Internet of things-based approach for glycemic control in people with type 2 diabetes: A randomized controlled trial.

AIMS: The utilization of long-term effect of internet of things (IoT) on glycemic control is controversial. This trial aimed to examine the effect of an IoT-based approach for type 2 diabetes. MATERIALS AND METHODS: This randomized controlled trial enrolled 1,159 adults aged 20-74 years with type 2 diabetes with a HbA1c of 6.0-8.9% (42-74 mmol/mol), who were using a smartphone on a daily basis were randomly assigned to either the IoT-based approach group (ITG) or the control group (CTG). The ITG were supervised to utilize an IoT automated system that demonstrates a summary of lifelogging data (weight, blood pressure, and physical activities) and provides feedback messages that promote behavioral changes in both diet and exercise. The primary end point was a HbA1c change over 52 weeks. RESULTS: Among the patients, 581 were assigned to the ITG and 578 were in the CTG. The changes in HbA1c from baseline to the final measurement at 52 weeks [mean (standard deviation)] were -0.000 (0.6225)% in ITG and - 0.006 (0.6449)% in CTG, respectively (P = 0.8766). In the per protocol set, including ITG using the IoT system almost daily and CTG, excluding those using the application almost daily, the difference in HbA1c from baseline to 52 weeks were -0.098 (0.579)% and 0.027 (0.571)%, respectively (P = 0.0201). We observed no significant difference in the adverse event profile between the groups. CONCLUSIONS: The IoT-based approach did not reduce HbA1c in patients with type 2 diabetes. IoT-based intervention using data on the daily glycemic control and HbA1c level may be required to improve glycemic control.

Lifestyle factors associated with a rapid decline in the estimated glomerular filtration rate over two years in older adults with type 2 diabetes-Evidence from a large national database in Japan.

BACKGROUND: The present study investigated lifestyle risk factors from metabolic syndrome-related lifestyles for a rapid decline in the estimated glomerular filtration rate (eGFR) among adults aged 40-74 years with treated and untreated type 2 diabetes. METHODS AND RESULTS: This study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, encompassing the period from fiscal year (FY) 2017 to FY2020. We established FY2018 as our baseline year. The subjects of this study were adults aged 40-74 in FY2018(baseline) who had type 2 diabetes and underwent specific health checkups in FY2020. We excluded adults with a medical record of kidney dialysis between FY2017 and FY2018, records of suspected type 1 diabetes between FY2017 and FY2020, or a baseline eGFR >85 mL/min/1.73 m2 or missing eGFR data as of FY2020. Eventually we analyzed 573,860 individuals. The outcome variable was a rapid decline in eGFR (≥30%) during the follow-up. Exposure lifestyle factors included skipping breakfast, late-night dinners, regular smoking, a high alcohol intake, non-refreshing sleep, and a lack of habitual exercise. Logistic regression models were stratified by age (40-59 and 60-74 years) and baseline eGFR levels (60-85, 30-59, and <30 mL/min/1.73 m2). Covariates included sex, a history of heart disease, a history of stroke, a history of renal failure, anemia, low-density lipoprotein, systolic blood pressure, hemoglobin A1C, body mass index, antidiabetic medications, antihypertension drugs, lipid-lowering drugs, the oral adsorbent Kremezin, non-steroidal anti-inflammatory drugs, and drugs for the treatment of renal anemia. A rapid decline in eGFR was detected in approximately 1.3% of participants (7,683 cases). In the baseline eGFR >30 subgroups (60-85 or 30-59 mL/min/1.73 m2), skipping breakfast and regular smoking were associated with a rapid decline in eGFR in both age groups, while a lack of habitual exercise and late-night dinners in the 60-74 age group and non-refreshing sleep in the 40-59 age group were identified as risk factors. Additionally, skipping breakfast was a risk factor for a rapid decline in eGFR in the 60-74 age group regardless of baseline eGFR levels. In the baseline eGFR <30 mL/min/1.73 m2 subgroup, skipping breakfast and non-refreshed sleep were risk factors for a rapid decline in eGFR. CONCLUSIONS: We found specific lifestyle risk factors were associated with a rapid eGFR decline among people with type 2 diabetes from a nationwide database in Japan. The associations varied by baseline eGFR level, age, and sex. Lifestyle modifications may effectively prevent the aggravation of diabetic kidney disease.

Temporal change in the association between life satisfaction and functional decline with gender differences: an age-specific prospective cohort study.

BACKGROUND: Although life satisfaction (LS) has been shown to predict mortality, research studying the relationship between LS and functional decline is scarce. This study examined the association between LS and functional decline across four time points in young-old Japanese adults. METHODS: We analysed 1,899 community-dwelling 65-year-olds in this age-specific cohort study conducted between 2000 and 2005. The Life Satisfaction Index K was used to evaluate LS and was classified into quartiles. Functional decline was determined using the Japanese Long-Term Care Insurance (LTCI) system: 1) mild disability; 2) severe disability; 3) all-cause mortality; 4) mild or severe disability; 5) severe disability or death; 6) mild or severe disability, or death. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were calculated using the Cox proportional hazard model. The analyses were conducted in the 8th, 10th, 12th, and 14th years to assess the effect of LS on functional decline across time points. RESULTS: The impact of LS gradually weakened over time. In the 8th year (aged 72-73), a higher LS was associated with a lower risk of mild or severe disability among the women participants (adjusted HR [95% CI] = 0.30 [0.11-0.81]). However, the effect disappeared gradually (adjusted HR [95% CI] = 0.55 [0.27-1.14]) in the 10th year (aged 74-75), 0.72 (0.41-1.26) in the 12th year (aged 76-77), and 0.68 (0.41-1.14) in the 14th year (aged 78-79). This trend continued in severe disability or death (adjusted HR [95% CI] = 0.24 [0.06-0.70], 0.31 [0.11-0.76], 0.57 [0.28-1.14], and 0.60 [0.32-1.12]) and mild or severe disability, or death (adjusted HR [95% CI] = 0.30 [0.14-0.68], 0.46 [0.24-0.87], 0.67 [0.41-1.10], and 0.65 [0.42-1.02]) in the 8th, 10th, 12th, and 14th years, respectively. No statistically significant association was found among men at any time points or in any classification of outcomes. CONCLUSIONS: Higher LS scores in 65-year-old women were associated with a lower risk for functional decline in any combination of mild disability, severe disability, or death. Additionally, the effect of LS was observed to weaken over time. TRIAL REGISTRATION: This is not an intervention survey and does not require registration.

Effect of the Diabetic Nephropathy Aggravation Prevention Program on medical visit behavior in individuals under the municipal national health insurance.

AIMS/INTRODUCTION: We aimed to clarify the effectiveness of the Diabetic Nephropathy Aggravation Prevention Program in Japan by comparing the diabetes-related medical visit behavior of individuals under the municipal national health insurance according to insurers' effort levels. MATERIALS AND METHODS: We assessed changes in medical visit behavior according to insurers' effort levels, "Full Efforts," "Some Efforts" and "No Effort," using longitudinal data from the National Database of Health Insurance Claims and Specific Health Checkups before 2015 and after 2018 regarding the national health insurance programs in Japan. We analyzed the effect of the Diabetic Nephropathy Aggravation Prevention Program using a generalized linear mixed model for 208,388 participants with diabetes. RESULTS: The additive effect on medical visit behavior was significantly higher for insurers with "Full Efforts" than for those with "No Effort;" the coefficient (log odds ratio) was 0.159 (95% confidence interval 0.063-0.256). The additive effects on medical visit behavior sizes for the people with hemoglobin A1c ≥7.0%, positive urinary protein and systolic blood pressure ≥140 mmHg were 0.508, 0.402 and 0.232, respectively, which were larger than the overall effect size (0.159) for insurers with "Full Efforts." CONCLUSIONS: Our findings showed that insurer efforts had an additive effect on the increase in the number of medical visits, suggesting that this national program could reduce the number of end-stage renal failures or dialysis in Japan.

Current status of the rapid decline in renal function due to diabetes mellitus and its associated factors: analysis using the National Database of Health Checkups in Japan.

The increasing number of patients undergoing dialysis due to diabetes mellitus (DM) is causing serious economic problems, and its reduction is an urgent policy issue in developed countries, including Japan. We aimed to assess the association between the annual rapid decline in renal function and health checkup measures, including blood pressure, to identify health guidance targets for preventing diabetic nephropathy (DN) and diabetic kidney disease (DKD) among individuals in a medical checkup system ("Tokuteikenshin" program) in 2018. This longitudinal analysis included 3,673,829 individuals who participated in the "Tokuteikenshin" program in 2018, had hemoglobin A1c (HbA1c) levels ≥5.6%, were available for follow-up, and underwent estimated glomerular filtration rate (eGFR) evaluation. We estimated the incidence of the relative annual decrease in eGFR ≥10% per 1000 person-years and odds ratios to evaluate the rapid decline in renal function and determine health guidance goals and their role in preventing DN and DKD. Overall, 20.83% of patients with DM had a rapid decline in renal function within the observation period. A rapid decline in renal function was associated with high systolic blood pressure, poor or strict DM control, increased urinary protein excretion, and decreased blood hemoglobin levels. The incidence of rapid decline in renal function is higher in DM, and appropriate systolic blood pressure and glycemic control are important to prevent the progression to DN or DKD. Our findings will be useful for researchers, clinicians, and other public health care members in establishing effective health guidance and guidelines for CKD prevention.

Predictive validity of the Questionnaire for Medical Checkup of Old-Old for functional disability: Using the National Health Insurance Database System.

AIM: To enhance health services that can address multifaceted issues, the Questionnaire for Medical Checkup of Old-Old (QMCOO) was strategically developed to ascertain frailty status. Using the National Health Insurance database system, we aimed to clarify whether the QMCOO can predict new certifications for long-term care for disabilities. METHOD: Of 20 151 adults aged ≥75 years who underwent health checkups in Kashiwa City, Japan, in fiscal year 2020 (examination rate 36.8%), 18 130 persons were included (mean age 80.1 ± 4.1 years, 55.1% women). The outcome was the new certification of long-term care until January 2022. From the medical care receipt data, QMCOO, age, sex, living arrangement, body mass index, comorbidity, and musculoskeletal and connective tissue diseases were evaluated. RESULT: During the follow-up period, 727 (4.0%) participants had an incident disability (median follow up 457 days [quartile range 408-519 days]). The QMCOO's predictive accuracy for new long-term care needs was optimal when the total score of 3/4 was used as the threshold. Older adults with scores ≥4 had a higher adjusted hazard ratio for incident disability (adjusted hazard ratio 2.5, 95% confidence interval 2.1-2.9). Furthermore, the adjusted hazard ratio was greatly enhanced with comorbidity (6.6, 95% confidence interval 4.8-8.9). CONCLUSION: The QMCOO, which reflects multifaceted frailty, might be predictive of incident disability, and its predictive accuracy could be improved by considering comorbidities. The comprehensive QMCOO could contribute to extending healthy life expectancy through efficiently assessing health care and preventing long-term care, even among the old-old in the latter stage who tended to suffer from multimorbidity. Geriatr Gerontol Int 2023; 23: 124-130.

Association of dietary diversity with all-cause mortality by body mass index in Japanese older adults: An age-specific prospective cohort study (NISSIN project).

AIM: Dietary diversity might reduce the risk of malnutrition, although it is also linked to obesity. We examined whether dietary diversity is associated with all-cause mortality in Japanese older adults based on their body mass index (BMI). METHODS: The current study included 2944 people aged 64-65 years who participated in the New Integrated Suburban Seniority Investigation (NISSIN) project from 1996 to 2005. Dietary diversity was measured using the Food Variety Score (FVS), which calculates the frequency of all food items consumed daily using a self-administered food frequency questionnaire. Participants were divided into tertiles according to their FVS (first: low, second: middle, third: high). Multivariate adjusted hazard ratios with 95% confidence intervals were calculated using the Cox proportional hazard regression model. For the stratified analysis, BMI was used to divide the participants into three groups - lean (BMI <20), normal (BMI 20-24.9) and overweight/obese (BMI ≥25). RESULTS: Overall, 454 (30.7%) men and 222 (15.2%) women died over a median follow-up period of 16.6 years. No significant association was observed between FVS and all-cause mortality. However, when grouped by BMI, for the participants in the lean group, the multivariate adjusted hazard ratios were 0.56 (95% confidence interval 0.32-0.96) for the middle FVS and 0.50 (95% confidence interval 0.25-1.02) for the high FVS, compared with the low FVS (P for trend = 0.059). In overweight/obese women, although not significant, total mortality was higher in the middle and high FVS. CONCLUSIONS: These findings show that dietary diversity should be promoted in lean older Japanese adults. Geriatr Gerontol Int 2022; 22: 736-744.

Association between daily sleep duration and the risk of incident dementia according to the presence or absence of diseases among older Japanese individuals in the New Integrated Suburban Seniority Investigation (NISSIN) project.

OBJECTIVE: This study aimed to investigate the association between daily sleep duration and incident dementia among physically and socially independent older people with/without diseases (hypertension, diabetes mellitus, cardiovascular diseases) in a Japanese age-specific cohort. METHODS: We carried out a prospective cohort study including 1954 (1006 men and 948 women) Japanese individuals aged 64/65 years. Information on daily sleep duration, medical status, demographics, and lifestyle characteristics was collected by a baseline questionnaire survey and health checkup (2000-2005). Dates of incident dementia were confirmed using the nationally standardized dementia scale proposed by the Ministry of Health, Labor, and Welfare. A competing risk model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident dementia. We treated censored cases due to death as competing events. RESULTS: During a median of 15.6 years of follow-up, 260 participants reported incident dementia. Compared with participants without diseases and who slept 6-7.9 h/day, those with a shorter daily sleep duration of <6 h/day, presence of disease and shorter, moderate, or longer daily sleep duration ≥8 h/day had an increased risk of incident dementia (HR 1.73; 95% CI 1.04-2.88, HR 1.98; 95% CI 1.14-3.44, HR 1.44; 95% CI 1.03-2.00, and HR 2.09; 95% CI 1.41-3.09, respectively) with a significant interaction between the presence of diseases and sleep duration (p < 0.001). CONCLUSIONS: The present findings suggest that habitual sleep duration predicts future risk of dementia.

Plasma Angiopoietin-Like Protein 2 Levels and Mortality Risk Among Younger-Old Japanese People: A Population-Based Case-Cohort Study.

Aging is an important medical and social problem. Excessive angiopoietin-like protein (ANGPTL)-2 signaling causes chronic tissue inflammation, promoting development and progression of aging-related diseases. Moreover, circulating ANGPTL2 levels reportedly predict the risk of some aging-related diseases and subsequent death. However, there are, as yet, no reports of whether circulating ANGPTL2 levels predict vital prognosis in younger-old, community-dwelling populations. This study investigated associations between plasma ANGPTL2 levels and all-cause and specific-cause mortality in this population. The case-cohort study was abstracted from an ongoing, age-specific prospective cohort study: the New Integrated Suburban Seniority Investigation Project. This project enrolled 3 073 participants aged 64 years at the beginning of the investigation from 1996 through 2005. A subcohort of 714 randomly sampled participants plus 387 cases representing deceased participants followed through 2015 underwent survival analysis. Plasma ANGPTL2 concentrations were positively associated with >80% and 100% higher risk of all-cause mortality and cancer mortality, respectively, after adjustment for gender, smoking, alcohol consumption, walking time, sleep duration, caloric intake, medical status, disease history, BMI, and triglyceride, creatinine, uric acid, and high sensitivity C-reactive protein levels. A more robust association between ANGPTL2 levels and all-cause and cancer mortality was seen in participants with either frailties or with lifestyles of heavier drinking or current smoking. Elevated plasma ANGPTL2 levels are associated with high all-cause and cancer mortality in a community-dwelling sample of younger-old adults. These findings expand our knowledge of human aging and associated diseases.

Effectiveness and Components of Web-Based Interventions on Weight Changes in Adults Who Were Overweight and Obese: A Systematic Review with Meta-Analyses.

Overweight and obesity have reached epidemic proportions worldwide. The COVID-19 pandemic resulted in an increased need for remote implementation of weight-loss interventions; therefore, the effectiveness of web-based interventions needed to be assessed. This study aimed to examine the effectiveness of web-based interventions and their potency in facilitating weight changes in adults who were overweight or obese. We searched PubMed and Ichu-shi Web from the first year of inclusion in each database until the search date (30 September 2020). Among 1466 articles retrieved from the two databases and manual search, 97 were selected to undergo qualitative analysis and 51 articles were subjected to quantitative analysis. Qualitative analysis of 97 articles demonstrated that articles showing significant effectiveness mostly used the following components: social support, self-monitoring for behavior, self-monitoring for the outcome (weight), behavioral goal setting, information about health consequences, and outcome goal setting. Quantitative analysis of 51 articles showed a significant effectiveness of web-based intervention (standardized mean difference, -0.57; 95% confidence interval, -0.75 to -0.40). This study demonstrated the effectiveness of web-based interventions on weight change in adults with overweight and obesity. Subgroup meta-analyses identified personalized information provision and expert advice to be remarkably effective components.

Association between frequency of snacking and all-cause mortality among community-dwelling young-old adults: An age-specific prospective cohort study.

AIM: We aimed to clarify whether snacking habits decrease the risk of all-cause mortality in an older Japanese population. METHODS: The study participants were 64- or 65-year-old community-dwelling residents recruited each survey year from 1996 through 2005. Data on the frequency of snacking and other lifestyle factors were obtained during the baseline survey using self-administered questionnaires, and the participants were followed up annually until the end of 2017. In total, 2943 participants (1484 men and 1459 women) were eligible. All-cause mortality was compared among participants grouped by frequency of snacking (no snacking, one to four times/week, or every day). RESULTS: The number of deaths recorded over the study period of 43 204 person-years was 357 (24.1%) for men and 173 (11.9%) for women. The mean ± standard deviations for the follow-up period were 14.2 ± 4.9 years in men and 15.2 ± 4.5 years in women. Cox proportional hazard regression analyses showed that after adjusting for potential confounding factors, the hazard ratios for women were 0.64 (95% confidence interval [CI], 0.43-0.94) in the group that had a habit of snacking one to four times/week, and 0.93 (95% CI 0.63-1.36) in the group that had a habit of snacking every day compared with those in the no snacking group. These associations were not observed among men. CONCLUSIONS: A moderate frequency of snacking slightly decreases the risk of all-cause mortality among women. Our findings might be useful for improving the nutrition statuses in older female adults. Geriatr Gerontol Int 2021; 21: 697-704.

Prediabetes is associated with proteinuria development but not with glomerular filtration rate decline: A longitudinal observational study.

AIMS: Diabetes is recognized as the leading cause of chronic kidney disease (CKD); however, the association of prediabetes with CKD remains unclear, in particular, the independent effect of prediabetes on proteinuria or estimated glomerular filtration rate (eGFR) has not been evaluated. This study aimed to investigate the associations of prediabetes with the proteinuria development and with eGFR decline separately in the Japanese general population without CKD. METHODS: Participants who underwent health check-ups in 2014 and had adequate data after 2 years were retrospectively analysed. A total of 405,487 participants without CKD (eGFR, ≥60 ml min-1  1.73 m-2 , with negative or trace urinary protein) at baseline were categorized according to fasting plasma glucose as having diabetes (≥126 mg/dl [7.0 mmol/l]), prediabetes (100-125 mg/dl [5.6-6.9 mmol/l]) or normal glucose level (˂100 mg/dl [5.6 mmol/l]). Logistic regression analysis was used to analyse the effects of prediabetes (vs. normal glucose level) on the proteinuria development (urinary protein of ≥1+) and eGFR decline (˂60 ml min-1  1.73 m-2 ) after 2 years. RESULTS: After 2 years, 7037 participants (1.7%) developed proteinuria alone, 19,015 (4.7%) presented eGFR decline alone and 636 (0.2%) showed both proteinuria and eGFR decline. Compared to normal glucose level and adjusting for prognostic factors, prediabetes was independently associated with the proteinuria development (odds ratio [OR] 1.233; 95% confidence interval [CI] 1.170-1.301], whereas prediabetes was not associated with eGFR decline (OR 0.981; 95% CI 0.947-1.017). CONCLUSIONS: Prediabetes is associated with the proteinuria development but not with eGFR decline in the general population.

Prediction of 11-year incidence of psychophysically dependent status or death among community-dwelling younger elderlies: from an age-specified community-based cohort study (the NISSIN project).

BACKGROUND: Predicting adverse health events and implementing preventative measures are a necessary challenge. It is important for healthcare planners and policymakers to allocate the limited resource to high-risk persons. Prediction is also important for older individuals, their family members, and clinicians to prepare mentally and financially. The aim of this study is to develop a prediction model for within 11-year dependent status requiring long-term nursing care or death in older adults for each sex. METHODS: We carried out age-specified cohort study of community dwellers in Nisshin City, Japan. The older adults aged 64 years who underwent medical check-up between 1996 and 2000 were included in the study. The primary outcome was the incidence of the psychophysically dependent status or death or by the end of the year of age 75 years. Univariable logistic regression analyses were performed to assess the associations between candidate predictors and the outcome. Using the variables with p-values less than 0.1, multivariable logistic regression analyses were then performed with backward stepwise elimination to determine the final predictors for the model. RESULTS: Of the 1525 female participants at baseline, 105 had an incidence of the study outcome. The final prediction model consisted of 15 variables, and the c-statistics for predicting the outcome was 0.763 (95% confidence interval [CI] 0.714-0.813). Of the 1548 male participants at baseline, 211 had incidence of the study outcome. The final prediction model consisted of 16 variables, and the c-statistics for predicting the outcome was 0.735 (95% CI 0.699-0.771). CONCLUSIONS: We developed a prediction model for older adults to forecast 11-year incidence of dependent status requiring nursing care or death in each sex. The predictability was fair, but we could not evaluate the external validity of this model. It could be of some help for healthcare planners, policy makers, clinicians, older individuals, and their family members to weigh the priority of support.

Food group intakes and all-cause mortality among a young older Japanese population of the same age: the New Integrated Suburban Seniority Investigation Project.

Evaluating the effects of dietary intake on mortality in older populations has become increasingly important in modern aging societies. The objective of the present study was to investigate the associations between food group intakes and all-cause mortality among a young older population. We conducted a prospective study on 1,324 men and 1,338 women aged 64-65 years at baseline who were living in a suburban city from 1996 to 2005. The participants were followed for all-cause mortality from 1996 through 2015 to assess the effects of 17 food group intakes (g) per 1,000 kcal after multivariable adjustments in proportional hazard models. During follow-up (mean: 13.2 years), 339 deaths were registered. In women, total mortality was significantly and inversely associated with the consumption of milk and dairy products and vegetables. The hazard ratios across intake quartiles after multivariable adjustment were 1, 0.70 (95% confidence interval: 0.42-1.17), 0.66 (0.40-1.10), and 0.40 (0.22-0.75) (P for trend = 0.003) for milk and dairy products, and 1, 0.77 (0.46-1.28), 0.83 (0.50-1.38), and 0.42 (0.23-0.78) (P for trend = 0.008) for vegetables. In men, a positive association was found between total mortality and sugar and sweetener consumption (P for trend = 0.038). Higher consumption of milk and dairy products and vegetables was suggested to reduce all-cause mortality in young older women.

Healthy lifestyle reduces incidence of trace/positive proteinuria and rapid kidney function decline after 2 years: from the Japan Ningen Dock study.

BACKGROUND: Lifestyle modification is recommended for subjects with trace proteinuria during health checkups. However, whether overall healthy lifestyle reduces the incidence of trace/positive proteinuria or rapid decline in estimated glomerular filtration rate (eGFR) is not clarified. METHODS: A total of 451 534 people (277 494 men and 174 040 women) ages 20-79 years with negative proteinuria were included. The number of three healthy lifestyle factors (LFs) was assessed: noncurrent smoking, healthy eating habits (late dinner, snacking and skipping breakfast <3 times/week) and body mass index <25. The incidence of trace (±) and positive (≥1+) proteinuria by the dipstick method and eGFR decline ≥20% over 2 years were compared with the number of healthy LFs. RESULTS: The incidence of trace/positive proteinuria and rapid eGFR decline decreased with an increasing number of healthy LFs as follows: odds ratios (ORs) for trace proteinuria, 0.91 [95% confidence interval (CI) 0.86-0.96], 0.82 (0.78-0.87) and 0.72 (0.68-0.77); ORs for positive proteinuria, 0.76 (95% CI 0.67-0.86), 0.56 (0.50-0.63) and 0.46 (0.40-0.53); and ORs for an eGFR decline ≥20%, 0.93 (95% CI 0.82-1.05), 0.90 (0.79-1.02) and 0.81 (0.70-0.93) for those with one, two and three healthy LFs compared with those with none of the three healthy LFs, respectively. Overall, subjects with a healthy lifestyle showed 28, 54 and 19% reduced risk of developing trace proteinuria, positive proteinuria and eGFR decline ≥20%, respectively, compared with those with an unhealthy lifestyle after 2 years. This association was similarly observed even among subjects without hypertension (HT) or diabetes mellitus (DM). CONCLUSIONS: Subjects with an overall healthy lifestyle showed a lower incidence of trace/positive proteinuria by dipstick test and rapid eGFR decline over 2 years in a nationwide general population. Thus lifestyle modification should be recommended for subjects with trace proteinuria during health checkups, even for subjects without HT or DM.

Correction: The Smart Life Stay (SLS) program: effects of a lifestyle intervention program in combination with health tourism and health guidance for type 2 diabetes.

Following publication, the authors asked to add the following institution to the affiliations of author Madoka Matsushita: Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine Both the PDF and HTML versions of the Article have been updated accordingly.

The Smart Life Stay (SLS) program: effects of a lifestyle intervention program in combination with health tourism and health guidance for type 2 diabetes.

BACKGROUND: The aim of this study was to determine the effectiveness of the Smart Life Stay (SLS) program, which is an experience-oriented stayover program, in combination with health tourism and mandatory health guidance on glucose metabolism after 2 years. METHODS: The participants of the SLS program (n = 792) were recruited from a database of 23 medical insurers. They underwent a mandatory health examination termed Specific Health Checkups in 2014. The participants were included if they had diabetes or were at a high risk of diabetes and if they satisfied the following inclusion criteria: (1) body mass index (BMI; kg/m2) > 25, or (2) waist circumference (WC; cm) > 85 for men and > 90 for women, or (3) hemoglobin A1c (HbA1c; %) > 5.6, or (4) fasting plasma glucose (FPG; mg/dl) > 100. Individuals who corresponded to one or more items were included as study participants. The control subjects (n = 3645) were nonparticipants of the program who were selected from the database and met the inclusion criteria. The lifestyle changes and changes in mean BMI, WC, FPG, and HbA1c in both groups from baseline to 2-year follow-up were compared by inverse probability weighting of a propensity score. RESULTS: The percentage of people who exercised regularly increased significantly in the SLS group compared with the control group. In the SLS group, BW, BMI, and WC significantly decreased by 1.75 kg, 0.60 kg/m2, and 1.45 cm, respectively, whereas in the control group, WC, FPG, and HbA1c increased significantly by 0.38 cm, 3.37 mg/dl, and 0.12%, respectively. The comparison between groups revealed that the BW, BMI, WC, FPG, and HbA1c improved significantly in the SLS group. CONCLUSIONS: The SLS program is suggested to help improve glucose metabolism. This program could be a feasible option as a lifestyle intervention program for diabetes.

Oral hypofunction and its association with frailty in community-dwelling older people.

AIM: This large epidemiological survey of older people examined oral hypofunction and the relationship between oral hypofunction and frailty. METHODS: Participants were community-dwelling adults aged 65-85 years in Japan. The oral function evaluation included seven items (oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function), and oral hypofunction was defined as having abnormalities in at least three of these items. The frailty status was classified into three categories (robust, pre-frail and frail) according to the total Kihon Checklist score. We analyzed 978 subjects with complete data. The relationship between oral function and frailty status was analyzed using multivariate multinomial logistic regression analyses. RESULTS: Approximately 60% of the older adults had oral hypofunction. The multivariate odds ratios (ORs) for a pre-frail or frail status were significantly higher for older people with reduced occlusal force, reduced tongue-lip motor function and deteriorated swallowing function than in those without deterioration of those items. Of the oral function items, swallowing function was most strongly associated with the frailty status, and the ORs (95% confidence interval [CI]) for deteriorated swallowing function in pre-frail and frail patients were 6.4 (3.9-10.8) and 10.2 (5.4-19.1), respectively. Those with oral hypofunction had significantly higher adjusted ORs for pre-frail (OR 1.4, 95% CI 1.1-2.0) and frail (OR 2.1, 95% CI 1.2-3.5) statuses. CONCLUSION: Many community-dwelling older people have reduced oral function or oral hypofunction, which is significantly associated with frailty in older people. Geriatr Gerontol Int 2020; 20: 917-926.