Dietary intake habits and the prevalence of nocturia in Japanese patients with type 2 diabetes mellitus

No reports have been published on the association between dietary intake habits and nocturia in the diabetes population. We therefore evaluated this issue among Japanese patients with diabetes mellitus.

Related papers:

title: Nocturia and Prevalence of Depressive Symptoms in Japanese Adult Patients With Type 2 Diabetes Mellitus: The Dogo Study.
abstract: No studies have investigated the association between nocturia and depressive symptoms in patients with type 2 diabetes mellitus. Because nocturia and depressive symptoms are common in patients with type 2 diabetes, we examined this association in Japanese patients with type 2 diabetes.



We studied 762 Japanese patients with type 2 diabetes. A self-administered questionnaire was used to collect information about the variables under study. The subjects were divided into 3 groups according to their nocturnal micturition: 1) no nocturia; 2) mild nocturia (1 void per night) and 3) moderate to severe nocturia (2 or more voids per night). Depressive symptoms were defined as being present when a subject had a Self-Rating Depression Scale score higher than 49.



The prevalence values of mild nocturia, moderate to severe nocturia and depressive symptoms were 39.5%, 41.9% and 16.8%, respectively. Both mild nocturia and moderate to severe nocturia were independently positively associated with depressive symptoms in all patients; the adjusted ORs were 1.96 (95% CI 1.06 to 3.77) and 2.58 (95% CI 1.38 to 5.04). In female patients, both mild nocturia and moderate to severe nocturia were independently associated with depressive symptoms; the adjusted ORs were 5.26 (95% CI 1.73 to 20.61) and 6.91 (95% CI 2.15 to 28.54), respectively. In male patients, neither mild nocturia nor moderate to severe nocturia was significantly related to depressive symptoms.



In Japanese female patients with type 2 diabetes, nocturia may be positively associated with depressive symptoms.

title: Fruit and Vegetable Intake in Relation to Lower Urinary Tract Symptoms and Erectile Dysfunction Among Southern Chinese Elderly Men
abstract: role of fruit and vegetable (FV) intake in relation to prostate health remains inconclusive. This 4-year longitudinal study aims to explore the association of FV intake and the development of lower urinary tract symptoms (LUTS, a cluster of chronic urinary symptoms occurring in bladder, prostate and urethra), incidence of symptomatic benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) in Chinese elderly men.Data were obtained from a 4 years longitudinal study (Mr OS Hong Kong, the largest prospective study on bone health in Chinese elderly). Two thousand Chinese men aged 65 years and older were recruited from the local community, of whom 1998 (99.9%) at baseline and 1564 (78.2%) at 4-year follow-up reported data on LUTS, which were evaluated by a validated International Prostate Symptoms Scale (IPSS). Erectile function was evaluated by the International Index of Erectile Dysfunction-5 (IIEF-5) questionnaires at 2- (n = 386) and 4-year (n = 475) follow-ups. Dietary intake was assessed using a validated food frequency questionnaire at baseline. Analysis was conducted using multivariate linear and logistic regression.For total FV and most of their subclasses, moderate consumption had the lowest mean changes of LUTS; we thus applied the moderate levels as the reference in the regression models. The high levels of total FV intake (>350 g/1000 kcal/day) were significantly associated with reduced IPSS by scores of -1.174 ± 0.459 (or -17.3% of basal IPSS, P = 0.011) relative to the moderate groups (250–350 g/1000 kcal/day). FV consumption had no significant association with the score change of ED or the odds of sexual activities at 4-year (all P > 0.05). High intake of dark and leafy vegetables (>50 g/1000 kcal/day) significantly reduced the risk of LUTS progression by 37.2% [odds ratio (OR) (95% confidence interval, 95% CI): 0.628 (0.466∼0.848), P = 0.002] or risk of symptomatic BPH by 34.3% [OR (95% CI): 0.657 (0.442–0.976), P = 0.038] after 4 years compared with the moderate group (25–50 g/1000 kcal/day).Adequate FV intakes, especially dark and leafy vegetables, were associated with improved LUTS among Chinese elderly men, but lack an association with ED and sexuality.

title: Association of Dietary Elements and Lower Urinary Tract Symptoms
abstract: The purpose of the study was to establish whether dietary elements are related to lower urinary tract symptoms (LUTS) and thus to diseases causing LUTS.  This population-based study was carried out in 1994; a questionnaire was mailed to all men born in 1924, 1934 or 1944 living in Tampere or 11 rural or semi-rural municipalities in the same county, altogether 3143 men. Of this population, 68% were ultimately included in the study.  was used to assess urinary symptoms and problems arising from them. A symptom index was formed by multiplying the symptom and problem scores for hesitancy, incomplete emptying, urge, urge incontinence, nocturia and daytime frequency, and totalling the products. The men were also asked to report on their medical history, how often they ate vegetables and meat, whether they used butter, margarine or vegetable oil in food, how much alcohol and coffee they consumed, their smoking history and their weight and height. The risk of LUTS was estimated according to the frequency of meat and vegetable intake and the kind of fat used.  The confounder-adjusted risk of LUTS was 0.68 (95% CI 0.54-0.86) among men consuming vegetables daily compared with men consuming vegetables less frequently. Compared with men who eat meat less frequently, the confounder-adjusted risk of LUTS was 2.08 (95% CI 1.00-4.10) among men consuming meat weekly, and 2.56 (95% CI 1.30-5.02) among men consuming meat daily. The confounder-adjusted risk of LUTS was 0.73 (95% CI 0.58-0.93) among men who consumed butter compared to those who did not.  Dietary elements may also have an important role in the development of diseases causing LUTS. Direct effects of food components may likewise influence the occurrence of LUTS.

title: Intakes of energy and macronutrients and the risk of benign prostatic hyperplasia.
abstract: Benign prostatic hyperplasia (BPH) is a common disease of older men. Although the etiology remains unclear, nutritional factors may have an effect on the disease.



Because the literature on the relations between macronutrient intakes and BPH risk is limited, we examined these relations among men in the Health Professionals Follow-up Study.



We followed men aged 40-75 y from baseline in 1986 to 1994. Total BPH cases (n = 3523) comprised men who reported BPH surgery (n = 1589) or who did not undergo surgery but scored 15-35 points on the lower urinary tract symptom questionnaire of the American Urological Association (n = 1934); non-cases were men who scored < or = 7 points (n = 24388). Odds ratios (ORs) and 95% CIs were calculated by using multivariate logistic regression.



The ORs rose with increasing total energy intake in a comparison of the highest and lowest quintiles for total BPH (OR: 1.29; 95% CI: 1.14, 1.45) and symptoms of BPH (1.43; 1.23, 1.66). Energy-adjusted total protein intake was positively associated with total BPH (1.18; 1.05, 1.33) and BPH surgery (1.26; 1.06, 1.49). Energy-adjusted total fat intake was not associated with risk of total BPH, but intakes of eicosapentaenoic, docosahexaenoic, and arachidonic acids were associated with a moderate increase in risk of total BPH.



We observed modest direct associations between BPH and intakes of total energy, protein, and specific long-chain polyunsaturated fatty acids. Because eicosapentaenoic, docosahexaenoic, and arachidonic acids are highly unsaturated fatty acids, our findings support a possible role of oxidative stress in the etiology of BPH.

title: The association between isoflavone and lower urinary tract symptoms in elderly men
abstract: The objective of the present study is to explore the association between lower urinary tract symptoms (LUTS) and dietary isoflavone in elderly men. In a large prospective cohort of 2000 Chinese men, the association between dietary isoflavone and LUTS were studied using standardized structured questionnaires. Dietary intake was assessed by a modified version of the Block FFQ. LUTS were assessed by the Chinese version of the International Prostatic Symptoms Score. Demographic, lifestyle and other medical information were also collected and were adjusted for in the analysis. After excluding 299 men with history of bladder surgery, bladder or prostate cancer or who were current users of medication for urinary problems, the association between LUTS and dietary isoflavone was explored. A total of 96·2 % of subjects reported some consumption of genistein, glycitein or daidzein. In ordinal multinominal logistic regression, subjects with dietary total isoflavone of more than 5·1 mg were significantly less likely to suffer from more severe LUTS (dietary intake from 5·1 to 9·5 mg: OR 0·59; 95 % CI 0·44, 0·80; from 9·6 to 14·3 mg: OR 0·81; 95 % CI 0·61, 1·09; from 14·4 to 21·7 mg: OR 0·68; 95 % CI 0·51, 0·92; 21·8 mg and above: OR 0·73; 95 % CI 0·54, 0·98) after adjustment for covariates. In this cross-sectional study, we showed a strong inverse association between dietary intake of isoflavone and the risk of LUTS.

title: Intake of caffeinated, carbonated, or citrus beverage types and development of lower urinary tract symptoms in men and women.
abstract: Evidence to substantiate recommendations for restriction of caffeinated or acidic beverages as self-management for lower urinary tract symptoms (LUTS) is limited. We examined longitudinal and acute associations between beverage intake and LUTS in the Boston Area Community Health (BACH) cohort (n = 4,144) between 2002 and 2010. Multivariable models tested associations between baseline intakes and progression of LUTS at 5-year follow-up, between follow-up intakes and International Prostate Symptom Scores at follow-up, and between 5-year intake changes and LUTS progression. Greater coffee or total caffeine intake at baseline increased the odds of LUTS progression in men (coffee: >2 cups/day vs. none, odds ratio = 2.09, 95% confidence interval: 1.29, 3.40, P-trend = 0.01; caffeine: P-trend < 0.001), particularly storage symptoms. Women who increased coffee intake by at least 2 servings/day during follow-up (compared with categories of decreased or unchanged intakes) had 64% higher odds of progression of urgency (P = 0.003). Women with recently increased soda intake, particularly caffeinated diet soda, had higher symptom scores, urgency, and LUTS progression. Citrus juice intake was associated with 50% lower odds of LUTS progression in men (P = 0.02). Findings support recommendations to limit caffeinated beverage intake for LUTS, and in men, they suggest benefits of citrus juice consumption. Further clinical research is warranted, particularly of the precise role of sodas containing artificial sweeteners in bladder sensations and urological function.

title: Dietary macronutrients, cholesterol, and sodium and lower urinary tract symptoms in men.
abstract: Little is known about dietary correlates of lower urinary tract symptoms (LUTS).



To examine associations between dietary intakes of total energy, carbohydrates, protein, fats, cholesterol, and sodium and LUTS in men.



Cross-sectional study of 1545 men aged 30-79 yr in the Boston Area Community Health survey (2002-2005), a random population-based sample. Dietary data were assessed by validated self-administered food frequency questionnaire. LUTS and covariate data were collected during in-person interviews. Primary analyses used multivariate logistic regression.



Outcomes were moderate to severe LUTS, storage symptoms, and voiding symptoms as measured by the American Urological Association Symptom Index.



Greater total energy intake was associated with higher LUTS symptom score (p(trend)<0.01) and increased likelihood of storage symptoms. No associations were observed with total, saturated, or monounsaturated fat intake or carbohydrates. Men who consumed more protein were less likely to report LUTS, particularly voiding symptoms (quintile 5 vs quintile 1 OR=0.35; 95% CI, 0.17-0.74; p=0.006). Sodium intake had positive linear associations with LUTS (p(trend)=0.01) and storage symptom score (p(trend)=0.004); this finding should be confirmed by studies using biomarkers of sodium exposure. Storage symptoms increased slightly with greater polyunsaturated fat intake (p(trend)=0.006). Data on specific polyunsaturated fats were unavailable.



This community-based study of men found that total energy and sodium intake were positively associated with LUTS, whereas greater protein intake was inversely associated with LUTS.

title: The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women
abstract: To investigate the role of diet and other lifestyle factors in the incidence of overactive bladder and stress incontinence in women. Studies have suggested relationships between different aspects of lifestyle and symptoms of urinary incontinence, but there is a lack of firm evidence about their role in its cause.

title: Nutrient composition of the diet and the development of overactive bladder: A longitudinal study in women
abstract: Evidence for an association between diet and the symptom syndrome overactive bladder (OAB) would be valuable in understanding its aetiology. The present study investigates prospectively the association between the nutrient composition of the diet and the onset of OAB.

title: Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial.
abstract: This study examined dietary risk factors for incident benign prostatic hyperplasia (BPH) in 4,770 Prostate Cancer Prevention Trial (1994-2003) placebo-arm participants who were free of BPH at baseline. BPH was assessed over 7 years and was defined as medical or surgical treatment or repeated elevation (>14) on the International Prostate Symptom Score questionnaire. Diet, alcohol, and supplement use were assessed by use of a food frequency questionnaire. There were 876 incident BPH cases (33.6/1,000 person-years). The hazard ratios for the contrasts of the highest to lowest quintiles increased 31% for total fat and 27% for polyunsaturated fat and decreased 15% for protein (all p(trend) < 0.05). The risk was significantly lower in high consumers of alcoholic beverages (0 vs. > or =2/day: hazard ratio (HR) = 0.67) and vegetables (<1 vs. > or =4/day: HR = 0.68) and higher in daily (vs. <1/week) consumers of red meat (HR = 1.38). There were no associations of supplemental antioxidants with risk, and there was weak evidence for associations of lycopene, zinc, and supplemental vitamin D with reduced risk. A diet low in fat and red meat and high in protein and vegetables, as well as regular alcohol consumption, may reduce the risk of symptomatic BPH.

title: Fruit and vegetable consumption, intake of micronutrients, and benign prostatic hyperplasia in US men.
abstract: Nutrients with antioxidant properties or that influence cell growth and differentiation might reduce the risk of benign prostatic hyperplasia (BPH).



The objective was to evaluate the association of fruit, vegetable, and micronutrient intakes with BPH.



The participants were members of the Health Professionals Follow-Up Study and were aged 46-81 y in 1992. In 1992 and biennially thereafter, the men reported having surgery for an enlarged prostate, and in 1992 and on 3 subsequent questionnaires they completed the American Urological Association symptom index (AUASI). BPH cases were men who reported having surgery or who had an AUASI score of 15-35 (n = 6092). Control subjects were men who had not had surgery and never had an AUASI score >7 (n = 18 373). Men with a score of 8-14 were excluded (n = 7800). Intakes of fruit, vegetables, and antioxidants were assessed with a food-frequency questionnaire in 1986. We calculated odds ratios (ORs) of BPH and 95% CIs using logistic regression.



Vegetable consumption was inversely associated with BPH (fifth compared with first quintile-OR: 0.89; 95% CI: 0.80, 0.99; P for trend = 0.03), whereas fruit intake was not. Consumption of fruit and vegetables rich in beta-carotene (P for trend = 0.004), lutein (P for trend = 0.0004), or vitamin C (P for trend = 0.05) was inversely related to BPH. With increasing vitamin C intake from foods, men were less likely to have BPH (P for trend = 0.0009). Neither alpha- nor gamma-tocopherol intake from foods was associated with BPH (P for trend = 0.05 and 0.84, respectively).



Our findings are consistent with the hypothesis that a diet rich in vegetables may reduce the occurrence of BPH.

title: High‐risk group for benign prostatic hypertrophy
abstract: A case control study was conducted on 100 patients with benign prostatic hypertrophy (BPH) and 100 controls matched by age and residence. Interviews were performed by well‐ trained urologists using an original questionnaire. Matched‐pair analysis revealed the following characteristics and relative risks (RR) as being significantly (P < 0.05) different among the BPH patients versus the controls: higher educational background (RR = 2.77); not engaged in farming, forestry, or fishing (RR = 4.82); no environmental pollution at work (RR = 2.90); a present annual income of more than 2,400,000 yen (RR = 3.84); a previous annual income of more than 2,400,000 yen (RR = 3.82); practice the highest standard of living (RR = 4.24); more than two children (RR = 2.67); experienced first nocturnal emission before reaching the age of 20 (RR = 3.11); expending more than 10 min to complete one act of sexual intercourse (RR = 2.43); having no episode of sexual impotence that lasted more than 1 month (RR = 2.29); no family history of gastric ulcer (RR = 7.98); no family history of breast cancer (RR = 8.25); regular consumption of milk (RR = 2.25); irregular consumption of green and yellow vegetables (RR = 3.91); and pickles not consumed at every meal (RR = 1.99). Characteristics that did not achieve a high level of statistical significance (0.05 < P < 0.10) between cases and controls were as follows: past history of gonorrhea, urethritis, or prostatitis and syphilis (RR = 1.84, 2.76, and 4.26, respectively), and daily meat consumption (RR = 3.18). On the basis of interviews of the patients and cases reported in this study, we conclude that dietaly and sexual habits may be important factors which place individuals at a higher risk for developing BPH.

title: Food groups and risk of benign prostatic hyperplasia.
abstract: To evaluate the role of a wide range of foods on the risk of benign prostatic hyperplasia (BPH), we conducted a case-control study in Italy between 1991 and 2002. Although BPH is an extremely common condition, particularly among older men, its risk factors, including dietary ones, remain largely undefined.



Included in the study were 1369 patients younger than 75 years old surgically treated for BPH and 1451 controls younger than 75 years of age who had been admitted to the same hospitals as cases for a wide spectrum of acute, non-neoplastic conditions. A validated and reproducible food frequency questionnaire, including 78 foods and beverages, plus a separate section on alcoholic beverages, was used to assess patients' dietary habits 2 years before diagnosis or hospital admission. Multivariate odds ratios (OR) were obtained after allowance for energy intake and other major potential confounding factors.



A significant trend of increasing risk with more frequent consumption was found for cereals (OR 1.55 for the greatest versus lowest quintile), bread (OR 1.69), eggs (OR 1.43), and poultry (OR 1.39). Inverse associations were observed for soups (OR 0.74), pulses (OR 0.74), cooked vegetables (OR 0.66), and citrus fruit (OR 0.82). No association was observed for milk and yogurt products, coffee and tea, pasta and rice, fish, cheese, row vegetables, potatoes, fruit, or desserts.



The results of this study suggest a role for dietary habits on the risk of BPH. In particular, a diet rich in cereals and some types of meat and poor in vegetables and pulses may have an unfavorable effect in this Italian population.

title: Nocturia and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: The Dogo Study
abstract: Several epidemiological studies have reported a positive association between nocturia and erectile dysfunction (ED). Yet only limited evidence exists regarding the association between nocturia and ED among patients with type 2 diabetes mellitus, although nocturia and ED are common among type 2 diabetes mellitus patients.

title: Microvascular Complications and Prevalence of Nocturia in Japanese Patients With Type 2 Diabetes Mellitus: The Dogo Study.
abstract: To evaluate the association between microvascular complications and nocturia among Japanese patients with type 2 diabetes mellitus.



Study subjects were 731 Japanese patients with type 2 diabetes mellitus. A self-administered questionnaire was used to collect information on the variables under study. Study subjects were considered to have nocturia if they answered "once or more" to the question: "How many times do you typically wake up to urinate from sleeping at night until waking in the morning?" Diabetic neuropathy was diagnosed if the patients showed two or more of the following three characteristics: neuropathic symptoms, the absence of the Achilles reflex, or abnormal vibration perception. Diabetic nephropathy was defined as positive when the estimated glomerular filtration rate was <30 mL/min/1.73 m(2) and/or the urine albumin-to-creatinine ratio was ≥34 mg/mmol creatinine. Several ophthalmology specialists were responsible for evaluating diabetic retinopathy. Adjustment was made for sex, age, body mass index, duration of diabetes mellitus, current smoking, current drinking, hypertension, stroke, ischemic heart disease, and glycated hemoglobin.



The prevalence of nocturia was 80.4%. Diabetic retinopathy was independently positively associated with nocturia (adjusted odds ratio 2.39 [95% confidence interval: 1.08-6.11]). In contrast, diabetic nephropathy or diabetic neuropathy was not associated with nocturia.



In Japanese patients with type 2 diabetes mellitus, only diabetic retinopathy was independently positively associated with nocturia.

title: A new Classification of Diabetic Nephropathy 2014: a report from Joint Committee on Diabetic Nephropathy
abstract: The Joint Committee on Diabetic Nephropathy has revised its Classification of Diabetic Nephropathy (Classification of Diabetic Nephropathy 2014) in line with the widespread use of key concepts, such as the estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD). In revising the Classification, the Committee carefully evaluated, as relevant to current revision, the report of a study conducted by the Research Group of Diabetic Nephropathy, Ministry of Health, Labor and Welfare of Japan. Major revisions to the Classification are summarized as follows: (i) eGFR is substituted for GFR in the Classification; (ii) the subdivisions A and B in stage 3 (overt nephropathy) have been reintegrated; (iii) stage 4 (kidney failure) has been redefined as a GFR <30 mL/min/1.73 m2, regardless of the extent of albuminuria; and (iv) stress has been placed on the differential diagnosis of diabetic nephropathy versus non‐diabetic kidney disease as being crucial in all stages of diabetic nephropathy.

title: Classification and treatment of diabetic retinopathy.
abstract: Diabetic retinopathy is the leading cause of blindness. In Japan about 45% of diabetic patients under medical care have retinopathy and 10% have proliferative retinopathy. Until recently, Scott's classification (1953, 1957) of retinopathy was commonly used in Japan. As there are several problems with this classification, I proposed a new classification in 1983. It aims to separate benign and malignant types and to be more useful clinically so that each stage corresponds better to the indication of specific treatment. Diabetic retinopathy is divided into benign (type A) and malignant (type B) retinopathy, and each type is subdivided into 5 stages. Benign retinopathy is unlikely to cause blindness unless maculopathy is present. It includes background retinopathy (A1 and A2) and interrupted proliferative retinopathy (A3, A4 and A5) after photocoagulation or vitrectomy. Malignant retinopathy is likely to get worse and may lead to blindness if left without specific treatment. It includes preproliferative retinopathy (B1), early (B2), advanced (B3) and end-stage (B4 and B5) proliferative retinopathy. The presence of specific findings is described by the addition of letters: maculopathy (M), tractional retinal detachment (D), neovascular glaucoma (G), and ischemic optic neuropathy (N). Systemic metabolic control of diabetes is the best means of treatment for benign retinopathy, but malignant retinopathy should immediately be seen by ophthalmologists for specific treatment: focal photocoagulation for B1, focal or panretinal photocoagulation for B2 and panretinal photocoagulation for B3-B5. Vitrectomy is indicated in B4 or more severe stages.

title: Rationale and usefulness of newly devised abbreviated diagnostic criteria and staging for diabetic polyneuropathy.
abstract: In order to establish a diagnostic criteria for diabetic polyneuropathy (DP) for daily practice, usefulness of the abbreviated diagnostic criteria proposed by Diabetic Neuropathy Study Group in Japan was examined in 131 diabetic patients in admission and outpatient clinic. The prerequisite condition includes: (1) diagnosed as diabetes and (2) other neuropathies than diabetic neuropathy can be excluded. The criteria should meet any of the following three items: (1) sensory symptoms considered to be due to DP, (2) bilaterally decreased or absent ankle reflex and (3) decreased vibratory sensation in bilateral medial malleoli. Using this criteria, sensitivity (68%) and specificity (74%) were obtained by evaluating nerve conduction study as gold standard, suggesting usefulness of the criteria for diagnosis of DP especially for daily practice. Staging of DP is now sought to establish the consensus for the specific therapy for its stage. Thirty-one diabetic patients in admission was evaluated to examine usefulness of the newly devised staging system of DP. Staging was almost consistent between the new staging system and Dyck's staging (gold standard) and nerve function deteriorated with increasing stage, suggesting that usefulness and rationale of this staging system is well substantiated.

title: Association between dietary behavior and risk of hypertension among Japanese male workers
abstract: Dietary behavior can worsen or prevent hypertension. However, data on the association between dietary behavior and the risk of hypertension in Asians are limited. The aim of this study was to determine these associations in Japanese male workers. We conducted a prospective study of 30–71-year-old Japanese male workers in Osaka, Japan, between 2001 and 2011. The study subjects were 3486 normotensive males who were assessed for an average of 4.6 years using an annual survey. We defined hypertension by a systolic blood pressure of ⩾140 mm Hg, a diastolic blood pressure of ⩾90 mm Hg and/or the use of antihypertensive medications. Dietary behavior questionnaires were included in the annual surveys. For each question on dietary behavior, we calculated the odds ratios (ORs) for the risk of hypertension using logistic regression models. We used subjects who consistently gave affirmative answers in the baseline and end-point surveys as a reference. The number of new cases of hypertension was 846 among 3486 subjects. Compared with subjects who eat meat frequently, subjects who did not eat meat frequently showed a higher risk of hypertension (OR=1.26, 95% confidence interval (CI): 1.00–1.59). Subjects who did not consume dairy products every day showed a higher risk of hypertension (OR=1.39, 95% CI: 1.13–1.71) compared with those who did. Meat and dairy product intake was associated with the prevention of hypertension among Japanese male workers.

title: Diet and benign prostatic hyperplasia: a study in Greece.
abstract: To evaluate the nutritional etiology of benign prostatic hyperplasia (BPH) by conducting a case-control study in Athens, Greece. Despite the high morbidity and substantial human suffering produced by BPH, little research has been undertaken concerning the nutritional etiology of this disease.



The study sample consisted of 184 patients with histologically confirmed BPH and 246 control patients without clinical evidence of prostate disease. All patients and controls were permanent residents of the greater Athens area. The data were modeled through unconditional logistic regression.



Among the food groups, fruits were inversely related to BPH risk, with a logistic regression-derived odds ratio of 0.79 per quintile increase and 95% confidence interval 0.67 to 0.93. Increased consumption of both butter and margarine was positively associated with BPH risk, and a marginally significant positive association was also evident for seed oils. No overall association was found with respect to consumption of olive oil. In analyses evaluating the role of nutrients rather than foods, zinc, an element selectively concentrated in the prostate gland, was significantly positively associated with BPH risk.



Our study provides evidence that, among added lipids, butter and margarine may increase the risk of BPH, and fruit intake may reduce this risk. Dietary zinc may play an important role in the etiology of BPH.

title: Pathology of benign prostatic hyperplasia
abstract: The epidemiology of benign prostatic hyperplasia (BPH) is complex and not fully understood. The androgenic hormones testosterones and dihydrotestosterone play at least a permissive and important role. Growth factors and other hormones including estrogens may also play a role. BPH is a truely hyperplastic process resulting in growth of glandular-epithelial and stromal/muscle tissue in the prostate, leading to often measurable growth taking on different shapes and configurations which may impact symptoms and secondary outcomes. It is important to recognize that BPH is a histological conditions, which is one but not the only cause of lower urinary tract symptoms, and may or may not be associated with prostate enlargement and bladder outlet obstruction. Recognizing the different entities and determining their presence in individual patients may help with therapeutic decision making.

title: Eating vegetables before carbohydrates improves postprandial glucose excursions
abstract: Large fluctuations in blood glucose are reported to promote the micro- and macrovascular complications associated with Type 2 diabetes. Postprandial plasma glucose and glycaemic spikes are more strongly associated with atherosclerosis than fasting plasma glucose or HbA1c level 1. Therefore, safe and effective interventions, including diet, are needed to reduce glycaemic variability and minimize hypoglycaemic events. The continuous glucose monitoring system is capable of detecting hypoglycaemia and hyperglycaemia that may be undetectable by self monitoring blood glucose and HbA1c 2. In particular, the mean amplitude of glycaemic excursions is a significant determinant of overall metabolic control, as well as increased risk of diabetes complications. 
 
We reported acute effects of eating vegetables before carbohydrates on postprandial glucose and insulin levels 3 and the long-term glycaemic improvements in patients with Type 2 diabetes 4. The method of the education included nutritional advice given in the form of a simple and easy meal plan of eating vegetables before carbohydrates. In order to reduce postprandial hyperglycaemia, patients were encouraged to consume every meal by eating vegetables prior to carbohydrates. In this study we evaluated whether eating vegetables before carbohydrates could reduce the daily postprandial glucose excursions assessed by continuous glucose monitoring system in Japanese patients with Type 2 diabetes and subjects with normal glucose tolerance. 
 
Consecutive patients with Type 2 diabetes were recruited among outpatients regularly attending a diabetes clinic, the Kajiyama Clinic located in Kyoto, Japan, from 2011 to 2012. Diagnosis of diabetes was made according to the World Health Organization criteria. Confirmation of normal glucose tolerance was based on fasting blood glucose < 5.6 mmol/l and 2-h glucose concentration in an oral glucose tolerance test < 7.8 mmol/l. All participants were assigned to perform the continuous glucose monitoring system (CGMS, Medtronic Minimed Gold; Medtronic Minimed, Northridge, CA, USA) for 72 h by eating test meals of vegetables before carbohydrates and carbohydrates before vegetables on the 2nd and the 3rd day in a randomized crossover design. The test meals consisted of rice/bread, meat/fish and 500 g of vegetables, and contained 21 g of dietary fibre and 125.6 kJ kg−1 per day. The energy ratio of protein, fat and carbohydrates was 17, 25 and 58%, respectively. The subjects ate the first dish of vegetables for 5 min, then the main dishes, and consumed rice or bread with a 10-min interval between vegetables and carbohydrates in each meal, and then vice versa. 
 
The glucose fluctuations were assessed by the following parameters obtained from the continuous glucose monitoring system and compared between the day of eating vegetables before carbohydrates and the day of eating the carbohydrates before the vegetables: the mean plasma glucose, standard deviation (sd), mean amplitude of glycaemic excursions and the largest amplitude of glycaemic excursions, postprandial plasma glucose, incremental area under the curve 0–3h (IAUC0–3h), and incremental glucose peak. 
 
Nineteen outpatients with Type 2 diabetes [men/women 6/13; age 65.5 ± 9.4 years, duration of diabetes 16.4 ± 10.2 years; BMI 22.5 ± 3.1 kg/m2; HbA1c 55.0 ± 10.9 mmol/mol (7.2 ± 1.0%); fasting plasma glucose 8.06 ± 2.67 mmol/l, diet/oral hypoglycaemic agents/insulin + oral hypoglycaemic agents 3/3/13; mean ± sd or n] and 21 subjects with normal glucose tolerance [men/women 2/19; age 29.8 ± 11.3 years; BMI 20.8 ± 3.0 kg/m2; HbA1c 36.0 ± 6.6 mmol/mol (5.4 ± 0.6%); fasting plasma glucose 4.89 ± 0.50 mmol/l] were enrolled in the study. The levels of standard deviation, mean amplitude of glycaemic excursions, largest amplitude of glycaemic excursions, 1-h postprandial plasma glucose of breakfast, IAUC0–3h of lunch and dinner, mean IAUC0–3h and incremental glucose peak were significantly reduced when the participants ate vegetables before carbohydrates compared with the reverse regimen in both subjects with Type 2 diabetes and those with normal glucose tolerance; however, the values of mean plasma glucose were not different in either of the subject groups (Table 1). Two-hour postprandial plasma glucose levels of lunch and dinner, and IAUC0–3h of breakfast were also significantly reduced in patients with Type 2 diabetes, while 1-h postprandial plasma glucose levels of lunch and dinner were significantly decreased in subjects with normal glucose tolerance. The reason for the reduction of postprandial plasma glucose levels by eating vegetables before carbohydrates can be explained, partly, by the dietary fibre content in the vegetables taken before the carbohydrates. Dietary carbohydrates consumed after vegetables were digested slowly and required less insulin for subsequent metabolic disposal 5. Other factors may influence the glycaemic response and digestion of carbohydrates in the small intestine, including the rate of digestion, cooking method, transit time and rate of intestinal absorption. Vegetables given before carbohydrates might stimulate incretin hormone secretion, which leads to the reduction in glycaemic excursions 6. 
 
 
 
Table 1 
 
Characteristics of glycaemic excursion in subjects with Type 2 diabetes and normal glucose tolerance 
 
 
 
In this study, we demonstrated that eating vegetables before carbohydrates reduced the postprandial glucose excursions compared with the reverse regimen in both subjects with Type 2 diabetes and those with normal glucose tolerance using continuous glucose monitoring system for the first time. The result of this study is important because eating vegetables before carbohydrates could be a novel method to reduce the incidence of cardiovascular disease 7–10. As one of the educational points in nutrition, the advice to patients with Type 2 diabetes should be to eat vegetables before carbohydrates, and this advice could even be applicable to healthy subjects in order to prevent future cardiovascular events.

title: Meal-Generated Oxidative Stress in Type 2 Diabetic Patients
abstract: Free radical production has been reported to be increased in diabetic patients and to be involved in the pathogenesis of diabetic complications. In this study, a standardized meal was administered to 10 type 2 diabetic patients and 10 healthy matched normal subjects to evaluate its effects on plasma oxidative stress generation.  In diabetic patients, at baseline and after the meal, plasma malondialdehyde (MDA), vitamin C, protein SH groups, uric acid, vitamin E, and total plasma radical-trapping parameter, which evaluates plasma antioxidant capacity due to known and unknown antioxidants present in the plasma as well as their mutual cooperation, were measured.  After the meal, plasma MDA and vitamin C increased, while protein SH groups, uric acid, vitamin E, and total plasma radical-trapping parameter decreased more significantly in the diabetic subjects than in control subjects.  This finding shows that in the absorptive phase, free radicals are produced in diabetic patients. Since plasma glucose, but not insulin, rose significantly more in diabetic subjects than in control subjects, hyperglycemia may play an important role in the generation of postprandial oxidative stress in diabetic patients.

title: Fruit and vegetable intake and risk of total cancer and cardiovascular disease: Japan Public Health Center-Based Prospective Study.
abstract: Few studies have investigated the effects of fruit and vegetables on the risk of both cancer and cardiovascular disease (CVD). The authors examined associations between fruit and vegetable consumption and risk of total cancer and CVD in the same Japanese population.  During as many as 459,320 person-years of follow-up until the end of 2002, 3,230 cancer cases and 1,386 CVD cases were identified. Higher consumption of fruit, but not vegetables, was associated with significantly lower risk of CVD: multivariate hazard ratios for the highest versus lowest quartiles of intake were 0.81 (95% confidence interval (CI): 0.67, 0.97; trend p = 0.01) for fruit and 0.97 (95% CI: 0.82, 1.15; trend p = 0.66) for vegetables. Consumption of fruit or vegetables was not associated with decreased risk of total cancer: corresponding hazard ratios were 1.02 (95% CI: 0.90, 1.14; trend p = 0.95) for fruit and 0.94 (95% CI: 0.84, 1.05; trend p = 0.16) for vegetables. This prospective cohort study demonstrated that, in the Japanese population, consumption of fruit is associated with lower risk of CVD, whereas fruit or vegetables may not be associated with lower risk of total cancer.

title: Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study.
abstract: Epidemiologic studies report inconsistent findings on the association of fruit and vegetable intake with the risk of cardiovascular disease.



The objective was to examine the relation between fruit and vegetable intake and the risk of cardiovascular disease.



We studied 9608 adults aged 25-74 y participating in the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study and free of cardiovascular disease at the time of their baseline examination between 1971 and 1975. Fruit and vegetable intake at baseline was measured with a food-frequency questionnaire. The incidence of and mortality from cardiovascular disease were obtained from medical records and death certificates.



Over an average of 19 y, 888 strokes (218 fatal), 1786 ischemic heart disease events (639 fatal), 1145 cardiovascular disease deaths, and 2530 all-cause deaths were documented. Consuming fruit and vegetables > or = 3 times/d compared with <1 time/d was associated with a 27% lower stroke incidence [relative risk (RR): 0.73; 95% CI: 0.57, 0.95; P for trend = 0.01), a 42% lower stroke mortality (0.58; 0.33, 1.02; P for trend = 0.05), a 24% lower ischemic heart disease mortality (0.76; 0.56, 1.03; P for trend = 0.07), a 27% lower cardiovascular disease mortality (0.73; 0.58, 0.92; P for trend = 0.008), and a 15% lower all-cause mortality (0.85; 0.72, 1.00; P for trend = 0.02) after adjustment for established cardiovascular disease risk factors.



We showed an inverse association of fruit and vegetable intake with the risk of cardiovascular disease and all-cause mortality in the general US population.

title: The international prostate symptom score overestimates nocturia assessed by frequency-volume charts.
abstract: We analyzed differences in nocturia, as estimated by the International Prostate Symptom Score and 7-day frequency-volume charts.



A total of 398 forms were collected from 500 consecutive urological outpatients willing to record a 7-day frequency-volume chart. All patients completed a general questionnaire, an International Prostate Symptom Score, and a bladder symptom and bother score. Missed recordings were indicated by a coded letter. Patients who lacked essential data, bedtimes or an International Prostate Symptom Score, or who recorded the frequency-volume chart for less than 5 days were excluded from study.



A total of 186 men and 115 women with a mean age of 56 years were evaluable. In 10.6% of patients no nocturia occurred. Of those with nocturia 70% and 34% experienced nocturia a mean of 1 or more and 2 or more times, respectively. In 43% of patients the International Prostate Symptom Score equaled calculated categorized nocturia while 50% had a higher International Prostate Symptom Score nocturia score than calculated nocturia. On univariate analysis the correlation of International Prostate Symptom Score question 7 with mean nocturia increased with frequency-volume chart duration (day 1 r = 0.52 to day 3 r = 0.63). On longer duration frequency-volume charts the correlation showed no further increase. Multivariate regression analysis revealed that the nocturia score was determined by mean nocturia in the frequency-volume chart, the nocturia bother score and patient age.



The International Prostate Symptom Score nocturia score overestimated nocturia in most patients, as derived from a 7-day frequency-volume chart. When scoring International Prostate Symptom Score nocturia question 7, patients included a degree of bother. The correlation of question 7 with mean nocturia increased with frequency-volume chart duration until day 3.

title: Daily salt intake is an independent risk factor for pollakiuria and nocturia
abstract: To clarify the relationships between daily salt intake and lower urinary tract symptoms.