To evaluate the role of dietary factors in the etiology of inflammatory bowel disease (IBD), we conducted a multicenter hospital-based case-control study in a Japanese population. Cases were IBD patients aged 15 to 34 years [ulcerative colitis (UC) 111 patients; Crohn's disease (CD) 128 patients] within 3 years after diagnosis in 13 hospitals. One control subject was recruited for each case who was matched for sex, age, and hospital. A semiquantitative food frequency questionnaire was used to estimate preillness intakes of food groups and nutrients. All the available control subjects (n = 219) were pooled, and unconditional logistic models were applied to calculate odds ratios (ORs). In the food groups, a higher consumption of sweets was positively associated with UC risk [OR for the highest versus lowest quartile, 2.86; 95% confidence interval (CI), 1.24 to 6.57], whereas the consumption of sugars and sweeteners (OR, 2.12; 95% CI, 1.08 to 4.17), sweets (OR, 2.83; 95% CI, 1.38 to 5.83), fats and oils (OR, 2.64; 95% CI, 1.29 to 5.39), and fish and shellfish (OR, 2.41; 95% CI, 1.18-4.89) were positively associated with CD risk. In respect to nutrients, the intake of vitamin C (OR, 0.45; 95% CI, 0.21 to 0.99) was negatively related to UC risk, while the intake of total fat (OR, 2.86; 95% CI, 1.39 to 5.90), monounsaturated fatty acids (OR, 2.49; 95% CI, 1.23 to 5.03) and polyunsaturated fatty acids (OR, 2.31; 95% CI, 1.12 to 4.79), vitamin E (OR, 3.23; 95% CI, 1.45 to 7.17), and n-3 (OR, 3.24; 95% CI, 1.52 to 6.88) and n-6 fatty acids (OR, 2.57; 95% CI, 1.24 to 5.32) was positively associated with CD risk. Although this study suffers from the shortcoming of recall bias, which is inherent in most retrospective studies (prospective studies are warranted to confirm the associations between diet and IBD risk), the present findings suggest the importance of dietary factors for IBD prevention.

A ten-year follow-up study of stroke among residents 40 years and older in a rural community located on Shikoku Island, Japan, was completed in 1977. The response rate for the initial examinations was 85% of 920 males and 90% of 1,012 females. Seven hundred and seventy-two males and 901 females who were initially free of stroke were followed from July 1967 through June 1977. The incidence of all strokes was 10.47 per thousand person-years for males and 6.41 per thousand person-years for females. The statistically significant risk factors for stroke were age, male sex, elevated blood pressure, ECG abnormalities, and funduscopic abnormalities. Elevated blood pressure was the strongest risk factor and mean arterial pressure was the best predictive measure. Twice as high a proportion of strokes were subclassified as cerebral hemorrhage (26%) in this study as have been reported in comparable studies in the United States (12-15%). An inverse relationship between serum cholesterol levels and cerebral hemorrhage incidence, but not cerebral infarct, was observed. High alcohol intake was a risk factor for cerebral hemorrhage but not for cerebral infarct. No relationship between stroke and weight was observed despite the relationship of stroke to blood pressure and of weight to blood pressure.

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Excessive weight gain between 20 and 40 years of age, diabetes mellitus, and lumbago were found to be independent risk factors for ossification of the posterior longitudinal ligament of the spine. Follow-up studies, including the addition of hospital-based control participants and analysis of genetic polymorphisms, will be needed in the future.

Most traditional risk factors, including blood pressure and its related organ diseases, were confirmed, but serum total cholesterol had almost no effect. Physical activity had both negative and positive effects on stroke risk. In these findings, however, some differences related to sex were also observed.

Background and Purpose-Epidemiological evidence suggests that vitamin C may decrease the risk of stroke. The purpose of the present study was to examine the association of serum vitamin C concentration with the subsequent incidence of stroke. Methods-In a Japanese rural community, a cohort of 880 men and 1241 women aged 40 years and older who were initially free of stroke was examined in 1977 and followed until 1997. The baseline examination included a measurement of serum vitamin C concentration. The incidence of stroke was determined by annual follow-up examinations and registry. Results-During the 20-year observation period, 196 incident cases of all stroke, including 109 cerebral infarctions and 54 hemorrhagic strokes, were documented. Strong inverse associations were observed between serum vitamin C concentration and all stroke (sex-and age-adjusted hazard ratios were 0.93, 0.72, and 0.59, respectively, for the second, third, and fourth quartiles compared with the first quartile; P for trendϭ0.002), cerebral infarction (0.71, 0.59, and 0.51; P for trendϭ0.015), and hemorrhagic stroke (0.89, 0.75, and 0.45; P for trendϭ0.013). Additional adjustments for blood pressure, serum total cholesterol, body mass index, physical activity, smoking, alcohol drinking, antihypertensive medication, atrial fibrillation, and history of ischemic heart disease did not attenuate these associations markedly. Conclusions-Serum vitamin C concentration was inversely related to the subsequent incidence of stroke. This relationship was significant for both cerebral infarction and hemorrhagic stroke. Additional mechanistic hypotheses may be required to explain our findings.

SummaryThe aim of the present study is to investigate the validity of a new method to estimate the food intake of individual subjects by a household-based dietary survey . The new method is based on the combination of household-based food weighing and approxi mating the proportions by which family members shared each dish or food in the house hold, which has been one of the components of the National Nutrition Survey, Japan , since 1995. We analyzed two sets of data from 64 volunteers (female students taking a dietitian course and their mothers) in 32 households by the approximated proportion method (method A) and the individual-based food weighing method (B) as a reference measurement. Energy and macronutrient intake by individual subjects estimated by method A was highly correlated to the corresponding values by method B (Pearson's correlation coefficients; r=0.90-0,92).Average energy intake was likely to be underestimated by method A com pared with method B, being lower by 94kcal (6.2% of the reference value in method B), at least in the young and middle-aged female adults that were the subjects of this study . When intake of boiled rice was separately analyzed , underestimation of energy intake by method A was 44kcal, which contributed to approximately 50% of the total magnitude of the under estimation. The procedure manual for the National Nutrition Survey requests the partici pants to individually weigh the amount of boiled rice taken by family members in the house hold. However, this procedure is not observed in many actual settings . Therefore, following this procedure would be an effective measure to improve the accuracy of the dietary data . Key Words dietary survey, food weighing method , individual-based survey, validation, biasThe dietary survey is a core component of nation wide nutrition monitoring (1), including the National Nutrition Survey, Japan (NNS-J), The NNS-J was initi ated in 1946 with the main purpose of obtaining basic information for emergency food supplies from other countries (2), Thus, household-based food consumption data had been conventionally collected from the stand point of food security. The aim of the survey, however, has shifted from food supply issues to chronic disease prevention, and individual-based dietary data have be come essential to clarify diet-disease relationships .A new method (hereinafter called the approximated proportion method) to estimate the food intake of individ ual subjects in a household has been used in the NNS-J since 1995. This method is based on a combination of household-based food weighing and an approximation of proportions by which family members shared each dish or kind of food in the household (3 , 4) (Fig. 1). This hybrid method was adopted by the NNS-J because it was * To whom correspond ence should be addressed. E-mail: nobuoyos@nih.go.jp expected to allow comparisons with dietary data that had been conventionally collected for more than 50 years by the household-based food weighing method.The aim of the study is to investigate the valid...

Background and Purpose-The association between apolipoprotein E (apoE) polymorphisms and stroke has been controversial. These controversies may be due to inaccurate classification of stroke and differences in age ranges. We investigated the association between apoE genotypes and stroke subtypes (confirmed by CT or MRI findings) by case-control study in a Japanese rural population. Methods-First-ever-stroke patients (nϭ322; cerebral infarction, nϭ201, intracerebral hemorrhage, nϭ84, and subarachnoid hemorrhage, nϭ37) aged 40 to 89 years were recruited from Hokuetsu Hospital, Japan. Healthy controls (nϭ1126) were selected from the general population in the same area. ApoE genotypes were determined by restriction fragment-length polymorphism analysis. Results-Compared with apoE ⑀3/⑀3 subjects, ⑀2 carriers had a 2-fold risk of cerebral infarction (OR 1.9, 95% CI 1.1 to 3.2). Among cerebral infarction patients, ⑀2 carriers had increased risks of cortical infarction (OR 2.4, 95% CI 1.3 to 4.6) (an anatomic subtype) and atherothrombosis (OR 3.9, 95% CI 1.7 to 9.0) and cardioembolism (OR 4.9, 95% CI 1.6 to 14.4) but not lacunar infarction (clinical subtypes). ApoE ⑀4 carriers had a 2.5-fold risk of subarachnoid hemorrhage (OR 2.5, 95% CI 1.1 to 5.4). ApoE ⑀2/⑀2 subjects had an increased risk of intracerebral hemorrhage (OR 4.4, 95% CI 1.0 to 19.7). ApoE ⑀3/⑀4 subjects showed Ϸ2-fold increased risk of atherothrombosis (OR 2.1, 95% CI 1.0 to 4.1) and intracerebral hemorrhage (OR 1.8, 95% CI 1.0 to 3.3). The association between ⑀2 and stroke was accentuated in subjects aged 70 years or older but not in those aged 40 to 69 years. Conclusions-Our study suggests that apoE ⑀2 is a risk factor for atherothrombosis, cardioembolism, and intracerebral hemorrhage, whereas ⑀4 is a risk factor for atherothrombosis, intracerebral hemorrhage, and subarachnoid hemorrhage. The occurrence of stroke may be affected by interaction between age and apoE gene polymorphisms. (Stroke.