Dietary patterns in Western populations have been linked to type 2 diabetes, but the association of distinctive dietary patterns of Japanese population remains unclear. We prospectively investigated the association between dietary patterns and risk of developing type 2 diabetes among Japanese adults.
Participants were 27 816 men and 36 889 women aged 45–74 years who participated in the second survey of the Japan Public Health Center-based prospective study and had no history of diabetes. Dietary patterns were derived by using principal component analysis of the consumption of 134 food and beverage items ascertained by a food frequency questionnaire. Odds ratios of self-reported physician-diagnosed type 2 diabetes over 5 year were estimated using logistic regression analysis.
A total of 1194 new cases (692 men and 502 women) of type 2 diabetes were self-reported. We identified three dietary patterns: prudent, westernized and traditional Japanese patterns. Any dietary pattern was not significantly associated with type 2 diabetes risk after adjustment for covariates in both men and women. The multivariate-adjusted odds ratios (95% confidence interval) for type 2 diabetes for the highest versus lowest quartile of each dietary pattern score in men and women, respectively, were 0.93 (0.74–1.16) and 0.90 (0.69–1.16) for the prudent pattern, 1.15 (0.90–1.46) and 0.81 (0.61–1.08) for the westernized pattern, and 0.97 (0.74–1.27) and 0.87 (0.66–1.15) for the traditional pattern.
Although a small protective effect of the prudent dietary pattern cannot be excluded, dietary patterns may not be appreciably associated with type 2 diabetes risk in Japanese.
Type 2 diabetes has been increasing worldwide.1 In Japan, in particular, the prevalence of diabetes has increased from 6.9 to 8.9 million between 1997 and 2007.2 Although obesity, a strong determinant of type 2 diabetes, is much less common among Japanese than among Western populations,3 the prevalence of type 2 diabetes in Japanese population is not dramatically lower than that in Western population.4 This has been attributed to a genetic difference between Asian and Caucasian populations,5 but evidence is limited about the role of environmental factors, especially dietary factors, that could account for the epidemic of type 2 diabetes among Japanese.
Some observational studies have examined type 2 diabetes risk in relation to white rice,6 soy products,7, 8, 9, 10 and fish,11, 12, 13, 14, 15 which are commonly consumed in Japan. White rice has been shown to be associated with an increased risk of type 2 diabetes,6 whereas soy products8, 10 and fish11, 12, 13, 15 have been linked to a decreased risk. As we consume food as part of a diet, the analysis of dietary patterns that integrates consumption of various foods or food groups in a few parameters could give us an additional insight into the role of diet in the pathogenesis of type 2 diabetes.
In some Western studies, a dietary pattern characterized by high intake of fruits and vegetables has been associated with a decreased risk of type 2 diabetes,16, 17, 18 whereas a dietary pattern characterized by high intake of meat, fatty foods or refined grains has been associated with an increased risk.16, 17, 19, 20, 21, 22, 23, 24 In Japan, a cross-sectional study reported an inverse association between a dietary pattern characterized by high intake of dairy products, milk, vegetable, fruit and bread and the prevalence of type 2 diabetes among male self-defense officials;25 however, evidence from prospective studies is lacking. Here, we prospectively investigated the association of major dietary patterns with type 2 diabetes risk, using data from a large-scale population-based cohort study in Japan.
Subjects and methods
The Japan Public Health Center-based Prospective (JPHC) Study was launched in 1990 for cohort I and in 1993 for cohort II.26 The participants were residents of 11 Japanese Public Health Center areas aged 40–69 years at each baseline survey. Study participants were informed about the objectives of the study and those who responded to the survey questionnaire were regarded as consenting to participate in the study. A questionnaire survey was conducted at baseline and at the 5-year (second survey) and 10-year (third survey) follow-ups. This study was approved by the Institutional Review Board of the National Cancer Center of Japan.
Among the study population at baseline (n=140 420), 102 695 responded to the second survey including the diet-related portion. After exclusion of 1065 participants who reported extreme total energy intake, 101 630 participants (47 408 men and 54 222 women) were included for identification of dietary patterns. Of these, we excluded 25 399 participants who did not respond to baseline or third surveys. A further 11 526 participants who reported history of type 2 diabetes or severe disease at baseline or second surveys were excluded, leaving a total of 64 705 participants (27 816 men and 36 889 women) ultimately enrolled.
Although participants completed self-administered questionnaires at each survey, we used data from the second survey as baseline, because the questionnaire used for that particular survey contained more comprehensive information on food intake than did the first. At the second survey, a food frequency questionnaire (FFQ) was used to assess the average intake of 147 food and beverage items over the previous year.27 For most food items, participants were asked consumption frequency and their usual portion size. The validity and reproducibility of the FFQ had already been established as reasonable.28, 29, 30
Details of identification of dietary pattern have been described elsewhere.31 In short, we used 134 food and beverage items of the FFQ (excluding 11 items that correlated strongly with others and 2 items with no energy or nutrition). Some foods or food groups similar in nutritional content or culinary use were combined, leaving 48 food groups. We performed principal component analysis based on 48 food group intakes. The factors were rotated by orthogonal transformation (varimax rotation) to maintain uncorrelated factors and greater interpretability. We determined three factors with eigenvalues, the scree test and the interpretability of the factors. The factor scores for each dietary pattern were calculated for each participant by summing intakes of food items weighted by their factor loadings. The score were energy-adjusted using residual method. The validity and reproducibility of the identified dietary patterns were acceptable.31
Ascertainment of type 2 diabetes
Type 2 diabetes newly diagnosed during the 5-year period after the second survey was determined by a self-administered questionnaire at the third survey. At the third survey, study participants were asked if they had ever been diagnosed as diabetes, and if so, when the initial diagnosis had been made. Only participants who were diagnosed after the second survey, baseline of the present analysis, were regarded as incident cases. To assess the validity of self-reported diabetes, we examined a series of medical records of some study participants in three districts of the study areas, finding that 94% of self-reported diabetes cases of diabetes were confirmed by medical records.32
Participants were divided into quartiles of the factor scores of each dietary pattern based on the distribution for men and women separately. Trend associations between the confounding factors and each dietary pattern were tested using the Mantel–Haenszel χ2-test for categorical variables and linear regression analysis for continuous variables. Odds ratios and 95% confidence intervals of type 2 diabetes for quartiles of scores for each dietary pattern were estimated using multiple logistic regression analysis. The first model was adjusted for age (year, continuous) and study area (11 areas), and the second model was further adjusted for smoking habit (lifetime nonsmoker, former smoker or current smoker with a consumption of either <20 or ⩾20 cigarettes/day), total physical activity (metabolic equivalent task hours/day, quartiles), history of hypertension (yes or no), family history of diabetes (yes or no) and total energy intake (kcal/day, continuous). An indicator variable for missing data was created for each covariate. In the final model, body mass index (BMI: <21.0, 21.0–22.9, 23.0–24.9, 25.0–26.9 or ⩾27.0 kg/m2) was added to the second model. Trend association was assessed by assigning ordinal numbers 0–3 to quartile categories of each dietary pattern. We also analyzed the association between the dietary patterns and type 2 diabetes by BMI (<25 or ⩾25 kg/m2), smoking status in men only (nonsmoker or current smoker) and menopausal status in women only (pre- or postmenopausal). An interaction term by multiplying the dietary patterns (quartile) and the above stratifying variables (dichotomous) was created and added to the model to assess statistical interactions. Two sided P-values <0.05 were regarded as statistically significant. All analyses were performed using Statistical Analysis System (SAS) version 9.1 (SAS Institute, Cary, NC, USA).
We identified three dietary patterns by principal component analysis (Table 1). The first factor was named a prudent pattern because it characterized by high intakes of vegetables, fruit, potatoes, soy products, seaweed, mushrooms, fish and green tea. A dietary pattern associated with high intakes of meat, processed meat, bread, dressing, dairy products, fish, coffee, black tea and sauces was named a westernized pattern. Another dietary pattern, which was characterized by high intakes of fish, pickles, seafood other than fish, miso soup and rice, was named a traditional Japanese pattern. The first to third dietary patterns totally explained 29.2% for men and 28.9% for women of the variability.
In both men and women, participants with a higher score of the prudent pattern were more likely to be older and to report a history of hypertension and were less likely to be a smoker than those with a lower score (Table 2). Participants with a higher score of the westernized pattern were more likely to be younger and to report lower levels of total physical activity and history of hypertension. BMI was positively associated with the westernized pattern in men but inversely associated with the traditional pattern in men and women.
We identified 1194 new cases (692 men and 502 women) of self-reported type 2 diabetes over the 5-year period. Among both men and women, although the risk of type 2 diabetes decreased by 7–10% in the highest quartile of the prudent pattern score compared with the lowest quartile, the trend association was not significant (Table 3). The westernized pattern was marginally and positively associated with type 2 diabetes risk after adjustment for covariates other than BMI in men (P for trend=0.06). However, the trend association was attenuated after additional adjustment for BMI (P for trend=0.12). The multivariate-adjusted odds ratio of type 2 diabetes for the third quartile of the westernized pattern score was significantly higher than that for the lowest category in men (odds ratio, 1.26; 95% confidence interval, 1.01–1.57). The traditional Japanese pattern was not associated with type 2 diabetes risk.
In stratified analyses, the prudent pattern was suggestively associated with a decreased risk of type 2 diabetes among nonsmoking men (P for trend=0.07) and among women with BMI <25 kg/m2 (P for trend=0.08), though P for interaction between the dietary pattern and smoking status (0.21) or BMI (0.50 in women) was not statistically significant. The multivariate-adjusted odds ratios (95% confidence interval) of type 2 diabetes for the highest versus the lowest quartile of the prudent pattern score were 0.79 (0.58–1.07) among nonsmoking men and 0.71 (0.47–1.06) among non-obese women. For the westernized pattern, a significant association with an increased risk of type 2 diabetes was observed among nonsmoking men (P for trend=0.03); the corresponding values for the westernized pattern score were 1.50 (1.08–2.09) (P for interaction=0.23). For the traditional Japanese pattern, there was no association with type 2 diabetes risk in any subgroup.
We identified three dietary patterns; prudent, westernized and traditional Japanese patterns. Although there was a suggestion of a positive trend association between the westernized pattern and type 2 diabetes risk among men, the association was attenuated after adjustment for BMI. In either overall men or overall women, neither the prudent pattern nor the traditional Japanese pattern was associated with type 2 diabetes risk. In stratified analyses, however, there was a suggestion of a decreasing risk of type 2 diabetes with the prudent pattern in nonsmoking men and non-obese women. In addition, the westernized pattern was significantly associated with an increased risk of type 2 diabetes risk among nonsmoking men. To our knowledge, this is the first prospective study to examine the association of dietary patterns with type 2 diabetes among Japanese population.
Some Western studies16, 17, 18 have reported a significantly decreased risk of type 2 diabetes associated with a dietary pattern characterized by high intake of vegetables and fruit. However, we did not find clear association between the prudent pattern characterized by high intake of vegetables, fruit, potatoes, soy products, seaweed, mushrooms, fish and green tea and type 2 diabetes risk in either men or women, though the risk of type 2 diabetes for the highest category of this pattern was 7–10% lower compared with the lowest category. Similarly, several Western studies19, 20, 21, 23, 24 have observed a statistically nonsignificant decreased risk of type 2 diabetes associated with a similar pattern. A lack of significant association in our and the latter Western studies seems to be consistent with the observation that vegetable and fruit intake, a common feature of this dietary pattern across studies, was not associated with a lower risk of type 2 diabetes in a meta-analysis of six cohort studies33 as well as in our study population.34 Studies that reported a significant inverse association16, 17, 18 did not adjust for important confounding factors including physical activity and family history of diabetes, leaving a possibility of overestimation of the effect of that dietary pattern. Alternatively, the inconsistent findings among studies might be ascribed, at least in part, to the difference of foods contributing to this dietary pattern by region and ethnicity, or difference of the effect of a food on type 2 diabetes risk among ethnic groups.15 The role of the so-called prudent pattern for the type 2 diabetes prevention warrants further investigation.
Many Western studies have observed an increased risk of type 2 diabetes associated with a dietary pattern characterized by high intake of meat, processed meat, fatty foods or refined grains.16, 17, 19, 20, 21, 22, 23, 24 These findings were consistent with the observation that red meat and processed meat was associated with an increased risk of type 2 diabetes.35 We also detected an increased risk of type 2 diabetes associated with high meat intake among Japanese men, who consume less amount of meat than Westerners (manuscript in preparation). However, we did not find a clear trend association between the westernized pattern characterized by high intakes of meat, processed meat, bread, dressing, dairy products, fish and coffee and type 2 diabetes risk, though odds ratio for the third quartile category of this dietary pattern was significantly increased in men. Similarly, a previous Japanese cross-sectional study reported no association between a similar pattern (characterized by high intake of meat, seafood, processed meat and fish products) and prevalence of type 2 diabetes.25 The discrepancy between Japanese and Western studies might be partly ascribed to the difference of foods characterizing the dietary pattern. Specifically, not only meat and fatty foods but also fish, which may decrease type 2 diabetes risk,12 contributed to that dietary pattern in Japanese studies including the present study. Moreover, the westernized pattern in the present study was moderately associated with dairy products36 and coffee,37 which have been linked to a decreased risk of type 2 diabetes. The potential adverse effect of meat on risk of type 2 diabetes might be attenuated by consuming these foods that might have a beneficial role in glucose metabolism.
We observed a suggestive protective association between the prudent pattern and type 2 diabetes risk among nonsmoking men and non-obese women and a significant positive association between the westernized pattern and type 2 diabetes among nonsmoking men. As smoking38 and obesity3 are important risk factors of type 2 diabetes, they might mask the associations between these dietary pattern and type 2 diabetes, if any. Dietary pattern may have a significant role in the pathogenesis of type 2 diabetes only among those with a lower risk of this disease such as nonsmokers or non-obese individuals.
The traditional Japanese pattern characterized by high intake of fish, pickles, rice and miso soup have also been observed in previous Japanese studies.25, 39, 40, 41 Moreover, a pattern that could be viewed as a mirror image of the traditional Japanese pattern has been demonstrated in some studies.42, 43, 44, 45, 46 The no association between this pattern and type 2 diabetes risk in the present study is consistent with a finding from a Japanese study that examined the prevalence of type 2 diabetes in relation to a similar pattern characterized by high intake of soy products, seaweed, pickles, vegetables and fish.25 In contrast, in another Japanese cross-sectional study,44 a westernized breakfast pattern (characterized by infrequent consumption of rice and miso soup and frequent consumption of bread, margarine and coffee), which appears to be a mirror image of the traditional Japanese pattern, was associated with lower level of glycated hemoglobin. The discrepancy among these Japanese studies might be explained by the following reasons. In the present study, fish was strongly associated with this dietary pattern, whereas rice was not. In a previous study,44 however, rice was strongly and inversely associated with this pattern, whereas fish was not. As fish is potentially protective against type 2 diabetes,12 whereas rice can increase its risk,47 the difference in the contribution of these foods to the traditional dietary pattern could influence dietary pattern - type 2 diabetes association. Alternatively, the discrepancy among studies might be owing to the difference of outcome measure; glycated hemoglobin but not type 2 diabetes was used in a previous study.44
Strengths of the present study include our large sample size, the population-based prospective design, the use of a validated FFQ and extensive adjustment of potentially important confounding factors, including obesity, smoking habit, family history of diabetes, physical activity and total energy intake. However, several limitations to the present study warrant mention. First, the diagnosis of type 2 diabetes was ascertained by self-report. Although case ascertainment based on self-reporting might underestimate the incidence of type 2 diabetes, this misclassification would occur virtually independent of dietary patterns and thus might not cause serious bias in our estimate. Second, dietary intakes were measured at only one time point, and thus may not reflect long-term intake levels. Third, results of subgroup analyses may be owing to chance and thus should be interpreted with caution. Fourth, our study sample size may not be sufficiently large to detect a modest association, if any, with statistical significance, leaving a possibility of small protective effect of prudent dietary pattern. Our data will contribute to meta-analysis on this issue. Finally, principal component analysis requires subjective decisions in determining the number of factor to retain, in choosing the method of rotation of the initial factors, and in labeling the dietary patterns.48, 49 However, we confirmed that the validity and reproducibility of the three dietary patterns derived from subsample were reasonable.31
In conclusion, any dietary pattern was not significantly associated with type 2 diabetes risk in either overall men or overall women. This finding suggests that dietary pattern might not be a strong determinant of type 2 diabetes risk among Japanese, although a small protective effect of the prudent pattern cannot be excluded, especially in a subgroup of nonsmoking men or non-obese women. Given changes of dietary pattern because of the new trend of food marketing and other social factors influencing food intake, further investigation of overall dietary pattern is required for the prevention of type 2 diabetes.
Wild S, Roglic G, Green A, Sicree R, King H . Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047–1053.
Kenko Eiyo Joho Kenkyukai. The National Health and Nutrition Survey in Japan, 2007. Daiichi-shuppan: Tokyo, Japan, 2010.
Huxley R, Omari A, Caterson ID . Obesity and diabetes. In: Ekoe JM, Rewers M, Williams R, Zimmet P, (eds). The Epidemiology of Diabetes Mellitus 2nd edn. Wiley-Blackwell: West Sussex, UK, 2008.
International Diabetes Federation. IDF Diabetes Atlas 4th edn. International Diabetes Federation, 2009.
Yazaki Y, Kadowaki T . Combating diabetes and obesity in Japan. Nat Med 2006; 12: 73–74.
Hu EA, Pan A, Malik V, Sun Q . White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ 2012; 344: e1454.
Morimoto Y, Steinbrecher A, Kolonel LN, Maskarinec G . Soy consumption is not protective against diabetes in Hawaii: the Multiethnic Cohort. Eur J Clin Nutr 2011; 65: 279–282.
Mueller NT, Odegaard AO, Gross MD, Koh WP, Yu MC, Yuan JM et al. Soy intake and risk of type 2 diabetes mellitus in Chinese Singaporeans: soy intake and risk of type 2 diabetes. Eur J Nutr 2011 e-pub ahead of print 18 November 2011; doi:10.1007/s00394-011-0276-2.
Nanri A, Mizoue T, Takahashi Y, Kirii K, Inoue M, Noda M et al. Soy product and isoflavone intakes are associated with a lower risk of type 2 diabetes in overweight Japanese women. J Nutr 2010; 140: 580–586.
Villegas R, Gao YT, Yang G, Li HL, Elasy TA, Zheng W et al. Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study. Am J Clin Nutr 2008; 87: 162–167.
Feskens EJ, Bowles CH, Kromhout D . Inverse association between fish intake and risk of glucose intolerance in normoglycemic elderly men and women. Diabetes Care 1991; 14: 935–941.
Nanri A, Mizoue T, Noda M, Takahashi Y, Matsushita Y, Poudel-Tandukar K et al. Fish intake and type 2 diabetes in Japanese men and women: the Japan Public Health Center-Based Prospectuve Study. Am J Clin Nutr 2011; 94: 884–891.
Patel PS, Forouhi NG, Kuijsten A, Schulze MB, van Woudenbergh GJ, Ardanaz E et al. The prospective association between total and type of fish intake and type 2 diabetes in 8 European countries: EPIC-InterAct Study. Am J Clin Nutr 2012; 95: 1445–1453.
Villegas R, Xiang YB, Elasy T, Li HL, Yang G, Cai H et al. Fish, shellfish, and long-chain n-3 fatty acid consumption and risk of incident type 2 diabetes in middle-aged Chinese men and women. Am J Clin Nutr 2011; 94: 543–551.
Wallin A, Di Giuseppe D, Orsini N, Patel PS, Forouhi NG, Wolk A . Fish consumption, dietary long-chain n-3 fatty acids, and risk of type 2 diabetes: systematic review and meta-analysis of prospective studies. Diabetes Care 2012; 35: 918–929.
Erber E, Hopping BN, Grandinetti A, Park SY, Kolonel LN, Maskarinec G . Dietary patterns and risk for diabetes: the multiethnic cohort. Diabetes Care 2010; 33: 532–538.
Montonen J, Knekt P, Härkänen T, Järvinen R, Heliövaara M, Aromaa A et al. Dietary patterns and the incidence of type 2 diabetes. Am J Epidemiol 2005; 161: 219–227.
Williams DE, Prevost AT, Whichelow MJ, Cox BD, Day NE, Wareham NJ . A cross-sectional study of dietary patterns with glucose intolerance and other features of the metabolic syndrome. Br J Nutr 2000; 83: 257–266.
Fung TT, Schulze M, Manson JE, Willett WC, Hu FB . Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Arch Intern Med 2004; 164: 2235–2240.
Gittelsohn J, Wolever TM, Harris SB, Harris-Giraldo R, Hanley AJ, Zinman B . Specific patterns of food consumption and preparation are associated with diabetes and obesity in a Native Canadian community. J Nutr 1998; 128: 541–547.
Hodge AM, English DR, O’Dea K, Giles GG . Dietary patterns and diabetes incidence in the Melbourne Collaborative Cohort Study. Am J Epidemiol 2007; 165: 603–610.
Kim HS, Park SY, Grandinetti A, Holck PS, Waslien C . Major dietary patterns, ethnicity, and prevalence of type 2 diabetes in rural Hawaii. Nutrition 2008; 24: 1065–1072.
Nettleton JA, Steffen LM, Ni H, Liu K, Jacobs DR . Dietary patterns and risk of incident type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 2008; 31: 1777–1782.
van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB . Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Ann Intern Med 2002; 136: 201–209.
Mizoue T, Yamaji T, Tabata S, Yamaguchi K, Ogawa S, Mineshita M et al. Dietary patterns and glucose tolerance abnormalities in Japanese men. J Nutr 2006; 136: 1352–1358.
Tsugane S, Sobue T . Baseline survey of JPHC study--design and participation rate. Japan Public Health Center-based Prospective Study on cancer and cardiovascular diseases. J Epidemiol 2001; 11: S24–S29.
Sasaki S, Kobayashi M, Ishihara J, Tsugane S . Self-administered food frequency questionnaire used in the 5-year follow-up survey of the JPHC Study: questionnaire structure, computation algorithms, and area-based mean intake. J Epidemiol 2003; 13: S13–S22.
Ishihara J, Sobue T, Yamamoto S, Yoshimi I, Sasaki S, Kobayashi M et al. Validity and reproducibility of a self-administered food frequency questionnaire in the JPHC Study Cohort II: study design, participant profile and results in comparison with Cohort I. J Epidemiol 2003; 13: S134–S147.
Sasaki S, Ishihara J, Tsugane S . Reproducibility of a self-administered food frequency questionnaire used in the 5-year follow-up survey of the JPHC Study Cohort I to assess food and nutrient intake. J Epidemiol 2003; 13: S115–S124.
Sasaki S, Kobayashi M, Tsugane S . Validity of a self-administered food frequency questionnaire used in the 5-year follow-up survey of the JPHC Study Cohort I: comparison with dietary records for food groups. J Epidemiol 2003; 13: S57–S63.
Nanri A, Shimazu T, Ishihara J, Takachi R, Mizoue T, Inoue M et al. Reproducibility and validity of dietary patterns assessed by a food frequency questionnaire used in the 5-year follow-up survey of the Japan Public Health Center-Based Prospective Study. J Epidemiol 2012; 22: 205–215.
Kato M, Noda M, Inoue M, Kadowaki T, Tsugane S . Psychological factors, coffee and risk of diabetes mellitus among middle-aged Japanese: a population-based prospective study in the JPHC study cohort. Endocr J 2009; 56: 459–468.
Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ . Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 341: c4229.
Kurotani K, Nanri A, Goto A, Mizoue T, Noda M, Kato M et al. Vegetable and fruit intake and risk of type 2 diabetes: Japan Public Health Center-based Prospective Study. Br J Nutr 2012; 9: 1–9.
Aune D, Ursin G, Veierod MB . Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies. Diabetologia 2009; 52: 2277–2287.
Tong X, Dong JY, Wu ZW, Li W, Qin LQ . Dairy consumption and risk of type 2 diabetes mellitus: a meta-analysis of cohort studies. Eur J Clin Nutr 2011; 65: 1027–1031.
van Dam RM, Hu FB . Coffee consumption and risk of type 2 diabetes: a systematic review. JAMA 2005; 294: 97–104.
Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J . Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2007; 298: 2654–2664.
Hirose K, Matsuo K, Iwata H, Tajima K . Dietary patterns and the risk of breast cancer in Japanese women. Cancer Sci 2007; 98: 1431–1438.
Kim MK, Sasaki S, Sasazuki S, Tsugane S . Prospective study of three major dietary patterns and risk of gastric cancer in Japan. Int J Cancer 2004; 110: 435–442.
Monma Y, Niu K, Iwasaki K, Tomita N, Nakaya N, Hozawa A et al. Dietary patterns associated with fall-related fracture in elderly Japanese: a population based prospective study. BMC Geriatr 2010; 10: 31.
Masaki M, Sugimori H, Nakamura K, Tadera M . Dietary patterns and stomach cancer among middle-aged male workers in Tokyo. Asian Pac J Cancer Prev 2003; 4: 61–66.
Nanri A, Kimura Y, Matsushita Y, Ohta M, Sato M, Mishima N et al. Dietary patterns and depressive symptoms among Japanese men and women. Eur J Clin Nutr 2010; 64: 832–839.
Nanri A, Mizoue T, Yoshida D, Takahashi R, Takayanagi R . Dietary patterns and A1C in Japanese men and women. Diabetes Care 2008; 31: 1568–1573.
Sadakane A, Tsutsumi A, Gotoh T, Ishikawa S, Ojima T, Kario K et al. Dietary patterns and levels of blood pressure and serum lipids in a Japanese population. J Epidemiol 2008; 18: 58–67.
Shimazu T, Kuriyama S, Hozawa A, Ohmori K, Sato Y, Nakaya N et al. Dietary patterns and cardiovascular disease mortality in Japan: a prospective cohort study. Int J Epidemiol 2007; 36: 600–609.
Nanri A, Mizoue T, Noda M, Takahashi Y, Kato M, Inoue M et al. Rice intake and type 2 diabetes in Japanese men and women: the Japan Public Health Center-based Prospective Study. Am J Clin Nutr 2010; 92: 1468–1477.
Hu FB . Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin. Lipidol 2002; 13: 3–9.
Martinez ME, Marshall JR, Sechrest L . Invited commentary: Factor analysis and the search for objectivity. Am J Epidemiol 1998; 148: 17–19.
This study was supported by Grants-in-Aid for Cancer Research (19 shi–2) and a Health Sciences Research Grant (Research on Comprehensive Research on Cardiovascular Diseases H19-016) from the Ministry of Health, Labor and Welfare of Japan.
The authors declare no conflict of interest.
Study group members: Members of the Japan Public Health Center-based Prospective Study (JPHC Study, principal investigator: S Tsugane) Group are: S Tsugane, M Inoue, T Sobue and T Hanaoka, National Cancer Center, Tokyo, Japan; J Ogata, S Baba, T Mannami, A Okayama and Y Kokubo, National Cardiovascular Center, Osaka, Japan; K. Miyakawa, F Saito, A Koizumi, Y Sano, I Hashimoto, T Ikuta and Y Tanaba, Iwate Prefectural Ninohe Public Health Center, Iwate, Japan; Y Miyajima, N Suzuki, S Nagasawa, Y Furusugi and N Nagai, Akita Prefectural Yokote Public Health Center, Akita, Japan; H Sanada, Y Hatayama, F Kobayashi, H Uchino, Y Shirai, T Kondo, R Sasaki, Y Watanabe, Y Miyagawa and Y Kobayashi, Nagano Prefectural Saku Public Health Center, Nagano, Japan; Y Kishimoto, E Takara, T Fukuyama, M Kinjo, M Irei and H. Sakiyama, Okinawa Prefectural Chubu Public Health Center, Okinawa, Japan; K Imoto, H Yazawa, T Seo, A Seiko, F Ito, F Shoji and R Saito, Katsushika Public Health Center, Tokyo, Japan; A Murata, K Minato, K Motegi and T Fujieda, Ibaraki Prefectural Mito Public Health Center, Ibaraki, Japan; K Matsui, T Abe, M Katagiri and M Suzuki, Niigata Prefectural Kashiwazaki and Nagaoka Public Health Center, Niigata, Japan; M Doi, A Terao, Y Ishikawa and T Tagami, Kochi Prefectural Chuo-higashi Public Health Center, Kochi, Japan; H Sueta, H Doi, M Urata, N Okamoto and F Ide, Nagasaki Prefectural Kamigoto Public Health Center, Nagasaki, Japan; H Sakiyama, N Onga, H. Takaesu and M Uehara, Okinawa Prefectural Miyako Public Health Center, Okinawa, Japan; F Horii, I Asano, H Yamaguchi, K Aoki, S Maruyama, M Ichii and M Takano, Osaka Prefectural Suita Public Health Center, Osaka, Japan; Y Tsubono, Tohoku University, Miyagi, Japan; K. Suzuki, Research Institute for Brain and Blood Vessels Akita, Akita, Japan; Y Honda, K Yamagishi, S Sakurai and N Tsuchiya, Tsukuba University, Ibaraki, Japan; M Kabuto, National Institute for Environmental Studies, Ibaraki, Japan; M Yamaguchi, Y Matsumura, S Sasaki and S Watanabe, National Institute of Health and Nutrition, Tokyo, Japan; M Akabane, Tokyo University of Agriculture, Tokyo, Japan; T. Kadowaki, Tokyo University, Tokyo, Japan; M Noda and T Mizoue, National Center for Global Health and Medicine, Tokyo, Japan; Y Kawaguchi, Tokyo Medical and Dental University, Tokyo, Japan; Y. Takashima and M Yoshida, Kyorin University, Tokyo, Japan; K. Nakamura, Niigata University, Niigata, Japan; S Matsushima and S Natsukawa, Saku General Hospital, Nagano, Japan; H Shimizu, Sakihae Institute, Gifu, Japan; H Sugimura, Hamamatsu University, Shizuoka, Japan; S Tominaga, Aichi Cancer Center Research Institute, Aichi, Japan; H Iso, Osaka University, Osaka, Japan; M Iida, W Ajiki and A Ioka, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan; S Sato, Chiba Prefectural Institute of Public Health, Chiba, Japan; E. Maruyama, Kobe University, Hyogo, Japan; M Konishi, K Okada and I Saito, Ehime University, Ehime, Japan; N Yasuda, Kochi University, Kochi, Japan; and S. Kono, Kyushu University, Fukuoka, Japan.
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