1
|
Sekizawa Y. Japan's intensive health guidance program has limited effects on cardiovascular risk factors: a regression discontinuity analysis. Public Health 2024; 232:108-113. [PMID: 38772198 DOI: 10.1016/j.puhe.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/03/2024] [Accepted: 04/16/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES It is uncertain whether the effects of health counselling programs differ depending on their intensity. This study compared the effectiveness of intensive health guidance (IHG) and less intensive motivation-enhancing guidance (MEG) on cardiovascular risk factors. STUDY DESIGN A regression discontinuity design (RDD) was applied. METHODS In Japan's specific health checkup (SHC) and guidance program, those with a high risk of metabolic syndrome are assigned to IHG or MEG. An RDD was applied using an SHC results database. Four groups were created in which IHG or MEG assignment was solely determined by single cut-off values of the running variables of triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), or haemoglobin A1c (HbA1c) measured during SHC. Outcomes were one year's changes in body mass index (BMI), waist circumference (WCF), systolic and diastolic blood pressure, HDL-C, low-density lipoprotein cholesterol, FBG, and HbA1c. RESULTS A total of 541,809 observations among 225,115 people from 2008 to 2017 were analysed. Men assigned to IHG had a significantly but slightly lower BMI and WCF than those assigned to MEG the next year, only when TG or FBG was a running variable. There were no significant differences between IHG and MEG for women's BMI and WCF and other cardiovascular risk factors for both sexes. CONCLUSION Since IHG has limited additional effects on cardiovascular risk factors compared with MEG, abolishing IHG may have little negative impact on the general public's health.
Collapse
Affiliation(s)
- Y Sekizawa
- Research Institute of Economy, Trade, and Industry, Chiyoda-ku, Kasumigaseki 1-3-1, Tokyo, 100-8901, Japan.
| |
Collapse
|
2
|
Vu T, Kokubo Y, Inoue M, Yamamoto M, Mohsen A, Martin-Morales A, Inoué T, Dawadi R, Araki M. Machine Learning Approaches for Stroke Risk Prediction: Findings from the Suita Study. J Cardiovasc Dev Dis 2024; 11:207. [PMID: 39057627 PMCID: PMC11276746 DOI: 10.3390/jcdd11070207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/12/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Stroke constitutes a significant public health concern due to its impact on mortality and morbidity. This study investigates the utility of machine learning algorithms in predicting stroke and identifying key risk factors using data from the Suita study, comprising 7389 participants and 53 variables. Initially, unsupervised k-prototype clustering categorized participants into risk clusters, while five supervised models including Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosted Machine (LightGBM) were employed to predict stroke outcomes. Stroke incidence disparities among identified risk clusters using the unsupervised k-prototype clustering method are substantial, according to the findings. Supervised learning, particularly RF, was a preferable option because of the higher levels of performance metrics. The Shapley Additive Explanations (SHAP) method identified age, systolic blood pressure, hypertension, estimated glomerular filtration rate, metabolic syndrome, and blood glucose level as key predictors of stroke, aligning with findings from the unsupervised clustering approach in high-risk groups. Additionally, previously unidentified risk factors such as elbow joint thickness, fructosamine, hemoglobin, and calcium level demonstrate potential for stroke prediction. In conclusion, machine learning facilitated accurate stroke risk predictions and highlighted potential biomarkers, offering a data-driven framework for risk assessment and biomarker discovery.
Collapse
Affiliation(s)
- Thien Vu
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
- Department of Cardiac Surgery, Cardiovascular Center, Cho Ray Hospital, Ho Chi Minh City 72713, Vietnam
| | - Yoshihiro Kokubo
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
| | - Mai Inoue
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
| | - Masaki Yamamoto
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
| | - Attayeb Mohsen
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
| | - Agustin Martin-Morales
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
| | - Takao Inoué
- Faculty of Informatics, Yamato University, 2-5-1 Katayama, Suita 564-0082, Japan;
| | - Research Dawadi
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
| | - Michihiro Araki
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, 3-17 Senrioka-Shinmachi, Settsu 566-0002, Japan; (M.I.); (M.Y.); (A.M.); (A.M.-M.); (R.D.)
- National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita 564-8565, Japan;
- Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
- Graduate School of Science Technology and Innovation, Kobe University, 1-1 Rokkodai Nada-ku, Kobe 657-8501, Japan
| |
Collapse
|
3
|
Noh J. Navigating Cardiometabolic Health Behavior during the Pandemic: Strategies for Metabolic Syndrome Management. J Obes Metab Syndr 2024; 33:89-91. [PMID: 38852946 PMCID: PMC11224927 DOI: 10.7570/jomes24024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/02/2024] [Accepted: 06/02/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| |
Collapse
|
4
|
Kabata D, Saeki N, Kajimoto K, Tanaka R, Kakiuchi N, Shintani A, Koretsune Y. Health guidance intervention mitigates the escalation of predicted comprehensive cardiovascular disease risk: Interrupted time series design. Prev Med 2024; 183:107972. [PMID: 38670435 DOI: 10.1016/j.ypmed.2024.107972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Metabolic syndrome increases the risk of cardiovascular events. Despite the Japanese healthcare system's efforts in early detection and intervention, particularly through Specific Health Checkup and Guidance programs, research on their effectiveness is limited. This study evaluated the impact of Specific Health Guidance on the predicted risk of atherosclerotic cardiovascular disease (ASCVD) in working-age Japanese individuals. METHODS Employing an Interrupted Time Series (ITS) design, this study compared the trends in predicted ASCVD risk and each individual risk factor used for the prediction of ASCVD risk before and after intervention in individuals participating in the guidance. RESULTS Analyses based on the ITS design indicated that participation in Specific Health Guidance programs, specifically the intensive level program, mitigates the increase trend of the predicted ASCVD risk. On the other hand, the impact on the trends of individual cardiovascular risk factors was minimal. CONCLUSIONS The intensive level Specific Health Guidance appeared to reduce the increasing trend in ASCVD risk, emphasizing the importance of comprehensive risk assessment in evaluating health interventions. However, the results are limited owing to the specific demographics and short evaluation period. Further research is necessary to understand the long-term impacts and broader applicability.
Collapse
Affiliation(s)
- Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
| | - Noriko Saeki
- Safety & Health Care Department, Daihatsu Health Care Center, Daihatsu Motor Co.,Ltd., Osaka, Japan
| | - Katsufumi Kajimoto
- Safety & Health Care Department, Daihatsu Health Care Center, Daihatsu Motor Co.,Ltd., Osaka, Japan
| | - Riho Tanaka
- Safety & Health Care Department, Daihatsu Health Care Center, Daihatsu Motor Co.,Ltd., Osaka, Japan
| | - Noriaki Kakiuchi
- Safety & Health Care Department, Daihatsu Health Care Center, Daihatsu Motor Co.,Ltd., Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yukihiro Koretsune
- Safety & Health Care Department, Daihatsu Health Care Center, Daihatsu Motor Co.,Ltd., Osaka, Japan
| |
Collapse
|
5
|
Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
| |
Collapse
|
6
|
Nambo R, Karashima S, Mizoguchi R, Konishi S, Hashimoto A, Aono D, Kometani M, Furukawa K, Yoneda T, Imamura K, Nambo H. Prediction and causal inference of cardiovascular and cerebrovascular diseases based on lifestyle questionnaires. Sci Rep 2024; 14:10492. [PMID: 38714730 PMCID: PMC11076536 DOI: 10.1038/s41598-024-61047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/30/2024] [Indexed: 05/10/2024] Open
Abstract
Cardiovascular and cerebrovascular diseases (CCVD) are prominent mortality causes in Japan, necessitating effective preventative measures, early diagnosis, and treatment to mitigate their impact. A diagnostic model was developed to identify patients with ischemic heart disease (IHD), stroke, or both, using specific health examination data. Lifestyle habits affecting CCVD development were analyzed using five causal inference methods. This study included 473,734 patients aged ≥ 40 years who underwent specific health examinations in Kanazawa, Japan between 2009 and 2018 to collect data on basic physical information, lifestyle habits, and laboratory parameters such as diabetes, lipid metabolism, renal function, and liver function. Four machine learning algorithms were used: Random Forest, Logistic regression, Light Gradient Boosting Machine, and eXtreme-Gradient-Boosting (XGBoost). The XGBoost model exhibited superior area under the curve (AUC), with mean values of 0.770 (± 0.003), 0.758 (± 0.003), and 0.845 (± 0.005) for stroke, IHD, and CCVD, respectively. The results of the five causal inference analyses were summarized, and lifestyle behavior changes were observed after the onset of CCVD. A causal relationship from 'reduced mastication' to 'weight gain' was found for all causal species theory methods. This prediction algorithm can screen for asymptomatic myocardial ischemia and stroke. By selecting high-risk patients suspected of having CCVD, resources can be used more efficiently for secondary testing.
Collapse
Affiliation(s)
- Riku Nambo
- School of Electrical Information Communication Engineering, College of Science and Engineering, Kanazawa University, Kanazawa, Japan
| | - Shigehiro Karashima
- Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, Japan.
| | - Ren Mizoguchi
- Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Japan
| | - Seigo Konishi
- Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Japan
| | - Atsushi Hashimoto
- Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Japan
| | - Daisuke Aono
- Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Japan
| | - Mitsuhiro Kometani
- Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Japan
| | - Kenji Furukawa
- Health Care Center, Japan Advanced Institute of Science and Technology, Nomi, Japan
| | - Takashi Yoneda
- Department of Health Promotion and Medicine of the Future, Kanazawa University, Kanazawa, Japan
| | - Kousuke Imamura
- Faculty of Electrical, Information and Communication Engineering, Institute of Science and Engineering, Kanazawa University, Kanazawa, Japan
| | - Hidetaka Nambo
- Institute of Transdisciplinary Sciences, Kanazawa University, Kanazawa, Japan.
| |
Collapse
|
7
|
Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| |
Collapse
|
8
|
Akune Y, Anezaki H, Nakao YM, Goto R. Cost-effectiveness of behavioural counselling intervention compared with non-intervention for adult patients with metabolic syndrome to prevent cardiovascular diseases and type 2 diabetes in Japan: a microsimulation modelling study. BMJ Open 2024; 14:e072688. [PMID: 38580368 PMCID: PMC11002415 DOI: 10.1136/bmjopen-2023-072688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/26/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVES Nationwide lifestyle intervention-specific health guidance (SHG) in Japan-employs counselling and education to change unhealthy behaviours that contribute to metabolic syndrome, especially obesity or abdominal obesity. We aimed to perform a model-based economic evaluation of SHG in a low participation rate setting. DESIGN A hypothetical population, comprised 50 000 Japanese aged 40 years who met the criteria of the SHG, used a microsimulation using the Markov model to evaluate SHG's cost-effectiveness compared with non-SHG. This hypothetical population was simulated over a 35-year time horizon. SETTING SHG is conducted annually by all Japanese insurers. OUTCOME MEASURES Model parameters, such as costs and health outcomes (including quality-adjusted life-years, QALYs), were based on existing literature. Incremental cost-effectiveness ratios were estimated from the healthcare payer's perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted to evaluate the uncertainty around the model input parameters. RESULTS The simulation revealed that the total costs per person in the SHG group decreased by JPY53 014 (US$480) compared with that in the non-SHG group, and the QALYs increased by 0.044, wherein SHG was considered the dominant strategy despite the low participation rates. PSA indicated that the credibility intervals (2.5th-97.5th percentile) of the incremental costs and the incremental QALYs with the SHG group compared with the non-SHG group were -JPY687 376 to JPY85 197 (-US$6226 to US$772) and -0.009 to 0.350 QALYs, respectively. Each scenario analysis indicated that programmes for improving both blood pressure and blood glucose levels among other risk factors for metabolic syndrome are essential for improving cost-effectiveness. CONCLUSIONS This study suggests that even small effects of counselling and education on behavioural modification may lead to the prevention of acute life-threatening events and chronic diseases, in addition to the reduction of medication resulting from metabolic syndrome, which results in cost savings.
Collapse
Affiliation(s)
- Yoko Akune
- Graduate School of Health Management, Keio University, Tokyo, Japan
| | | | - Yoko M Nakao
- Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Rei Goto
- Graduate School of Health Management, Keio University, Tokyo, Japan
- Graduate School of Business Administration, Keio University, Tokyo, Japan
| |
Collapse
|
9
|
Shoji A, Kudo K, Murashita K, Nakaji S, Igarashi A. Reduction in all-cause medical and caregiving costs through innovative health awareness projects in a rural area in Japan: a retrospective cohort study. BMC Health Serv Res 2024; 24:370. [PMID: 38528523 DOI: 10.1186/s12913-024-10836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND This study evaluates cost reduction in participants of a health awareness program (the Center of Healthy Aging Program, CHAP) in a Japanese rural area, characterized by an annual check-up and personalized interview on health issues and related risks immediately after the check-up. METHODS This is a cross-sectional study using medical and caregiving costs and Japan-specific health check-up results in Hirosaki residents stored by the local government, which were individually-based linked to the CHAP information collected by Hirosaki University. This is the first study that used anonymized data with individually-based linkages to both a research institute and a local government in Japan under a strict limitation regarding linking to third-party data. We included residents who had been continuously enrolled for > 6 months as of 1 July 2015. We compared 5-year all-cause costs between three groups (with CHAP, with Japan-specific health check-up, and no check-up) using a multivariate negative binomial regression model considering risk factors including lifestyle habits and an inverse probability weight to adjust for baseline characteristics: age, sex, Charlson comorbidity index, baseline care level, and risk score of coronary heart diseases. RESULTS A total of 384, 9805, and 32,630 residents aged 40-74 years were included for the CHAP, Japan-specific health check-up, and no check-up groups, respectively. The Japan-specific health check-up group showed older and higher Charlson comorbidity index than the others. After inverse probability weight adjusting, the amount of all-cause medical costs was significantly lower only in the CHAP group. Faster walking speed and exercise habits were independently associated with lower all-cause medical and caregiving costs. CONCLUSIONS We demonstrated a 5-year all-cause cost reduction in residents who participated in the CHAP and also suggested the effect of exercise habits in Hirosaki, which indicated the significance of individually-based data linkages to external third-party data for all local governments to improve the health condition of residents.
Collapse
Affiliation(s)
- Ayako Shoji
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
- Healthcare Consulting, Inc, 1-8-19, Fujimi, Chiyoda-Ku, Tokyo, 102-0071, Japan.
| | - Kennichi Kudo
- Research Institute of Health Innovation, Hirosaki University, 5 Zaifu-Cho, Hirosaki City, Aomori, 036-8562, Japan
| | - Koichi Murashita
- Research Institute of Health Innovation, Hirosaki University, 5 Zaifu-Cho, Hirosaki City, Aomori, 036-8562, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, 5 Zaifu-Cho, Hirosaki City, Aomori, 036-8562, Japan
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
- Department of Public Health and Preventive Medicine, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-Ku, Yokohama City, Kanagawa, 236-0004, Japan
| |
Collapse
|
10
|
Li Y, Babazono A, Jamal A, Liu N, Liang L, Yamao R, Zhao R, Yao L. Effect of the national lifestyle guidance intervention for metabolic syndrome among middle-aged people in Japan. J Glob Health 2024; 14:04007. [PMID: 38334270 PMCID: PMC10854208 DOI: 10.7189/jogh.14.04007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Background Japan has implemented a national lifestyle guidance intervention programme for potential metabolic syndrome among adults aged 40-74 years; however, there is limited evidence regarding the causal impact of this intervention. The study aims to determine the causal effect of this intervention on health outcomes and health care utilisation. Methods We performed a regression discontinuity design study. A total of 46 975 adults with ≥1 cardiovascular risk factor in 2015 were included in the study. A two-stage evaluation process (stage 1: waist circumference ≥85 cm for men or ≥90 cm for women and ≥1 cardiovascular risk factor; stage 2: body mass index (BMI)≥25 kg/m2 and ≥2 cardiovascular risk factors) was applied. Changes in obesity, cardiovascular outcomes, and health care utilisation were evaluated in a one-year follow-up in the fiscal year 2016. Results Participants who received lifestyle guidance intervention based on the waist circumference had a statistically significant reduction in obesity outcomes (Δ weight: -0.30 kg, 95% CI = -0.46 to -0.11; Δ waist circumference: -0.26 cm, 95% CI = -0.53 to -0.02; Δ BMI = -0.09 kg/m2, 95% CI = -0.17 to -0.04) but not in other cardiovascular risk factors and health care utilisation. Analyses based on BMI and results according to demographic subgroups did not reveal significant findings. Conclusions The provision of this intervention had a limited effect on health improvement and a decrease in health care costs, health care visits, and length of stay. A more intensive intervention delivery could potentially improve the efficacy of this intervention programme.
Collapse
Affiliation(s)
- Yunfei Li
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Aziz Jamal
- Health Administration Program, Faculty of Business & Management, Universiti Teknologi MARA, Selangor, Malaysia
| | - Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Lifan Liang
- Department of Human Genetics, University of Chicago, Chicago, Illinois, USA
| | - Reiko Yamao
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rui Zhao
- National Center for Medicine and Technology Assessment, China National Health Development Research Center, Beijing, China
| | - Lan Yao
- School of Medicine & Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| |
Collapse
|
11
|
Jamal A, Babazono A, Liu N, Yamao R, Fujita T, Kim SA, Li Y. Associating Liver Enzymes and Their Interactions with Metabolic Syndrome Prevalence in a Japanese Working Population. Metab Syndr Relat Disord 2024; 22:27-38. [PMID: 38350086 DOI: 10.1089/met.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background: Serum gamma-glutamyltransferase (γ-GT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels often increase in metabolic diseases. Objective: This study was conducted to determine which liver enzymes are strongly associated with metabolic syndrome (MetS), how they interact to produce different probability estimates, and what cutoff levels should be used to guide clinical decision-making. Methods: The researchers examined the insurance-based medical checkup data of 293,610 employees ≥35 years years of age, who underwent medical checkups between April 1, 2016, and March 31, 2017. Liver enzyme levels were grouped into quartiles. The association and interaction of liver enzymes with MetS were examined using logistic regression, and receiver operating characteristic (ROC) analyses were used to determine the optimal cutoff values for each liver enzyme in detecting the prevalence of MetS. Results: High levels of γ-GT and ALT were more strongly associated with MetS than AST. At various levels, the tested liver enzymes were found interactive, and associated with the likelihood of MetS prevalence. ROC analysis underscored the significance of all liver enzymes in predicting the development of MetS. The cutoff values for each liver enzyme were determined. Conclusion: This findings of this study directly support the identification of MetS risks within the population, prioritize prevention strategies, and potentially inform policy formulation.
Collapse
Affiliation(s)
- Aziz Jamal
- Health Administration Program, Faculty of Business & Management, Universiti Teknologi MARA, Bandar Puncak Alam, Malaysia
- Department of Health Care Management & Administration, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Management & Administration, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Rieko Yamao
- Department of Health Care Management & Administration, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takako Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sung-A Kim
- Department of Health Care Management & Administration, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- St. Mary's Research Center, St. Mary's Hospital, Kurume, Japan
| | - Yunfei Li
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Shinjuku-ku, Japan
| |
Collapse
|
12
|
Kanamori S, Tomiyama K, Haruyama Y. Comparison of BMI changes in Japanese adults receiving face-to-face versus online counseling for specific health guidance: a noninferiority prospective observational study. J Occup Health 2024; 66:uiae026. [PMID: 38729214 PMCID: PMC11170213 DOI: 10.1093/joccuh/uiae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the noninferiority of online counseling over face-to-face counseling for specific health guidance (SHG). METHODS This prospective observational study was conducted using specific health checkup (SHC) and SHG data of individuals with health insurance in Japan. We analyzed data from 1431 participants who met the inclusion criteria, including those who underwent online or face-to-face counseling between April 1, 2020 and March 31, 2021, and received an SHC in the following year but no earlier than 90 days after their first counseling session. Assessed variables comprised demographics, counseling methods, and SHC results, including baseline questionnaire findings and body mass index (BMI) at follow-up. We performed inverse probability of treatment weighting (IPTW) using propensity scores, with changes in BMI as the objective variable and the counseling method as the explanatory variable. We set the noninferiority margin to 0.175, based on a previous study. RESULTS The online and face-to-face counseling groups comprised 455 (31.8%) and 976 (68.2%) participants, respectively. The number of men and mean age were 214 (47.0%) and 49.9 years (SD: 6.9 years), respectively, in the online counseling group, and 491 (50.3%) and 51.1 years (SD: 7.6 years), respectively, in the face-to-face counseling group. IPTW using propensity scores revealed a regression coefficient of -0.014 (95% CI: -0.157 to 0.129) for the online group compared with the face-to-face group (P = .847). The CI was within the noninferiority margin. CONCLUSIONS The effects of online counseling on BMI are likely noninferior to those of face-to-face counseling.
Collapse
Affiliation(s)
- Satoru Kanamori
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Kiyomi Tomiyama
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University School of Medicine, Tochigi, Japan
| |
Collapse
|
13
|
Baden MY, Kato S, Niki A, Hara T, Ozawa H, Ishibashi C, Hosokawa Y, Fujita Y, Fujishima Y, Nishizawa H, Kozawa J, Muraki I, Furuya Y, Yonekura A, Shigyo T, Kawabe T, Shimomura I, Eisenberg DM. Feasibility pilot study of a Japanese teaching kitchen program. Front Public Health 2023; 11:1258434. [PMID: 38146475 PMCID: PMC10749421 DOI: 10.3389/fpubh.2023.1258434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/06/2023] [Indexed: 12/27/2023] Open
Abstract
Background This pilot study examined the feasibility of a new lifestyle modification program involving a "Teaching Kitchen" in Japan. Our goal was to explore (1) feasibility of the program; (2) acceptability for class frequency (weekly vs. bi-weekly); and (3) changes in biometrics, dietary intakes, and lifestyle factors. Methods A total of 24 employees with obesity in a Japanese company were recruited. Participants were randomly divided into two groups (weekly or bi-weekly group), each attending the program consisting of four two-hour classes (lectures on nutrition, exercise, mindfulness, and culinary instructions). Participants were observed for changes in dietary intakes, biometrics, and health related quality of life over the subsequent 3 months. We tested the between-group differences in changes using linear mixed-effect models. Results The program completion rates were 83.3% in total (91.7% for weekly group and 75.0% for bi-weekly group). From baseline to post-intervention, significant decreases were observed in weight (p < 0.001), body mass index (p < 0.001), diastolic blood pressure (p = 0.03), body fat mass (p < 0.001), and dietary intakes in total fat (p = 0.03) and sodium (p = 0.008) among 17 participants who were available for measurements. Improvements in biometrics remained significant 1 month after the intervention (all p ≤ 0.03 in 14 participants). Participants' health related quality of life was significantly improved in bodily pain, general health, vitality, and mental component score (all p ≤ 0.047). Conclusions The new Japanese Teaching Kitchen program is feasible with high program completion rates in Japanese office workers with obesity. While this was a small feasibility study, significant multiple improvements in dietary intakes, biometrics, and health related quality of life suggest that this line of inquiry warrants further exploration to address obesity and obesity-related diseases in Japan.
Collapse
Affiliation(s)
- Megu Y. Baden
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Lifestyle Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Sarasa Kato
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Akiko Niki
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomoyuki Hara
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Harutoshi Ozawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Lifestyle Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Chisaki Ishibashi
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshiya Hosokawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yukari Fujita
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuya Fujishima
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Junji Kozawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Isao Muraki
- Division of Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | | | | | | | | | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - David M. Eisenberg
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| |
Collapse
|
14
|
Krupp K, Rao AP, Pope B, Ravi K, Khan A, Srinivas V, Madhivanan P, Srinivas A. Prevalence and correlates of metabolic syndrome among women living in urban slums, Mysore, India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000846. [PMID: 37418350 DOI: 10.1371/journal.pgph.0000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Metabolic Syndrome (MetSyn) is a predictor of cardiovascular disease (CVD). About a third of urban Indians suffer from MetSyn. This study examined the prevalence of MetSyn among women living in urban slums. A cross-sectional survey was carried out between October 2017 and May 2018 among a non-probability sample of slum-dwelling women, 40-64 years of age, in six government-designated slums in Mysore, India. Data were collected on demographics, diet, behavioral risks, anthropometry, blood pressure, serum glucose, hemoglobin A1c, and serum lipids. The study used a definition of MetSyn from the International Diabetes Federation Task Force on Epidemiology and Prevention with an HbA1c measure for average blood glucose. About two-fifths of the 607 participants had MetSyn (41.5%; 95% CI: 37.7-45.5). Of those, 40.9% met three criteria, 38.1% four, and 25.0%, all five criteria. Elevated BP was the most prevalent MetSyn factor (79.6%), followed by increased waist circumference (54.5%), low HDL (50.1%), elevated Hb A1c (37.1%), and elevated triglycerides (36.1%). Odds for MetSyn were 1.52 times greater for those who were 50-59 years of age compared with those 40-49 years of age (adjusted odds ratio[AOR]:1.52; 95% CI:0.96-2.40). Women with mobility issues had 1.29 times higher odds of MetSyn than those without it (AOR: 0.76, 95% CI: 0.96, 1.75). Housewives had 1.29 times greater odds of MetSyn (AOR: 1.29, 95% CI: 1.00, 1.67). There is a high prevalence of MetSyn among urban slum-dwelling women in Mysore. There is a need for interventions aimed at reducing CVD risk factors in this population.
Collapse
Affiliation(s)
- Karl Krupp
- Division of Public Health Practice & Translational Research, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, United States of America
- Public Health Research Institute of India, Mysore, India
| | - Arathi P Rao
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Benjamin Pope
- Department of Epidemiology & Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Kavitha Ravi
- Public Health Research Institute of India, Mysore, India
| | - Anisa Khan
- Public Health Research Institute of India, Mysore, India
| | | | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, India
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Arizona, Tucson, United States of America
- Division of Infectious Diseases, College of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Arun Srinivas
- Department of Cardiology, Apollo Hospital, Mysore, India
| |
Collapse
|
15
|
Aomori M, Matsumoto C, Takebayashi S, Matsuyama N, Uto Y, Tanaka M, Samukawa S, Kato H, Nakajima H, Maeda H. Effects of a smartphone app-based diet and physical activity program for men living with HIV who have dyslipidemia: A pilot randomized controlled trial. Jpn J Nurs Sci 2023:e12535. [PMID: 37060244 DOI: 10.1111/jjns.12535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 04/16/2023]
Abstract
AIMS People living with HIV are at a high risk for cardiovascular disease owing to antiretroviral therapy use and chronic inflammation. There is limited evidence on the evaluation of serum lipid levels through lifestyle modification. This study aims to evaluate the effect of a smartphone application-based diet and exercise improvement program on men living with HIV and dyslipidemia. METHODS This was a randomized controlled trial recruiting Japanese men living with HIV who have dyslipidemia: intervention group (n = 19) and control group (n = 19). The intervention group received a third individual guidance session during the 6-month intervention and was encouraged to record their diet on a smartphone application. An intention-to-treat analysis of the results was conducted. RESULTS The intervention group showed significantly reduced change in low-density lipoprotein levels compared to the control group (-4.00 ± 20.2 mg/dL vs. 10.11 ± 21.1 mg/dL) (p = .042) from baseline to 6 months post-intervention. No significant differences were found in other serum lipid levels. Abdominal circumference decreased significantly in the intervention group (p = .048) from baseline to 6 months post-intervention. Total energy, protein, carbohydrate, fat, and salt intake, dietary and physical activity behavior change stages and social support, dietary self-efficacy, and loneliness significantly improved in the intervention group (p < .05) from baseline to 6 months post-intervention. CONCLUSIONS A diet and physical activity improvement program using a smartphone application based on Japanese-specific health guidance may reduce low-density lipoprotein cholesterol levels in this population. Further sample expansion and examination of long-term effects are needed.
Collapse
Affiliation(s)
- Maki Aomori
- Doctoral Program of Nursing, Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan
- Department of Nursing, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Chiharu Matsumoto
- Department of Nursing, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Sanae Takebayashi
- Nursing Department, Yokohama City University Hospital, Yokohama, Japan
| | - Nao Matsuyama
- Nursing Department, Yokohama City University Hospital, Yokohama, Japan
| | - Yukiko Uto
- Nursing Department, Yokohama City University Hospital, Yokohama, Japan
| | - Miho Tanaka
- Nursing Department, Yokohama City University Hospital, Yokohama, Japan
| | - Sei Samukawa
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Kato
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hitomi Maeda
- Department of Nursing, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
16
|
Ma E, Ohira T, Fukasawa M, Yasumura S, Miyazaki M, Suzuki T, Furuyama A, Kataoka M, Hosoya M. Prevalence trends of metabolic syndrome in residents of postdisaster Fukushima: a longitudinal analysis of Fukushima Health Database 2012-2019. Public Health 2023; 217:115-124. [PMID: 36878120 DOI: 10.1016/j.puhe.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/08/2022] [Accepted: 01/31/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES The study aimed to evaluate the long-term metabolic risk profiles of Fukushima residents after the Great East Japan Earthquake of March 2011. STUDY DESIGN This was a cross-sectional and a longitudinal design. METHODS The Fukushima Health Database (FDB) contains 2,331,319 annual health checkup records of participants aged 40-74 years between 2012 and 2019. We checked the validity of the FDB by comparing the prevalence of metabolic factors with the National Database of Health Insurance Claims and Specific Health Checkups (NDB). We applied a regression analysis to determine the changes and project the trends of metabolic factors over the years. RESULTS Compared to the NDB, the prevalence of metabolic factors in Fukushima was higher than the country average from 2013 to 2018, and they showed the same trends as those from the FDB. The prevalence of metabolic syndrome (MetS) increased from 18.9% in 2012 to 21.4% in 2019 (an annual increase of 2.74%) in men and from 6.8 to 7.4% (an annual increase of 1.80%) in women in Fukushima. The standardized prevalence of MetS, being overweight, and diabetes is projected to continue increasing, with disparities among subareas being higher in evacuees than in non-evacuees. An annual decrease of 0.38-1.97% in hypertension was mainly observed in women. CONCLUSIONS The prevalence of metabolic risk is higher in Fukushima as compared to the country average. The increasing metabolic risk in subareas, including the evacuation zone, highlights the need to control MetS in Fukushima residents.
Collapse
Affiliation(s)
- E Ma
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - T Ohira
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; Radiation Medical Science Centre for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - M Fukasawa
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - S Yasumura
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Radiation Medical Science Centre for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - M Miyazaki
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Radiation Medical Science Centre for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - T Suzuki
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Computer Science and Information Systems, The University of Aizu, Fukushima 965-8580, Japan
| | - A Furuyama
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - M Kataoka
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - M Hosoya
- Health Promotion Center, Fukushima Medical University, Fukushima 960-1295, Japan; Radiation Medical Science Centre for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| |
Collapse
|
17
|
Li Y, Babazono A, Jamal A, Liu N, Fujita T, Zhao R, Maeno Y, Su Y, Liang L, Yao L. The impact of lifestyle guidance intervention on health outcomes among Japanese middle-aged population with metabolic syndrome: A regression discontinuity study. Soc Sci Med 2022; 314:115468. [PMID: 36327638 DOI: 10.1016/j.socscimed.2022.115468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/28/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Metabolic syndrome (MetS) prevalence has increased globally with considerable morbidity and economic burden at both individual and national levels. Japan is the first and only country that has introduced a nationwide lifestyle guidance intervention program to manage and control MetS. We conducted a quasi-experiment approach-regression discontinuity design-to evaluate the impact of this intervention on health outcomes at the population level. We retrospectively collected data of adults aged ≥35 years who participated in health checkups in 2015. Age in 2015 was used as the assignment variable, and an age of 40 years old was the threshold because those with MetS aged ≥40 were required to receive lifestyle guidance intervention. Among 26,772 MetS adults, those who received the intervention had significant reductions in obesity measurements (bodyweight, waist circumference, and body mass index [BMI]) after 1 year of this intervention. Blood pressure was also significantly reduced in men after 1 year of undertaking the intervention. The results were similar when including demographic, socioeconomic, and behavioral covariates and using alternative functional forms to estimate the impact, or when bandwidths around intervention thresholds were changed. Our results showed that lifestyle guidance intervention for MetS has an important impact on weight loss and blood pressure reduction at the population level. This intervention could address the high burden of obesity and cardiovascular diseases in Japan and other countries with an unmet need for MetS prevention and management.
Collapse
Affiliation(s)
- Yunfei Li
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan; Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Akira Babazono
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Aziz Jamal
- Health Administration Program, Faculty of Business & Management, Universiti Teknologi MARA, Selangor, Malaysia.
| | - Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takako Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rui Zhao
- National Center for Medicine and Technology Assessment, China National Health Development Research Center, Beijing, China
| | - Yukari Maeno
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ya Su
- Shanghai Jiao Tong University, School of Nursing, Shanghai, China
| | - Lifan Liang
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Lan Yao
- School of Medicine & Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| |
Collapse
|
18
|
Shibuta T, Waki K, Miyake K, Igarashi A, Yamamoto-Mitani N, Sankoda A, Takeuchi Y, Sumitani M, Yamauchi T, Nangaku M, Ohe K. Preliminary Efficacy, Feasibility, and Perceived Usefulness of a Smartphone-Based Self-Management System with Personalized Goal Setting and Feedback to Increase Step Count among Workers with High Blood Pressure: Before-After Study (Preprint). JMIR Cardio 2022. [PMID: 37477976 PMCID: PMC10403795 DOI: 10.2196/43940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND High blood pressure (BP) and physical inactivity are the major risk factors for cardiovascular diseases. Mobile health is expected to support patients' self-management for improving cardiovascular health; the development of fully automated systems is necessary to minimize the workloads of health care providers. OBJECTIVE The objective of our study was to evaluate the preliminary efficacy, feasibility, and perceived usefulness of an intervention using a novel smartphone-based self-management system (DialBetes Step) in increasing steps per day among workers with high BP. METHODS On the basis of the Social Cognitive Theory, we developed personalized goal-setting and feedback functions and information delivery functions for increasing step count. Personalized goal setting and feedback consist of 4 components to support users' self-regulation and enhance their self-efficacy: goal setting for daily steps, positive feedback, action planning, and barrier identification and problem-solving. In the goal-setting component, users set their own step goals weekly in gradual increments based on the system's suggestion. We added these fully automated functions to an extant system with the function of self-monitoring daily step count, BP, body weight, blood glucose, exercise, and diet. We conducted a single-arm before-and-after study of workers with high BP who were willing to increase their physical activity. After an educational group session, participants used only the self-monitoring function for 2 weeks (baseline) and all functions of DialBetes Step for 24 weeks. We evaluated changes in steps per day, self-reported frequencies of self-regulation and self-management behavior, self-efficacy, and biomedical characteristics (home BP, BMI, visceral fat area, and glucose and lipid parameters) around week 6 (P1) of using the new functions and at the end of the intervention (P2). Participants rated the usefulness of the system using a paper-based questionnaire. RESULTS We analyzed 30 participants (n=19, 63% male; mean age 52.9, SD 5.3 years); 1 (3%) participant dropped out of the intervention. The median percentage of step measurement was 97%. Compared with baseline (median 10,084 steps per day), steps per day significantly increased at P1 (median +1493 steps per day; P<.001), but the increase attenuated at P2 (median +1056 steps per day; P=.04). Frequencies of self-regulation and self-management behavior increased at P1 and P2. Goal-related self-efficacy tended to increase at P2 (median +5%; P=.05). Home BP substantially decreased only at P2. Of the other biomedical characteristics, BMI decreased significantly at P1 (P<.001) and P2 (P=.001), and high-density lipoprotein cholesterol increased significantly only at P1 (P<.001). DialBetes Step was rated as useful or moderately useful by 97% (28/29) of the participants. CONCLUSIONS DialBetes Step intervention might be a feasible and useful way of increasing workers' step count for a short period and, consequently, improving their BP and BMI; self-efficacy-enhancing techniques of the system should be improved.
Collapse
|
19
|
Yoshida Y, Zeni JA, Zhu Y, Rhyne RL. Concurrent Validity Between Potential Screening Tests for Early Mobility Decline in Independent Community Dwellers. J Geriatr Phys Ther 2022; 45:E161-E168. [PMID: 36112039 PMCID: PMC9588461 DOI: 10.1519/jpt.0000000000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
BACKGROUND AND PURPOSE Standardized screening tests that detect early mobility decline, regardless of etiology, are needed for healthy aging. The locomotive syndrome (LS) tests are designed to identify stages of mobility decline and inform appropriate levels of intervention. The long-term goal of this research is to develop standardized mobility screening tests that can be used across health care settings and throughout a patient's lifespan to guide appropriate medical care. As the first step in this process, this study examines the concurrent validity between the reference and the LS tests. METHODS This cross-sectional study examined correlations between the LS functional tests and a set of reference tests and the ability to differentiate the 3 stages of mobility decline. The reference tests included the stair-climbing test, the 30-second chair rise test, the 6-minute walk test, the Global Physical Health (GPH) portion of the PROMIS, and the Lower Extremity Functional Scale (LEFS). The LS tests included the Stand-Up Test, the 2-Step Test, and the 25-question Geriatric Locomotive Function Scale (25-GLFS). A total of 115 community dwellers of 61.2 years old on average (±10.0 years), with n = 71 (61%) older than 60 years, voluntary participated in this prospective study. Nonparametric analyses of variance and correlations were used to examine the concurrent validity. RESULTS AND DISCUSSION Performance-based tests were significantly correlated (| r | = 0.38-0.61, P < .001) with LS tests. The LEFS was correlated with all LS tests, but the GPH was only correlated with the 25-GLFS. Also, significant differences were found in reference test scores between the 3 LS stages ( P < .05). CONCLUSIONS The LS tests and reference tests demonstrated significant correlations, and participants performed significantly worse on reference tests as LS severity increased. Given these results, it is possible that the LS standardized tests may play an important role in mobility screening. Future research should investigate feasibility, sensitivity, and specificity of these tests.
Collapse
Affiliation(s)
- Yuri Yoshida
- Division of Physical Therapy at the University of New Mexico
| | - Joseph A. Zeni
- Department of Rehabilitation and Movement Science, Rutgers the State University of New Jersey
| | - YiLiang Zhu
- Department of Internal Medicine, University of New Mexico School of Medicine
| | - Robert L. Rhyne
- Department of Family and Community Medicine, University of New Mexico School of Medicine
| |
Collapse
|
20
|
Relationship between Cardiometabolic Factors and the Response of Blood Pressure to a One-Year Primary Care Lifestyle Intervention in Metabolic Syndrome Patients. Metabolites 2022; 12:metabo12090861. [PMID: 36144265 PMCID: PMC9500796 DOI: 10.3390/metabo12090861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Systemic hypertension has been recognized as a modifiable traditional cardiovascular risk factor and influenced by many factors such as eating habits, physical activity, diabetes, and obesity. The objective of this cross-sectional study was to identify factors that predict changes in blood pressure induced by a one-year lifestyle intervention in primary care settings involving a collaboration between family physicians, dietitians, and exercise specialists. Patients with metabolic syndrome diagnosis were recruited by family physicians participating in primary care lifestyle intervention among several family care clinics across Canada. Participants for whom all cardiometabolic data at the beginning (T0) and the end (T12) of the one-year intervention were available were included in the present analysis (n = 101). Patients visited the dietitian and the exercise specialist weekly for the first three months and monthly for the last nine months. Diet quality, exercise capacity, anthropometric indicators, and cardiometabolic variables were evaluated at T0 and at T12. The intervention induced a statistically significant decrease in waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, and plasma triglycerides, and an increase in cardiorespiratory fitness (estimated VO2max). Body weight (p < 0.001), body mass index (BMI) (p < 0.001), and fasting blood glucose (p = 0.006) reduction, and VO2max increase (p = 0.048) were all related to changes in SBP. WC was the only variable for which changes were significantly correlated with those in both SBP (p < 0.0001) and DBP (p = 0.0004). Variations in DBP were not associated with changes in other cardiometabolic variables to a statistically significant extent. Twelve participants were identified as adverse responders (AR) in both SBP and DBP and displayed less favorable changes in WC. The beneficial effects of the primary care lifestyle intervention on blood pressure were significantly associated with cardiometabolic variables, especially WC. These findings suggest that a structured lifestyle intervention in primary care can help improve cardiometabolic risk factors in patients with metabolic syndrome and that WC should be systematically measured to better stratify the patient’s hypertension risk.
Collapse
|
21
|
Potential crowdedness of mechanical thrombectomy and cerebral infarction mortality in Japan: Application of inverted two-step floating catchment area method. J Stroke Cerebrovasc Dis 2022; 31:106625. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
|
22
|
Narisada A, Shibata E, Hasegawa T, Wakayama R, Suzuki K. The impact of the National Health Program on diabetes incidence among working-age men with prediabetes: A regression discontinuity analysis of a nation-wide database in Japan. Diabetes Res Clin Pract 2022; 189:109946. [PMID: 35691477 DOI: 10.1016/j.diabres.2022.109946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/29/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
Abstract
AIM This study aimed to investigate the impact of the National Health Program in Japan ("Specific Health Check-ups and Specific Health Guidance") on diabetes prevention among working-age men with prediabetes. METHODS This study used a regression discontinuity design, based on the program's criterion that the program starts at age 40 or older and that the intervention is provided only to prediabetic individuals with abdominal obesity, to assess the impact of the program on the diabetes incidence in a total of 49,848 men with prediabetes, aged 37-42 years. RESULTS The National Health Program in which interventions were provided for individuals aged 40 years or over with both prediabetes and abdominal obesity was associated with a decrease in diabetes incidence rate equivalent to 10.1 reduction/1000 person-years. The relative risk was 0.75. However, among those without abdominal obesity and not subjected to the intervention, there was no significant change in the diabetes incidence at age 40. CONCLUSIONS The National Health Program in Japan was associated with a decrease in the incidence of diabetes among working-age men with prediabetes and abdominal obesity and may have a meaningful impact among working-age men.
Collapse
Affiliation(s)
- Akihiko Narisada
- Institute for Occupational Health Science, Aichi Medical University, Nagakute, Japan.
| | - Eiji Shibata
- Yokkaichi Nursing and Medical Care University, Yokkaichi, Japan; Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Tomomi Hasegawa
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Nagakute, Japan
| | - Rei Wakayama
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kohta Suzuki
- Institute for Occupational Health Science, Aichi Medical University, Nagakute, Japan; Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| |
Collapse
|
23
|
Iakoubova OA, Tong CH, Rowland CM, Arellano AR, Bare LA, Fragala MS, Birse CE. Workplace Outreach Program Improves Management of Chronic Kidney Disease. J Occup Environ Med 2022; 64:482-487. [PMID: 34967765 PMCID: PMC9275843 DOI: 10.1097/jom.0000000000002475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Assess whether an employee outreach program improved management of chronic kidney disease (CKD). METHODS Participants with suspected CKD (eGFR <60 mL/min/1.73m 2 ) identified in employee health assessments in 2017 and 2018 were contacted by phone and offered physician consultation. Subsequent nephrologist visits at 11 months of follow up were compared between those who were (outreach group) and were not (control group) successfully contacted. RESULTS Most CKD risk factors at baseline were similar in outreach and control groups. At the end of the follow-up, outreach participants had more than 2-fold greater incidence of visiting a nephrologist compared with controls (HR = 2.3; 95% CI 1.2-4.2, P = 0.01), after adjusting for potential confounders. Conclusions: Employee outreach program increased utilization of nephrologist care.
Collapse
Affiliation(s)
- Olga A Iakoubova
- From the Department of Quest Diagnostics, San Juan Capistrano, California (Dr Iakoubova, Ms Tong, Mr Rowland, Arellano, Dr Bare, Dr Fragala, and Dr Birse)
| | | | | | | | | | | | | |
Collapse
|
24
|
Nakata M, Senoo K, Yamaoka M, Kumagai M, Nishimura H, Matoba S, Teramukai S. Effects of Longitudinal Changes in Lifestyle-Related Risk Factors on the Incidence of Major Adverse Cardiac and Cerebrovascular Disease in Young Adults. Int Heart J 2022; 63:1055-1062. [DOI: 10.1536/ihj.22-317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mitsuko Nakata
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Keitaro Senoo
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | | | | | | | - Satoaki Matoba
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| |
Collapse
|
25
|
Park S, Kim CG, Kim Y. Comparison of metabolic syndrome and related factors in married pre-menopausal white- and blue-collar woman. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2021; 77:744-754. [PMID: 34882506 DOI: 10.1080/19338244.2021.2007834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study aimed to identify the prevalence and associated factors of metabolic syndrome in pre-menopausal married women with white-collar and blue-collar jobs. This study analyzed 4,447 women with jobs in the Korean National Health and Nutrition Examination Survey (2010-2018). The prevalence of metabolic syndrome was higher among blue-collar women (15.3%) than among white-collar women (10.5%). Age, family type, alcohol consumption, frequency of high-risk drinking, perceived health status, and body mass index (BMI) were significantly associated with metabolic syndrome in the white-collar (p < .05). Age, family type, frequency of eating out, and BMI were associated in the blue-collar (p < .05). Blue-collar women were more vulnerable to metabolic syndrome than white-collar ones. To prevent metabolic syndrome in pre-menopausal married women with jobs, lifestyle modifications such as mitigating obesity and reducing alcohol consumption with aging are necessary.
Collapse
Affiliation(s)
- Seungmi Park
- Department of Nursing, Chungbuk National University, Cheongju, Republic of Korea
| | - Chul-Gyu Kim
- Department of Nursing, Chungbuk National University, Cheongju, Republic of Korea
| | - Youngji Kim
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju-Si, Chungcheongnam-Do, Republic of Korea
| |
Collapse
|
26
|
Iso H, Cui R, Takamoto I, Kiyama M, Saito I, Okamura T, Miyamoto Y, Higashiyama A, Kiyohara Y, Ninomiya T, Yamada M, Nakagawa H, Sakurai M, Shimabukuro M, Higa M, Shimamoto K, Saito S, Daimon M, Kayama T, Noda M, Ito S, Yokote K, Ito C, Nakao K, Yamauchi T, Kadowaki T. Risk Classification for Metabolic Syndrome and the Incidence of Cardiovascular Disease in Japan With Low Prevalence of Obesity: A Pooled Analysis of 10 Prospective Cohort Studies. J Am Heart Assoc 2021; 10:e020760. [PMID: 34796738 PMCID: PMC9075363 DOI: 10.1161/jaha.121.020760] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
Background It is uncertain whether risk classification under the nationwide program on screening and lifestyle modification for metabolic syndrome captures well high-risk individuals who could benefit from lifestyle interventions. We examined the validity of risk classification by linking the incidence of cardiovascular disease (CVD). Methods and Results Individual-level data of 29 288 Japanese individuals aged 40 to 74 years without a history of CVD from 10 prospective cohort studies were used. Metabolic syndrome was defined as the presence of high abdominal obesity and/or overweight plus risk factors such as high blood pressure, high triglyceride or low high-density lipoprotein cholesterol levels, and high blood glucose levels. The risk categories for lifestyle intervention were information supply only, motivation-support intervention, and intensive support intervention. Sex- and age-specific hazard ratios and population attributable fractions of CVD, which were also further adjusted to consider non-high density lipoprotein cholesterol levels, were estimated with reference to nonobese/overweight individuals, using Cox proportional hazard regression. Since the reference category included those with risk factors, we set a supernormal group (nonobese/overweight with no risk factor) as another reference. We documented 1023 incident CVD cases (565 men and 458 women). The adjusted CVD risk was 60% to 70% higher in men and women aged 40 to 64 years receiving an intensive support intervention, and 30% higher in women aged 65 to 74 years receiving a motivation-support intervention, compared with nonobese/overweight individuals. The population attributable fractions in men and women aged 40 to 64 years receiving an intensive support intervention were 17.7% and 6.6%, respectively, while that in women aged 65 to 74 years receiving a motivation-support intervention was 9.4%. Compared with the supernormal group, nonobese/overweight individuals with risk factors had similar hazard ratios and population attributable fractions as individuals with metabolic syndrome. Conclusions Similar CVD excess and attributable risks among individuals with metabolic syndrome components in the absence and presence of obesity/overweight imply the need for lifestyle modification in both high-risk groups.
Collapse
Affiliation(s)
- Hiroyasu Iso
- Public HealthDepartment of Social MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Renzhe Cui
- Public HealthDepartment of Social MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Iseki Takamoto
- Department of Diabetes and Metabolic DiseasesGraduate School of MedicineThe University of Tokyo HospitalTokyoJapan
- Department of Diabetes, Metabolism and EndocrinologyIchikawa HospitalInternational University of Health and WelfareChibaJapan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease PreventionOsakaJapan
| | - Isao Saito
- Department of Public Health and EpidemiologyFaculty of MedicineOita UniversityOitaJapan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public HealthKeio University School of MedicineTokyoJapan
| | - Yoshihiro Miyamoto
- Preventive CardiologyNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Aya Higashiyama
- Preventive CardiologyNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Yutaka Kiyohara
- Hisayama Research Institute for Lifestyle DiseasesFukuokaJapan
- Department of Epidemiology and Public HealthGraduate School of MedicineKyushu UniversityFukuokaJapan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public HealthGraduate School of MedicineKyushu UniversityFukuokaJapan
| | - Michiko Yamada
- Department of Clinical StudiesRadiation Effects Research FoundationHiroshimaJapan
| | - Hideaki Nakagawa
- Department of Social and Environmental MedicineKanazawa Medical UniversityIshikawaJapan
| | - Masaru Sakurai
- Department of Social and Environmental MedicineKanazawa Medical UniversityIshikawaJapan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and MetabolismFukushima Medical UniversityFukushimaJapan
| | - Moritake Higa
- Diabetes and Life‐Style Related Disease CenterTomishiro Central HospitalOkinawaJapan
| | | | | | - Makoto Daimon
- Global Center of Excellence Program Study GroupYamagata University School of MedicineYamagataJapan
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineAomoriJapan
| | - Takamasa Kayama
- Department of Advanced MedicineYamagata University School of MedicineYamagataJapan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and EndocrinologyIchikawa HospitalInternational University of Health and WelfareChibaJapan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular MedicineDepartment of MedicineTohoku University HospitalMiyagiJapan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and GerontologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Chikako Ito
- Grand Tower Medical Court Life Care ClinicHiroshimaJapan
| | - Kazuwa Nakao
- Medical Innovation CenterKyoto University Graduate School of MedicineKyotoJapan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic DiseasesGraduate School of MedicineThe University of Tokyo HospitalTokyoJapan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic DiseasesGraduate School of MedicineThe University of Tokyo HospitalTokyoJapan
- PresidentTranomon HospitalTokyoJapan
| |
Collapse
|
27
|
Arafa A, Kokubo Y, Sheerah HA, Sakai Y, Watanabe E, Li J, Honda-Kohmo K, Teramoto M, Kashima R, Koga M. Weight Change Since Age 20 and the Risk of Cardiovascular Disease Mortality: A Prospective Cohort Study. J Atheroscler Thromb 2021; 29:1511-1521. [PMID: 34803086 PMCID: PMC9529374 DOI: 10.5551/jat.63191] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: Weight change could have many health outcomes. This study aimed to investigate the association between weight change and mortality risk due to total cardiovascular disease (CVD), ischemic heart disease (IHD), and stroke among Japanese.
Methods: We used Suita Study data from 4,746 people aged 30-79 years in this prospective cohort study. Weight change was defined as the difference between baseline weight and weight at age 20. We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of total CVD, IHD, and stroke mortality for 1) participants with a weight change (>10, 5 to 10, -5 to -10, and <-10 kg) compared to those with stable weight (-4.9 to 4.9 kg) and 2) participants who moved from one body mass index category (underweight, normal weight, or overweight) to another compared to those with normal weight at age 20 and baseline.
Results: Within a median follow-up period of 19.9 years, the numbers of total CVD, IHD, and stroke mortality were 268, 132, and 79, respectively. Weight loss of >10 kg was associated with the increased risk of total CVD mortality 2.07 (1.29, 3.32) and stroke mortality 3.02 (1.40, 6.52). Moving from normal weight at age 20 to underweight at baseline was associated with the increased risk of total CVD, IHD, and stroke mortality: 1.76 (1.12, 2.77), 2.10 (1.13, 3.92), and 2.25 (1.05, 4.83), respectively.
Conclusion: Weight loss, especially when moving from normal to underweight, was associated with the increased risk of CVD mortality.
Collapse
Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University.,Department of Public Health, Faculty of Medicine, Beni-Suef University
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Haytham A Sheerah
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Yukie Sakai
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Emi Watanabe
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Jiaqi Li
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Kyoko Honda-Kohmo
- Division of Preventive Healthcare, National Cerebral and Cardiovascular Center
| | - Masayuki Teramoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Rena Kashima
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Public Health Division, Ibaraki Public Health Center, Osaka Prefectural Government
| | - Masatoshi Koga
- Division of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| |
Collapse
|
28
|
Kabayama M, Akagi Y, Wada N, Higuchi A, Tamatani M, Tomita J, Nakata Y, Takiuchi S, Yamamoto K, Sugimoto K, Shintani A, Rakugi H, Kamide K. A Randomized Trial of Home Blood-Pressure Reduction by Alcohol Guidance During Outpatient Visits: OSAKE Study. Am J Hypertens 2021; 34:1108-1115. [PMID: 34023888 PMCID: PMC8557396 DOI: 10.1093/ajh/hpab082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/05/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of the nurse-led alcohol guidance to control home blood pressure (HBP) in the morning among male patients with hypertension during outpatient visits. METHODS We enrolled 53 male patients with an HBP of ≥135/85 mm Hg with excessive drinking (alcohol ≥210 g/week or ≥60 g/day habitually) among outpatients in a randomized trial. Patients were assigned to a nurse-led alcohol guidance intervention or to the control. The primary outcomes were the mean HBP of 5 consecutive days at 6 months and alcohol consumption. RESULTS Twenty-eight and 25 patients were randomized to intervention and control groups, respectively (mean age; 62.7 years old and 64.5, respectively). At baseline, the groups were well balanced across most characteristics. At 6 months, the mean HBP was 131/82 mm Hg in the intervention group vs. 145/87 mm Hg in the control group (SBP <0.001, DBP = 0.09). An HBP level of less than 135/85 mm Hg was achieved among 55.6% of the participants in the intervention group vs. 16.7% in the control group (P = 0.004). The alcohol consumption at 6 months was 256 ± 206 g/w vs. 413 ± 260 g/w, respectively (P = 0.020). CONCLUSIONS We confirmed the effectiveness of the nurse-led alcohol guidance to control the HBP in male patients with hypertension during outpatient visits. PUBLIC TRIALS REGISTRY NUMBER UMIN000017454 (UMIN Clinical Trials Registry).
Collapse
Affiliation(s)
- Mai Kabayama
- Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuya Akagi
- Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Naoko Wada
- Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsuko Higuchi
- Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Jun Tomita
- Toyonaka Watanabe Clinic, Toyonaka, Japan
| | | | - Shin Takiuchi
- Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Koichi Yamamoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ken Sugimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine and Faculty of Medicine, Osaka, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kei Kamide
- Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|
29
|
Nomura S, Sakamoto H, Rauniyar SK, Shimada K, Yamamoto H, Kohsaka S, Ichihara N, Kumamaru H, Miyata H. Analysis of the relationship between the HbA1c screening results and the development and worsening of diabetes among adults aged over 40 years: a 4-year follow-up study of 140,000 people in Japan - the Shizuoka study. BMC Public Health 2021; 21:1880. [PMID: 34663286 PMCID: PMC8524880 DOI: 10.1186/s12889-021-11933-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/30/2021] [Indexed: 11/11/2022] Open
Abstract
Background Hemoglobin A1c (HbA1c) levels are routinely measured during health check-ups and are used as an indicator of glycemic control in Japan. However, only a few studies have followed up individuals to assess the risk of diabetes development and worsening based on HbA1c screening results. This study evaluated the relationship between HbA1c screening results and the risk of diabetes development and worsening. Methods Data were collected from the Shizuoka Kokuho Database, a Japanese administrative claims database of insured individuals aged > 40 years. We included individuals available for follow-up from April 2012 to March 2018 who had not received any diabetes treatment before March 2014. HbA1c screening results were categorized into 4 groups based on the HbA1c levels at the 2012 and 2013 health check-ups: group A, those whose HbA1c levels were < 6.5% in 2012 and 2013; group B, those whose HbA1c levels > 6.5% in 2012 but < 6.5% in 2013; group C, those whose HbA1c levels were > 6.5% in 2012 and 2013; and group D, those whose HbA1c levels were < 6.5% in 2012 and > 6.5% in 2013. Logistic regression models were used to analyze diabetes development and worsening, defined as the initiation of diabetes treatment by March 2018 and the use of injection drugs by participants who initiated diabetes treatment by March 2018. Results Overall, 137,852 individuals were analyzed. After adjusting for covariates, compared with group A, group B was more likely to initiate treatment within 4 years (odds ratio: 22.64; 95% confidence interval: 14.66–34.99). In patients who initiated diabetes treatment by March 2018, injection drugs were less likely used by group D than by group A (odds ratio: 0.28; 95% confidence interval: 0.12–0.61). Conclusions Our study suggests that although HbA1c levels measured during health check-ups were correlated with the risk of diabetes development and worsening, HbA1c levels in a single year may not necessarily provide sufficient information to consider these future risks. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11933-z.
Collapse
Affiliation(s)
- Shuhei Nomura
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan. .,Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.
| | - Haruka Sakamoto
- Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Santosh Kumar Rauniyar
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koki Shimada
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroyuki Yamamoto
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shun Kohsaka
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Nao Ichihara
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiraku Kumamaru
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
30
|
Hanatani S, Izumiya Y, Yamamoto M, Araki S, Fujisue K, Arima Y, Takashio S, Yamamoto E, Kaikita K, Matsushita K, Tsujita K. A simple method of sarcopenia detection can predict adverse cardiovascular events in patients with abdominal obesity. Int J Obes (Lond) 2021; 45:2214-2220. [PMID: 34218263 DOI: 10.1038/s41366-021-00895-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/06/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although sarcopenic obesity is associated with a higher risk of cardiovascular events compared with obesity without sarcopenia, it is difficult to diagnose sarcopenia in daily clinical settings. Recently, a simple scoring system has been developed to identify sarcopenia patients based on three variables (age, hand grip strength, and calf circumference). However, the utility of this score for cardiovascular risk stratification in patients with abdominal obesity is unknown. METHODS We calculated the sarcopenia score in 262 patients with abdominal obesity, defined as a waist circumference ≥90 cm in women or ≥85 cm in men. The composite endpoint of this study was cardiovascular mortality, nonfatal myocardial infarction, stroke, unstable angina, and heart failure hospitalization. RESULTS Of the 262 patients, 108 had a high sarcopenia score based on previously established criteria (≥105 in men and ≥120 in women). The patients with a high sarcopenia score had a significantly higher plasma level of B-type natriuretic peptide compared with those with a low sarcopenia score (median 56.7, interquartile range [28.2-142.9] vs. 37.9 [13.8-76.1] pg/mL; p < 0.0001). Kaplan-Meier curves revealed a significantly lower event-free survival rate in those with a high compared with a low sarcopenia score (log-rank test p = 0.001), even after adjustment for confounding factors using propensity score matching (log-rank test p = 0.009). Multivariate Cox proportional hazard analysis identified a high sarcopenia score (hazard ratio: 2.46; 95% confidence interval: 1.31-4.64, p = 0.005) as an independent predictor of the primary endpoints. The combination of a high sarcopenia score and low body mass index (<25 kg/m2) predicted a significantly higher risk of future adverse events (p = 0.005). Furthermore, patients with a high sarcopenia score and high B-type natriuretic peptide level (≥200 pg/mL) had the poorest prognosis (p < 0.0001). CONCLUSIONS This simple screening test for sarcopenia can predict future adverse cardiovascular events in patients with abdominal obesity.
Collapse
Affiliation(s)
- Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. .,Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Masahiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Araki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,International Research Center for Medical Sciences (IRCMS), Kumamoto University, Kumamoto, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Center for Metabolic Regulation of Healthy Aging (CMHA), Kumamoto University, Kumamoto, Japan
| |
Collapse
|
31
|
Enomoto N, Nakamura S, Kanda S, Endo H, Yamada E, Kobayashi S, Kido M, Inoue R, Shimakura J, Narimatsu H. Efficacy of Additional Intervention to the Specific Health Guidance in Japan: The Takahata GENKI Project. Risk Manag Healthc Policy 2021; 14:3935-3943. [PMID: 34584471 PMCID: PMC8464379 DOI: 10.2147/rmhp.s323444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose A tailored approach to individual risk factors for developing lifestyle-related diseases would help induce behavioral changes toward intervention acceptability. The addition of preventive healthcare programs to nationwide specific health guidance in Japan is adapted in a given region. Patients and Methods We conducted a prospective parallel-group comparison study on 195 eligible residents from Takahata, Japan, with a high risk of lifestyle-related diseases from 2014 to 2017 to examine whether such an intervention could improve the body mass index (BMI) and estimated glomerular filtration rate (eGFR). Results Of the 195 enrolled residents, 117 were assigned to the control group and 78 to the intervention group. They were ≤65 years old and had a BMI ≥25 kg/m2 and an eGFR ≤90 mL/kg/1.73 m2. We conducted certain interventions for each group, including additional blood testing, regular health guidance, and specific health guidance. After one year, neither BMI (intervention: 26.7 ± 2.17 kg/m2 vs control: 27.3 ± 2.12 kg/m2, p = 0.076) nor eGFR (intervention: 72.2 ± 11.1 mL/kg/1.73 m2 vs control: 73.1 ± 10.5 mL/kg/1.73 m2, p = 0.608) differed significantly between groups. However, after three years, the BMI in the intervention group (26.4 ± 2.05 kg/m2) was significantly reduced compared to that in the control group (27.4 ± 2.26 kg/m2; p = 0.005). Conclusion The additional interventions might have contributed to a reduction in metabolic syndrome. Trial Registration This study was registered in the UMIN-Clinical Trials Registry (ID:000013581). More information: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000015868. The registration date was 31/03/2014.
Collapse
Affiliation(s)
- Nao Enomoto
- Section of Health and Longevity Service, Takahata Town Office, Takahata, Yamagata, Japan
| | - Sho Nakamura
- Graduate School of Health of Innovation, Kanagawa University of Human Services, Kawasaki, Kanagawa, Japan.,Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan.,CIKOP, Specified Nonprofit Corporation, Yamagata, Japan
| | - Satoru Kanda
- Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan.,CIKOP, Specified Nonprofit Corporation, Yamagata, Japan.,Department of Clinical Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroko Endo
- Section of Health and Longevity Service, Takahata Town Office, Takahata, Yamagata, Japan
| | - Emiko Yamada
- Section of Health and Longevity Service, Takahata Town Office, Takahata, Yamagata, Japan
| | - Sachiyo Kobayashi
- Section of Health and Longevity Service, Takahata Town Office, Takahata, Yamagata, Japan
| | - Miki Kido
- Section of Health and Longevity Service, Takahata Town Office, Takahata, Yamagata, Japan
| | - Rina Inoue
- CIKOP, Specified Nonprofit Corporation, Yamagata, Japan
| | - Junko Shimakura
- Section of Welfare and Child Service, Takahata Town Office, Takahata, Yamagata, Japan
| | - Hiroto Narimatsu
- Graduate School of Health of Innovation, Kanagawa University of Human Services, Kawasaki, Kanagawa, Japan.,Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan.,CIKOP, Specified Nonprofit Corporation, Yamagata, Japan.,Department of Genetic Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| |
Collapse
|
32
|
Yahata S, Tamura M, Yamaoka A, Fujioka Y, Okayama M. Comprehensive Geriatric Assessment Using the Yoitoko Check-Up, a Novel Health Check-Up Providing Positive Feedback to Older Adults: A Before-After Study. Int J Gen Med 2021; 14:2589-2598. [PMID: 34163228 PMCID: PMC8216198 DOI: 10.2147/ijgm.s307423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The Yoitoko check-up, a novel health check-up providing positive feedback, has been developed to promote health among older adults, and consists of several comprehensive geriatric assessment items. This report aimed to describe the details of the Yoitoko check-up and to explore the future possibility of the check-up by evaluating the participants’ short-term behavioral changes in terms of comprehensive functioning, using a before-after study design. Patients and Methods Four Yoitoko check-ups were conducted, at 3-month intervals, between December 2018 and September 2019. Study participants aged ≥65 years included those who had undergone ≥2 Yoitoko check-ups. The results of each visit after the second check-ups were retrospectively compared with those of the baseline, and the mean changes and the odds ratios were calculated using a paired t-test or a McNemar test, respectively. Results Of 84 participants, the results of 16 (19.0%) participants were analyzed. The mean (standard deviation) age was 75.3 (4.7) years. The mean Tokyo Metropolitan Institute of Gerontology Index of Competence score, a measure of high-level functional capacity, increased 0.9 (95% confidence interval; range, 0.2–1.5) points between the first and second visits. Conclusion We developed the Yoitoko check-up and introduced the details of it. Our study findings suggested that the Yoitoko check-up may further motivate older adults to improve their health and promote positive behavioral changes. Future studies are needed to evaluate the effectiveness of this novel assessment method.
Collapse
Affiliation(s)
- Shinsuke Yahata
- Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Minoru Tamura
- Kobe University Graduate School of Economics, Kobe, Hyogo, Japan
| | - Atsushi Yamaoka
- Kobe University Graduate School of Economics, Kobe, Hyogo, Japan
| | | | - Masanobu Okayama
- Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
33
|
Nozawa K, Higa S, Ii Y, Yamamoto Y, Asami Y. Antidyslipidemic Drug Prescriptions and Lipid Control Status After Unfavorable Annual Health Checkup Results: A Retrospective Cohort Study Using a Health Insurance Database. Drugs Real World Outcomes 2021; 8:227-240. [PMID: 33751470 PMCID: PMC8128960 DOI: 10.1007/s40801-021-00231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Japanese employers are obligated to offer employees annual health checkups and guidance programs for their health promotion and maintenance to prevent cardiovascular (CV) and lifestyle-related diseases. Under these programs, checkup recipients are notified of the checkup results, and in case of abnormal findings, employers are expected to provide employees with follow-up encouragement to change their behavior; for example, with medical consultations or lifestyle modifications. However, the effect of these programs on behavioral changes and their subsequent clinical outcomes has not been clearly assessed. OBJECTIVE The aim of this study was to investigate changes in CV risk management behaviors after receiving unfavorable health checkup results on serum lipid levels among subjects without antidyslipidemic drug prescription and uncontrolled lipid levels and at elevated risk of CV events in a real-world setting. PATIENTS AND METHODS This retrospective cohort study used a Japanese employment-based health insurance database managed by MinaCare Co., Ltd. This study analyzed the data from the annual health checkups of recipients aged 20-74 years with data on their low-density lipoprotein-cholesterol (LDL-c), high-density lipoprotein-cholesterol (HDL-c), and triglyceride (TG) values from 2015 to 2017, who had uncontrolled lipid levels based on their checkup results at baseline in 2015, and without prescription records of antidyslipidemic drugs. Lipid status was considered uncontrolled if any of the following were detected: LDL-c ≥ 140 mg/dL, HDL-c < 40 mg/dL, or TG ≥ 150 mg/dL. Changes in antidyslipidemic drug prescription, as a primary CV risk management behavior measure, and in lipid control status in 2016 and 2017 were investigated. Potential factors associated with lipid control were also explored using logistic regression analysis. RESULTS Among 154,421 subjects without antidyslipidemic drug prescription and with uncontrolled lipid levels in 2015, 93.6% remained without antidyslipidemic drug prescription in both 2016 and 2017. Of these subjects, 76.8% and 76.4% continued having uncontrolled lipid levels in 2016 and 2017, respectively. Fewer subjects without prescription achieved lipid control than those with prescription. Various factors were associated with lipid control, with high LDL-c as the greatest risk factor for uncontrolled lipid levels. CONCLUSIONS These results suggest that most health checkup recipients may not have changed their behaviors; that is, they may have not sought medical treatment and continued having uncontrolled lipid levels in the years following the unfavorable health checkup results. To encourage subjects to initiate desirable behavioral changes, more practical support may be essential.
Collapse
Affiliation(s)
- Kazutaka Nozawa
- Pfizer Japan Inc., Shinjuku Bunka Quint Bldg. 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
| | - Shingo Higa
- Pfizer Japan Inc., Shinjuku Bunka Quint Bldg. 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
| | | | | | - Yuko Asami
- Pfizer Japan Inc., Shinjuku Bunka Quint Bldg. 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| |
Collapse
|
34
|
Murayama H, Takahashi Y, Shimada S. Effectiveness of an Out-of-Pocket Cost Removal Intervention on Health Check Attendance in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115612. [PMID: 34073994 PMCID: PMC8197396 DOI: 10.3390/ijerph18115612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 11/16/2022]
Abstract
Annual health checks are important for identifying individuals at high risk for cardiometabolic diseases. However, there are socioeconomic disparities in health check attendance rates, and an intervention to lower financial barriers could be useful for increasing health check utilization. In this study, we aimed to evaluate the effectiveness of an out-of-pocket cost removal intervention on health check attendance in Japan. Data were obtained on beneficiaries of the National Health Insurance system of Yokohama City, Kanagawa Prefecture, Japan. In 2018, Yokohama started an intervention to remove out-of-pocket costs for specific health checks for all National Health Insurance beneficiaries. We analyzed data from 2015-2018 (131,295 people aged 40-74 years; 377,660 observations). A generalized estimating equation showed that people were more likely to receive specific health checks in 2018 (after the out-of-pocket cost removal intervention started) than in 2017 (immediately before the intervention; odds ratio [95% confidence interval] = 1.167 [1.149-1.185]), after adjusting for age, gender, tax exemption, and residential area. Stratified analyses revealed that the effectiveness of the out-of-pocket cost removal intervention was greater among the older age group and those who did not receive a tax exemption (i.e., those with relatively higher income). The present study showed that the out-of-pocket cost removal intervention could promote specific health check utilization. This indicates that removing financial barriers could motivate people's behavior regarding health check attendance.
Collapse
Affiliation(s)
- Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
- Correspondence: ; Tel.: +81-3-3964-3241
| | - Yuta Takahashi
- Health and Welfare Bureau, City of Yokohama, Kanagawa 231-0005, Japan; (Y.T.); (S.S.)
| | - Setaro Shimada
- Health and Welfare Bureau, City of Yokohama, Kanagawa 231-0005, Japan; (Y.T.); (S.S.)
| |
Collapse
|
35
|
Sato Y, Yoshihisa A, Maki T, Takeishi Y. Effects of daily alcohol intake on glomerular filtration rate over three years. Fukushima J Med Sci 2021; 67:1-7. [PMID: 33408305 PMCID: PMC8075561 DOI: 10.5387/fms.2020-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: The association between daily alcohol intake and changes in renal function in the Japanese general population is not well established. Methods: We analyzed data from 150 residents who underwent specific health checkups held in Mishima Town in 2016 and 2019. We divided participants on the basis of alcohol consumption: residents with daily alcohol intake of < 20 g/day (the none-to-low group, n = 104, 69.3%); those with daily alcohol intake of ≥ 20 but < 40 g/day (the intermediate group, n = 30, 20.0%); and those with daily alcohol intake of ≥ 40 g/day (the high group, n = 16, 10.7%). We compared baseline characteristics. The primary endpoint was a decrease in estimated glomerular filtration rate (eGFR), defined as the decrease in eGFR greater than the median decrease over three years. Results: The three-year changes in eGFR were +0.3 (−4.8, +3.0), −2.3 (−5.1, +1.2), and −4.9 (−8.2, −2.9) mL/min/1.73 m2 in the none-to-low, intermediate, and high groups, respectively (P = 0.007). In the multivariate logistic regression analysis, a high amount of alcohol intake was independently associated with a decrease in eGFR, with adjusted odds ratio of 11.418 (95% confidence interval 1.554-83.879, P = 0.017). Conclusion: A high average daily alcohol intake is associated with a decrease in eGFR.
Collapse
Affiliation(s)
- Yu Sato
- Department of Internal Medicine, Fukushima Prefectural Miyashita Hospital.,Department of Cardiovascular Medicine, Fukushima Medical University
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Takumi Maki
- Department of Internal Medicine, Fukushima Prefectural Miyashita Hospital
| | | |
Collapse
|
36
|
Higa S, Ii Y, Nozawa K, Yamamoto Y, Ohwaki K, Asami Y. Relationship of Annual Health Checkups with the Subject's Subsequent Behavior of Cardiovascular Risk Management in a Real-World Setting in Japan: A Retrospective Cohort Study on Changes in Antihypertensive Drug Prescription and Blood Pressure from 2015 to 2017. Drugs Real World Outcomes 2021; 8:215-225. [PMID: 33598872 PMCID: PMC8128959 DOI: 10.1007/s40801-020-00224-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background In Japan, workers receive a health checkup annually, and based on the results, a follow-up health guidance or intervention is provided when deemed necessary. However, it remains unclear whether the current real-world health checkup and guidance programs in Japan successfully lead to behavioral changes or improvement of clinical outcomes in individuals who require cardiovascular (CV) risk management. Objective This study aimed to explore the association between health checkup and the subsequent behavior change in CV risk management in subjects with uncontrolled blood pressure (BP) without antihypertensive drug prescription, who can have increased risk of CV events. Patients and Methods This was a retrospective cohort study that used health-checkup and claims data from a Japanese healthcare database managed by MinaCare Co., Ltd. Of those aged 20–74 years with available data on systolic and diastolic BP from 2015 to 2017, data from individuals with uncontrolled BP who were not prescribed antihypertensive drugs within 6 months before their baseline health checkup in 2015 were extracted and analyzed. The primary outcome measures were changes in antihypertensive drug prescription and BP control status based on health-checkup results from the baseline year (2015) to 2017. CV risk-management behavior was also assessed using body mass index (BMI) and smoking status, as these are the major modifiable CV risk factors. Results Among 39,242 subjects with uncontrolled BP without antihypertensive drug prescription at baseline, 88.9% remained without prescription in 2016. Of the subjects without prescription, 62.9% continued to have uncontrolled BP. Both statuses of the major modifiable CV risk factors remained unchanged in 2016: 92.1% of obese subjects (BMI ≥ 25 kg/m2) at baseline remained obese, and 93.8% of smokers at baseline aged ≥ 40 years continued to smoke. Logistic regression analysis revealed that age 60–69 years (vs. 40–49 years), hypertension (HT) stage II (vs. stage I), HT stage III (vs. stage I), and BMI ≥ 25.0 kg/m2 (vs. < 25.0 kg/m2) were factors associated with uncontrolled BP in 2016 (subsequent year), regardless of antihypertensive drug prescription. Conclusions Untreated HT for years increases the risk of CV events. These results suggest that current health-checkup and guidance programs are inadequately effective for behavioral change. Further practices for committing to lifestyle modifications and seeking medical advice based on their health-checkup results need to be undertaken to improve health behavior. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-020-00224-5.
Collapse
Affiliation(s)
- Shingo Higa
- Pfizer Japan Inc., Shinjuku Bunka Quint Bldg. 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan. .,Graduate School of Public Health, Teikyo University, Tokyo, Japan.
| | | | - Kazutaka Nozawa
- Pfizer Japan Inc., Shinjuku Bunka Quint Bldg. 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | | | - Kazuhiro Ohwaki
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
| | - Yuko Asami
- Pfizer Japan Inc., Shinjuku Bunka Quint Bldg. 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| |
Collapse
|
37
|
Fast walking is a preventive factor against new-onset diabetes mellitus in a large cohort from a Japanese general population. Sci Rep 2021; 11:716. [PMID: 33436978 PMCID: PMC7804125 DOI: 10.1038/s41598-020-80572-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Based on questionnaires from 197,825 non-diabetic participants in a large Japanese cohort, we determined impact of (1) habit of exercise, (2) habit of active physical activity (PA) and (3) walking pace on new-onset of type 2 diabetes mellitus. Unadjusted and multivariable-adjusted logistic regression models were used to determine the odds ratio of new-onset diabetes mellitus incidence in a 3-year follow-up. There were two major findings. First, habits of exercise and active PA were positively associated with incidence of diabetes mellitus. Second, fast walking, even after adjusting for multiple covariates, was associated with low incidence of diabetes mellitus. In the subgroup analysis, the association was also observed in participants aged ≥ 65 years, in men, and in those with a body mass index ≥ 25. Results suggest that fast walking is a simple and independent preventive factor for new-onset of diabetes mellitus in the health check-up and guidance system in Japan. Future studies may be warranted to verify whether interventions involving walking pace can reduce the onset of diabetes in a nation-wide scale.
Collapse
|
38
|
Kotoku J, Oyama A, Kitazumi K, Toki H, Haga A, Yamamoto R, Shinzawa M, Yamakawa M, Fukui S, Yamamoto K, Moriyama T. Causal relations of health indices inferred statistically using the DirectLiNGAM algorithm from big data of Osaka prefecture health checkups. PLoS One 2020; 15:e0243229. [PMID: 33362207 PMCID: PMC7757823 DOI: 10.1371/journal.pone.0243229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 11/17/2020] [Indexed: 11/18/2022] Open
Abstract
Causal relations among many statistical variables have been assessed using a Linear non-Gaussian Acyclic Model (LiNGAM). Using access to large amounts of health checkup data from Osaka prefecture obtained during the six fiscal years of years 2012–2017, we applied the DirectLiNGAM algorithm as a trial to extract causal relations among health indices for age groups and genders. Results show that LiNGAM yields interesting and reasonable results, suggesting causal relations and correlation among the statistical indices used for these analyses.
Collapse
Affiliation(s)
- Jun’ichi Kotoku
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
- * E-mail:
| | - Asuka Oyama
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
| | - Kanako Kitazumi
- Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
| | - Hiroshi Toki
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
- Research Center for Nuclear Physics, Osaka University, Osaka, Japan
| | - Akihiro Haga
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ryohei Yamamoto
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
| | - Maki Shinzawa
- Department of Nephrology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Miyae Yamakawa
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sakiko Fukui
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Keiichi Yamamoto
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
- Department of Medical Informatics, Wakayama Medical University Hospital, Wakayama, Japan
| | - Toshiki Moriyama
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
| |
Collapse
|
39
|
Shima D, Ii Y, Higa S, Kohro T, Hoshide S, Kono K, Fujimoto S, Niijima S, Tomitani N, Kario K. Validation of novel identification algorithms for major adverse cardiovascular events in a Japanese claims database. J Clin Hypertens (Greenwich) 2020; 23:646-655. [PMID: 33369149 PMCID: PMC8029538 DOI: 10.1111/jch.14151] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/24/2020] [Accepted: 12/13/2020] [Indexed: 12/29/2022]
Abstract
Predicting clinical outcomes can be difficult, particularly for life‐threatening events with a low incidence that require numerous clinical cases. Our aim was to develop and validate novel algorithms to identify major adverse cardiovascular events (MACEs) from claims databases. We developed algorithms based on the data available in the claims database International Classification of Diseases, Tenth Revision (ICD‐10), drug prescriptions, and medical procedures. We also employed data from the claims database of Jichi Medical University Hospital, Japan, for the period between October 2012 and September 2014. In total, we randomly extracted 100 potential acute myocardial infarction cases and 200 potential stroke cases (ischemic and hemorrhagic stroke were analyzed separately) based on ICD‐10 diagnosis. An independent committee reviewed the corresponding clinical data to provide definitive diagnoses for the extracted cases. We then assessed the algorithms’ accuracy using positive predictive values (PPVs) and apparent sensitivities. The PPVs of acute myocardial infarction, ischemic stroke, and hemorrhagic stroke were low only by diagnosis (81.6% [95% CI 72.5–88.7]; 31.0% [95% CI 22.8–40.3]; and 45.5% [95% CI 34.1–57.2], respectively); however, the PPVs were elevated after adding the prescription and procedure data (87.0% [95% CI 78.3–93.1]; 44.4% [95% CI 32.7–56.6]; and 46.1% [95% CI 34.5–57.9], respectively). When we added event‐specific prescription and procedure data to the algorithms, the PPVs for each event increased to 70%–98%, with apparent sensitivities exceeding 50%. Algorithms that rely on ICD‐10 diagnosis in combination with data on specific drugs and medical procedures appear to be valid for identifying MACEs in Japanese claims databases.
Collapse
Affiliation(s)
| | | | | | - Takahide Kohro
- Department of Clinical Informatics Jichi Medical University School of Medicine Tochigi Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Ken Kono
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Shigeru Fujimoto
- Division of Neurology Department of Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Satoshi Niijima
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Naoko Tomitani
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Tochigi Japan
| |
Collapse
|
40
|
Fukuma S, Iizuka T, Ikenoue T, Tsugawa Y. Association of the National Health Guidance Intervention for Obesity and Cardiovascular Risks With Health Outcomes Among Japanese Men. JAMA Intern Med 2020; 180:1630-1637. [PMID: 33031512 PMCID: PMC7536624 DOI: 10.1001/jamainternmed.2020.4334] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Obesity and cardiovascular risks have become major public health problems. However, evidence is limited as to whether population-level lifestyle interventions for obesity and cardiovascular risk factors are associated with improved population health outcomes. OBJECTIVE To investigate the association of the national health guidance intervention in Japan with population health outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a regression discontinuity design that included men aged 40 to 74 years who participated in the national health screening program in Japan from April 2013 to March 2018. EXPOSURES Assignment to the national health guidance intervention (counseling on healthy lifestyle and appropriate clinical follow-up for individuals found to have waist circumference of 85 cm or greater with 1 or more cardiovascular risk factors during annual national health screening program). MAIN OUTCOMES AND MEASURES Changes in obesity status (body weight, body mass index, waist circumference), and cardiovascular risk factors (blood pressure, hemoglobin A1c level, and low-density lipoprotein cholesterol level) 1 to 4 years after screening. RESULTS Of 74 693 men (mean [SD] age, 52.1 [7.8] years; mean [SD] baseline waist circumference, 86.3 [9.0] cm), the assignment to the health guidance intervention was associated with lower weight (adjusted difference, -0.29 kg; 95% CI, -0.50 to -0.08; P = .005), body mass index (-0.10; 95% CI, -0.17 to -0.03; P = .008), and waist circumference (-0.34 cm; 95% CI, -0.59 to -0.04; P = .02) 1 year after screening. The observed association of the guidance assignment attenuated over time and was no longer significant by years 3 to 4. No evidence was found that the health guidance intervention was associated with changes in participants' systolic blood pressure, diastolic blood pressure, hemoglobin A1c level, or low-density lipoprotein cholesterol level in years 1 to 4. CONCLUSIONS AND RELEVANCE Among working-age men in Japan, the national health guidance intervention was not associated with clinically meaningful weight loss or other cardiovascular risk factor reduction. Further research is warranted to understand the specific design of lifestyle interventions that are effective in improving obesity and cardiovascular risk factors.
Collapse
Affiliation(s)
- Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshiaki Iizuka
- Graduate School of Economics, the University of Tokyo, Tokyo, Japan
| | - Tatsuyoshi Ikenoue
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| |
Collapse
|
41
|
Longitudinal effects of a nationwide lifestyle intervention program on cardiometabolic outcomes in Japan: An observational cohort study. Prev Med 2020; 141:106301. [PMID: 33164885 DOI: 10.1016/j.ypmed.2020.106301] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023]
Abstract
The Japanese government launched a nationwide health screening and lifestyle intervention program in 2008 to prevent and reduce metabolic syndrome in at-risk individuals. This study examined the longitudinal effects of the program's lifestyle interventions on metabolic outcomes using health insurance data from one prefecture. The study population comprised 16,317 individuals aged 40-74 years who met the recommendation criteria for the interventions between 2009 and 2015. Participants were categorized into an overall intervention group (comprising a single-session motivational intervention group and a multi-session intensive intervention group) and a non-intervention group. We evaluated the interventions' effects on the initiation of medications for metabolic disorders (hyperlipidemia, hypertension, and hyperglycemia) and metabolic syndrome incidence for 6 years using discrete hazard models that adjusted for sex, age, health screening measurements, and smoking habit. The longitudinal effects on health screening measurements were also evaluated using regression models for repeated measures. The adjusted hazard ratios (aHRs) (95% confidence interval [CI]) for initiation of medications were 0.83 (0.77-0.90), 0.77 (0.71-0.84), and 0.66 (0.57-0.77) for overall, motivational, and intensive interventions, respectively. The aHRs (95%CI) for metabolic syndrome incidence were 0.84 (0.75-0.94), 0.80 (0.71-0.91), and 0.67 (0.51-0.89) for overall, motivational, and intensive interventions, respectively. The interventions reduced body mass index and waist circumference, but had modest effects on blood lipids, blood glucose, and hemoglobin A1c levels; blood pressure was unaffected. These interventions represent an effective strategy to prevent the progression of preclinical metabolic syndrome, but further studies are needed to evaluate their long-term preventive effects on cardiovascular disease and diabetes.
Collapse
|
42
|
Kontsevaya A, Drapkina O, Gorniy B, Kalinina A, Komkov D, Balanova Y, Bunova A, Kushunina D, Antsiferova A, Myrzamatova A, Lavrenova E, Nomura E, Iwatake M, Waki T, Tanaka-Mizuno S, Miura K, Miyamoto Y, Tsushita K. Protocol and Rationale for the Russian-Japanese "Tackle Obesity and Metabolic Syndrome Outcome by Diet, Activities and Checking Body Weight Intervention" (RJ-TOMODACHI) Randomized Controlled Trial. Circ Rep 2020; 2:695-700. [PMID: 33693197 PMCID: PMC7937500 DOI: 10.1253/circrep.cr-20-0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The prevalence of obesity in Russia has increased sharply since the mid-1990s. Interestingly, the prevalence of obesity in Japan is lower than in many Western countries. Japan has implemented different types of weight control programs using a smart device to monitor patients remotely. New health promotion methods from Japan are now being used in Russia. The Russian-Japanese "Tackle Obesity and Metabolic Syndrome Outcome by Diet, Activities and Checking Body Weight Intervention" (RJ-TOMODACHI) study aims to evaluate a preventive intervention using Japanese health monitoring technology in reducing excess body weight, compared with standard care, in Russia. Methods and Results: The trial is a single-center, 3-armed, parallel group randomized controlled trial conducted among overweight/obese adults. It has been designed to compare the effectiveness of 2 newly developed interventions against standard care for 6 months. Participants in the low- and high-intensity intervention groups will have 3 and 6 consultations over the study period, respectively. In all, 260 adults were screened at baseline; 65 did not participate in the trial for various reasons. The remaining 195 people were randomized into 3 groups (high-intensity intervention, n=73, low-intensity, n=73; standard care group, n=49). Conclusions: The trial protocol has been designed so that the methodology can be adapted for use in Russia.
Collapse
Affiliation(s)
- Anna Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine Moscow Russia
| | - Oxana Drapkina
- National Medical Research Center for Therapy and Preventive Medicine Moscow Russia
| | - Boris Gorniy
- National Medical Research Center for Therapy and Preventive Medicine Moscow Russia
| | - Anna Kalinina
- National Medical Research Center for Therapy and Preventive Medicine Moscow Russia
| | - Denis Komkov
- National Medical Research Center for Therapy and Preventive Medicine Moscow Russia
| | - Yulia Balanova
- National Medical Research Center for Therapy and Preventive Medicine Moscow Russia
| | - Anna Bunova
- National Medical Research Center for Therapy and Preventive Medicine Moscow Russia
| | - Daria Kushunina
- National Medical Research Center for Therapy and Preventive Medicine Moscow Russia
| | | | - Azalia Myrzamatova
- National Medical Research Center for Therapy and Preventive Medicine Moscow Russia
| | - Evgenia Lavrenova
- National Medical Research Center for Therapy and Preventive Medicine Moscow Russia
| | - Eri Nomura
- Comprehensive Health Science Center, Aichi Health Promotion Public Interest Foundation Aichi Japan
| | - Maki Iwatake
- Comprehensive Health Science Center, Aichi Health Promotion Public Interest Foundation Aichi Japan
| | | | | | | | | | - Kazuyo Tsushita
- Comprehensive Health Science Center, Aichi Health Promotion Public Interest Foundation Aichi Japan
| |
Collapse
|
43
|
Sugai K, Imamura H, Michikawa T, Asakura K, Nishiwaki Y. Awareness of Locomotive Syndrome and Factors Associated with Awareness: A Community-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197272. [PMID: 33027956 PMCID: PMC7579478 DOI: 10.3390/ijerph17197272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022]
Abstract
Locomotive syndrome is a condition of reduced mobility, and patients have a high risk of requiring nursing care. In order to investigate the level of awareness of the term “locomotive syndrome” and the factors relating to awareness in a community, awareness of locomotive syndrome was included in a questionnaire survey on health and daily life conducted in Koumi Town (Japan), which was distributed to 3181 eligible residents aged 40 years or older. Information on age, sex, marital status, educational attainment, lifestyle, and social environment was also collected, and the association of awareness with various factors was analyzed with two multivariable Poisson regression models. As a result, awareness among respondents was 44.6%. Awareness was significantly higher among women, those who were 60–79 years old, married, and had received higher education. Additionally, awareness was significantly associated with social factors, especially attendance at regional events within the last one year, in both women and men: the adjusted prevalence ratios (95% confidence intervals) were 1.26 (1.10–1.43) and 1.48 (1.19–1.83), respectively. In conclusion, in addition to strengthen awareness rising campaigns targeting men and for younger people, providing health education at social settings such as regional events may help improve future musculoskeletal health in the elderly.
Collapse
Affiliation(s)
- Keiko Sugai
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan;
| | - Haruhiko Imamura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo 143-8540, Japan; (T.M.); (K.A.); (Y.N.)
- Correspondence: ; Tel.: +81-3-3762-4151
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo 143-8540, Japan; (T.M.); (K.A.); (Y.N.)
| | - Keiko Asakura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo 143-8540, Japan; (T.M.); (K.A.); (Y.N.)
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo 143-8540, Japan; (T.M.); (K.A.); (Y.N.)
| |
Collapse
|
44
|
Kaneko K, Yatsuya H, Li Y, Uemura M, Chiang C, Hirakawa Y, Ota A, Tamakoshi K, Aoyama A. Risk and population attributable fraction of metabolic syndrome and impaired fasting glucose for the incidence of type 2 diabetes mellitus among middle-aged Japanese individuals: Aichi Worker's Cohort Study. J Diabetes Investig 2020; 11:1163-1169. [PMID: 32022993 PMCID: PMC7477517 DOI: 10.1111/jdi.13230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/13/2020] [Accepted: 02/03/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS/INTRODUCTION The Japanese government started a nationwide screening program for metabolic syndrome (MetS) to prevent cardiovascular diseases and diabetes in 2008. Although impaired fasting glucose (IFG) is a strong predictor for type 2 diabetes mellitus, the program does not follow up IFG in non-MetS individuals. This study aimed to examine the risk and the population attributable fraction (PAF) of MetS and IFG for incidence of type 2 diabetes mellitus. MATERIALS AND METHODS Japanese workers (3,417 men and 714 women) aged 40-64 years without a history of diabetes were prospectively followed. MetS was defined as either abdominal obesity plus two or more metabolic risk factors, or being overweight in the case of normal waist circumference plus three or more metabolic risk factors. IFG was defined as fasting blood glucose 100-125 mg/dL. RESULTS During a mean 6.3 years, 240 type 2 diabetes mellitus cases were identified. Compared with those without MetS and IFG, the multivariable-adjusted hazard ratios (95% confidence interval) of non-MetS individuals with IFG, MetS individuals without IFG and MetS individuals with IFG for type 2 diabetes mellitus were 4.9 (3.4-7.1), 2.4 (1.6-3.5) and 8.3 (5.9-11.5), respectively. The corresponding PAFs for type 2 diabetes mellitus incidence were 15.6, 9.1 and 29.7%, respectively. CONCLUSIONS IFG represented a higher risk and PAF than MetS for type 2 diabetes mellitus incidence in middle-aged Japanese individuals. The coexistence of MetS and IFG showed the highest risk and PAF for type 2 diabetes mellitus incidence. The current Japanese MetS screening program should be reconsidered to follow up non-MetS individuals with IFG.
Collapse
Affiliation(s)
- Kayo Kaneko
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
| | - Hiroshi Yatsuya
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
- Department of Public HealthFujita Health University School of MedicineToyoakeJapan
| | - Yuanying Li
- Department of Public HealthFujita Health University School of MedicineToyoakeJapan
| | - Mayu Uemura
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
| | - Chifa Chiang
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
| | - Atsuhiko Ota
- Department of Public HealthFujita Health University School of MedicineToyoakeJapan
| | - Koji Tamakoshi
- Department of NursingNagoya University School of Health SciencesNagoyaJapan
| | - Atsuko Aoyama
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
- Nagoya University of Arts and SciencesNissinJapan
| |
Collapse
|
45
|
Park S, Lee S, Kim Y, Lee Y, Kang MW, Han K, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Reduced risk for chronic kidney disease after recovery from metabolic syndrome: A nationwide population-based study. Kidney Res Clin Pract 2020; 39:180-191. [PMID: 32344501 PMCID: PMC7321670 DOI: 10.23876/j.krcp.20.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background Metabolic syndrome (MetS) is linked to various chronic comorbidities, including chronic kidney disease (CKD). However, few large studies have addressed whether recovery from MetS is associated with reduction in the risks of such comorbidities. Methods This nationwide population-based study in Korea screened 10,664,268 people who received national health screening ≥ 3 times between 2012 and 2016. Those with a history of major cardiovascular events or preexisting CKD were excluded. We classified study groups into four, according to the course of MetS state, as defined by the harmonizing criteria. The main study outcome was incidental CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2 which was persistent until the last health exams). The study outcomes were investigated using multivariable logistic regression analysis, which was adjusted for clinical variables and the previous severity of MetS. Results Four study groups included 6,315,301 subjects: 4,537,869 people without MetS, 1,034,605 with chronic MetS, 438,287 who developed MetS, and 304,540 who recovered from preexisting MetS. Those who developed MetS demonstrated higher risk of CKD (adjusted odds ratio [OR], 1.26 [1.23-1.29]) than did those who did not develop MetS. In contrast, MetS-recovery was associated with decreased risk of CKD (adjusted OR, 0.84 [0.82-0.86]) than that in people with chronic MetS. Among the MetS components, change in hypertension was associated with the largest difference in CKD risk. Conclusion Reducing or preventing MetS may reduce the burden of CKD on a population-scale. Clinicians should consider the clinical importance of altering MetS status for risk of CKD.
Collapse
Affiliation(s)
- Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Soojin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Yeonhee Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Woo Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
46
|
Watanabe D, Yoshida T, Watanabe Y, Yamada Y, Kimura M. A U-Shaped Relationship Between the Prevalence of Frailty and Body Mass Index in Community-Dwelling Japanese Older Adults: The Kyoto-Kameoka Study. J Clin Med 2020; 9:jcm9051367. [PMID: 32384756 PMCID: PMC7290950 DOI: 10.3390/jcm9051367] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/16/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022] Open
Abstract
The relationship between body mass index (BMI) and frailty remains unclear. Using two validated frailty assessment tools, this study aimed to investigate the relationship between the prevalence of frailty and BMI in Japanese older adults. This cross-sectional study used baseline data of 7191 individuals aged ≥65 years, living in Kameoka City, Kyoto, Japan. The BMI was calculated based on self-reported height and body weight, and classified into six categories. Frailty was defined using two validated assessment tools, the Fried phenotype (FP) model and Kihon Checklist (KCL). We evaluated the relationship between frailty and BMI using a multivariate restricted cubic spline logistic regression. The prevalence of frailty defined using the FP model was 25.3%, 19.6%, 14.3%, 12.4%, 12.6%, and 19.4% for each BMI category of <18.5, 18.5–19.9, 20.0–22.4, 22.5–24.9, 25.0–27.4, and ≥27.5 kg/m2, respectively. The spline model showed a significant U-shaped relationship between BMI and the prevalence of frailty defined using both, KCL and FP models. This study found that the BMI range corresponding to lowest prevalence of frailty defined using both tools was 21.4–25.7 kg/m2. Thus, a healthy BMI may reduce the prevalence of frailty, and the risk of frailty needs to be evaluated in individuals who are underweight or overweight.
Collapse
Affiliation(s)
- Daiki Watanabe
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Correspondence:
| | - Tsukasa Yoshida
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
- Senior Citizen’s Welfare Section, Kameoka City Government, Kyoto 621-8501, Japan
| | - Yuya Watanabe
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
- Faculty of Health and Sports Science, Doshisha University, Kyoto 610-0394, Japan
| | - Yosuke Yamada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (T.Y.); (Y.W.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 621-8555, Japan;
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| |
Collapse
|
47
|
Yoshioka N, Ishigami M, Watanabe Y, Sumi H, Doisaki M, Yamaguchi T, Ito T, Ishizu Y, Kuzuya T, Honda T, Ishikawa T, Haruta JI, Fujishiro M. Effect of weight change and lifestyle modifications on the development or remission of nonalcoholic fatty liver disease: sex-specific analysis. Sci Rep 2020; 10:481. [PMID: 31949229 PMCID: PMC6965633 DOI: 10.1038/s41598-019-57369-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022] Open
Abstract
The effects of changes in various lifestyle habits on nonalcoholic fatty liver disease (NAFLD) have not been well elucidated. We aimed to clarify how weight change and lifestyle modifications were associated with the development or remission of NAFLD. In this longitudinal cohort study, we reviewed the periodic health checkup data of 1,421 subjects with no causes of liver disease besides NAFLD who had received at least two health checkups between 2009 and 2018. The prevalence of NAFLD at baseline was 34.1% (484/1,421). During follow-up period (4.6 ± 2.8 years), 104 subjects developed NAFLD and 127 subjects demonstrated NAFLD remission. The frequency of NAFLD development or that of NAFLD remission significantly increased as the larger weight gain or weight loss was, respectively (both, p < 0.001). Approximately 40% of the subjects who maintained ≥ 1%/year weight loss achieved NAFLD remission. By multivariate analysis, quitting smoking were independently associated with NAFLD development (adjusted odds ratio [AOR], 2.86; 95% CI, 1.24–6.62). Subjects who quit smoking demonstrated large weight gain (≥1%/year) significantly more frequently than the other subjects (p < 0.001). In sex-specific analysis, starting to exercise was independently associated with NAFLD remission in men (AOR, 2.38; 95% CI, 1.25–4.53).
Collapse
Affiliation(s)
- Naoki Yoshioka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.,Department of Gastroenterology and Hepatology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yasuko Watanabe
- Health control Center, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hajime Sumi
- Department of Gastroenterology and Hepatology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Masao Doisaki
- Department of Gastroenterology and Hepatology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Takeo Yamaguchi
- Department of Gastroenterology and Hepatology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Teiji Kuzuya
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tetsuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jun-Ichi Haruta
- Department of Gastroenterology and Hepatology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
48
|
Yamana H, Ono S, Okada A, Jo T, Yasunaga H. Association between mandatory health examination attendance and diabetes treatment initiation among employees being treated for hypertension. J Occup Health 2020; 62:e12183. [PMID: 33296133 PMCID: PMC7725135 DOI: 10.1002/1348-9585.12183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/17/2020] [Accepted: 11/11/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES It is unclear whether mandatory health examination is effective for employees who are already being treated for chronic diseases. We focused on patients being treated for hypertension and evaluated the association between employer-based health examination attendance and diabetes treatment initiation. METHODS Using a database that stores health insurance claims and health examination results of subscribers enrolled in society-managed health insurance plans in Japan, we identified employees aged 40-59 years who were being treated for hypertension when starting diabetes treatment from April 2012 to December 2016. A case-crossover analysis was conducted using 90, 180, and 270 days prior to diabetes treatment initiation as reference points and 90 days after the mandatory health examination as the exposure period. We conducted a subgroup analysis by hemoglobin A1c (HbA1c) level and frequency of outpatient blood glucose testing before the mandatory health examination. RESULTS We identified 1464 individuals starting treatment for diabetes while on antihypertensive drugs. The overall odds ratio for starting diabetes treatment within 90 days of the health examination was 1.89 (95% confidence interval: 1.70-2.10). The subgroup analysis showed that this odds ratio increased as HbA1c level increased and as blood glucose testing frequency decreased. CONCLUSIONS Among employees starting treatment for diabetes while being treated for hypertension, employer-based mandatory health examination attendance was associated with initiation of diabetes treatment. The health examinations may be functioning as a complement to screening in outpatient settings.
Collapse
Affiliation(s)
- Hayato Yamana
- Department of Health Services ResearchGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Sachiko Ono
- Department of Eat‐loss MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related DiseasesGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Taisuke Jo
- Department of Health Services ResearchGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthThe University of TokyoTokyoJapan
| |
Collapse
|
49
|
Park S, Lee S, Kim Y, Lee Y, Kang MW, Han K, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Altered Risk for Cardiovascular Events With Changes in the Metabolic Syndrome Status: A Nationwide Population-Based Study of Approximately 10 Million Persons. Ann Intern Med 2019; 171:875-884. [PMID: 31766057 DOI: 10.7326/m19-0563] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Population-scale evidence for the association between dynamic changes in metabolic syndrome (MetS) status and alterations in the risk for major adverse cardiovascular events (MACE) is lacking. OBJECTIVE To investigate whether recovery from or development of MetS in a population is associated with an altered risk for MACE. DESIGN Nationwide cohort study. SETTING An analysis based on the National Health Insurance Database of Korea. PARTICIPANTS A total of 27 161 051 persons who received national health screenings from 2009 to 2014 were screened. Those with a history of MACE were excluded. We determined the MetS status of 9 553 042 persons using the following harmonizing criteria: MetS-chronic (n = 1 486 485), MetS-developed (n = 587 088), MetS-recovery (n = 538 806), and MetS-free (n = 6 940 663). MEASUREMENTS The outcome was the occurrence of MACE, including acute myocardial infarction, revascularization, and acute ischemic stroke, identified from the claims database. The incidence rate ratios (IRRs) were calculated with adjustments for body mass index, comorbidity scores, previous metabolic variables, and other clinical or demographic variables. RESULTS At a median follow-up of 3.54 years, the MetS-recovery group (incidence rate, 4.55 per 1000 person-years) had a significantly lower MACE risk (adjusted IRR, 0.85 [95% CI, 0.83 to 0.87]) than that of the MetS-chronic group (incidence rate, 8.52 per 1000 person-years). The MetS-developed group (incidence rate, 6.05 per 1000 person-years) had a significantly higher MACE risk (adjusted IRR, 1.36 [CI, 1.33 to 1.39]) than that of the MetS-free group (incidence rate, 1.92 per 1000 person-years). Among the MetS components, change in hypertension was associated with the largest difference in MACE risk. LIMITATION Limited assessment of mortality and short follow-up. CONCLUSION Recovery from MetS was significantly associated with decreased risk for MACE, whereas development of MetS was associated with increased risk. PRIMARY FUNDING SOURCE Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea.
Collapse
Affiliation(s)
- Sehoon Park
- Seoul National University College of Medicine, Seoul, and Armed Forces Capital Hospital, Gyeonggi-do, Korea (S.P.)
| | - Soojin Lee
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea (S.L., Y.L., M.W.K.)
| | - Yaerim Kim
- Keimyung University School of Medicine, Daegu, Korea (Y.K.)
| | - Yeonhee Lee
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea (S.L., Y.L., M.W.K.)
| | - Min Woo Kang
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea (S.L., Y.L., M.W.K.)
| | - Kyungdo Han
- College of Medicine, Catholic University of Korea, Seoul, Korea (K.H.)
| | - Seung Seok Han
- Seoul National University Hospital and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (S.S.H., H.L., K.W.J., Y.S.K., D.K.K.)
| | - Hajeong Lee
- Seoul National University Hospital and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (S.S.H., H.L., K.W.J., Y.S.K., D.K.K.)
| | - Jung Pyo Lee
- Seoul National University Boramae Medical Center and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (J.P.L., C.S.L.)
| | - Kwon Wook Joo
- Seoul National University Hospital and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (S.S.H., H.L., K.W.J., Y.S.K., D.K.K.)
| | - Chun Soo Lim
- Seoul National University Boramae Medical Center and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (J.P.L., C.S.L.)
| | - Yon Su Kim
- Seoul National University Hospital and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (S.S.H., H.L., K.W.J., Y.S.K., D.K.K.)
| | - Dong Ki Kim
- Seoul National University Hospital and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (S.S.H., H.L., K.W.J., Y.S.K., D.K.K.)
| |
Collapse
|
50
|
Izumida T, Nakamura Y, Ishikawa S. Impact of body mass index and metabolically unhealthy status on mortality in the Japanese general population: The JMS cohort study. PLoS One 2019; 14:e0224802. [PMID: 31697720 PMCID: PMC6837339 DOI: 10.1371/journal.pone.0224802] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/22/2019] [Indexed: 12/13/2022] Open
Abstract
This study aimed to investigate the associations of body mass index (BMI) and metabolically unhealthy weight with all-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality as well as the effect of age on the associations. This prospective study enrolled Japanese individuals in the general population. Participants were divided into eight phenotypes according to the BMI classification and metabolic status. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a Cox regression hazard model. In total, 10,824 individuals with a mean age of 55.3 years were evaluated. During a mean follow-up of 18.4 years (198,776 person-years), 2,274 participants died. Among the metabolically unhealthy, the association between BMI and mortality was J-shaped after adjustment for various confounders (multivariable HR [95% CI] for all-cause mortality: underweight, 2.0 [1.5-2.7]; obesity 2.8 [2.1-3.6]). The association remained the same in metabolically unhealthy participants aged <65 years and ≥65 years. The results were compatible in the analyses restricted to subjects who never smoked. Regardless of age, metabolically unhealthy underweight (MUHU) have approximately a 3-fold higher risk of CVD mortality, compared with metabolically healthy normal weight. Not only metabolically unhealthy obesity, but also MUHU was strongly associated with an increased risk of mortality. More attention should be given to the health issues of metabolically unhealthy participants without obesity, particularly those with MUHU.
Collapse
Affiliation(s)
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shizukiyo Ishikawa
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
- * E-mail:
| |
Collapse
|