Japanese Dietary Pattern and All‐Cause and Cardiovascular Disease Mortality Across Diverse Topographical Settings: The Japan Collaborative Cohort Study

Figures

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  FIGURE 1. Flowchart of the participant selection process. Flow of participants from initial enrolment to the final analytic cohort, including inclusion and exclusion criteria. JDI‐8, Japanese Diet Index 8.

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  FIGURE 2. Proportion of participants above the sex‐specific median for each JDI‐8 component by residential area. (A) Bar chart showing the proportion of participants with intake above the sex‐specific median for each JDI‐8 component, stratified by residential area. (B) Heatmap displaying the percentage point difference compared with mountainous areas. Positive values (green) indicate higher proportions than mountainous areas; negative values (red) indicate lower proportions. Urban residents had notably lower proportions for miso soup (−19.1 percentage points), fish (−9.6), and rice (−11.1), while coastal residents showed higher proportions for fish (+4.1) and green and yellow vegetables (+14.7) but lower for pickles (−13.9). JDI‐8, Japanese Diet Index 8.

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  FIGURE 3. Associations between quartiles of the JDI‐8 score and mortality from all causes and cardiovascular disease. HRs and 95% CIs were estimated using shared frailty Cox proportional hazards models with a random intercept for municipality (33 municipalities) to account for within‐area clustering. Residential area (coastal, urban inland, flat/intermediate inland, mountainous inland) was included as a fixed effect. Results were obtained from multiple imputation (20 datasets, pooled by Rubin's rules). p for trend was calculated by assigning integer values (1–4) to the quartiles and modeling the variable as continuous. Quartile 1 (Q1) is the reference group. Models were adjusted for age, sex, total energy intake, body mass index (< 18.5, 18.5–24.9, and ≥ 25.0 kg/m2), smoking status (current, former, never), alcohol consumption (current, former, and never), sleep duration (< 5, 5, 6, 7, 8, 9, and ≥ 10 h/day), education level (age at last graduation: < 15, 15–18, and ≥ 19 years), employment status (regular employment, part‐time, self‐employed, homemaker, unemployed, and other), marital status (married, widowed, divorced, single), participation in sports (≥ 5, 3–4, 1–2 h/week, and none),…

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  FIGURE 4. Associations between quartiles of the JDI‐8 score and mortality stratified by residential area. HRs and 95% CIs were estimated using shared frailty Cox proportional hazards models with a random intercept for municipality within each residential area stratum. Results were obtained from multiple imputation (20 datasets, pooled by Rubin's rules). Quartile 1 (Q1) is the reference group within each stratum. p for interaction was calculated using a likelihood ratio test comparing shared frailty models with and without the cross‐product terms between JDI‐8 quartiles and residential area. p for trend was calculated by assigning integer values (1–4) to the quartiles and modeling the variable as continuous within each stratum. Models were adjusted for the same covariates as in Figure 3, excluding residential area. Residential areas were classified based on the National Land Numerical Information C23 Coastline Dataset and the Ministry of Agriculture, Forestry and Fisheries Agricultural Area Typology (see Section 2). CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; JDI‐8, Japanese Diet Index 8.