPON DATA, Research Group

Circulation journal : official journal of the Japanese Circulation Society (The Japanese Circulation Society) 83 ( 7 ) 1506 - 1513 2019

Research paper (scientific journal), Joint Work, Accepted, ISSN 13469843

Background:Several cohort studies have demonstrated an association between socioeconomic status (SES) and health outcomes in Japan. As long-term employment is common in Japan, the size of the company may be related to cardiovascular disease (CVD) mortality risk. We examined the association of employment conditions with CVD mortality risk among working-age Japanese men (30–59 years, n=2,091).Methods and Results:We used 20-year follow-up data from NIPPON DATA90, for which baseline data were obtained from the 4th National Survey on Circulatory Disorders in 1990. Participants were classified into 4 groups: 3 strata for indefinite-term employees according to company size (large company/public office, moderate-sized, or small), and the self-employed/administrator group. Multivariable-adjusted hazard ratios (HRs) were adjusted for age, lifestyle, and CVD risk factors. Smokers were more common, habitual exercise was less common, and the average systolic blood pressure was higher among indefinite-term employees of small companies compared with employees at large companies/public offices. There was no significant difference in the total CVD mortality risk between indefinite-term employees and self-employed/administrator participants. The age-adjusted HR (95% confidence interval) for total CVD using indefinite-term employees of large companies/public office as a reference was 2.53 (1.12, 5.69) for employees of small companies.Conclusions:Working as an indefinite-term employee at a small company in Japan was significantly associated with elevated risk of CVD mortality among Japanese men.

Associations of Overweight, Obesity, and Underweight With High Serum Total Cholesterol Level Over 30 Years Among the Japanese Elderly: NIPPON DATA 80, 90, and 2010.

Shibata Y, Ojima T, Nakamura M, Kuwabara K, Miyagawa N, Saito Y, Nakamura Y, Kiyohara Y, Nakagawa H, Fujiyoshi A, Kadota A, Ohkubo T, Okamura T, Ueshima H, Okayama A, Miura K

Journal of epidemiology (Japan Epidemiological Association) 29 ( 4 ) 133 - 138 2019

Research paper (scientific journal), Joint Work, Accepted, ISSN 09175040

BACKGROUND: The trend of association between overweight and high serum total cholesterol (TC) among the elderly is unclear. In addition, there is little evidence of risk of underweight for high TC. Therefore, we examined the trend of association of overweight or underweight with high TC among Japanese elderly people using nationwide population-based data. METHODS: Data of the National Survey on Circulatory Disorders and National Health and Nutrition Survey for 1980, 1990, 2000, and 2010 were used in the analysis. High TC was defined as 220 mg/dL and above. For participants aged ≥50 years, sex-specific odds ratios (ORs) of overweight or underweight compared with normal body mass index participants for high TC were calculated using a logistic regression model adjusted for age, smoking, drinking, exercise, food, and treatment of hyperlipidemia. RESULTS: A total of 5,734, 4,673, 5,059, and 2,105 participants enrolled in these surveys in 1980, 1990, 2000, and 2010, respectively. Although overweight was positively and significantly associated with high TC in 1980, the association has gradually weakened since (ORs in 1980 and 2010 were 2.44; 95% confidence interval [CI], 1.83-3.24 and 0.92; 95% CI, 0.66-1.27 among men and 1.43; 95% CI, 1.18-1.72 and 1.08; 95% CI, 0.81-1.44 among women, respectively). While underweight was inversely and significantly associated with high TC in 1980, the association also gradually weakened among women (ORs in 1980 and 2010 were 0.28; 95% CI, 0.12-0.60 and 0.37; 95% CI, 0.10-1.28 among men and 0.39; 95% CI, 0.26-0.57 and 0.96; 95% CI, 0.58-1.57 among women, respectively). CONCLUSIONS: These findings provide evidence that high TC prevention efforts must expand the target to not only overweight but also to normal and underweight people.

Cardiovascular Risk Assessment Chart by Dietary Factors in Japan - NIPPON DATA80.

Kondo K, Miura K, Tanaka-Mizuno S, Kadota A, Arima H, Okuda N, Fujiyoshi A, Miyagawa N, Yoshita K, Okamura T, Okayama A, Ueshima H, NIPPON DATA, Research Group

Circulation journal : official journal of the Japanese Circulation Society (The Japanese Circulation Society) 83 ( 6 ) 1254 - 1260 2019

Research paper (scientific journal), Joint Work, Accepted, ISSN 13469843

BACKGROUND: Many studies show that dietary factors such as vegetables, fruit, and salt are associated with cardiovascular disease (CVD) risk. However, a risk assessment chart for CVD mortality according to combinations of dietary factors has not been established.Methods and Results:Participants were 9,115 men and women aged 30-79 years enrolled in the National Nutritional Survey of Japan in 1980 with a 29-year follow-up. Dietary intake was assessed using a 3-day weighed dietary record at baseline. Cox regression models were used to estimate the hazard ratio (HR) of CVD mortality stratified by vegetables, fruit, fish, and salt consumption. HRs of CVD mortality according to combinations of dietary factors were color coded on an assessment chart. Higher intakes of vegetables, fruit, and fish, and lower salt intake were associated with lower CVD mortality risk. HRs calculated from combinations of dietary factors were displayed using 5 colors corresponding to the magnitude of the HR. People with the lowest intake of vegetables, fruit, and fish, and higher salt intake had a HR of 2.87 compared with those with the highest intake of vegetables, fruit, and fish, and lower salt intake. CONCLUSIONS: Vegetables, fruit, fish, and salt intake were independently associated with CVD mortality risk. The assessment chart generated could be used in Japan as an educational tool for CVD prevention.

Vegetable Protein Intake was Inversely Associated with Cardiovascular Mortality in A 15-Year Follow-Up Study of A General Japanese Population.

Kurihara A, Okamura T, Sugiyama D, Higashiyama A, Watanabe M, Okuda N, Kadota A, Miyagawa N, Fujiyoshi A, Yoshita K, Ohkubo T, Okayama A, Miura K, Ueshima H, NIPPON DATA, Research Group

Journal of atherosclerosis and thrombosis (Japan Atherosclerosis Society) 26 ( 2 ) 198 - 206 2019

Research paper (scientific journal), Joint Work, Accepted, ISSN 13403478

AIM: To examine the relationship between the intake of dietary vegetable protein and CVD mortality in a 15-year follow-up study of a representative sample of the Japanese population. METHODS: A total of 7,744 participants aged 30 years or older (3,224 males and 4,520 females) who were free of CVD at baseline were included in this analysis. Vegetable protein intake (% energy) was assessed using a three-day semi-weighed dietary record at baseline. Multivariable-adjusted hazard ratios (HRs) were calculated using Cox's proportional hazards model after adjusting for confounding factors. RESULTS: The total person-years studied were 107,988 with a mean follow-up period of 13.9 years. There were 1,213 deaths during the follow-up period, among which 354 (29.2%) were due to CVD. Vegetable protein intake was associated inversely with CVD and cerebral hemorrhage mortality, with the HRs for a 1% energy increment in vegetable protein intake being 0.86 (95% CI, 0.75-0.99) and 0.58 (95% CI, 0.35-0.95), respectively. In the subgroup analysis of participants with or without hypertension, the inverse association between vegetable protein intake and CVD mortality was more evident in the nonhypertensive group, with the HRs for CVD and stroke being 0.68 (95% CI, 0.50-0.94) and 0.50 (95% CI, 0.30-0.84), respectively. CONCLUSIONS: Vegetable protein intake may prevent future CVD, particularly in nonhypertensive subjects in the Japanese population. However, further studies are necessary to examine the biological mechanisms of this effect.

Relationship of serum irisin levels to prevalence and progression of coronary artery calcification: A prospective, population-based study.

Hisamatsu T, Miura K, Arima H, Fujiyoshi A, Kadota A, Kadowaki S, Zaid M, Miyagawa N, Satoh A, Kunimura A, Horie M, Ueshima H, SESSA Research Group

International journal of cardiology (International Journal of Cardiology) 267 177 - 182 2018.09

Research paper (scientific journal), Joint Work, Accepted, ISSN 01675273

BACKGROUND: The mechanisms by which exercise reduces the risk of coronary heart disease remain poorly understood. Irisin, an exercise-induced polypeptide secreted from skeletal muscles, is proposed to potentially mediate beneficial effects of exercise, especially in metabolic regulation and development of atherosclerosis. We examined whether higher serum irisin levels are associated with lower prevalence and progression of coronary atherosclerosis. METHODS AND RESULTS: We performed a prospective, population-based study of Japanese men aged 40-79 years without known coronary heart disease. We measured baseline serum irisin levels using an enzyme-linked immunosorbent assay and quantified coronary artery calcification (CAC) from serial computed tomography scans. Of 1038 participants (mean age, 63.9 years) at baseline, 670 (64.6%) had prevalent CAC. Of 810 participants at follow-up (median, 5.1 years), 407 (50.3%) experienced CAC progression. In Poisson regression with robust error variance adjusted for age and behavioral factors, serum irisin levels were inversely associated with CAC prevalence (relative risk [RR] of 4th versus 1st quartiles [95% confidence interval], 0.88 [0.78-0.99]; trend P = 0.016) and CAC progression (RR, 0.76 [0.63-0.91]; trend P = 0.002). After further adjustment for cardiometabolic risk factors, the inverse association with CAC prevalence disappeared (RR, 0.95 [0.84-1.08]; trend P = 0.319), but that with CAC progression persisted (RR, 0.77 [0.64-0.93]; trend P = 0.003). These associations were consistent when we applied ordinal logistic regression and across subgroups by cardiometabolic risk factor status. CONCLUSIONS: Higher serum irisin levels were associated with less burden of coronary atherosclerosis. This association would be mediated through and beyond traditional cardiometabolic pathways.

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Serum magnesium, phosphorus, and calcium levels and subclinical calcific aortic valve disease: A population-based study.

Hisamatsu T, Miura K, Fujiyoshi A, Kadota A, Miyagawa N, Satoh A, Zaid M, Yamamoto T, Horie M, Ueshima H, SESSA Research Group

Atherosclerosis (Atherosclerosis) 273 145 - 152 2018.06

Research paper (scientific journal), Joint Work, Accepted, ISSN 00219150

BACKGROUND AND AIMS: Calcific aortic valve disease (CAVD) is the most common valve disease. Although micronutrients are known to contribute to cardiovascular disease, the relationship with CAVD remains poorly evaluated. We examined the association of serum levels of magnesium, phosphorus, and calcium with prevalence, incidence, and progression of aortic valve calcification (AVC). METHODS: We conducted a prospective study in a population-based sample of Japanese men aged 40-79 years without known cardiovascular disease and chronic kidney disease at baseline, and quantified AVC from serial computed tomographic images with the Agatston method. RESULTS: Of 938 participants at baseline (mean age, 63.7 ± 9.9 years), AVC prevalence was observed in 173 (18.4%). Of 596 participants without baseline AVC at follow-up (median duration, 5.1 years), AVC incidence was observed in 138 (23.2%). After adjustment for demographics, behaviors and cardiovascular risk factors, relative risks (95% confidence intervals) in the highest versus lowest categories of serum magnesium, phosphorus, and calcium were 0.62 (0.44-0.86), 1.45 (1.02-2.04), and 1.43 (0.95-2.15), respectively, for AVC prevalence and 0.62 (0.42-0.92), 1.93 (1.28-2.91), and 1.09 (0.77-1.55), respectively, for AVC incidence. Their linear trends of serum magnesium and phosphorus were also all statistically significant. Of 131 participants with baseline AVC, there was no association of any serum micronutrients with AVC progression. CONCLUSIONS: Serum magnesium was inversely associated, while serum phosphorus was positively associated with AVC prevalence and incidence, suggesting that these serum micronutrients may be potential candidates for risk prediction or prevention of CAVD, and warranting further studies.

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Overweight or underweight and the risk of decline in activities of daily living in a 22-year cohort study of a Japanese sample.

Okamoto S, Okamura T, Sugiyama D, Hayakawa T, Nakamura Y, Miyagawa N, Kurita S, Takashima N, Ohkubo T, Kadota A, Fujiyoshi A, Miura K, Okayama A, Ueshima H

Geriatrics & gerontology international (Geriatrics and Gerontology International) 18 ( 5 ) 799 - 805 2018.05

Research paper (scientific journal), Joint Work, Accepted, ISSN 14441586

Aim: The present study aimed to clarify the association between body mass index (BMI) and the activities of daily living (ADL). Although BMI is likely to be concerned regarding the relationship with specific diseases or mortality, few studies have focused on the relationship of BMI and ADL. Methods: A total of 3353 Japanese participants of a 22-year cohort study from 1990 to 2012 aged 45–74 years at baseline were divided into four groups according to their BMI levels: ≤18.5, 18.5–21.9 (reference), 22.0–24.9 and ≥25.0 kg/m 2 . Outcomes were becoming dependent in ADL (including death after ADL decline) and death without observation of ADL decline as a competing risk. Sex-specific multinomial logistic regression analysis was carried out in 2017 to estimate the odds ratios (OR) after adjusting for age, smoking, alcohol drinking, hypertension, hypercholesterolemia, diabetes and serum albumin. Results: After multivariable adjustment, though the relationship between BMI and risk of ADL decline was U-shaped among women, only those with BMI ≥25.0 showed a higher risk for ADL decline (OR 1.39, 95% CI 1.01–1.92) compared with the reference. The OR for death without observation of ADL decline was significantly lower for men with BMI ≥25.0 (OR 0.70, 95% CI 0.50–0.98). Conclusions: This study suggests being overweight is a good predictor of future decline in ADL for women, whereas men with BMI 22.0–24.9 had lower risks of ADL decline. Appropriate management of weight in older women could prevent disabilities. Geriatr Gerontol Int 2018; 18: 799–805.

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Dietary tofu intake and long-term risk of death from stroke in a general population

Ho N. Nguyen, Naoko Miyagawa, Katsuyuki Miura, Nagako Okuda, Katsushi Yoshita, Yusuke Arai, Hideaki Nakagawa, Kiyomi Sakata, Toshiyuki Ojima, Aya Kadota, Naoyuki Takashima, Akira Fujiyoshi, Takayoshi Ohkubo, Robert D. Abbott, Tomonori Okamura, Akira Okayama, Hirotsugu Ueshima, NIPPON DATA80 Research Group

Clinical Nutrition (Churchill Livingstone) 37 ( 1 ) 182 - 188 2018.02

Research paper (scientific journal), Joint Work, Accepted, ISSN 02615614

Background &amp
aim: Although dietary soy intake is linked with health benefits, a relation with stroke has not been established. The present study examined the association between the intake of tofu, the richest source of dietary soy, with stroke mortality in a general population cohort of Japanese men and women. Methods: Data comprise 9244 Japanese enrolled in the National Nutrition Survey of Japan in 1980. Participants were free of cardiovascular disease and followed for 24 years. Dietary intake was estimated from 3-day weighed food records. Multivariable Cox regression models were used to estimate hazard ratios across levels of tofu intake. Results: During follow-up, there were 417 deaths due to stroke (88 cerebral hemorrhage [CH], 245 cerebral infarction [CI], and 84 of other subtypes). Among all men, and in women aged 65 years or more, tofu intake was unrelated to each form of stroke. For young women (&lt
65 years of age), a significantly lower risk of CH in the top versus bottom quartile of tofu intake was observed (Multivariable-adjusted HR = 0.26, 95% CI: 0.08–0.85). Conclusions: In this large prospective study with long follow-up of Japanese men and women, consumption of tofu was unrelated to the risk of stroke except for CH in women &lt
65 years of age. Whether the association in younger women is real or due to chance alone warrants further study.

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Socioeconomic Status Associated With Urinary Sodium and Potassium Excretion in Japan: NIPPON DATA2010.

Miyagawa N, Okuda N, Nakagawa H, Takezaki T, Nishi N, Takashima N, Fujiyoshi A, Ohkubo T, Kadota A, Okamura T, Ueshima H, Okayama A, Miura K

Journal of epidemiology (Japan Epidemiological Association) 28 ( Supplement_III ) S29 - S34 2018

Research paper (scientific journal), Joint Work, Lead author, Accepted, ISSN 09175040

BACKGROUND: Although socioeconomic status (SES) may affect food and nutrient intakes, few studies have reported on sodium (Na) and potassium (K) intakes among individuals with various SESs in Japan. We investigated associations of SES with Na and K intake levels using urinary specimens in a representative Japanese population. METHODS: This was a cross-sectional study of 2,560 men and women (the NIPPON DATA2010 cohort) who participated in the National Health and Nutrition Survey Japan in 2010. Casual urine was used to calculate estimated excretion in 24-hour urinary Na (E24hr-Na) and K (E24hr-K). The urinary sodium-to-potassium (Na/K) ratio was calculated from casual urinary electrolyte values. An analysis of covariance was performed to investigate associations of aspects of SES, including equivalent household expenditure (EHE), educational attainment, and job category, with E24hr-Na, E24hr-K, and the Na/K ratio for men and women separately. A stratified analysis was performed on educational attainment and the job category for younger (<65 years) and older (≥65 years) participants. RESULTS: In men and women, average E24hr-Na was 176.2 mmol/day and 172.3, average E24hr-K was 42.5 and 41.3, and the average Na/K ratio was 3.61 and 3.68, respectively. Lower EHE was associated with a higher Na/K ratio in women and lower E24hr-K in men and women. A shorter education was associated with a higher Na/K ratio in women and younger men, and lower E24hr-K in older men and women. CONCLUSION: Lower EHE and a shorter education were associated with a lower K intake and higher Na/K ratio estimated from casual urine specimens in Japanese men and women.

Associations of High-Density Lipoprotein Particle and High-Density Lipoprotein Cholesterol With Alcohol Intake, Smoking, and Body Mass Index - The INTERLIPID Study.

Zaid M, Miura K, Okayama A, Nakagawa H, Sakata K, Saitoh S, Okuda N, Yoshita K, Choudhury SR, Rodriguez B, Masaki K, Willcox B, Miyagawa N, Okamura T, Chan Q, Elliott P, Stamler J, Ueshima H, INTERLIPID, INTERMAP Research Groups

Circulation journal : official journal of the Japanese Circulation Society (The Japanese Circulation Society) 82 ( 10 ) 2557 - 2565 2018

Research paper (scientific journal), Joint Work, Accepted, ISSN 13469843

BACKGROUND: Recently, high-density lipoprotein particles (HDL-P) have been found to be more strongly inversely associated with coronary artery disease (CAD) risk than their counterpart, HDL cholesterol (HDL-C). Given that lifestyle is among the first targets in CAD prevention, we compared the associations of HDL-P and HDL-C with selected lifestyle factors. Methods and Results: We examined 789 Japanese participants of the INTERLIPID Study: men (n=386) and women (n=403) aged 40-59 years in 1996-1998. Participants treated for dyslipidemias were excluded. Lifestyle factors included alcohol intake, smoking amount, and body mass index (BMI). Multivariable linear regression was used for cross-sectional analyses of these factors with HDL-P, HDL-C, HDL-P size subclasses (small, medium and large) and mean HDL-P size. In men, higher alcohol intake was associated with higher HDL-P and higher HDL-C. The associations of alcohol, however, were strongest with HDL-P. A higher smoking amount tended to be associated with lower HDL-P and HDL-C. In contrast, BMI was not associated with HDL-P, but was strongly inversely associated with HDL-C. While alcohol intake favored larger mean HDL-P size, smoking and BMI favored a lipid profile with smaller HDL-P subclasses and overall smaller mean HDL-P size. Similar, but generally weaker results were observed in women. CONCLUSIONS: Although both HDL-P and HDL-C are parameters of HDL, they have different associations with alcohol, smoking and BMI.

Differences in Lifestyle Improvements With the Intention to Prevent Cardiovascular Diseases by Socioeconomic Status in a Representative Japanese Population: NIPPON DATA2010.

Goryoda S, Nishi N, Hozawa A, Yoshita K, Arai Y, Kondo K, Miyagawa N, Hayakawa T, Fujiyoshi A, Kadota A, Ohkubo T, Okamura T, Okuda N, Ueshima H, Okayama A, Miura K

Journal of epidemiology (Japan Epidemiological Association) 28 ( Supplement_III ) S35 - S39 2018

Research paper (scientific journal), Joint Work, Accepted, ISSN 09175040

BACKGROUND: The relationships among socioeconomic status and lifestyle improvements have not yet been examined in a representative Japanese population. METHODS: We analyzed data from 2,647 participants (1,087 men and 1,560 women) who participated in NIPPON DATA2010. This survey inquired about lifestyle improvements and socioeconomic status. Education was categorized as low (≤9 years), middle (10-12 years), and high (≥13 years). Marital status was categorized as married, divorced, widowed, and never married/other. A multivariable logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of lifestyle improvements with the intention of preventing cardiovascular diseases for educational attainment and marital status, with adjustments for age and awareness of cardiovascular disease risk factors. RESULTS: Overall, 1,507 (56.9%) participants practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome, and the OR of lifestyle improvements was significantly higher with a high education than with a low education in men (OR 2.86; 95% CI, 1.96-4.17) and women (OR 2.36; 95% CI, 1.67-3.33). The number of participants who practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome was significantly lower in divorced than in married men (OR 0.46; 95% CI, 0.22-0.95) and women (OR 0.53; 95% CI, 0.33-0.86). CONCLUSIONS: Specific differences caused by educational attainment and marital status may exist in lifestyle improvements.

Effectiveness of a Self-monitoring Device for Urinary Sodium-to-Potassium Ratio on Dietary Improvement in Free-Living Adults: a Randomized Controlled Trial.

Iwahori T, Ueshima H, Ohgami N, Yamashita H, Miyagawa N, Kondo K, Torii S, Yoshita K, Shiga T, Ohkubo T, Arima H, Miura K

Journal of epidemiology (Japan Epidemiological Association) 28 ( 1 ) 41 - 47 2018

Research paper (scientific journal), Joint Work, Accepted, ISSN 09175040

Background: Reducing the urinary sodium-to-potassium ratio is important for reducing both blood pressure and risk of cardiovascular disease. Among free-living Japanese individuals, we carried out a randomized trial to clarify the effect of lifestyle modification for lowering urinary sodium-to-potassium ratio using a self-monitoring device.Methods: This was an open, prospective, parallel randomized, controlled trial. Ninety-two individuals were recruited from Japanese volunteers. Participants were randomly allocated into intervention and control groups. A month-long dietary intervention on self-monitoring urinary sodium-to-potassium ratio was carried out using monitors (HEU-001F, OMRON Healthcare Co., Ltd., Kyoto, Japan). All participants had brief dietary education and received a leaflet as usual care. Monitors were handed out to the intervention group, but not to the control group. The intervention group was asked to measure at least one spot urine sodium-to-potassium ratio daily, and advised to lower their sodium-to-potassium ratio toward the target of less than 1. Outcomes included changes in 24-hour urinary sodium-to-potassium ratio, sodium excretion, potassium excretion, blood pressure, and body weight in both groups.Results: Mean measurement frequency of monitoring was 2.8 times/day during the intervention. Changes in urinary sodium-to-potassium ratio were −0.55 in the intervention group and −0.06 in the control group (P = 0.088); respective sodium excretion changes were −18.5 mmol/24 hours and −8.7 mmol/24 hours (P = 0.528); and corresponding potassium excretion was 2.6 mmol/24 hours and −1.5 mmol/24 hours (P = 0.300). No significant reductions were observed in either blood pressure or body weight after the intervention.Conclusions: Providing the device to self-monitor a sodium-to-potassium ratio did not achieve the targeted reduction of the ratio in “pure self-management” settings, indicating further needs to study an effective method to enhance the synergetic effect of dietary programs and self-monitoring practice to achieve the reduction. However, we cannot deny the possibility of reducing sodium-to-potassium ratio using a self-monitoring device.

Relationships among Food Group Intakes, Household Expenditure, and Education Attainment in a General Japanese Population: NIPPON DATA2010.

Nagahata T, Nakamura M, Ojima T, Kondo I, Ninomiya T, Yoshita K, Arai Y, Ohkubo T, Murakami K, Nishi N, Murakami Y, Takashima N, Okuda N, Kadota A, Miyagawa N, Kondo K, Okamura T, Ueshima H, Okayama A, Miura K

Journal of epidemiology (Japan Epidemiological Association) 28 ( Supplement_III ) S23 - S28 2018

Research paper (scientific journal), Joint Work, Accepted, ISSN 09175040

BACKGROUND: A lower socioeconomic status (SES) may be related to the intake of unhealthy food; however, this relationship has not been examined in detail. This study was undertaken to examine relationships among food group intakes and SES in a representative Japanese population. METHODS: This was a cross-sectional study using the baseline data of NIPPON DATA2010, which is a prospective cohort study of the National Health and Nutrition Survey in Japan. A total of 2,898 participants were included in the baseline survey in 2010. The effects of age (<65 years and ≥65 years), equivalent household expenditure (EHE), and education attainment on food group intakes (gram per 1,000 kcal) were analyzed using a two-way analysis of variance. RESULTS: When EHE was lower, cereal intake was higher in men and women. Among men, fish, milk, and alcohol intakes were reduced with lower EHE. Among women, vegetable intake was reduced with lower EHE. In men and women, cereal intake was higher with lower education attainment. In contrast, meat intake was reduced with lower education attainment. CONCLUSIONS: Lower SES was associated with a higher cereal intake and lower vegetable, fish, meat, and milk intakes in a representative Japanese population. Socioeconomic discrepancies need to be considered in order to promote healthier dietary habits.

肥満、非肥満別の各種循環器疾患危険因子による循環器疾患死亡の集団寄与危険割合　NIPPON DATA80の29年追跡結果より

宮澤伊都子, 三浦克之, 宮本恵宏, 岡村智教, 東山綾, 辰巳友佳子, 門田文, 高嶋直敬, 宮川尚子, 近藤慶子, 佐藤敦, 有馬久富, 岡山明, 上島弘嗣, NIPPON DATA80研究グループ

日本循環器病予防学会誌 ((一社)日本循環器病予防学会) 52 ( 3 ) 269 - 278 2017.12

Research paper (scientific journal), ISSN 1346-6267

【背景】我が国では、2008年より特定健診が開始され、肥満を必須とするメタボリックシンドローム該当者に対する保健指導介入が行われている。残る非肥満に対する有効な介入方法が模索されているが、肥満、非肥満別に循環器疾患危険因子による循環器疾患死亡の集団寄与危険割合を検討した報告は少ない。【目的】循環器疾患危険因子(血圧、血糖、喫煙)による循環器疾患死亡の集団寄与危険割合(Population Attributable Fraction:PAF)を非肥満群、肥満群に分けて検討する。【方法】対象は1980年に実施された循環器疾患基礎調査の受検者を29年間追跡したNIPPON DATA80対象者のうち、40歳〜74歳の男女計6,662人である。肥満の有無と循環器疾患危険因子のカテゴリーを組み合わせて対象者を分類し、"非肥満かつ循環器疾患危険因子正常群"に対する、各群の多変量調整ハザード比とPAFを算出した。PAFはより現在に近い2010年の危険因子の分布でも算出し、1980年との比較を行った。【結果】循環器疾患死亡に対する多変量調整ハザード比(95%信頼区間)は、血圧は正常、正常高値、高血圧1度、高血圧2度以上と上昇するに従い、非肥満群、肥満群ともに上昇を認めた(非肥満かつ高血圧2度以上群:2.10(1.64-2.70)、肥満かつ高血圧2度以上群:2.72(1.95-3.80)。血糖は正常(随時血糖140mg/dl未満)、境界型(140-200mg/dl)、糖尿病域(200mg/dl以上)と上昇するに従い、非肥満群、肥満群ともに上昇を認めた(非肥満かつ糖尿病域群:2.01(1.33-3.03)、肥満かつ糖尿病域群5.08(2.98-8.66)。喫煙は非喫煙、過去喫煙、現在喫煙(≦20本/日、≦21本/日)の順に上昇を認めた(非肥満かつ現在喫煙≦21本/日群:1.94(1.47-2.55)、肥満かつ現在喫煙≧21本/日群:1.98(1.24-3.15)。2010年の危険因子分布を用いた血圧のPAF合計は非肥満群37.2%、肥満群21.7%、血糖のPAF合計は非肥満群14.4%、肥満群16.3%、喫煙のPAF合計は非肥満群7.0%、肥満群0.9%と、いずれにおいても非肥満群のPAFは肥満群と同等もしくは高値を示した。【結論】各種循環器疾患危険因子は非肥満群、肥満群のどちらにおいても循環器疾患死亡リスクと関連していた。PAFは非肥満群の方が肥満群よりも大きい傾向であり、非肥満者に対しても循環器疾患危険因子に対する介入が重要であることが示唆された。(著者抄録)

Comparison of weighed food record procedures for the reference methods in two validation studies of food frequency questionnaires

Yuri Ishii, Junko Ishihara, Ribeka Takachi, Yurie Shinozawa, Nahomi Imaeda, Chiho Goto, Kenji Wakai, Toshiaki Takahashi, Hiroyasu Iso, Kazutoshi Nakamura, Junta Tanaka, Taichi Shimazu, Taiki Yamaji, Shizuka Sasazuki, Norie Sawada, Motoki Iwasaki, Haruo Mikami, Kiyonori Kuriki, Mariko Naito, Naoko Okamoto, Fumi Kondo, Satoyo Hosono, Naoko Miyagawa, Etsuko Ozaki, Sakurako Katsuura-Kamano, Keizo Ohnaka, Hinako Nanri, Noriko Tsunematsu-Nakahata, Takamasa Kayama, Ayako Kurihara, Shiomi Kojima, Hideo Tanaka, Shoichiro Tsugane

JOURNAL OF EPIDEMIOLOGY (ELSEVIER SCIENCE INC) 27 ( 7 ) 331 - 337 2017.07

Research paper (scientific journal), Accepted, ISSN 0917-5040

Background: Although open-ended dietary assessment methods, such as weighed food records (WFRs), are generally considered to be comparable, differences between procedures may influence outcome when WFRs are conducted independently. In this paper, we assess the procedures of WFRs in two studies to describe their dietary assessment procedures and compare the subsequent outcomes.
Methods: WFRs of 12 days (3 days for four seasons) were conducted as reference methods for intake data, in accordance with the study protocol, among a subsample of participants of two large cohort studies. We compared the WFR procedures descriptively. We also compared some dietary intake variables, such as the frequency of foods and dishes and contributing foods, to determine whether there were differences in the portion size distribution and intra-and inter-individual variation in nutrient intakes caused by the difference in procedures.
Results: General procedures of the dietary records were conducted in accordance with the National Health and Nutrition Survey and were the same for both studies. Differences were seen in 1) selection of multiple days (non-consecutive days versus consecutive days); and 2) survey sheet recording method (individual versus family participation). However, the foods contributing to intake of energy and selected nutrients, the portion size distribution, and intra-and inter-individual variation in nutrient intakes were similar between the two studies.
Conclusion: Our comparison of WFR procedures in two independent studies revealed several differences. Notwithstanding these procedural differences, however, the subsequent outcomes were similar. (C) 2017 The Authors. Publishing services by Elsevier B.V. on behalf of The Japan Epidemiological Association.

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Food sources of dietary sodium in the Japanese adult population: the international study of macro-/micronutrients and blood pressure (INTERMAP)

Nagako Okuda, Akira Okayama, Katsuyuki Miura, Katsushi Yoshita, Shigeyuki Saito, Hideaki Nakagawa, Kiyomi Sakata, Naoko Miyagawa, Queenie Chan, Paul Elliott, Hirotsugu Ueshima, Jeremiah Stamler

EUROPEAN JOURNAL OF NUTRITION (SPRINGER HEIDELBERG) 56 ( 3 ) 1269 - 1280 2017.04

Research paper (scientific journal), Accepted, ISSN 1436-6207

Purpose It is often reported that Na intake levels are higher in Japan than in western countries. Detailed analysis of food intake and its association with Na intake are necessary for supporting further decreases in Na consumption in Japan. We investigated the association between Na and food intake by food group using data from the Japanese participants of the INTERMAP Study.
Method Results from the Japanese participants of the INTERMAP Study who did not use antihypertensive medication and/or consume a reduced Na diet were used (531 men and 518 women, aged 40-59 years), obtained from four 24-h dietary recalls and two 24-h urine collections from each participant. We developed a classification system with 46 food group classifications; food consumption and Na intake from these groups were compared across quartiles of participants determined by 24-h urinary Na excretion per unit of body weight (UNa/BW).
Results Average daily Na intake from Japanese high-Na foods was 2552 mg/day. Participants with a higher UNa/BW consumed a significantly greater amount of high-Na Japanese foods, such as salted fish (P= 0.001) and miso soup (P < 0.001). They also had greater amount of rice (P = 0.001). Participants with lower UNa/BW consumed a significantly greater amount of western foods, such as bread (P < 0.001) and milk and dairy products (P < 0.001).
Conclusions Detailed analyses of various Japanese and western food intakes in addition to Na intake were performed. These results can be used to help draw up effective programs for the reduction in Na intake and prevention of prehypertension/hypertension in the Japanese population.

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Significant inverse association of equol-producer status with coronary artery calcification but not dietary isoflavones in healthy Japanese men

Vasudha Ahuja, Katsuyuki Miura, Abhishek Vishnu, Akira Fujiyoshi, Rhobert Evans, Maryam Zaid, Naoko Miyagawa, Takashi Hisamatsu, Aya Kadota, Tomonori Okamura, Hirotsugu Ueshima, Akira Sekikawa

BRITISH JOURNAL OF NUTRITION (CAMBRIDGE UNIV PRESS) 117 ( 2 ) 260 - 266 2017.01

Research paper (scientific journal), Accepted, ISSN 0007-1145

Equol, a metabolite of the dietary isoflavone daidzein, is produced by the action of gut bacteria in some individuals who are termed as equol-producers. It is proposed to have stronger atheroprotective properties than dietary isoflavones. We examined a cross-sectional association of dietary isoflavones and equol-producer status with coronary artery calcification (CAC), a biomarker of coronary atherosclerosis, among men in Japan. A population-based sample of 272 Japanese men aged 40-49 years recruited from 2004 to 2007 was examined for serum isoflavones, serum equol, CAC and other factors. Equol-producers were classified as individuals having a serum level of equol >83 nm. The presence of CAC was defined as a coronary Ca score 10 Agatston units. The associations of dietary isoflavones and equol-producers with CAC were analysed using multiple logistic regression. The median of dietary isoflavones, equol and CAC were 5127 (interquartile range (IQR) 1941, 11700), 91 (IQR 010, 331) and 00 (IQR 00, 10) nm, respectively. Prevalence of CAC and equol-producers was 96 and 160 %, respectively. Dietary isoflavones were not significantly associated with CAC. After multivariable adjustment, the OR for the presence of CAC in equol-producers compared with equol non-producers was 010 (95 % CI 001, 090, P<004). Equol-producers had significantly lower CAC than equol non-producers, but there was no significant association between dietary isoflavones and CAC, suggesting that equol may be a key factor for atheroprotective properties of isoflavones in Japanese men. This finding must be confirmed in larger studies or clinical trials of equol that is now available as a dietary supplement.

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