• Kayo Kurotani, Shamima Akter, Ikuko Kashino, Atsushi Goto, Tetsuya Mizoue, Mitsuhiko Noda, Shizuka Sasazuki, Norie Sawada, Shoichiro Tsugane, and Japan Public Health Center based Prospective Study Group.
• Department of Epidemiology and Prevention, Centre for Clinical Sciences, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan, 162-8655 kkurotani@ri.ncgm.go.jp.
• BMJ. 2016 Jan 1;352:i1209.

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.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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