Dose-Response Relationships between Diet Quality and Mortality among Frail and Non-Frail Older Adults: A Population-Based Kyoto-Kameoka Prospective Cohort Study.

OBJECTIVES: Although better diet quality is inversely associated with mortality risk, the association between diet quality and mortality remains unclear in frail and non-frail older adults. Thus, we aimed to examine this association in older Japanese adults. DESIGN: A prospective cohort study. SETTING AND PARTICIPANTS: We used the data of 8,051 Japanese older adults aged ≥65 years in the Kyoto-Kameoka study. MESUREMENTS: Dietary intake was estimated using a validated food frequency questionnaire. Diet quality was evaluated by calculating the adherence scores to the Japanese Food Guide Spinning Top (range, 0 [worst] to 80 [best]), which were stratified into quartiles. Frailty status was assessed using the validated self-administered Kihon Checklist (KCL) and the Fried phenotype (FP) model. Survival data were collected between February 15, 2012 and November 30, 2016. Statistical analysis was performed using the multivariate Cox proportional hazard analysis and the spline model. RESULTS: During the median 4.75-year follow-up (36,552 person-years), we recorded 661 deaths. After adjusting for confounders, compared with the bottom adherence score quartile, the top quartile was associated with lower hazard ratio (HR) of mortality in frailty (HR, 0.73; 95% confidence interval [CI], 0.54-1.00) and non-frailty, as defined by the KCL (HR, 0.72; 95% CI, 0.52-1.01). In the spline model, regardless of frailty status defined by the KCL and FP model, adherence score showed a strongly dose-dependent inverse association with mortality up to approximately 55 points; however, no significant differences were observed thereafter. This association was similar to the results obtained in individuals with physical, cognitive, and depression as domains of KCL in the spline model. CONCLUSIONS: Our findings demonstrate an L-shaped association between diet quality and mortality in both frail and non-frail individuals. This study may provide important knowledge for improving poor diet quality in older individuals with frailty or domains of frailty.

Screening for Malnutrition in Community Dwelling Older Japanese: Preliminary Development and Evaluation of the Japanese Nutritional Risk Screening Tool (NRST).

BACKGROUND: Early and effective screening for age-related malnutrition is an essential part of providing optimal nutritional care to older populations. OBJECTIVE: This study was performed to evaluate the adaptation of the original SCREEN II questionnaire (Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II) for use in Japan by examining its measurement properties and ability to predict nutritional risk and sarcopenia in community-dwelling older Japanese people. The ultimate objective of this preliminary validation study is to develop a license granted full Japanese version of the SCREEN II. PARTICIPANTS: The measurement properties and predictive validity of the NRST were examined in this cross-sectional study of 1921 community-dwelling older Japanese people. MEASUREMENTS: Assessments included medical history, and anthropometric and serum albumin measurements. Questions on dietary habits that corresponded to the original SCREEN II were applied to Nutritional Risk Screening Tool (NRST) scoring system. Nutritional risk was assessed by the Geriatric Nutrition Risk Index (GNRI) and the short form of the Mini-Nutritional Assessment (MNA-SF). Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People. RESULTS: The nutritional risk prevalences determined by the GNRI and MNA-SF were 5.6% and 34.7%, respectively. The prevalence of sarcopenia was 13.3%. Mean NRST scores were significantly lower in the nutritionally at-risk than in the well-nourished groups. Concurrent validity analysis showed significant correlations between NRST scores and both nutritional risk parameters (GNRI or MNA-SF) and sarcopenia. The areas under the receiver operating characteristic curves (AUC) of NRST for the prediction of nutritional risk were 0.635 and 0.584 as assessed by GNRI and MNA-SF, respectively. AUCs for the prediction of sarcopenia were 0.602 (NRST), 0.655 (age-integrated NRST), and 0.676 (age and BMI-integrated NRST). CONCLUSIONS: These results indicate that the NRST is a promising screening tool for the prediction of malnutrition and sarcopenia in community-dwelling older Japanese people. Further development of a full Japanese version of the SCREEN II is indicated.

Weight change after 20 years of age and the incidence of dyslipidemia: a cohort study of Japanese male workers.

BACKGROUND: While heavier weight is known to increase the incidence of dyslipidemia, limited data are available on the relationship between weight gain and its development. METHODS: A total of 2647 males were categorized into the following four groups according to the difference between their self-reported weight at 20 years of age and their measured weight in 1994-95: a loss of ≥5% (decrease), loss of <5% or gain of <5% (no change), gain of ≥5 to <15% (increase) and gain of ≥15% (sizable increase). They were followed up until their 2002-03 health examination. Using the 'no change' group as reference, the multivariable-adjusted odds ratio (adjusted for age, body mass index at 20 years of age, physical activity, smoking and alcohol intake) and 95% confidence interval (95% CI) for the incidence of dyslipidemia were determined using logistic regression models. RESULTS: A total of 1342 participants developed dyslipidemia during the follow-up period. The 'increase' and 'sizable increase' groups had odds ratios for the incidence of dyslipidemia of 1.97 (95% CI, 1.59-2.45) and 2.68 (2.15-3.34), respectively, demonstrating that there was a significant dose-response association between weight gain since 20 years of age and the incidence of dyslipidemia (P < 0.001 for trend). CONCLUSION: These results suggest that dyslipidemia could be prevented by avoiding weight gain in adulthood.

One-year change in the second metacarpal bone mass associated with menopause nutrition and physical activity.

OBJECTIVES: To clarify the annual changes and effects of nutrition and physical activity on bone mass at the second metacarpal using computed X-ray densitometry. DESIGN: Population-based prospective follow-up study. MEASUREMENTS: Bone mass measurements and assessments of nutritional intake, exercise habits, and health status were conducted twice with a one-year interval. PARTICIPANT: 269 Japanese women aged 40 - to -80 - years old. RESULTS: The annual change rate among subjects who started menopause during the observation period was -4.2 +/- 4.9%. Bone mass subsequently continued to decrease 3% annually until 6 years after menopause. Subjects who consumed high levels of milk or calcium in the first year showed no substantial decrease in bone mass among the post-menopausal subjects. Premenopausal subjects who began or continued exercise evidenced increased bone mass, and peri-menopausal subjects who continued exercise or a high level of daily physical activity showed inhibited bone loss. CONCLUSION: Second metacarpal bone changed by menopause, nutrition and physical activity similar with other bone site presented in the previous studies.

Validation of self-reported energy intake by a self-administered diet history questionnaire using the doubly labeled water method in 140 Japanese adults.

OBJECTIVE: To validate reported energy intake (rEI) with a self-administered diet history questionnaire (DHQ) against total energy expenditure (TEE) by the doubly labeled water (DLW) method. SUBJECTS: A total of 140 healthy Japanese adults (67 men and 73 women) aged 20-59 years living in four areas in Japan. METHODS: Energy intake was assessed twice with DHQ over a 1-month period before and after TEE measurement (rEI(DHQ1) and rEI(DHQ2), respectively). TEE was measured by DLW during 2 weeks (TEE(DLW)). RESULTS: Mean rEI(DHQ1) was lower than those of TEE(DLW) by 1.9+/-2.4 MJ/day (16.4%, P<0.001) for men and 0.6+/-1.9 MJ/day (6.0%, P<0.01) for women. In men and women together, 62 subjects (44%) were defined as underreporters (rEI(DHQ1)/TEE(DLW) <0.84), 58 (41%) as acceptable reporters (0.84-1.16) and 20 (14%) as over-reporters (>1.16). Pearson correlation coefficient was 0.34 for men and 0.22 for women. After adjustment for the dietary and non-dietary factors related to rEI(DHQ1)/TEE(DLW), the correlation coefficient improved to 0.42 and 0.37, respectively. CONCLUSION: The energy intake assessed with DHQ correlated low to modestly with TEE measured by DLW. In addition, DHQ underestimated energy intake at a group level. Caution is needed when energy intake was evaluated by DHQ at both individual and group levels.

Physical activity level in healthy free-living Japanese estimated by doubly labelled water method and International Physical Activity Questionnaire.

OBJECTIVE: To measure total energy expenditure (TEE) for normal healthy Japanese by the doubly labelled water (DLW), and to compare the physical activity level (PAL) among categories classified by the categories used in daily reference intake (DRI), Japan and the International Physical Activity Questionnaire (IPAQ). SUBJECTS AND METHODS: A total of 150 healthy Japanese men and women aged 20- to 59-year-old living in four districts of Japan. TEE was measured by the DLW method, and the PAL was calculated from TEE divided by basal metabolic rate. Simultaneously with TEE measurement, the PAL was assessed employing the categories used in DRI, Japan and IPAQ. RESULTS: The average TEE and PAL were 10.78+/-1.67 MJ/day and 1.72+/-0.22 for males and 8.37+/-1.30 MJ/day and 1.72+/-0.27 for females, respectively. The subjects in the highly active categories assessed by both DRI and IPAQ showed significantly higher PAL compared with less active categories. However, PALs among light and moderate categories by DRI, and insufficient and sufficiently active by IPAQ were not significantly different. CONCLUSIONS: In developed countries, highly active subjects could be assessed by a simple questionnaire. However, the questionnaire should be improved to clarify the sedentary to moderately active subjects by assessing carefully very light to moderate physical activity.

A dose-response relation between aerobic exercise and visceral fat reduction: systematic review of clinical trials.

OBJECTIVE: It has been suggested that exercise has preferential effects on visceral fat reduction. However, the dose-response effect remains unclear because of limited evidence from individual studies. The purpose of this study was to systematically review the current literature to establish whether reduction of visceral fat by aerobic exercise has a dose-response relationship. METHODS: A database search was performed (PubMed, 1966-2006) with appropriate keywords to identify studies exploring the effects of aerobic exercise as a weight loss intervention on visceral fat reduction. Visceral fat reduction was expressed as the percentage of visceral fat change per week (%DeltaVF/w). The energy expenditure by aerobic exercise was expressed as Sigma (metabolic equivalents x h per week (METs x h/w)). RESULTS: Nine randomized control trials and seven non-randomized control trials were selected. In most of the studies, the subjects performed aerobic exercise generating 10 METs x h/w or more. Among all the selected groups (582 subjects), visceral fat decreased significantly (P<0.05) in 17 groups during the intervention, but not in the other 4 groups. There was no significant relationship between METs x h/w from aerobic exercise and %DeltaVF/w in all the selected groups. However, when subjects with metabolic-related disorders were not included (425 subjects), METs x h/w from aerobic exercise had a significant relationship with %DeltaVF/w (r=-0.75). Moreover, visceral fat reduction was significantly related to weight reduction during aerobic exercise intervention, although a significant visceral fat reduction may occur without significant weight loss. CONCLUSION: These results suggest that at least 10 METs x h/w in aerobic exercise, such as brisk walking, light jogging or stationary ergometer usage, is required for visceral fat reduction, and that there is a dose-response relationship between aerobic exercise and visceral fat reduction in obese subjects without metabolic-related disorders.

Interindividual variability in sleeping metabolic rate in Japanese subjects.

INTRODUCTION: Basal metabolic rate (BMR) or sleeping metabolic rate (SMR) is the largest component of total energy expenditure (EE). An accurate prediction of BMR or SMR is needed to accurately predict total EE or physical activity EE for each individual. However, large variability in BMR and SMR has been reported. OBJECTIVES: This study was designed to develop prediction equations using body size measurements for the estimation of both SMR and BMR and to compare the prediction errors with those in previous reports. METHODS: We measured body size, height, weight and body composition (fat mass and fat-free mass) from skinfold thickness in adult Japanese men (n=71) and women (n=66). SMR was determined as the sum of EE during 8 h of sleep (SMR-8h) and minimum EE during 3 consecutive hours of sleep (SMR-3h) measured using two open-circuit indirect human calorimeters. BMR was determined using a human calorimeter or a mask and Douglas bag. RESULTS: The study population ranged widely in age. The SMR/BMR ratio was 1.01+/-0.09 (range 0.82-1.42) for SMR-8h and 0.94+/-0.07 (range 0.77-1.23) for SMR-3h. The prediction equations for SMR accounted for a 3-5% larger variance with 2-3% smaller standard error of estimate (SEE) than the prediction equations for BMR. DISCUSSION: SMR can be predicted more accurately than previously reported, which indicates that SMR interindividual variability is smaller than expected, at least for Japanese subjects. The prediction equations for SMR are preferable to those for BMR because the former exhibits a smaller prediction error than the latter.

Relationship of lifestyle factors to bone mass in Japanese women.

BACKGROUND: Japanese women have a lower bone mass and smaller calcium intake than Caucasians. OBJECTIVE: To investigate the differences in the relationship between bone mass and lifestyle among Japanese women of different life stages. DESIGN: Cross-sectional and longitudinal investigations of the relationship between bone mass and lifestyle in Japanese women aged 15-69 years. RESULTS: In both cross-sectional and longitudinal investigations of high school students, exercise was shown to effectively increase bone mass. In the longitudinal investigation, bone mass was generally greater with high or increased milk consumption. In the cross-sectional investigation of nonparous women and women more than 36 months post partum, those who exercised had significantly higher bone mass. Twelve to 35 months post partum, bone mass was greater in women with higher calcium or milk intake. The effects of parity were not investigated longitudinally, but women who continuously exercised or started exercise had greater bone mass. Non-exercising women with a higher or increased frequency of intake of dairy products, small fish, and soy products had increased bone mass. The longitudinal investigations suggest that exercise increases bone mass in pre-menopausal women. In women just after menopause, it was shown cross-sectionally that bone mass was greater with a higher calcium intake, and longitudinally that exercise resulted in a slower decrease in bone mass. Among women more than 6-7 years past menopause, exercise inhibited the decrease in bone mass. CONCLUSION: The relationship between these lifestyle factors and bone mass differs according to pregnancy status and time since menopause.

Obesity, weight change and risks for hypertension, diabetes and hypercholesterolemia in Japanese men.

OBJECTIVE: To examine the effects of the degree of body mass index and weight gain as the risks for hypertension, hypercholesterolemia and diabetes in Japanese men, and to compare that to the corresponding effects in a Caucasian population. DESIGN: Prospective cohort study. SETTING: Cohort of all male employees at a company. SUBJECTS: A total of 4737 male employees followed until retirement or for 4 y (longest term 4 y). RESULTS: Increase of body mass index beyond 22 kg/m(2) related to an increased risk for hypertension even after being adjusted for possible confounding factors such as age, smoking status, alcohol intake, family history and baseline value of systolic blood pressure. The risks greatly increased in subjects with a body mass index above 27 kg/m(2) for hypertension, and 29 kg/m(2) for diabetes and hypercholesterolemia. Weight gain (more than 2 kg) was strongly related to an increased risk for hypertension and hypercholesterolemia after being adjusted for possible confounding factors. However, weight gain was not related to diabetes, and weight loss did not decrease the risks for any of the three diseases. CONCLUSIONS: Among Japanese, the degrees of body mass index associated with risks for hypertension, diabetes and hypercholesterolemia were lower than those in Caucasians. The risks for hypertension and hypercholesterolemia were strongly associated with weight gain in a Japanese male population who showed a low prevalence of severe obesity, and the risks were similar to or somewhat higher than those in a Caucasian population with a high prevalence of severe obesity. SPONSORSHIP: Health Science Research Grant by the Ministry of Health and Welfare of Japan.