Abstract
Objective: To examine the association between adherence to the Japanese Food Guide Spinning Top and total and cause specific mortality. Design: Large scale population based prospective cohort study in Japan with follow-up for a median of 15 years. Setting: 11 public health centre areas across Japan. Participants: 36,624 men and 42,970 women aged 45-75 who had no history of cancer, stroke, ischaemic heart disease, or chronic liver disease. Main outcome measures: Deaths and causes of death identified with the residential registry and death certificates. Results: Higher scores on the food guide (better adherence) were associated with lower total mortality; the multivariable adjusted hazard ratios (95% confidence interval) of total mortality for the lowest through highest scores were 1.00, 0.92 (0.87 to 0.97), 0.88 (0.83 to 0.93), and 0.85 (0.79 to 0.91) (P<0.001 for trend) and the multivariable adjusted hazard ratio associated with a 10 point increase in food guide scores was 0.93 (0.91 to 0.95; P<0.001 for trend). This score was inversely associated with mortality from cardiovascular disease (hazard ratio associated with a 10 point increase 0.93, 0.89 to 0.98; P=0.005 for trend) and particularly from cerebrovascular disease (0.89, 0.82 to 0.95; P=0.002 for trend). There was some evidence, though not significant, of an inverse association for cancer mortality (0.96, 0.93 to 1.00; P=0.053 for trend). Conclusion: Closer adherence to Japanese dietary guidelines was associated with a lower risk of total mortality and mortality from cardiovascular disease, particularly from cerebrovascular disease, in Japanese adults.