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The Hekinan Children's Study

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The Hekinan Children's Study Journal of Epidemiology Original Article J Epidemiol 2019;29(7):272-277 The Hekinan Children’s Study: Design and Profile of Participants at Baseline Chisato Nagata1, Keiko Wada1, Yukari Sahashi1, Takashi Tamura1,2, Kie Konishi1, Yuko Goto1, Michiyo Yamakawa1, Sachi Koda1, Fumi Mizuta1, Takahiro Uji1, Kozue Nakamura1,3, Michiko Tsuji1,4, Hideshi Nagai5, Naoko Itakura5, Kou Harada5, Osamu Takahara5, and Hiromichi Yamanaka5 1Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan 2Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan 3Department of Food and Nutrition, Gifu City Women’s College, Gifu, Japan 4Department of Food Science and Nutrition, Nagoya Women’s University, Nagoya, Japan 5Hekinan Medical Association, Hekinan, Aichi, Japan Received January 27, 2018; accepted June 24, 2018; released online October 20, 2018 ABSTRACT Background: The early life environment is now recognized as a key factor contributing to susceptibility to certain diseases in later life. Methods: We initiated a cohort study among school children in 2011 to primarily investigate the associations between lifestyle and environmental factors and some surrogate markers of chronic diseases, such as cardiometabolic risk factors (ie, obesity, high blood pressure, high blood glucose, insulin, or lipids) and cancer risk factors (ie, height and age at menarche). A baseline questionnaire asked for information, including demographic variables, medical history and use of medication, dietary habits, physical activity, sleep habits, and behavioral and emotional problems of children. Follow-up surveys are planned for the fourth grade of elementary school and the first grade of junior high school. At these follow-up surveys, fasting blood samples will be obtained to measure cardiometabolic markers. We also checked the validity of a food frequency questionnaire, which was originally created for 6-year-olds but was modified for use in older children. Results: A total of 3,141 first-year students at elementary schools in Hekinan City, Aichi Prefecture, participated in the study. The response rate was 87.4%. The means of age and body mass index were 6.99 (standard deviation, 0.28) years and 15.3 (standard deviation, 1.7) kg=m2, respectively, in the 3,067 Japanese children (1,639 boys and 1,428 girls). Conclusions: This cohort will reveal determinants of cardiometabolic risk factors and cancer risk factors during childhood. Key words: profile; school children; cohort studies; Japan Copyright © 2018 Chisato Nagata et al. This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. menarche for breast cancer.11 Child cohort studies can have INTRODUCTION advantages because they can capture such surrogate endpoints in Chronic lifestyle-related diseases, such as cardiovascular diseases early life. To date, epidemiologic research has focused primarily and cancer, are major causes of death among Japanese. The early on adult populations. Several child cohort studies are now life environment is now recognized as a key factor contributing to ongoing in Japan.12–19 However, the accumulating evidence for susceptibility to these diseases later in life.1,2 This hypothesis has the role of early life exposures is still insufficient. In particular, proven difficult to test, as disease outcomes occur decades later. dietary intake has not been commonly assessed in previous cohort However, the use of proxy outcomes that lie on the causal studies, probably because there are few questionnaires validated pathway linking an exposure to the risk of the diseases could for use among Japanese children.20,21 We launched the Hekinan potentially identify important predictors or determinants of later Children’s Health Study in 2011 to primarily investigate the health and disease.3 Several epidemiologic studies have shown associations between lifestyle and environmental factors and that the atherosclerotic process begins in childhood, and surrogate markers of chronic diseases, such as cardiometabolic individual cardiovascular risk factors, such as obesity, blood risk factors and cancer risk factors, among school children in pressure, blood lipid, and glucose levels, tend to persist over time Hekinan City, Aichi Prefecture. Our study pays special attention from childhood to adulthood.4–8 Established risk factors for to the potential role of diet as a determinant of these surrogate certain cancers emerge in the early stages of life: for example, endpoints. As secondary endpoints, we include allergies, pubertal height for colorectal,9 breast,9 and prostate10 cancers and age at development, myopia, back and neck pain, and other health Address for correspondence. Chisato Nagata, Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan (e-mail: [email protected]). DOI https://doi.org/10.2188/jea.JE20180005 272 HOMEPAGE http://jeaweb.jp/english/journal/index.html Nagata C, et al. conditions. As lifestyles, including eating behaviors, are thought noon, from noon until 6 pm, and after 6 pm the child spent to track across childhood and into adulthood,22,23 we also playing in the yard or street around the house and in the park assessed changes in environmental and lifestyle behaviors, as and playground or outdoor recreation area. These questions were well as surrogate markers, during follow-up. Here, we describe asked for both weekday and weekend activities. Playtime the study’s design and the profile of participants at the study’s categories (0, 1–15, 16–30, 31–60, or ≥61 minutes) were baseline. An additional aim of the present study is to validate provided as response options for each question. They were a food frequency questionnaire (FFQ) for use in follow-up on scored as 0 for 0 minutes to 4 for ≥60 minutes, and the sum of participants’ diet. these scores was regarded as the physical activity score (the maximum score was 40). The details, including reproducibility, have been described elsewhere.27 Information regarding the METHODS child’s participation in organized sports, games, and other Study participants activities supervised by adults was also sought. Parents were We recruited a cohort that consists of first-year students at asked to identify each organized physical activity in which the elementary schools in Hekinan City, Aichi Prefecture. Hekinan child was involved, the average number of times per week the City is located in central Aichi Prefecture and is within 40 km of child participated, and the average duration of participation. Nagoya City. As of March 2010, the population was 72,018, and These questions were adapted from the questionnaire by Booth 4.3% of workers were employed in primary industries, 47.1% in et al.28 Time spent in moderate-to-vigorous physical activity secondary industries, and 45.1% in tertiary industries. Hekinan (METs ≥3.0) was calculated for each child. Each child’s City has the relatively warm climate (the overall mean behavioral and emotional problems were assessed using a temperature was 16.6°C in 2010). The survey covered all schools Strength and Difficulties Questionnaire.29 (n = 7) in the city. Information sheets and consent forms were Each question was checked for implausible and missing values, distributed to 3,594 parents via the schools, where they were and correct information was sought again from parents whenever informed and invited to let their children participate in the present possible. Parents were also asked to provide their child’s first study. Informed consent was obtained from each parent. The morning void of urine. Urine was collected at home and brought study was approved by the ethics board of the Gifu University to the school on the same day. Urine samples were aliquoted at Graduate School of Medicine. the same day and stored at −80°C until assayed. Biomarkers of passive smoking, vitamins, flavonoids, trace elements, hormones, Baseline survey and antioxidants will be measured using urine samples. The baseline survey was conducted from September 2011 through October 2015. A total of 3,141 students participated in Follow-up surveys the study. The participation rate was 87.4%. The annual response Follow-up surveys are planned for the fourth grade of elementary rates for 2011 through 2015 were 87.4, 83.2%, 89.6%, 89.7%, school and the first grade of junior high school. The second and and 87.0%, respectively. The parents completed a questionnaire third surveys will include anthropometric measurements, blood asking birth size, height, and weight at the 4-month, 1.5-year, and pressure measurements, and fasting blood analysis. Fasting blood 3-year health check-ups provided by the city; number of siblings; samples will be obtained at heath check-ups at the schools, health status, including major diseases and the frequency of aliquoted on the same day, and stored at −80°C until assayed. common colds or fever; use of medication or supplements; use of Follow-up questionnaires will ask questions similar to those on sunscreen; dietary intake and diet behavior; physical activity and the baseline questionnaire; however, some questions will be sedentary behavior; sleep habits; use of cellular phones; and modified, considering the age of the children. For example, behavioral and emotional problems of children. For the common questions assessing physical activity
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