"Risk of overestimating treatment effects and generalizability of computer-based tailored dietary counseling".

Letter to the Edito

Seven-plus hours of daily sedentary time and the subsequent risk of breast cancer : Japan Multi-Institutional Collaborative Cohort Study

This study aimed to investigate the association between daily sedentary time and the risk of breast cancer (BC) in a large Japanese population. The participants were 36,023 women aged 35–69 years from the Japan Multi-Institutional Collaborative Cohort Study. Cox proportional hazards analysis was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for BC incidence in relation to time spent sedentarily (categorical variables: <7 and ≥7 hours/day [h/d]). Additionally, the associations of BC incidence to the joint effect of sedentary time with each component of physical activity, such as leisure-time metabolic equivalents (METs), frequency of leisure-time physical activity, and daily walking time, were examined. During 315,189 person-years of follow-up, 554 incident cases of BC were identified. When compared to participants who spent <7 h/d sedentary, those who spent ≥7 h/d sedentary have a significantly higher risk of BC (HR, 1.36; 95% CI, 1.07–1.71). The corresponding HRs among participants who spent ≥7 h/d sedentary with more physical activity, such as ≥1 h/d for leisure-time METs, ≥3 days/week of leisure-time physical activity, and ≥1 h/d of daily walking were 1.58 (95% CI, 1.11–2.25), 1.77 (95% CI, 1.20–2.61), and 1.42 (95% CI, 1.10–1.83), respectively, compared with those who spent <7 h/d sedentary. This study found that spending ≥7 h/d of sedentary time is associated with the risk of BC. Neither leisure-time physical activity nor walking had a BC-preventive effect in those with ≥7 h/d of sedentary time

ショクジ セッシュ キジュン 2010ネンバン ニ ヨル カンリ エイヨウシ ヨウセイ カテイ ノ ジョシ ガクセイ ノ エイヨウ シンタイ カツドウ ヒョウカ

The purpose of this study was to assess the nutritional status of women university students in the third-grade of a registered dietitian training course, based on the Dietary Reference Intakes for Japanese(2010). We initially selected 46 students, and obtained valid responses from 41 students(89.1%). We performed body measurements, blood tests, a dietary weighing method for 3 days, and the measurement of physical activity by the accelerometer. In regard to the physique and blood test of the subjects, 24.4% were underweight, 4.9% were obese and 20.0% were anemic. The dietary weighing method showed that the rate of women who took vitamin C below the estimated average requirement was 90.0%, that of folic acid, iron and calcium were 41.0%, 83.0%, and 68.0% respectively. While the rate of salt intake greater than the dietary goal (7.5g/day)was 36.5%, the rate of fat energy ratio greater than the dietary goal(30%)was 31.7%. The average number of steps per day was 8,907 ± 2,293. These results showed that there was an overall insufficient intake of total energy, vitamins, and minerals, indicating that further nutritional management for the women students is required

Efficacy of a meal sequence in patients with type 2 diabetes : a systematic review and meta-analysis.

Introduction:This systematic review investigated the efficacy of a meal sequence, the carbohydrate-later meal pattern (CL), on type 2 diabetes mellitus (T2DM).Research design and methods:We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov until April 2020 to perform meta-analyses using random-effects models. Primary outcomes were hemoglobin A1c (HbA1c) and quality of life. Secondary outcomes were plasma concentrations of glucose, insulin and incretin 120 min after a meal, and any adverse outcomes. The revised Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development, and Evaluation approach were used to assess the quality of individual studies and the body of evidence, respectively. The present study was registered in the UMIN Clinical Trials Registry.Results:We included 230 participants in eight trials, including both trials that examined long-term changes (more than 2 months and less than 2 years) and short-term changes (in 2-hour postprandial values). CL resulted in a slight to no difference in HbA1c (mean difference (MD), -0.21% in the intervention group; 95% CI -0.44% to+0.03%), plasma glucose (MD,+4.94 mg/dL; 95% CI -8.34 mg/dL to +18.22 mg/dL), plasma insulin (MD, -3.63 μIU/mL; 95% CI -11.88 μIU/mL to +4.61 μIU/mL), plasma GLP-1 (MD, +0.43 pmol/L; 95% CI -0.69 pmol/L to +1.56 pmol/L), and plasma GIP (MD, -2.02 pmol/L; 95% CI -12.34 pmol/L to +8.31 pmol/L). All of these outcomes were of low-certainty evidence or very low-certainty evidence. None of the trials evaluated quality of life or adverse events.Conclusions:There was no evidence for the potential efficacy of recommending CL beyond standard dietary advice on T2DM.Trial registration number: UMIN000039979This systematic review investigated the efficacy of a meal sequence, the carbohydrate-later meal pattern (CL), on type 2 diabetes mellitus (T2DM).We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov until April 2020 to perform meta-analyses using random-effects models. Primary outcomes were hemoglobin A1c (HbA1c) and quality of life. Secondary outcomes were plasma concentrations of glucose, insulin and incretin 120 min after a meal, and any adverse outcomes. The revised Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development, and Evaluation approach were used to assess the quality of individual studies and the body of evidence, respectively. The present study was registered in the UMIN Clinical Trials Registry.We included 230 participants in eight trials, including both trials that examined long-term changes (more than 2 months and less than 2 years) and short-term changes (in 2-hour postprandial values). CL resulted in a slight to no difference in HbA1c (mean difference (MD), -0.21% in the intervention group; 95% CI -0.44% to+0.03%), plasma glucose (MD,+4.94 mg/dL; 95% CI -8.34 mg/dL to +18.22 mg/dL), plasma insulin (MD, -3.63 μIU/mL; 95% CI -11.88 μIU/mL to +4.61 μIU/mL), plasma GLP-1 (MD, +0.43 pmol/L; 95% CI -0.69 pmol/L to +1.56 pmol/L), and plasma GIP (MD, -2.02 pmol/L; 95% CI -12.34 pmol/L to +8.31 pmol/L). All of these outcomes were of low-certainty evidence or very low-certainty evidence. None of the trials evaluated quality of life or adverse events.There was no evidence for the potential efficacy of recommending CL beyond standard dietary advice on T2DM.UMIN000039979

Trends in Prevalence, Treatment, and Control of Hypertension According to 40-Year-Old Life Expectancy at Prefectures in Japan from the National Health and Nutrition Surveys

The prevalence of hypertension has been decreasing in Japan due to improved medical treatment and a decrease in dietary salt intake. However, disparities in the prevalence, treatment, and control of hypertension are expected to occur in different regions. This study aimed to investigate the trends in the prevalence, treatment, and control of hypertension at the prefectural level of life expectancy among Japanese population. We used data from the National Health and Nutrition Survey and analysed the individual survey information of individuals aged 40&ndash;69 years by dividing it into six terms, i.e., 1995&ndash;1997, 1999&ndash;2001, 2003&ndash;2005, 2007&ndash;2009, 2012, and 2016. Prefectures were classified into four groups according to their 40-year-old life expectancy in 2000. Outcome values were standardised to the population by 10-year age groups in 2010, and they were tested by two-way analysis of variance according to six terms and life expectancies. The prevalence of hypertension tended to decrease, especially among women, whereas the treatment and control tended to improve from the first to the sixth period in both men and women. The prevalence and treatment of hypertension in men with longer life expectancy tended to be lower than that in other groups, and there was no obvious difference in the control. In women, there were no obvious differences in the prevalence, treatment, or control. Reducing the prevalence of hypertension by improving lifestyle factors, such as high salt intake in each prefecture with a relatively short life expectancy, may be important to resolve the disparity in life expectancy among prefectures

Effectiveness of angiotensin converting enzyme inhibitors in preventing pneumonia : A systematic review and meta-analysis

We performed a systematic review and meta-analysis to re-evaluate the effectiveness of angiotensin-converting enzyme inhibitors (ACE-I) in the reduction of pneumonia risk. We searched relevant publications in five databases. All studies included patients older than 18 years, who had used ACE-I as an intervention, and had assessed pneumonia. Seven RCTs (n = 8704) and 38 observational studies (n = 1,705,030) were included. The overall risk of bias was high. ACE-I-treated patients were associated with a slightly lower risk of pneumonia, both from pooled estimates of RCTs [pooled odds ratio (OR), 0.75; 95% confidence interval (CI), 0.62–0.90; low certainty of evidence] and observational studies (pooled OR, 0.85; 95% CI, 0.78–0.92; very low certainty of evidence). Considering the small effect size of ACE-I in preventing pneumonia and the low quality of the evidence, routine use of ACE-I for pneumonia prevention is not recommended