Advertisement

European Journal of Epidemiology

, Volume 34, Issue 10, pp 917–926 | Cite as

Green tea consumption and mortality in Japanese men and women: a pooled analysis of eight population-based cohort studies in Japan

  • Sarah Krull Abe
  • Eiko Saito
  • Norie Sawada
  • Shoichiro Tsugane
  • Hidemi Ito
  • Yingsong Lin
  • Akiko Tamakoshi
  • Junya Sado
  • Yuri Kitamura
  • Yumi Sugawara
  • Ichiro Tsuji
  • Chisato Nagata
  • Atsuko Sadakane
  • Taichi Shimazu
  • Tetsuya Mizoue
  • Keitaro Matsuo
  • Mariko Naito
  • Keitaro Tanaka
  • Manami InoueEmail author
  • Research Group for the Development and Evaluation of Cancer Prevention Strategies in Japan
META-ANALYSIS

Abstract

The aim of our study was to assess the association between green tea consumption and all-cause and cause-specific mortality in a pooled analysis of eight Japanese population-based cohort studies. Pooled hazard ratios (HR) and 95% confidence intervals (CI), derived from random effects models, were used to evaluate the associations between green tea consumption, based on self-report at baseline, and risk of all-cause and cause-specific mortality. During a mean follow-up of 17.3 years, among 313,381 persons, 52,943 deaths occurred. Compared with individuals who consumed < 1 cup/day, those in the highest consumption category (≥ 5 cups/day) had a decreased risk of all-cause mortality [the multivariate-adjusted HR was 0.90 (95% CI 0.87–0.94) for men and 0.82 (0.74–0.90) for women]. A similar inverse association was observed for heart disease mortality [HR 0.82 (0.75–0.90) for men, and 0.75 (0.68–0.84) for women], and cerebrovascular disease mortality [HR 0.76 (0.68–0.85) for men, and 0.78 (0.68–0.89) for women]. Among women, green tea consumption was associated with decreased risk of total cancer mortality: 0.89 (0.83–0.96) for the 1–2 cups/day category and 0.91 (0.85–0.98) for the 3–4 cups/day category. Results for respiratory disease mortality were [HR 0.75 (0.61–0.94)] among 3–4 cup daily consumers and [HR 0.66 (0.55–0.79)] for ≥ 5 cups/day. Higher consumption of green tea is associated with lower risk for all-cause mortality in Japanese, especially for heart and cerebrovascular disease. Moderate consumption decreased the risk of total cancer and respiratory disease mortality in women.

Keywords

Green tea Mortality Cohort study Pooled analysis Japan 

Abbreviations

JPHC-I

The Japan Public Health Center-based Prospective Study, Cohort I

JPHC-II

The Japan Public Health Center-based Prospective Study, Cohort II

JACC

The Japan Collaborative Cohort Study

MIYAGI

The Miyagi Cohort Study

OHSAKI

The Ohsaki National Health Insurance Cohort Study

3-pref MIYAGI

The Three Prefecture Study—Miyagi portion

3-pref AICHI

The Three Prefecture Study—Aichi portion

3-pref OSAKA

The Three Prefecture Study—Osaka portion

Notes

Author’s contribution

MI designed the research. SKA performed the analyses, prepared the tables and drafted the paper. MI, ES, NS, ST, YL, and AS supported analyses, discussions and finalizing of the paper. HI, YL, AT, JS, YK, YS, IT, CN, TS, TM, KM, MN, and KT provided valuable feedback regarding interpretation of the results. All authors read and approved the final manuscript.

Funding

This study was supported by the National Cancer Center Research and Development Funds (30-A-15, 27-A-4, 24-A-3) and the Health and Labour Sciences Research Grants for the Third Term Comprehensive Control Research for Cancer (H21-3jigan-ippan-003, H18-3jigan-ippan-001, H16-3jigan-010). The funders had no role in the design, data collection, analysis, interpretation or manuscript drafting, or in the decision to submit the manuscript for publication.

Compliance with ethical standards

Conflict of interest

The authors have no potential conflicts of interests.

Supplementary material

10654_2019_545_MOESM1_ESM.docx (38 kb)
Supplementary material 1 (DOCX 39 kb)
10654_2019_545_MOESM2_ESM.png (73 kb)
Supplementary material 2 (PNG 73 kb)
10654_2019_545_MOESM3_ESM.png (75 kb)
Supplementary material 3 (PNG 74 kb)
10654_2019_545_MOESM4_ESM.png (70 kb)
Supplementary material 4 (PNG 70 kb)
10654_2019_545_MOESM5_ESM.png (74 kb)
Supplementary material 5 (PNG 74 kb)
10654_2019_545_MOESM6_ESM.png (72 kb)
Supplementary material 6 (PNG 71 kb)
10654_2019_545_MOESM7_ESM.png (69 kb)
Supplementary material 7 (PNG 68 kb)

References

  1. 1.
    Graham HN. Green tea composition, consumption, and polyphenol chemistry. Prev Med. 1992;21(3):334–50.CrossRefGoogle Scholar
  2. 2.
    Boehm K, Borrelli F, Ernst E, et al. Green tea (Camellia sinensis) for the prevention of cancer. Cochrane Database Syst Rev. 2009;3:CD005004.  https://doi.org/10.1002/14651858.CD005004.pub2.CrossRefGoogle Scholar
  3. 3.
    Iso H, Date C, Wakai K, Fukui M, Tamakoshi A, Group JS. The relationship between green tea and total caffeine intake and risk for self-reported type 2 diabetes among Japanese adults. Ann Intern Med. 2006;144(8):554–62.CrossRefGoogle Scholar
  4. 4.
    Kuriyama S, Shimazu T, Ohmori K, et al. Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki study. JAMA. 2006;296(10):1255–65.  https://doi.org/10.1001/jama.296.10.1255.CrossRefGoogle Scholar
  5. 5.
    Suzuki E, Yorifuji T, Takao S, et al. Green tea consumption and mortality among Japanese elderly people: the prospective Shizuoka elderly cohort. Ann Epidemiol. 2009;19(10):732–9.  https://doi.org/10.1016/j.annepidem.2009.06.003.CrossRefGoogle Scholar
  6. 6.
    Tang J, Zheng JS, Fang L, Jin Y, Cai W, Li D. Tea consumption and mortality of all cancers, CVD and all causes: a meta-analysis of eighteen prospective cohort studies. Br J Nutr. 2015;114(5):673–83.  https://doi.org/10.1017/S0007114515002329.CrossRefPubMedGoogle Scholar
  7. 7.
    Zhang C, Qin YY, Wei X, Yu FF, Zhou YH, He J. Tea consumption and risk of cardiovascular outcomes and total mortality: a systematic review and meta-analysis of prospective observational studies. Eur J Epidemiol. 2015;30(2):103–13.  https://doi.org/10.1007/s10654-014-9960-x.CrossRefGoogle Scholar
  8. 8.
    Arab L, Khan F, Lam H. Tea consumption and cardiovascular disease risk. Am J Clin Nutr. 2013;98(6 Suppl):1651S–9S.  https://doi.org/10.3945/ajcn.113.059345.CrossRefPubMedGoogle Scholar
  9. 9.
    Larsson SC. Coffee, tea, and cocoa and risk of stroke. Stroke. 2014;45(1):309–14.  https://doi.org/10.1161/STROKEAHA.113.003131.CrossRefPubMedGoogle Scholar
  10. 10.
    Johnson R, Bryant S, Huntley AL. Green tea and green tea catechin extracts: an overview of the clinical evidence. Maturitas. 2012;73(4):280–7.  https://doi.org/10.1016/j.maturitas.2012.08.008.CrossRefPubMedGoogle Scholar
  11. 11.
    Eisenstein M. Tea’s value as a cancer therapy is steeped in uncertainty. Nature. 2019;566(7742):S6.CrossRefGoogle Scholar
  12. 12.
    Gao YT, McLaughlin JK, Blot WJ, Ji BT, Dai Q, Fraumeni JF Jr. Reduced risk of esophageal cancer associated with green tea consumption. J Natl Cancer Inst. 1994;86(11):855–8.CrossRefGoogle Scholar
  13. 13.
    Zhong L, Goldberg MS, Gao YT, Hanley JA, Parent ME, Jin F. A population-based case-control study of lung cancer and green tea consumption among women living in Shanghai, China. Epidemiology. 2001;12(6):695–700.CrossRefGoogle Scholar
  14. 14.
    Ishikawa A, Kuriyama S, Tsubono Y, et al. Smoking, alcohol drinking, green tea consumption and the risk of esophageal cancer in Japanese men. J Epidemiol Jpn Epidemiol Assoc. 2006;16(5):185–92.CrossRefGoogle Scholar
  15. 15.
    Wang JM, Xu B, Rao JY, Shen HB, Xue HC, Jiang QW. Diet habits, alcohol drinking, tobacco smoking, green tea drinking, and the risk of esophageal squamous cell carcinoma in the Chinese population. Eur J Gastroenterol Hepatol. 2007;19(2):171–6.  https://doi.org/10.1097/MEG.0b013e32800ff77a.CrossRefPubMedGoogle Scholar
  16. 16.
    Wang M, Guo C, Li M. A case-control study on the dietary risk factors of upper digestive tract cancer. Zhonghua Liu Xing Bing Xue Za Zhi. 1999;20(2):95–7.PubMedGoogle Scholar
  17. 17.
    Inoue M, Tajima K, Hirose K, et al. Tea and coffee consumption and the risk of digestive tract cancers: data from a comparative case-referent study in Japan. Cancer Causes Control. 1998;9(2):209–16.CrossRefGoogle Scholar
  18. 18.
    Mu LN, Zhou XF, Ding BG, et al. A case-control study on drinking green tea and decreasing risk of cancers in the alimentary canal among cigarette smokers and alcohol drinkers. Zhonghua Liu Xing Bing Xue Za Zhi. 2003;24(3):192–5.PubMedGoogle Scholar
  19. 19.
    Saito E, Inoue M, Sawada N, et al. Association of green tea consumption with mortality due to all causes and major causes of death in a Japanese population: the Japan Public Health Center-based Prospective Study (JPHC Study). Ann Epidemiol. 2015;25(7):512–518e3.  https://doi.org/10.1016/j.annepidem.2015.03.007.CrossRefGoogle Scholar
  20. 20.
    Sasazuki S, Inoue M, Shimazu T, et al. Evidence-based cancer prevention recommendations for Japanese. Jpn J Clin Oncol. 2018;48(6):576–86.  https://doi.org/10.1093/jjco/hyy048.CrossRefPubMedGoogle Scholar
  21. 21.
    Tsugane S, Sawada N. The JPHC study: design and some findings on the typical Japanese diet. Jpn J Clin Oncol. 2014;44(9):777–82.  https://doi.org/10.1093/jjco/hyu096.CrossRefPubMedGoogle Scholar
  22. 22.
    Tamakoshi A, Yoshimura T, Inaba Y, et al. Profile of the JACC study. J Epidemiol Jpn Epidemiol Assoc. 2005;15(Suppl 1):S4–8.CrossRefGoogle Scholar
  23. 23.
    Tsuji I, Nishino Y, Tsubono Y, et al. Follow-up and mortality profiles in the Miyagi Cohort Study. J Epidemiol Jpn Epidemiol Assoc. 2004;14(Suppl 1):S2–6.CrossRefGoogle Scholar
  24. 24.
    Tsuji I, Takahashi K, Nishino Y, et al. Impact of walking upon medical care expenditure in Japan: the Ohsaki Cohort Study. Int J Epidemiol. 2003;32(5):809–14.  https://doi.org/10.1093/ije/dyg189.CrossRefPubMedGoogle Scholar
  25. 25.
    Sado J, Kitamura T, Kitamura Y, et al. Rationale, design, and profile of the Three-Prefecture Cohort in Japan: a 15-year follow-up. J Epidemiol Jpn Epidemiol Assoc. 2017;27(4):193–9.  https://doi.org/10.1016/j.je.2016.05.003.CrossRefGoogle Scholar
  26. 26.
    Tsubono Y, Nishino Y, Komatsu S, et al. Green tea and the risk of gastric cancer in Japan. N Engl J Med. 2001;344(9):632–6.  https://doi.org/10.1056/NEJM200103013440903.CrossRefPubMedGoogle Scholar
  27. 27.
    Tsubono Y, Kobayashi M, Sasaki S, Tsugane S, JPHC. Validity and reproducibility of a self-administered food frequency questionnaire used in the baseline survey of the JPHC Study Cohort I. J Epidemiol Jpn Epidemiol Assoc. 2003;13(1 Suppl):S125–33.  https://doi.org/10.2188/jea.13.1sup_125.CrossRefGoogle Scholar
  28. 28.
    Inoue M, Kurahashi N, Iwasaki M, et al. Effect of coffee and green tea consumption on the risk of liver cancer: cohort analysis by hepatitis virus infection status. Cancer Epidemiol Biomarkers Prev. 2009;18(6):1746–53.  https://doi.org/10.1158/1055-9965.EPI-08-0923.CrossRefPubMedGoogle Scholar
  29. 29.
    Ogawa K, Tsubono Y, Nishino Y, et al. Validation of a food-frequency questionnaire for cohort studies in rural Japan. Public Health Nutr. 2003;6(2):147–57.  https://doi.org/10.1079/PHN2002411.CrossRefPubMedGoogle Scholar
  30. 30.
    Kashino I, Akter S, Mizoue T, et al. Coffee drinking and colorectal cancer and its subsites: a pooled analysis of 8 cohort studies in Japan. Int J Cancer. 2018;143(2):307–16.  https://doi.org/10.1002/ijc.31320.CrossRefPubMedGoogle Scholar
  31. 31.
    World Health Organization. International statistical classification of diseases and related health problems. 10th Revision. Geneva: WHO; 1992.Google Scholar
  32. 32.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.CrossRefGoogle Scholar
  33. 33.
    Mineharu Y, Koizumi A, Wada Y, et al. Coffee, green tea, black tea and oolong tea consumption and risk of mortality from cardiovascular disease in Japanese men and women. J Epidemiol Community Health. 2011;65(3):230–40.  https://doi.org/10.1136/jech.2009.097311.CrossRefGoogle Scholar
  34. 34.
    Saito E, Inoue M, Tsugane S, et al. Smoking cessation and subsequent risk of cancer: a pooled analysis of eight population-based cohort studies in Japan. Cancer Epidemiol. 2017;51:98–108.  https://doi.org/10.1016/j.canep.2017.10.013.CrossRefPubMedGoogle Scholar
  35. 35.
    Iwasaki M. Commentary: factors associated with non-participation in cohort studies emphasize the need to generalize the results with care. J Epidemiol Jpn Epidemiol Assoc. 2015;25(2):89–90.  https://doi.org/10.2188/jea.JE20140269.CrossRefGoogle Scholar
  36. 36.
    Iwasaki M, Yamamoto S, Otani T, et al. Generalizability of relative risk estimates from a well-defined population to a general population. Eur J Epidemiol. 2006;21(4):253–62.  https://doi.org/10.1007/s10654-006-0004-z.CrossRefPubMedGoogle Scholar
  37. 37.
    Sugiyama K, Kuriyama S, Akhter M, et al. Coffee consumption and mortality due to all causes, cardiovascular disease, and cancer in Japanese women. J Nutr. 2010;140(5):1007–13.  https://doi.org/10.3945/jn.109.109314.CrossRefPubMedGoogle Scholar
  38. 38.
    Tamakoshi A, Lin Y, Kawado M, et al. Effect of coffee consumption on all-cause and total cancer mortality: findings from the JACC study. Eur J Epidemiol. 2011;26(4):285–93.  https://doi.org/10.1007/s10654-011-9548-7.CrossRefPubMedGoogle Scholar
  39. 39.
    Cui R, Iso H, Eshak ES, Maruyama K, Tamakoshi A, Group JS. Water intake from foods and beverages and risk of mortality from CVD: the Japan Collaborative Cohort (JACC) Study. Public Health Nutr. 2018;21(16):3011–7.  https://doi.org/10.1017/S1368980018001386.CrossRefPubMedGoogle Scholar
  40. 40.
    Tani Y, Asakura K, Sasaki S, et al. The influence of season and air temperature on water intake by food groups in a sample of free-living Japanese adults. Eur J Clin Nutr. 2015;69(8):907–13.  https://doi.org/10.1038/ejcn.2014.290.CrossRefPubMedGoogle Scholar
  41. 41.
    Zhao LG, Li HL, Sun JW, et al. Green tea consumption and cause-specific mortality: results from two prospective cohort studies in China. J Epidemiol Jpn Epidemiol Assoc. 2017;27(1):36–41.  https://doi.org/10.1016/j.je.2016.08.004.CrossRefGoogle Scholar
  42. 42.
    Liu J, Liu S, Zhou H, et al. Association of green tea consumption with mortality from all-cause, cardiovascular disease and cancer in a Chinese cohort of 165,000 adult men. Eur J Epidemiol. 2016;31(9):853–65.  https://doi.org/10.1007/s10654-016-0173-3.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Wang H, Provan G, Helliwell K. The functional benefits of flavonoids: the case of tea. In: Johnson I, Williamson G, editors. Phytochemical funtional foods. Cambridge: Woodhead Publishing; 2003.Google Scholar
  44. 44.
    Schneider C, Segre T. Green tea: potential health benefits. Am Fam Physician. 2009;79(7):591–4.PubMedGoogle Scholar
  45. 45.
    Nagao T, Hase T, Tokimitsu I. A green tea extract high in catechins reduces body fat and cardiovascular risks in humans. Obesity (Silver Spring). 2007;15(6):1473–83.  https://doi.org/10.1038/oby.2007.176.CrossRefGoogle Scholar
  46. 46.
    Zheng XX, Xu YL, Li SH, Liu XX, Hui R, Huang XH. Green tea intake lowers fasting serum total and LDL cholesterol in adults: a meta-analysis of 14 randomized controlled trials. Am J Clin Nutr. 2011;94(2):601–10.  https://doi.org/10.3945/ajcn.110.010926.CrossRefGoogle Scholar
  47. 47.
    Zheng XX, Xu YL, Li SH, Hui R, Wu YJ, Huang XH. Effects of green tea catechins with or without caffeine on glycemic control in adults: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2013;97(4):750–62.  https://doi.org/10.3945/ajcn.111.032573.CrossRefPubMedGoogle Scholar
  48. 48.
    Zucchi R, Ronca-Testoni S. The sarcoplasmic reticulum Ca2+ channel/ryanodine receptor: modulation by endogenous effectors, drugs and disease states. Pharmacol Rev. 1997;49(1):1–51.PubMedGoogle Scholar
  49. 49.
    Spyridopoulos I, Fichtlscherer S, Popp R, et al. Caffeine enhances endothelial repair by an AMPK-dependent mechanism. Arterioscler Thromb Vasc Biol. 2008;28(11):1967–74.  https://doi.org/10.1161/ATVBAHA.108.174060.CrossRefPubMedGoogle Scholar
  50. 50.
    Welsh EJ, Bara A, Barley E, Cates CJ. Caffeine for asthma. Cochrane Database Syst Rev. 2010;1:CD001112.  https://doi.org/10.1002/14651858.CD001112.pub2.CrossRefGoogle Scholar
  51. 51.
    Yang CS, Lee MJ, Chen L, Yang GY. Polyphenols as inhibitors of carcinogenesis. Environ Health Perspect. 1997;105(Suppl 4):971–6.CrossRefGoogle Scholar
  52. 52.
    Yang CS, Wang X, Lu G, Picinich SC. Cancer prevention by tea: animal studies, molecular mechanisms and human relevance. Nat Rev Cancer. 2009;9(6):429–39.  https://doi.org/10.1038/nrc2641.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Japanese Cancer Prevention Group. Green tea and stomach cancer risk [in Japanese]. National Cancer Center. https://epi.ncc.go.jp/can_prev/evaluation/2947.html. Accessed 12 Nov 2018.
  54. 54.
    Inoue M, Sasazuki S, Wakai K, et al. Green tea consumption and gastric cancer in Japanese: a pooled analysis of six cohort studies. Gut. 2009;58(10):1323–32.  https://doi.org/10.1136/gut.2008.166710.CrossRefPubMedGoogle Scholar
  55. 55.
    Suzuki Y, Tsubono Y, Nakaya N, Suzuki Y, Koizumi Y, Tsuji I. Green tea and the risk of breast cancer: pooled analysis of two prospective studies in Japan. Br J Cancer. 2004;90(7):1361–3.  https://doi.org/10.1038/sj.bjc.6601652.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Inoue M, Robien K, Wang R, Van Den Berg DJ, Koh WP, Yu MC. Green tea intake, MTHFR/TYMS genotype and breast cancer risk: the Singapore Chinese Health Study. Carcinogenesis. 2008;29(10):1967–72.  https://doi.org/10.1093/carcin/bgn177.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Lin Y, Kikuchi S, Tamakoshi A, et al. Green tea consumption and the risk of pancreatic cancer in Japanese adults. Pancreas. 2008;37(1):25–30.  https://doi.org/10.1097/MPA.0b013e318160a5e2.CrossRefPubMedGoogle Scholar
  58. 58.
    Islami F, Poustchi H, Pourshams A, et al. A prospective study of tea drinking temperature and risk of esophageal squamous cell carcinoma. Int J Cancer. 2019.  https://doi.org/10.1002/ijc.32220.CrossRefPubMedGoogle Scholar
  59. 59.
    Dietz C, Dekker M. Effect of green tea phytochemicals on mood and cognition. Curr Pharm Des. 2017;23(19):2876–905.  https://doi.org/10.2174/1381612823666170105151800.CrossRefPubMedGoogle Scholar
  60. 60.
    Wang Y, Ho CT. Polyphenolic chemistry of tea and coffee: a century of progress. J Agric Food Chem. 2009;57(18):8109–14.  https://doi.org/10.1021/jf804025c.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Sarah Krull Abe
    • 1
  • Eiko Saito
    • 2
  • Norie Sawada
    • 1
  • Shoichiro Tsugane
    • 1
  • Hidemi Ito
    • 3
    • 4
  • Yingsong Lin
    • 5
  • Akiko Tamakoshi
    • 6
  • Junya Sado
    • 7
  • Yuri Kitamura
    • 7
  • Yumi Sugawara
    • 8
  • Ichiro Tsuji
    • 8
  • Chisato Nagata
    • 9
  • Atsuko Sadakane
    • 10
  • Taichi Shimazu
    • 1
  • Tetsuya Mizoue
    • 11
  • Keitaro Matsuo
    • 4
    • 12
  • Mariko Naito
    • 13
  • Keitaro Tanaka
    • 14
  • Manami Inoue
    • 1
    • 15
    Email author
  • Research Group for the Development and Evaluation of Cancer Prevention Strategies in Japan
  1. 1.Epidemiology and Prevention Group, Center for Public Health SciencesNational Cancer CenterTokyoJapan
  2. 2.Division of Cancer Statistics and Integration, Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
  3. 3.Division of Cancer Information and ControlAichi Cancer Center Research InstituteNagoyaJapan
  4. 4.Department of EpidemiologyNagoya University Graduate School of MedicineNagoyaJapan
  5. 5.Department of Public HealthAichi Medical University School of MedicineNagakuteJapan
  6. 6.Department of Public HealthHokkaido University Graduate School of MedicineSapporoJapan
  7. 7.Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of MedicineOsaka UniversitySuitaJapan
  8. 8.Division of Epidemiology, Department of Public Health and Forensic MedicineTohoku University Graduate School of MedicineSendaiJapan
  9. 9.Department of Epidemiology and Preventive MedicineGifu University Graduate School of MedicineGifuJapan
  10. 10.Department of EpidemiologyRadiation Effects Research FoundationHiroshimaJapan
  11. 11.Department of Epidemiology and Prevention, Center for Clinical SciencesNational Center for Global Health and MedicineTokyoJapan
  12. 12.Division of Cancer Epidemiology and PreventionAichi Cancer Center Research InstituteNagoyaJapan
  13. 13.Department of Oral Epidemiology, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
  14. 14.Department of Preventive Medicine, Faculty of MedicineSaga UniversitySagaJapan
  15. 15.Department of Cancer Epidemiology, Graduate School of MedicineThe University of TokyoTokyoJapan

Personalised recommendations