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[...] when Ichihara and coworkers tried to implement this approach in Asia (3 ), they found significant differences in laboratory test results between similar reference populations in 6 Asian cities In this issue of Clinical Chemistry, Ichihara and coworkers (4) have conducted a follow-up study to explore possible causes of the between-city differences they previously noted. Using a multivariate model, Ichihara and coworkers (4 ) found the observed differences persisted after controlling for the effects of age, body mass index, sex, and lifestyle factors including smoking, ethanol intake, diet, and exercise, and these investigators hypothesized that the differences they observed likely reflect genetic or environmental effects.