Lucy S. Ito

Dietary Factors and the Risk of Gastric Cancer Among Japanese Women: a Comparison Between the Differentiated and Non-Differentiated Subtypes

PURPOSE Using data from the Hospital-based Epidemiologic Research Program at Aichi Cancer Center (HERPACC), a case-referent study was performed to clarify whether dietary habits differentially impact on the risk of female gastric cancers of different histological subtypes. METHODS The study subjects comprised 508 histologically confirmed female gastric cancer cases (156 differentiated, 352 non-differentiated), identified via hospital cancer registry and surgical records between 1988 to 1998. The referents were 36,490 cancer-free first-visit female outpatients over 30 years old presenting at the center within the same period of time. The odds ratios were estimated by logistic regression analyses and adjusted for potential confounding factors. RESULTS Frequent vegetable and fruit conferred reduced risk of both differentiated and non-differentiated female gastric cancers in similar patterns. In addition, reduced risk was observed for intake of fish and soybean products, particularly for the non-differentiated type. CONCLUSIONS These results suggest that both differentiated and non-differentiated female gastric cancers are preventable by frequent intake of vegetable and fruit, fish and soybean products, suggested to be common protective factors, although the possibility of some variation in the impact of the diet on different histopathological entities needs to be further addressed.

Height, weight, menstrual and reproductive factors and risk of gastric cancer among Japanese postmenopausal women: Analysis by subsite and histologic subtype

To clarify whether reproductive factors have an impact on gastric cancer in Japanese females, a case‐control study was conducted using data from the Hospital‐based Epidemiologic Research Program at Aichi Cancer Center (HERPACC), Japan. The study subjects included 365 postmenopausal women with gastric cancer and 1,825 age‐class frequency‐matched noncancer outpatients presenting at Aichi Cancer Center in 1988–1998. Cases were further divided with regard to the anatomic subsite (upper third, middle third, lower third) and histologic subtypes (differentiated, nondifferentiated) and the association was evaluated using odds ratios (ORs) estimated by the logistic regression model, adjusting for potential confounding factors. A high body weight and corresponding body mass index at age 20 moderately increased the risk of gastric cancer, especially for middle third and nondifferentiated cancers. Risk fluctuation with early or late age at menarche and menopause and total duration of fertility was not consistent. Individuals with a high age at first parity tended to show decreased risk of cancer, irrespective of their subsite or histologic subtype. The ORs were decreased with a short average period of breastfeeding, especially for upper third and nondifferentiated cancers. From these results, however, it appears that height, weight, menstrual and reproductive factors have less impact on gastric cancer than environmental factors such as smoking and dietary habits or family history of gastric cancer.

Lifestyle factors associated with atrophic gastritis among Helicobacter pylori-seropositive Japanese-Brazilians in SÃo Paulo

BackgroundStudies of lifestyle factors related to gastric atrophy development in Helicobacter pylori-infected individuals are limited. The present cross-sectional study aimed to examine the associations between lifestyle factors and serum pepsinogens (PGs) among anti-H. pylori antibody-seropositive Japanese in Brazil, where gastric cancer mortality was reported to be as high as in Japanese in Japan, and seropositive individuals were still frequently detected.MethodsThe subjects were 291 seropositive individuals (129 males and 162 females; age, 30 to 69 years) out of 656 Japanese-Brazilian volunteers in SÃo Paulo city. Information on lifestyle factors was obtained using a self-administered questionnaire. Atrophic gastritis was defined as a PG1 serum level less than 70 ng/ml and PG1/PG2 ratio less than 3.ResultsThe prevalence of atrophic gastritis was 31.9% (95% confidence intervals, 26.6%–37.6%). The proportion of subjects with atrophic gastritis increased with age, but there were no significantly marked differences in the proportions of subjects with atrophic gastritis among the three generations studied (first generation [Issei], second generation [Nisei], and third generation [Sansei]) for any 10-year age group. The associations with smoking and alcohol drinking were not significant. Length of education was inversely associated with gastric atrophy, while infrequent rice intake was preventive; the odds ratio relative to everyday rice intake was 0.13 (95% confidence intervals, 0.39–0.46) on multivariate analysis.ConclusionsThe present study demonstrated that frequent rice intake was a risk factor for atrophic gastritis among the H. pylori-infected Japanese-Brazilians, suggesting that diet including rice plays a role in the step from H. pylori infection to gastric atrophy.

A comparison of the prevalence of the metabolic syndrome and its components among native Japanese and Japanese Brazilians residing in Japan and Brazil.

Background This study investigated the prevalence of risk factors associated with the metabolic syndrome (MetSyn) among individuals of Japanese descent exposed to different cultural environments. Design A cross-sectional study to assess component risk factors for the diagnosis of MetSyn was undertaken in urban areas in Japan and Brazil. A total of 773 men and women aged 35 years or over were included in three groups: 249 native Japanese, 269 Brazilian individuals of Japanese ancestry residing in Japan, and 255 Brazilian individuals of Japanese ancestry residing in Brazil. Results Higher rates of metabolic abnormalities with respect to central obesity and serum lipid profiles were observed among Brazilian individuals of Japanese ancestry residing in Brazil compared with those residing in Japan and native Japanese. Likewise, an increased risk of hypertension was observed among Japanese Brazilian individuals residing in Japan. The prevalence of MetSyn in men was significantly higher among Brazilians of Japanese ancestry residing in Brazil (37.5%) compared with those residing in Japan (25.3%) or native Japanese (21.4%), whereas no significant difference was observed among women. In the logistic model, Brazilian individuals of Japanese ancestry residinginBrazil weretwice as likely to develop MetSyn compared with native Japanese, whereas no significant differences were found among those residing in Japan. Conclusions These findings underscore the significant heterogeneity in risk factors among communities of Japanese ancestry residing in Brazil and Japan, and suggest that immigrants exposed to the Brazilian cultural environment are more susceptible to the development of risk factors associated with MetSyn than native Japanese.

Helicobacter pylori Seropositivity among 963 Japanese Brazilians According to Sex, Age, Generation, and Lifestyle Factors

Seropositivity of anti–Helicobacter pylori antibody (HP+) was examined among Japanese Brazilians. The study was announced through 18 Japanese community culture associations in São Paulo, Curitiba, Mogi das Cruzes, and Mirandopolis in 2001. Among 969 participants, 963 individuals aged 33–69 years were analyzed. The overall HP+% was 48.1% (95% confidence interval, 44.9–51.3%). There was no difference in HP+% between 399 males and 564 females (49.6% and 47.0%, respectively). The HP+% increased with age; 35.3% for those aged 33–39 years, 46.2% for those aged 40–49 years, 46.5% for those aged 50–59 years, and 56.9% for those aged 60–69 years, but no differences were observed among the generations (Issei, Nisei, and Sansei) for each 10–year age group. Mogi das Cruzes, a rural area, showed a higher HP+%. Length of education was inversely associated with the positivity; the odds ratio (OR) relative to those with eight years or less of schooling was 0.61 (0.42–0.89) for those with 12 years or more. The associations with smoking and alcohol drinking were not significant. Fruit intake was associated with the HP+%; the OR relative to everyday intake was 1.38 (1.05–1.83) for less frequent intake, while intake frequencies of green tea, miso soup, and pickled vegetables (tsukemono) were not. Multivariate analysis including sex, 10–year age group, residence, education, and fruit intake showed that all factors except sex were significant. This is the largest study of HP infection among Japanese Brazilians, and the results indicated a similar pattern of age–specific infection rate to that for Japanese in Japan.

Community-based familial study of Helicobacter pylori infection among healthy Japanese Brazilians

BackgroundThe present study of Helicobacter pylori infection was conducted in family units of Japanese Brazilians living in São Paulo city. The authors attempted to determine the seroprevalence of H. pylori infection within family units of Japanese Brazilians and to identify risk factors associated with intrafamilial transmission.MethodsThe seroprevalence was determined in 1037 healthy and asymptomatic volunteer subjects aged 0–69 years (530 adults and 507 children) of 265 families. Demographic data and details of living conditions were obtained from each family.ResultsH. pylori seropositive infection was found in 39.2% of the parents and 9.3% of the children. A reduced risk of H. pylori infection was found for girls (odds ratio [OR] 0.45; 95% confidence interval [CI], 0.23–0.86). The prevalence of infection was 3.5% for children with uninfected parents; 9.9% (OR, 2.51; 95% CI, 0.95–6.61) for those with a seronegative mother and a seropositive father; 14.9% (OR, 4.93; 95% CI, 1.86–13.06) for those with a seropositive mother and a seronegative father; and 16.0% (OR, 5.29; 95% CI, 1.98–14.14) for those with seropositive parents. On multivariate analysis, the use of a pacifier, and mothers symptoms of nausea and vomiting were significantly associated with the risk of H. pylori infection for children, and the child having her/his own room was significantly associated with a reduced risk. Income was not associated with H. pylori infection in children and was inversely associated in parents.ConclusionThe prevalence of H. pylori infection in family units of Japanese Brazilians supports the hypothesis of a predominant role for mother–child transmission of H. pylori infection, mainly through contact with regurgitated gastric juice in the mothers mouth.

Associations of TNF-A-1031TT and -857TT genotypes with Helicobacter pylori seropositivity and gastric atrophy among Japanese Brazilians.

BackgroundOur previous study in a Japanese population showed elevated Helicobacter pylori seropositivity in those with tumor necrosis factor (TNF) A -1031TT and -857TT genotypes. This study examined the associations of this seropositivity and serum pepsinogen (PG) levels with these genotypes in Japanese Brazilians.MethodsThe subjects were 963 individuals (399 males and 564 females), aged 33 to 69 years, from four regions (Sao Paulo, Curitiba, Mogi das Cruzes, and Mirandopolis) in Brazil. Gastric atrophy was evaluated with serum pepsinogens (PGI < 70 ng/dl and PGI/II < 3), and TNF T-1031C and C-857T were genotyped by polymerase chain reaction with confronting two-pair primers (PCR-CTPP).ResultsThe frequency of TNF-A T-1031C was 68.4% TT, 28.4% TC, and 3.3% CC, and that of C-857T was 64.5% CC, 31.7% CT, and 3.8% TT, whose distributions were in Hardy-Weinberg equilibrium. No significant associations of the genotypes with H. pylori seropositivity or gastric atrophy were found. However, male participants with TNF-A -1031CC and -857CC showed the lowest seropositivity (43.8% out of 16), and males with TNF-A -1031TT and -857TT showed the highest (61.5% out of 13).ConclusionThis study demonstrated that the associations between H. pylori seropositivity and TNF-A genotypes were not marked for Japanese Brazilians. The genotypes were not associated with gastric atrophy among the seropositive individuals.

Significant association between PTPN11 polymorphism and gastric atrophy among Japanese Brazilians.

BackgroundHelicobacter pylori, especially the cytotoxin-associated antigen A (cagA)-positive strains, plays a crucial role in the development of gastric atrophy and gastric cancer. CagA delivered into gastric epithelial cells combines with src homology 2 domain-containing protein tyrosine phosphatase-2 (SHP-2), possibly leading to atrophy/cancer. Our previous study found that a single-nucleotide polymorphism (SNP; IMS-JST057927) of the PTPN11 gene encoding SHP-2, was associated with gastric atrophy among H. pylori-seropositive subjects. This study aimed to examine the reproducibility of the association among Japanese residing in a different circumstance.MethodsThe subjects were 918 healthy adult Japanese Brazilians from four different areas in Brazil. Blood was sampled from March to May 2001. The target SNP in intron 3 of PTPN11 was genotyped by polymerase chain reaction with confronting two-pair primers (PCR-CTPP). Gastric atrophy was evaluated with serum pepsinogens (PGs); PG I, less than 70 ng/dl and PG I/II ratio, less than 3.ResultsThe genotype frequency of PTPN11 was in Hardy-Weinberg equilibrium: 65.5% for G/G, 30.4% for G/A, and 4.1% for A/A. The PTPN11 polymorphism had no significant association with H. pylori seropositivity. Among the H. pylori-seropositive subjects, the odds ratios (ORs) of gastric atrophy were 0.93 (95% confidence interval [CI], 0.59–1.47) for the G/A genotype and 0.31 (95% CI, 0.10–0.95) for the A/A genotype, compared with the G/G genotype.ConclusionsThe present study reproduced the significant association between the A/A genotype and reduced risk of gastric atrophy among Japanese outside Japan. According to the Japan Single Nucleotide Polymorphisms (JSNP) database (db)SNP data, the G allele is very frequent among Japanese and rare in Caucasians. This fact may partly explain the distribution of gastric atrophy/cancer in the world.

Association of Lewis and Secretor gene polymorphisms and Helicobacter pylori seropositivity among Japanese-Brazilians.

BackgroundSecretor (Se) and Lewis (Le) genes are involved in the synthesis of Lewis b (Leb) and type I antigens throughout the body, especially in the epithelial cells of gastric mucosa. Helicobacter pylori can attach to the gastric epithelial cells with the blood group antigen-binding adhesin, which binds to Leb or H type I carbohydrate structures. In a previous study, a marked association between H. pylori seropositivity and polymorphism of the Se and Le genes was observed among Japanese outpatients of a gastroenterology clinic. The present work aims to investigate the associations between Se and Le gene polymorphisms and H. pylori infection among Japanese-Brazilians.MethodsThe subjects consisted of 942 healthy volunteer Japanese-Brazilians, who were tested for the presence of anti-H. pylori IgG antibodies and genotyped for Se and Le polymorphisms.ResultsThe sex-age-adjusted odds ratios (aORs) for H. pylori seropositivity were 0.99 for the Sese genotype relative to the SeSe genotype (95% confidence interval [CI], 0.73–1.33), and 1.03 for sese relative to SeSe (95% CI, 0.71–1.48). On the other hand, the aOR for the subjects with the le allele (Lele or lele) relative to the LeLe genotype was 1.48 (95% CI, 1.07–1.79). When the Se and Le genotypes were analyzed in combination according to risk group, no statistically significant association was observed.ConclusionsThese results are inconsistent with previous work and may have been modulated by an external factor or some other unidentified factor. Japanese-Brazilians are genotypically the same as Japanese, but their lifestyle is adapted to that of Brazil. Further investigations are necessary to clarify this influence on susceptibility to H. pylori infection.

Formação pedagógica em Moçambique: a voz dos participantes

portuguesO artigo destaca a voz dos profissionais do setor de saude em Mocambique, no relato das experiencias vividas durante um programa de formacao caracterizado pela abordagem da praxis, formas reflexivas e criticas e acoes autonomas e dialogicas. Por meio da voz dos participantes, investiga-se o impacto desse processo formativo nas mudancas por eles conduzidas em seu pais. O quadro teorico preve analise das mudancas inovadoras efetuadas pelos profissionais, a partir de indicadores (intelectuais, emocionais e de sustentabilidade) propostos por Andy Hargreaves. A escuta dos profissionais subsidia-se nas perspectivas de Larrosa e Contreras, que, ao dar visibilidade a experiencia vivida por cada participante, possibilita a descoberta do que se passa no processo formativo do qual participam. A metodologia de pesquisa privilegia entrevistas semiestruturadas, na forma de depoimentos dos participantes. Tais dados foram colhidos anualmente, em Maputo e Sao Paulo, no periodo de 2012 a 2015, envolvendo vinte profissionais da saude, tres peritos e um coordenador e informacoes de artigos produzidos pela equipe. 105 depoimentos compoem o conjunto dos dados empiricos, analisados conforme criterios de Bardin. Os resultados indicam que os profissionais adquiriram conhecimentos e habilidades no diagnostico e solucao de problemas da realidade mocambicana. As reflexoes acerca da pratica, com autonomia, protagonismo, dialogia e respeito a voz dos outros, evidenciam o reflexo do curso formativo e a construcao da identidade profissional e pessoal que leva ao trabalho colaborativo, na producao de mudancas inovadoras. EnglishThe article highlights the voice of health professionals in Mozambique in their account of experiences during a training programme characterised by the praxis approach, reflexive and critical methods, and autonomic and dialogical actions. The impact of this qualification process on the changes they are conducting in their country is investigated through the voice of the participants. The theoretical framework provides an analysis of the innovative changes made by the professionals, based on indicators (intellectual, emotional and sustainability) proposed by Andy Hargreaves. Listening to the professionals subsidises the perspectives of Larrosa and Contreras, which, by giving visibility to each participant’s experience, enables discovering what occurs in the qualification process they participate in. The research methodology favours semi-structured interviews as participant statements. The data was collected annually in Maputo and Sao Paulo in 2012-2015, involving twenty health professionals, three experts and a coordinator, and information in articles produced by the team. 105 statements comprise the set of empirical data that is analysed according to Bardin criteria. The results indicate that the professionals acquired knowledge and skills in diagnosing and solving problems in the Mozambican reality. Reflections about the practice, with autonomy, protagonism, dialogue and respect for the voice of others, show the reflection of the qualification course and the construction of the professional and personal identity that leads to collaborative work in producing innovative changes.