Urticaria is a global public health concern that incurs considerable costs and diminishes the patient's quality of life. Despite the potential association of autoimmunity with urticaria and the contribution of genetic predisposition, the impact of maternal autoimmune predisposition on urticaria in offspring remains unclear. Using antinuclear antibody (ANA) as an indicator of autoimmunity, we investigated the association of maternal ANA positivity with offspring urticaria by age 3 years. This prospective cohort study was conducted as an adjunct to the Japan Environment and Children's Study. ANA levels were determined using indirect immunofluorescence analysis with HEp-2 cells, and ANA positivity during pregnancy was defined as an antibody titer of 1:40 or higher at both the first and the second/third trimesters measurements. Clinical data related to childbirth were obtained from physician's records, while other data were collected through self-administered questionnaires completed by the mothers and fathers. The participants with stillbirth, multiple births, miscarriage or autoimmune diseases were excluded, and a total of 776 mother-child pairs included in the analysis. Among the mothers, 98 (12.6%) tested positive for ANA at both pregnancy time points. Among the children, 29 (3.7%) developed urticaria by age 3 years. Logistic regression analysis, adjusted for covariates, showed that maternal ANA positivity at both pregnancy time points was significantly associated with offspring urticaria by age 3 years (adjusted odds ratio, 2.74; 95% confidence interval: 1.16-6.46). This finding suggest that the mother's immune status may play a role in the development of childhood urticaria.

OBJECTIVE:This study aimed to examine the association between sedentary behavior at work and mental health among workers. METHODS:A cross-sectional study was conducted among 344 workers at a pharmaceutical manufacturing industry in Japan. Mental health conditions were assessed using the Kessler Psychological Distress Scale. Participants were classified into the two groups based on the frequency of breaking up prolonged sitting: high-frequency (standing at least once every 60 minutes) and low-frequency (intervals between standing exceeding 60 minutes or prolonged sitting) groups. Prevalence ratios and 95% confidence intervals for mental health were estimated using Poisson regression with robust variance. RESULTS:The low-frequency group had higher prevalence ratios for stress (1.82), anxiety (2.68), and depression (3.64) than the high-frequency group. CONCLUSIONS:Prolonged sitting at the workplace may be associated with worse mental health among Japanese workers.

Understanding the influence of both genetics and environment on human health, especially early in life, is essential for shaping long-term health. Here, we utilize a nationwide prospective birth cohort, the Japan Environment and Children's Study (JECS), to conduct a large-scale population-based genetic study using biannual questionnaire surveys and biological and physical measurements collected from both parents and their children since the participant mothers were pregnant. Analyses of genome-wide genotyping for 80,638 child participants with parental consent and sufficient DNA from cord blood samples represent the genetic diversity of the general population in Japan. Systematic genome-wide association studies of 1,163 child health and developmental traits (including, e.g., food allergy, anthropometry measurements or ASQ-3 developmental screening) and parental environmental exposure traits (including, e.g., mercury or PFAS exposure) identify 4,985 common genomic loci (of which 1,885 loci passed the phenome-wide significant P=4.3 x 10^(-11)), of which 25% of loci represent novel associations not previously reported. Additional longitudinal GWAS of BMI using Gaussian process regression identified 66 novel dynamic genetic associations along child development. In addition, genetic correlation analysis suggested some evidence that maternal environmental exposures during pregnancy influence child traits at birth. Together with studies of environmental exposures and genetic risk factors, across time and multiple outcomes, these demonstrate the uniqueness and value of the JECS data. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Ministry of the Environment, Japan. The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of the above government. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Japan Environment and Children's Study (JECS) protocol was reviewed and approved by the Ministry of the Environment's Institutional Review Board on Epidemiological Studies (No.100910001) and the Ethics Committees of all participating institutions. Written informed consent was obtained from all children's legal guardians. Following informed consent, participants were given further information about SNP genotyping using microarray technology and the possibility to withdraw from the genetic study at any time. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The latest GWAS results were downloaded from the GWAS Catalog (https://www.ebi.ac.uk/gwas/api/search/downloads/gwas\_catalog\_v1.0-associations\_e113\_r2024-11-03.tsv). Two imputation reference panels were obtained from the 1000 Genomes Project (ALL.chr*.shapeit2\_integrated\_snvindels\_v2a\_27022019.GRCh38.phased.vcf.gz and 1kGP\_high\_coverage\_Illumina.chr*.filtered.SNV\_INDEL\_SV\_phased\_panel.vcf.gz). The variant VCF of a South Korean population was obtained from the Korean Personal Genome Project (KPGP) (http://kpgp.kr/). The pre-computed LD scores using the 1000 Genomes Project East Asian Population (1000G\_Phase3\_EAS\_baselineLD\_v2.2\_ldscores.tgz) was downloaded from ZENODO (https://zenodo.org/records/10515792). GTEx eQTL summary statistics of the visceral adipose tissue (V8) was downloaded from the eQTL Catalogue (ftp.ebi.ac.uk/pub/databases/spot/eQTL/sumstats/QTS000015/QTD000121/QTD000121.all.tsv.gz). The GWAS summary statistics of all the 1,163 traits presented in the manuscript, are available via the JECS GWAS summary statistics request form (https://forms.office.com/r/qipvY8nNTK).

Mercury pollution, including from its use during gold mining and refining, remains an important problem worldwide. In particular, methylmercury, a microbial alteration of mercury released into the environment, is a major environmental neurotoxicant. Although there has been growing concern about the health hazards of exposure to low levels of mercury, the effects of prenatal mercury exposure on neurodevelopmental outcomes in children have remained controversial. In the Japan Environment and Children's Study, a large-scale nationwide birth cohort study, we measured methylmercury and inorganic mercury concentrations in cord blood and conducted developmental scoring tests at ages 2 and 4 years. We then analyzed the associations between mercury levels in cord blood and neurodevelopmental outcomes. Measurements of cord blood obtained from 3822 participants revealed median values of 7.39 ng/ml (5th percentile: 2.95, 95th percentile: 18.1) and 0.25 ng/ml (5th percentile: 0.10, 95th percentile: 0.58) for methylmercury and inorganic mercury, respectively. Analyzing the association with fish consumption, bonito-tuna was most strongly correlated with both methylmercury and inorganic mercury in cord blood. Although the association between cord blood mercury and neurodevelopmental scores was subsequently examined in 3083 individuals, we found no significant association with either methylmercury or inorganic mercury. Further quartile group analysis based on methylmercury concentrations in cord blood revealed no concentration-dependent association between a prenatal mercury exposure and neurodevelopment in children. However, various factors influence neurodevelopment, and long-term observational studies that consider those covariates are necessary for a more definitive conclusion. Although the findings of our study provide important insights into the association between prenatal mercury exposure and neurodevelopment, further research is needed to make recommendations for safe mercury intake thresholds during pregnancy.

Background Alkylphenols can originate from numerous products containing alkylphenol ethoxylates, including cleaning products, household items, and cosmetics. Some phenols, such as nonylphenol, are known to be endocrine disruptors, and exposure to them is thought to have contributed to the recent increase in allergic diseases such as asthma. However, the impacts of prenatal phenol exposure on asthma development in children are still unclear. Methods We analyzed the association between maternal urinary phenol concentrations during early pregnancy and the development of asthma in children at the age of 4, using data from the Japan Environment and Children’s Study (JECS), a large-scale nationwide birth cohort study. Results We recruited 3,513 pairs of mothers and children participating in the Sub-Cohort Study of JECS. We measured 24 phenols, including nitrophenol, parabens, bisphenol, octylphenol, and nonylphenol, in urine samples taken during the first trimester of pregnancy. The urinary levels of these phenols differed markedly, and some showed a broad spectrum of distribution. Methylparaben was detected at high levels in almost every participant (267.7 ng/ml, standard deviation 433.78). Logistic regression analysis revealed that the odds ratio of asthma onset for high exposure to butylparaben was 1.54 (95% confidence interval: 1.11-2.15). Additionally, logistic regression analysis by gender revealed an asthma development odds ratio of 2.09 (95% confidence interval: 1.20-3.65) for males and 0.65 (95% confidence interval: 0.25-1.70) for females born to mothers in whom 4-nonylphenol was detected, suggesting a gender difference. Conclusion Our current analysis using large cohort data suggests that high exposure to butylparaben and low exposure to 4-nonylphenol during pregnancy are risk factors for asthma development in children. These findings establish a valuable foundation for formulating recommendations about prenatal phenol exposure.

The quality of indoor environment is a risk factor for early childhood eczema and atopic dermatitis; however, its influence during pregnancy on childhood eczema in Japan has not been investigated. In this study, we aimed to determine the indoor environmental factors that are associated with eczema in children up to 3 years of age, using national birth cohort data from the Japan Environment and Children's Study (JECS).Information on indoor environments and eczema symptoms until 3 years of age was collected using self-administered questionnaires to the mothers. A total of 71,883 and 58,639 mother-child pairs at 1.5- and 3-years-old, respectively, were included in the former analyses. To account for prenatal indoor risk factors, 17,568 (1.5-years-old) and 7063 (3-years-old) children without indoor mold and/or ETS exposure were included in the final analysis. A higher mold index, gas heater use, parquet flooring use, and frequent insecticide use showed significantly increased risks for childhood eczema up to 3 years of age. These associations were consistent after stratification analysis among children whose parents did not have a history of allergies. The updated WHO guidelines on indoor air quality should be implemented based on recent findings regarding the effects of prenatal exposure to indoor dampness on health effects of children further in life, including asthma, respiratory effects, eczema, and other immunological effects.

Purpose: This study aimed to reveal the association between the osteoporosis self-assessment tool for Asians (OSTA) and airflow limitation (AL) in post-menopausal Japanese women. Participants and Methods: This cross-sectional study included 1580 participants undergoing a comprehensive health examination using spirometry and dual-energy X-ray absorptiometry. The OSTA was calculated by subtracting the age in years from the body weight (BW) in kilograms, and the result was multiplied by 0.2. The OSTA risk level was defined as low (>-1), moderate (-4 to -1), or high (<-4). AL was defined as forced expiratory volume in 1 s/forced vital capacity (FEV 1 /FVC) <0.7. The association between the OSTA and AL was assessed using logistic regression analysis. Results: The prevalence of AL was significantly higher in the high OSTA group (15.3%) than in the low OSTA group (3.1%) (p<0.001). In multiple linear regression analysis, the OSTA was independently associated with FEV 1 /FVC. In logistic regression models adjusted for smoking status, alcohol consumption, current use of medication for diabetes, hyperglycemia, rheumatoid arthritis, second-hand smoke, and ovary removal showed a significantly higher risk of AL (odds ratio: 5.48; 95% confidence interval: 2.90-10.37; p<0.001) in participants with OSTA high risk than in those with OSTA low risk. Conclusion: These results suggest that the OSTA high risk indicates reduced BMD at the femoral neck and presence of AL in Japanese post-menopausal women aged >= 45 years.

Context: Women with polycystic ovary syndrome (PCOS), which is the most common endocrine disorder in women of reproductive age, have a potentially increased risk of gestational diabetes mellitus (GDM). Objective: To examine the impact of PCOS on GDM based on maternal body mass index (BMI) using data from a large birth cohort study in Japan. Design: Prospective observational study using data from the Japan Environment and Children's Study (JECS). Participants: Singleton pregnancies in the JECS during 2011-2014 were included. Mothers with HbA1c levels of >= 6.5% in the first trimester and history of DM or steroid use during pregnancy were excluded. Main outcome measures: Participants were categorized according to their pre-pregnancy BMIs: G1 (<18.5 kg/m2), G2 (18.5-19.99 kg/m2), G3 (20.0-22.99 kg/m2), G4 (23.0-24.99 kg/m2), and G5 (>= 25.0 kg/m2). The impact of PCOS on early (Ed) and late-onset (Ld) GDM for each group was estimated using a multiple logistic regression model. Results: We included 92774 participants, comprising 2012 PCOS(+) cases. GDM occurrence was higher in women with PCOS (p<0.001). PCOS had no effect on GDM in G1, G2, and G3. In G4, PCOS increased the risk of Ed GDM (adjusted odds ratio [aOR]: 3.27, 95% confidence interval [CI]: 1.29-8.29). In G5, PCOS increased the risk of both Ed (aOR: 2.48, 95% CI: 1.53-4.02) and Ld GDM (aOR: 1.94, 95% CI: 1.23-3.07). Conclusions: The impact of PCOS on GDM occurrence depended on the pre-pregnancy BMIs, which may facilitate personalized preconception counseling among women with PCOS.

To examine whether patterns, such as the timings of onset or recovery from sleep disturbance, are associated with later developmental problems, including autism spectrum disorder (ASD). Mothers participating in the Japan Environment and Children's Study with a child aged 3 years were included in the analyses. Children were assessed for short sleep and frequent awakenings at 1 month, 6 months, and 1 year of age. Developmental problems were evaluated at 3 years of age based on ASD diagnosis and developmental delay, using the Japanese translation of the Ages and Stages Questionnaire (ASQ) 3rd edition. Sleep disturbance patterns were classified by onset age, and developmental problem risks were examined based on onset/recovery ages. Among 63,418 mother-infant dyads, 0.4% of infants were later diagnosed with ASD, and 14.4% had abnormal scores on any ASQ domains. The later the onset of short sleep, the lower the risk of abnormal ASQ scores (RR of short sleep onset at 1 year: 1.41; 6 months: 1.52; 1 month: 1.57). The earlier the infants recovered from short sleep persistence, the lower the risk of developmental delay (RR of remittance of sleep problems identified at 1 month by 6 months: 1.07; 1 year: 1.31; not before 1 year: 1.57). Although not all patterns were significant, later short sleep onset and earlier recovery were associated with lower ASD risk. These findings may have significant implications for future interventions in infant development.

Objectives: This study aimed to examine the relationship between physical activity (PA) and locomotive syndrome (LS) among young and middle-aged Japanese workers. Methods: This cross-sectional study included 335 participants from a company in Kumamoto, Japan. LS was evaluated using the 25-question Geriatric Locomotive Function Scale (GLFS-25); a GLFS-25 score >= 7 was defined as LS. Weekly PA was measured using the International Physical Activity Questionnaire. Work-related PA (time spent sitting, standing, walking, and strenuous work per day) and sedentary breaks were measured using a Work-related Physical Activity Questionnaire. Screen usage (television [TV], smartphones, tablets, and personal computers) during leisure time was recorded. The association between PA and LS was examined using a multivariate logistic regression analysis adjusted for age, sex, body mass index, history of musculoskeletal disorders, cancer, stroke, occupation, employment type, work time, shift system, employment status, and body pain. Results: A total of 149 participants had LS. Fewer sedentary breaks during work (>70-minute intervals, odds ratio [OR] = 2.96; prolonged sitting, OR = 4.12) and longer TV viewing time (>= 180 minutes, OR = 3.02) were significantly associated with LS. In contrast, moderate PA (OR = 0.75) was significantly associated with a lower risk of LS. Conclusions: Fewer sedentary breaks during work and longer TV viewing time could increase the risk of LS in young and middle-aged Japanese workers.

What is health? We all have a goal that we aspire for in our life-our "reason to live". Health is a pillar necessary for achieving our goal in life and I believe that altruism is the basic principle of this pillar. In this paper, I first discuss altruism in health from biological and economic perspectives, and then review the history of the concept of health. Next, I introduce the keywords necessary for understanding health and then present the points necessary for determining good health and for the role of each individual in issues concerning health. In conclusion, I would like to define health as a state of physical, mental and social well-being necessary for people to achieve self-achievement and happiness while living in society. Health is an attitude, and the very process of striving to achieve good health is itself "good health". In addition, altruism is fundamental to good health. The spirit of respect and empathy for not only humans health but also "planetary health" is important.

Antinuclear antibodies (ANA) are important biomarkers for the diagnosis of autoimmune diseases; however, the general population also tests positive at a low frequency, especially in women. Although the effects of various autoimmune diseases on pregnancy outcomes have been studied, the association of ANA with pregnancy outcomes in healthy individuals is unclear. Preterm birth (PTB), a major cause of neonatal death or long-term health problems, is a complex condition with a multifactorial etiology, and the underlying mechanism remains unclear. The present Adjunct Study aimed to determine the association between ANA and PTB in pregnant Japanese women based on a data analysis of the Japan Environment and Children’s Study. In a prospective cohort design, we analyzed the demographic and pregnancy outcome data of 1085 pregnant Japanese women who were recruited between January 2011 and March 2014 in the Kumamoto University target area. Demographic data were collected using self-administered questionnaires and physician records. A serum ANA titer of ≥ 1:40 was defined as positive. Statistical analysis was performed by logistic regression analysis with PTB as the objective variable. The PTB rate was significantly higher in those who were ANA-positive (adjusted odds ratio, 2.06; 95

BACKGROUND:In Japan, there are currently no definitive conclusions regarding the characteristics of multiple chemical sensitivity (MCS) and electromagnetic hypersensitivity (EHS). This study aimed to determine the prevalence and correlation of MCS and EHS with age, sex, and depression in the Japanese population.METHODS:An anonymous self-report questionnaire was distributed to 2,007 participants. Variables such as MCS, EHS, depression score, and demographic characteristics were individually evaluated using the U-test, chi-squared test, and correlation analyses. Moreover, we performed a covariance structure analysis to build a structural equation model.RESULTS:Older individuals and women were more likely to exhibit MCS and EHS symptoms. Moreover, depression was correlated with MCS and EHS.CONCLUSIONS:Although MCS and EHS are strongly correlated, they exhibit distinct characteristics and symptoms, indicating that they can be regarded as separate conditions.

Antinuclear antibodies (ANAs) are detected in healthy individuals, they are more prevalent in women than in men. Pregnant women are immunologically unique, but epidemiological data on ANA positivity in them remain limited. The exposure received from the mother during the fetal period impacts the future health of the fetus and has thus received increased attention in recent years. Thus, we investigated the association between ANA pos-itivity and chemical exposure among pregnant Japanese women, registered in the Japan Environment and Children's Study (JECS). ANA titers were assessed by indirect immunofluorescence with HEp-2 cells at a cutoff dilution of 1:40. Sociodemographic and other data were obtained in the JECS from a self-administered ques-tionnaire. We analyzed 1,235 Japanese women in their first trimester of pregnancy. The ANA prevalence was 17.2%. Among ANA-positive women, a speckled pattern was the most common (95.3%), followed by a homo-geneous pattern (72.3%). Exposure to chemicals more than once a week significantly increased the probability of ANA positivity (kerosene, petroleum, benzene, or gasoline: adjusted odds ratio [AOR], 2.11; 95% confidence interval [95% CI], 1.03-4.34; chlorine bleach or germicide: AOR, 1.97; 95% CI, 1.10-3.54; organic solvents: AOR, 5.34; 95% CI, 1.40-20.36; and photocopying machines or laser printers: AOR, 1.73; 95% CI, 1.17-2.54). ANA positivity was associated with exposure to several chemicals in Japanese women. Our exploratory results suggested that ANAs as potential markers of chemical exposure warrant further research.

Many developed countries, including Japan, have capitalist economies based on market principles. In capitalism, businesses try to develop new products and increase their added value, and expand the market in order to generate new profits. Owing to the universalization of capitalist efficiency, our daily lives are becoming condensed to only the necessary things in life. In addition, the advancement of science and technology, which is the driving force behind the expansion of profits, has forced people to become obsessed with new technology and information, and as a result, we have also lost our mental comfort. In this paper, first, we explain the time required to secure the energy necessary for human survival throughout human history. Second, we describe labor productivity with the emergence and development of capitalism. Third, we explain the difference between essential time and pressure-free time, and consider the necessity of pressure-free time during working hours. Finally, we discuss the relationships among pressure-free time, presenteeism, and work engagement.

This study aimed to observe and clarify the association between COVID-19 vaccine recipients’ characteristics and the types of adverse effects in the Japanese population. An anonymous self-report questionnaire was distributed to 4393 students and 1657 white and blue-collar workers (N=6050). Vaccine-related adverse effects were measured twice, once after each vaccination. The contents of each measurement were recorded daily from the day of injection (D0) until the sixth day after injection (D6). The adverse effects included local reactions at the injection site (pain, redness, and swelling) and systemic symptoms (fever, fatigue, headache, myalgia, joint pain, chills, and nausea or vomiting). Adverse reactions to the COVID-19 vaccination were more frequent in women than in men. Some adverse reactions included more severe symptoms in younger participants, and participants with a lower body mass index were more susceptible. The incidence of adverse effects was higher after the second dose of vaccination than after the first dose. The adverse effects after the first dose predicted the occurrence and severity of the adverse effects after the second dose. More care should be taken for younger participants, women, and those with a lower body mass index for adverse effects after receiving the COVID-19 vaccination.

Teenage pregnancy increases the threat of depression because of its many factors. Pregnancy during young adulthood may also have several risk factors for depression compared to older pregnancies. However, data on depression in young adult pregnancies are lacking. This study investigated the association between teenage and young adult pregnancy and depression. Data from the Japan Environment and Children's study was used as a nationwide multicenter prospective cohort study. A multivariate logistic regression was performed to investigate the association between age groups (14–19, 20–24, 25–29, 30–34, ≥ 35 years) and depression, adjusted for behavioral and sociodemographic characteristics. Depression was assessed using the Kessler Psychological Distress Scale. In total, 96,808 pregnant women responded to the questionnaire. Teenage (14–19 years) and young adult (20–24 years) pregnancy were associated with an increased risk of depression compared to older pregnancy (≥ 35 years) (teenage: OR 4.28, 95

Objectives: We aimed to identify and explore the association between the characteristics of coronavirus disease 2019 (COVID-19) vaccine recipients and the types of vaccine-related adverse effects in the general Japanese adult population. Methods: An anonymous self-report questionnaire was distributed to 4393 students and 1657 white and blue-collar workers (N = 6050). Data on vaccine-related adverse effects were collected twice, once after each vaccination. The data collection was performed daily from the day of injection (D0) until the sixth day after injection (D6). The list of adverse effects comprised local reactions at the injection site (pain, redness, and swelling) and systemic symptoms (fever, fatigue, headache, myalgia, joint pain, chills, and nausea or vomiting). The Student's t-test and Mann-Whitney U test were used to analyze parametric and non-parametric data, respectively. Results: The incidence of adverse reactions to the COVID-19 vaccination was higher after the second dose (e.g., redness: 47.1%; swelling: 60.6%; fever: 80.6%) of vaccination than after the first dose (e.g., redness: 16.4%; swelling: 37.2%; fever: 11.9%). Women reported adverse reactions to the vaccination more frequently. Some adverse reactions included more symptoms in younger participants, and participants with a lower body mass index were more at risk for these symptoms. Conclusions: Some adverse reactions to the COVID-19 vaccination are a greater risk of symptoms in the younger group, women, and participants with lower BMI. Care should be taken to monitor women, younger people, and individuals with a low body mass index for adverse effects after receiving the COVID-19 vaccination. & COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Several scoring methods for the Mediterranean diet, which is considered as a healthy diet, are available, but studies that have compared more than one of these scores are rare. In addition, the applicability of Mediterranean diet scoring has not been sufficiently examined outside of Mediterranean regions. We collected data on the Mediterranean diet during pregnancy and the incidence of type 1 allergies in offspring from the Japan Environment and Children’s Study. Using multiple Mediterranean diet scoring methods, we analyzed the effect of adherence to the Mediterranean diet in pregnancy on the allergies of the offspring. Overall, 46,532 pairs of mothers and children were analyzed. In Japan, a high adherence to the Mediterranean diet during pregnancy was associated with a lower incidence of asthma in the offspring (odds ratio: 0.896, 95% confidence interval: 0.835, 0.962). Furthermore, we found that the selection of the Mediterranean diet scoring method and the setting of the reference value significantly altered the results. Our findings suggest that an appropriate selection of scoring methods and a reference value for food items are important to analyze the effects of adherence to the Mediterranean diet inside and outside of Mediterranean regions.

Abstract Reduced respiratory function is associated with low bone mineral density and increased fracture risk. Therefore, we assessed the association between the osteoporosis self-assessment tool for Asians (OSTA) and airflow limitation (AL) in post-menopausal Japanese women. This cross-sectional study included 1,580 patients who underwent a comprehensive health examination using spirometry and dual-energy X-ray absorptiometry. The OSTA was calculated by subtracting the age in years from the body weight in kilograms, and the result was multiplied by 0.2. Furthermore, the OSTA risk level was defined as low (> -1), moderate (-4 to -1), or high (< -4); AL was defined as forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) < 0.7. Prevalence of AL was significantly higher in the high OSTA group (15.3%) than in the low OSTA group (3.1%). The OSTA was independently associated with FEV1/FVC. Moreover, in logistic regression models adjusted for smoking status, alcohol consumption, current use of medication for diabetes, hyperglycemia, rheumatoid arthritis, second-hand smoke, and removal of ovary, the risk of AL (adjusted odds ratio: 5.48; 95% confidence interval: 2.90–10.37) was significantly higher in participants with OSTA high-risk than in those with low-risk. Thus, OSTA high-risk indicates the presence of AL in Japanese post-menopausal women.