Protein Nutritional Status and Frailty: A Mendelian Randomization Study.

BACKGROUND: Observational studies have suggested that better protein nutritional status may contribute to prevention of frailty. OBJECTIVE: We sought to examine this hypothesis using a Mendelian randomization (MR) analysis. METHODS: We conducted a two-sample MR study using GWAS summary statistics data of the UK Biobank. We applied genetically predicted serum albumin as a primary exposure measure and serum total protein as a secondary exposure measure. The outcome measure was the Rockwood frailty index (FI) based on 49 deficits from 356,432 individuals (53.3% of them were women, with a mean ± SD age of 56.7 ± 8.0 y. The association between serum protein measures and FI was mainly analyzed by use of the inverse variance weighted method. RESULTS: A genetically predicted serum albumin concentration was not statistically significantly associated with FI in the full sample. However, in women, we observed a preventive association between genetically predicted serum albumin and FI (ß = -0.172 per g/L; 95% CI: -0.336, -0.007; P = 0.041). In the full sample, genetically predicted serum total protein was inversely associated with FI (ß: -0.153 per g/L; 95% CI: -0.251, -0.056; P = 0.002). In both women and men, higher serum total protein was significantly inversely associated with FI; regression coefficients were -0.148 per g/L (95% CI: -0.287, -0.009; P = 0.037) for women, -0.154 per g/L (95% CI: -0.290, -0.018; P = 0.027) for men. CONCLUSIONS: The present MR study implies that better protein nutritional status modestly contributes to reducing the risk of frailty.

Association between RNF213 c.14576G>A Variant (rs112735431) and Peripheral Pulmonary Artery Stenosis in Moyamoya Disease.

BACKGROUND: Moyamoya disease (MMD) and peripheral pulmonary artery stenosis (PPAS) are relatively rare and demonstrate steno-occlusive vascular lesions in different organs. Genetic studies identified RNF213 polymorphism c.14576G>A (rs112735431) as a susceptibility variant for East Asian MMD. RNF213 polymorphism c.14576G>A is further associated with various vascular lesions of other organs. In this study, we aimed to clarify the incidence and clinical manifestations of PPAS in MMD patients and analyze the correlation between RNF213 genotype and PPAS. METHODS: This retrospective case-control study investigated the association between RNF213 polymorphism and PPAS in 306 MMD/quasi-MMD patients, reviewing the medical charts and imaging records of consecutive patients with MMD admitted from January 2015 to December 2020. RESULTS: PPAS was observed in 3 MMD/quasi-MMD patients (0.98%, 3/306). RNF213 polymorphism c.14576G>A was determined for all 306 MMD/quasi-MMD patients. The incidence of PPAS in RNF213-wildtype, RNF213-heterozygote, and RNF213-homozygote MMD/quasi-MMD patients was 0% (0/101), 0.5% (1/200), and 40% (2/5), respectively. The association between PPAS and homozygote polymorphism of RNF213 c.14576G>A was statistically significant in MMD/quasi-MMD patients (p = 0.0018). In all cases, pulmonary artery hypertension due to PPAS was evident during their childhood and young adolescent stages. Surgical indications for MMD were discouraged in 1 case due to her severe cardiopulmonary dysfunction. CONCLUSIONS: The homozygote variant of RNF213 polymorphism c.14576G>A can be a potential predisposing factor for PPAS in MMD/quasi-MMD patients. Despite the relatively rare entity, PPAS should be noted to determine surgical indications for MMD/quasi-MMD patients.

Time spent walking and disability-free survival in older Japanese: The Ohsaki Cohort 2006 Study.

The extent to which long disability-free survival (DFS) time can be extended according to the amount of time spent walking has not been investigated. The aim of this study was to examine the association between time spent walking per day and DFS time in older adults. We conducted a cohort study of 14 342 disability-free individuals (aged ≥ 65 years) living in Ohsaki City, Japan. The amount of time spent walking per day (<0.5 h, 0.5-1 h, ≥1 h) by each individual in 2006 was assessed by a self-reported questionnaire. Data on 11-year incident functional disability were retrieved from the public Long-Term Care Insurance database. After estimating the multivariable-adjusted hazard ratios (HRs) of the composite outcome (incident functional disability or death), the multivariable-adjusted 50th percentile differences (50th PDs; difference in the period until the first 50% of the composite outcome occurred) were estimated according to time spent walking. Among 114 764 person-years, the composite outcome occurred in 7761 persons (67.6 per 1000 person-years). The HRs (95% confidence intervals) of the composite outcome were 1.00 (reference) for <0.5 h, 0.84 (0.79, 0.88) for 0.5-1 h, and 0.78 (0.74, 0.83) for ≥1 h (p-trend < 0.001). The 50th PDs (95% confidence intervals) of DFS time were 238 (155, 322) days longer for 0.5-1 h and 360 (265, 454) days longer for ≥1 h, in comparison with <0.5 h. The results suggest that longer time spent walking per day contributes to longer DFS time.

Associations of coffee and tea consumption with lung cancer risk.

Associations of coffee and tea consumption with lung cancer risk have been inconsistent, and most lung cancer cases investigated were smokers. Included in this study were over 1.1 million participants from 17 prospective cohorts. Cox regression analyses were conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Potential effect modifications by sex, smoking, race, cancer subtype and coffee type were assessed. After a median 8.6 years of follow-up, 20 280 incident lung cancer cases were identified. Compared with noncoffee and nontea consumption, HRs (95% CIs) associated with exclusive coffee drinkers (≥2 cups/d) among current, former and never smokers were 1.30 (1.15-1.47), 1.49 (1.27-1.74) and 1.35 (1.15-1.58), respectively. Corresponding HRs for exclusive tea drinkers (≥2 cups/d) were 1.16 (1.02-1.32), 1.10 (0.92-1.32) and 1.37 (1.17-1.61). In general, the coffee and tea associations did not differ significantly by sex, race or histologic subtype. Our findings suggest that higher consumption of coffee or tea is associated with increased lung cancer risk. However, these findings should not be assumed to be causal because of the likelihood of residual confounding by smoking, including passive smoking, and change of coffee and tea consumption after study enrolment.

Frailty and the risk of dementia: is the association explained by shared environmental and genetic factors?

BACKGROUND: Frailty has been identified as a risk factor for cognitive impairment and dementia. However, it is not known whether familial factors, such as genetics and shared environmental factors, underlie this association. We analyzed the association between frailty and the risk of dementia in a large twin cohort and examined the role of familial factors in the association. METHODS: The Rockwood frailty index (FI) based on 44 health deficits was used to assess frailty. The population-level association between FI and the risk of all-cause dementia was analyzed in 41,550 participants of the Screening Across the Lifespan Twin (SALT) study (full sample, aged 41-97 years at baseline), using Cox and competing risk models. A subsample of 10,487 SALT participants aged 65 and older who received a cognitive assessment (cognitive sample) was used in a sensitivity analysis to assess the effect of baseline cognitive level on the FI-dementia association. To analyze the influence of familial effects on the FI-dementia association, a within-pair analysis was performed. The within-pair model was also used to assess whether the risk conferred by frailty varies by age at FI assessment. RESULTS: A total of 3183 individuals were diagnosed with dementia during the 19-year follow-up. A 10% increase in FI was associated with an increased risk of dementia (hazard ratio [HR] 1.17 (95% confidence interval [CI] 1.07, 1.18)) in the full sample adjusted for age, sex, education, and tobacco use. A significant association was likewise found in the cognitive sample, with an HR of 1.13 (95% CI 1.09, 1.20), adjusted for age, sex, and cognitive level at baseline. The associations were not attenuated when adjusted for APOE ɛ4 carrier status or considering the competing risk of death. After adjusting for familial effects, we found no evidence for statistically significant attenuation of the effect. The risk conferred by higher FI on dementia was constant after age 50 until very old age. CONCLUSIONS: A higher level of frailty predicts the risk of dementia and the association appears independent of familial factors. Targeting frailty might thus contribute to preventing or delaying dementia.

Association between adherence to the Japanese diet and all-cause and cause-specific mortality: the Japan Public Health Center-based Prospective Study.

PURPOSE: The present study aimed to examine the association between adherence to the Japanese diet and the subsequent risk of all-cause and cause-specific mortality using a large-scale cohort from settings all over Japan. METHODS: We analyzed data from a cohort study of 92,969 Japanese adults aged 45-74 years, covering 11 public health center areas nationwide. We collected dietary information using a validated 147-item food frequency questionnaire. Adherence to the Japanese diet consisting of eight components (high intake of rice, miso soup, seaweeds, pickles, green and yellow vegetables, fish, and green tea; low intake of beef and pork) was assessed using 8-item Japanese Diet Index (JDI8) score, with scores ranging from 0 to 8. The Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for all-cause and cause-specific mortality. RESULTS: During a median follow-up of 18.9 years, we documented 20,596 deaths. A higher JDI8 score was significantly associated with a lower risk for all-cause and cardiovascular disease (CVD) mortality. The multivariable-adjusted HR of all-cause and CVD mortality for the highest JDI8 score group (score of 6-8) versus the lowest JDI8 score group (score of 0-2) were 0.86 (95% CI 0.81-0.90, P trend < 0.001), and 0.89 (95% CI 0.80-0.99, P trend = 0.007), respectively. CONCLUSIONS: Adhering to the Japanese diet, as assessed by the JDI8, was associated with a decreased risk of all-cause and CVD mortality among adults living in multiple areas across Japan.

Quantifying the association of low-intensity and late initiation of tobacco smoking with total and cause-specific mortality in Asia.

BACKGROUND: Little is known about the health harms associated with low-intensity smoking in Asians who, on average, smoke fewer cigarettes and start smoking at a later age than their Western counterparts. METHODS: In this pooled analysis of 738 013 Asians from 16 prospective cohorts, we quantified the associations of low-intensity (<5 cigarettes/day) and late initiation (≥35 years) of smoking with mortality outcomes. HRs and 95% CIs were estimated for each cohort by Cox regression. Cohort-specific HRs were pooled using random-effects meta-analysis. FINDINGS: During a mean follow-up of 11.3 years, 92 068 deaths were ascertained. Compared with never smokers, current smokers who consumed <5 cigarettes/day or started smoking after age 35 years had a 16%-41% increased risk of all-cause, cardiovascular disease (CVD), respiratory disease mortality and a >twofold risk of lung cancer mortality. Furthermore, current smokers who started smoking after age 35 and smoked <5 cigarettes/day had significantly elevated risks of all-cause (HRs (95% CIs)=1.14 (1.05 to 1.23)), CVD (1.27 (1.08 to 1.49)) and respiratory disease (1.54 (1.17 to 2.01)) mortality. Even smokers who smoked <5 cigarettes/day but quit smoking before the age of 45 years had a 16% elevated risk of all-cause mortality; however, the risk declined further with increasing duration of abstinence. CONCLUSIONS: Our study showed that smokers who smoked a small number of cigarettes or started smoking later in life also experienced significantly elevated all-cause and major cause-specific mortality but benefited from cessation. There is no safe way to smoke-not smoking is always the best choice.

Pre-operative higher hematocrit and lower total protein levels are independent risk factors for cerebral hyperperfusion syndrome after superficial temporal artery-middle cerebral artery anastomosis with pial synangiosis in adult moyamoya disease patients-case-control study.

Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is a standard treatment for adult moyamoya disease (MMD) patients. Cerebral hyperperfusion (CHP) syndrome is one of the most serious complications of this procedure that can result in deleterious outcomes, but predicting CHP before revascularization surgery remains challenging. Furthermore, the hematological/serological factors associated with CHP syndrome are unknown. To investigate the correlation between pre-operative hematological/serological factors and the development of CHP syndrome after STA-MCA anastomosis with encephalo-duro-myo-synangiosis (EDMS) for MMD., a pre-operative peripheral blood test was performed within 5 days before surgery. Local cerebral blood flow (CBF) at the site of anastomosis was quantified by N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography 1 and 7 days after surgery, and the pre-operative CBF value at the corresponding area was measured. We defined CHP syndrome as a local CBF increase over 150% compared with the pre-operative value, which was responsible for delayed intracranial hemorrhage, transient focal neurological deterioration, and/or seizure. Then, we retrospectively investigated the correlation between peripheral blood test results and the development of CHP syndrome. CHP syndrome 1 day after STA-MCA anastomosis with EDMS was observed in nine patients (9/114 hemispheres; 7.9%). Multivariate analysis with multiple imputation revealed that higher hematocrit value and lower total protein level were significantly associated with the development of CHP syndrome (p value: 0.028 and 0.043, respectively). Higher pre-operative hematocrit levels and lower pre-operative total protein levels are novel risk factors for CHP syndrome after direct revascularization surgery in adult MMD patients.

Mushroom consumption and incident risk of prostate cancer in Japan: A pooled analysis of the Miyagi Cohort Study and the Ohsaki Cohort Study.

In vivo and in vitro evidence has shown that mushrooms have the potential to prevent prostate cancer. However, the relationship between mushroom consumption and incident prostate cancer in humans has never been investigated. In the present study, a total of 36,499 men, aged 40-79 years, who participated in the Miyagi Cohort Study in 1990 and in the Ohsaki Cohort Study in 1994 were followed for a median of 13.2 years. Data on mushroom consumption (categorized as <1, 1-2 and ≥3 times/week) was collected using a validated food frequency questionnaire. Cox proportional hazards regression analysis was used to estimate multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for prostate cancer incidence. During 574,397 person-years of follow-up, 1,204 (3.3%) cases of prostate cancer were identified. Compared to participants with mushroom consumption <1 time/week, frequent mushroom intake was associated with a decreased risk of prostate cancer (1-2 times/week: HRs [95% CIs] = 0.92 [0.81, 1.05]; ≥3 times/week: HRs [95% CIs] = 0.83 [0.70, 0.98]; p-trend = 0.023). This inverse relationship was especially obvious among participants aged ≥50 years and did not differ by clinical stage of cancer and intake of vegetables, fruit, meat and dairy products. The present study showed an inverse relationship between mushroom consumption and incident prostate cancer among middle-aged and elderly Japanese men, suggesting that habitual mushroom intake might help to prevent prostate cancer.

The Mediating Effect of Life-style Behaviors on the Association Between Personality Traits and Cardiovascular Disease Mortality Among 29,766 Community-Dwelling Japanese.

OBJECTIVE: Personality traits have been associated with an increased risk of cardiovascular disease (CVD) mortality as well as life-style-related cardiovascular risk factors. However, the mediating effects of life-style behaviors in the association between personality factors and CVD mortality remain insufficiently understood. The aim of the present study was to examine the mediating effect of life-style behaviors on the association between personality traits and CVD mortality. METHODS: We conducted a prospective cohort study of 29,766 Japanese adults aged 40 to 64 years at the baseline and followed them up for 20.8 years from 1990 to 2011. Personality was measured using the Japanese version of the Eysenck Personality Questionnaire - Revised Short Form in 1990. We estimated the multivariable hazard ratio and 95% confidence interval for CVD mortality using Cox proportional hazards models, and explored the mediating effects of life-style behaviors (smoking, drinking, body mass index, and time spent walking) on the association between personality traits and CVD mortality. RESULTS: We documented 1033 deaths due to CVD during 562,446 person-years of follow-up. Psychoticism represents tough-mindedness, aggressiveness, coldness, a lack of deliberateness, and egocentricity. After adjusting for confounding variables, higher psychoticism was associated with CVD mortality (base model hazard ratio = 1.36, 95% confidence interval = 1.14-1.61, p trend < .001). All the life-style behaviors together mediated this association by 19.2%, with smoking having the greatest effect at 15.7%. For the other personality traits, no significant associations with CVD mortality were found. CONCLUSION: The present study demonstrated that life-style behaviors, especially smoking, partially mediate the association between psychoticism and CVD mortality.

Smoking cessation and incident dementia in elderly Japanese: the Ohsaki Cohort 2006 Study.

To investigate the association of smoking status and years since smoking cessation with the risk of incident dementia among elderly Japanese. We conducted a longitudinal analysis of smoking status and smoking cessation with dementia in prospective cohort study of 12,489 Japanese individuals aged ≥ 65 years who were followed up for 5.7 years. Information on smoking status and other lifestyle factors was collected via a questionnaire in 2006. Data on incident dementia were retrieved from the public Long-term Care Insurance Database. The Cox proportional hazards model was used to estimate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident dementia. During 61,613 person-years of follow-up, 1110 cases (8.9%) of incident dementia were documented. Compared with individuals who had never smoked, current smokers showed a higher risk of dementia (HR 1.46, 95% CI 1.17, 1.80). Among ex-smokers, the risk for those who had stopped smoking for ≤ 2 years was still high (HR 1.39, 95% CI 0.96, 2.01), however, quitting smoking for 3 years or longer mitigated the increased risk incurred by smokers; the multivariable HRs (95% CIs) were 1.03 (0.70, 1.53) for those who had stopped smoking for 3-5 years, 1.04 (0.74, 1.45) for 6-10 years, 1.19 (0.84, 1.69) for 11-15 years, and 0.92 (0.73, 1.15) for > 15 years. Our study suggests that the risk of incident dementia among ex-smokers becomes the same level as that of never smokers if they maintain abstinence from smoking for at least 3 years.

Polyunsaturated fatty acids and risk of Alzheimer's disease: a Mendelian randomization study.

PURPOSE: Observational studies have suggested that polyunsaturated fatty acids (PUFAs) may decrease Alzheimer's disease (AD) risk. In the present study, we examined this hypothesis using a Mendelian randomization analysis. METHODS: We used summary statistics data for single-nucleotide polymorphisms associated with plasma levels of n-6 PUFAs (linoleic acid, arachidonic acid) and n-3 PUFAs (alpha-linolenic acid, eicosapentaenoic acid, docosapentaenoic acid, docosahexaenoic acid), and the corresponding data for AD from a genome-wide association meta-analysis of 63,926 individuals (21,982 diagnosed AD cases, 41,944 controls). RESULTS: None of the genetically predicted PUFAs was significantly associated with AD risk; odds ratios (95% confidence interval) per 1 SD increase in PUFA levels were 0.98 (0.93, 1.03) for linoleic acid, 1.01 (0.98, 1.05) for arachidonic acid, 0.96 (0.88, 1.06) for alpha-linolenic acid, 1.03 (0.93, 1.13) for eicosapentaenoic acid, 1.03 (0.97, 1.09) for docosapentaenoic acid, and 1.01 (0.81, 1.25) for docosahexaenoic acid. CONCLUSIONS: This study did not support the hypothesis that PUFAs decrease AD risk.

Dental Status is Associated With Incident Functional Disability in Community-Dwelling Older Japanese: A Prospective Cohort Study Using Propensity Score Matching.

BACKGROUND: A growing number of epidemiology studies have shown that poor oral health is associated with an increased incidence of functional disability. However, there are few studies in which the confounding bias is adjusted appropriately. In this study, we examined whether dental status is associated with functional disability in elderly Japanese using a 13-year prospective cohort study after elimination of confounding factors with propensity score matching. METHODS: Participants were community-dwelling Japanese aged 70 years or older who lived in the Tsurugaya district of Sendai (n = 838). The number of remaining teeth (over 20 teeth vs 0-19 teeth) was defined as the exposure variable. The outcome was the incidence of functional disability, defined as the first certification of long-term care insurance (LTCI) in Japan. The variables that were used to determine propensity score matching were age, sex, body mass index (BMI), medical history (stroke, hypertension, myocardial infarction, cancer, and diabetes), smoking, alcohol consumption, educational attainment, depression symptoms, cognitive impairment, physical function, social support, and marital status. RESULTS: As a result of the propensity score matching, 574 participants were selected. Participants with 0-19 teeth were more likely to develop functional disability than those with 20 or more teeth (hazard ratio 1.33; 95% confidence interval, 1.01-1.75). CONCLUSIONS: In this prospective cohort study targeting community-dwelling older adults in Japan, having less than 20 teeth was confirmed to be an independent risk factor for functional disability even after conducting propensity score matching. This study supports previous publications showing that oral health is associated with functional disability.

The impact of risk factors for dementia in China.

BRIEF SUMMARY: We evaluated the impact of seven risk factors for dementia in China. Physical inactivity, midlife hypertension and low education are proposed to be the largest fraction contributors to dementia. 55% of dementia were attributable to one or more of the seven risk factors. BACKGROUND: Previous studies have highlighted the impact of seven risk factors (midlife obesity, physical inactivity, smoking, low education, diabetes mellitus, midlife hypertension and depression) against dementia. However, the impact of these risk factors on dementia has not been evaluated among the Chinese population. OBJECTIVE: To clarify the impact of seven major risk factors on the incidence of dementia in China. DESIGN: The prevalence of risk factors was derived from the latest national surveys. Relative risks of corresponding risk factors were derived from the latest cohort or cross-sectional studies. SETTING AND SUBJECTS: Three national surveys were included in the present study to obtain prevalence data of seven risk factors: the China Chronic Disease and Risk Factor Surveillance Survey (CCDRFSS) (2013), which covered about 170,000 adults (aged ≥18 years) from 31 provinces; (2) China National Survey of Chronic Kidney Disease (CNSCKD) (2010), which covered about 50,000 adults (aged ≥18 years) from 13 provinces; and (3) China Family Panel Studies Survey (CFPSS) (2012), which covered about 30,000 adults (aged ≥18 years) from 25 provinces. METHODS: Levin's formula was used to calculate the population attributable fraction (PAF) for each risk factor for dementia. The combined PAF of the seven risk factors was calculated assuming the independence of each risk factor. RESULTS: Physical inactivity (PAF, 24.3%), midlife hypertension (PAF, 22.1%) and low education (PAF: 11.9%) were the top three factors that contributed to dementia. The total PAF of the seven risk factors was 55% in the Chinese population. CONCLUSIONS: promotion of physical activity, control of hypertension and improvement of nationwide educational level may be helpful public health strategies to decrease the incidence of dementia in China.

Association between Adult Height and Risk of Lung Cancer Incidence among Japanese Men: The Miyagi Cohort Study.

It is already known that adult height is a factor associated with an increased risk of colon cancer and postmenopausal breast cancer, pancreatic cancer, premenopausal breast cancer, and ovarian cancer. However, the association between adult height and lung cancer incidence remains unclear. The purpose of the present study was to examine the association between adult height and the risk of lung cancer incidence in the Japanese population. We analyzed data for 43,743 men and women who were 40-64 years old at the baseline in 1990. We divided the participants into quintiles based on height at the baseline. Cox proportional hazards analysis was used to estimate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of lung cancer according to adult height, after adjustment for potential confounders. We identified 1,101 incident case of lung cancer during 24.5 years of follow-up. The multivariate HRs and 95% CIs for the highest category relative to the lowest were 1.48 (1.15-1.91) in men and 1.35 (0.91-1.99) in women. Furthermore, the association between adult height and the incidence of lung cancer was found the significant increased risk among ever smokers in men, but not never smokers. We also observed that adult height tend to be associated with an increased risk of small cell lung cancer and squamous cell carcinoma. This prospective cohort study has demonstrated a positive association between adult height and the risk of lung cancer incidence among men, especially those who have ever smoked.

Education Level, Monthly Per-Capita Expenditure, and Healthy Aging in the Older Indonesian Population: The Indonesia Family Life Survey 2007 and 2014.

In developed countries, the relationship between education level, wealth, and healthy aging have been found to be mediated by modifiable risk factors, such as obesity, physical activities, and smoking status. The present study was to investigate the association between education level, monthly per-capita expenditure (PCE), and healthy aging in the older Indonesian population, and to clarify modifiable risk factors that mediate this association. A 7-year prospective longitudinal study (2007-2014) was conducted on 696 older Indonesian individuals (≥ 50 years) living in 13 different provinces in Indonesia during the survey periods. Data on educational level, PCE, and modifiable risk factors were collected in 2007. Information on healthy aging was obtained in both 2007 and 2014. A multivariate-adjusted logistic regression model was used to estimate the odds ratio (ORs) and 95% confidence intervals (CIs) for healthy aging by education level and PCE. The mediating effects were estimated using a four-way effect decomposition. Out of 696 eligible subjects, 206 (29.6%) were judged as healthy aging in 2014. The OR (95% CI) for healthy aging for participants with a higher education level was 1.81 (1.23-2.65) compared with those with a lower education level, and no significant association was observed between PCE and healthy aging. An association was thus observed between education level and healthy aging, but not PCE. Importantly, the association between education level, PCE, and healthy aging does not appear to be mediated by the modifiable risk factors. Priorities in making health policy would be different between developed countries and developing countries.

Association of serum adiponectin levels and body mass index with worsening depressive symptoms in elderly individuals: a 10-year longitudinal study.

Objectives: Data regarding the association between adiponectin levels and body mass index (BMI) and long-term changes in depressive symptoms are limited and inconsistent. Thus, we investigated whether circulating adiponectin levels and BMI were independently and combinedly correlated to longitudinal changes in depressive symptoms.Methods: This prospective cohort study evaluated 269 elderly Japanese individuals aged ≥70 years who participated in the Tsurugaya Project conducted between 2002 and 2012. A short form of the Geriatric Depression Scale (GDS) was used to assess depressive status. Serum adiponectin levels were measured using an enzyme-linked immunosorbent assay or a latex particle-enhanced turbidimetric immunoassay. BMI was calculated as body weight (kg)/height (m2).Results: Multiple linear regression analysis revealed that baseline serum adiponectin levels were positively associated with changes in GDS scores (ß = 0.14, P = 0.035). However, no association was observed after adjusting for BMI (ß = 0.09, P = 0.185). Low BMI was associated with increased GDS scores at the 10-year follow-up (ß = -0.14, P = 0.033). Participants with a combination of high adiponectin levels and low BMI had a 3.3-fold higher risk of worsening depressive symptoms than those with low adiponectin levels and high BMI (odds ratio: 3.35, 95% confidence interval: 1.60-7.00; P = 0.001).Conclusions: This longitudinal study indicated that high serum adiponectin levels and low BMI were both associated with worsening depressive symptoms among older Japanese individuals. Furthermore, the combination of high adiponectin levels and low BMI was associated with worsening depressive symptoms.

Contribution of systemic inflammation and nutritional status to the relationship between tooth loss and mortality in a community-dwelling older Japanese population: a mediation analysis of data from the Tsurugaya project.

OBJECTIVES: To assess whether systemic inflammation and nutritional status contribute to a relationship between tooth loss and mortality in community-dwelling older Japanese individuals using mediation analyses. MATERIALS AND METHODS: This longitudinal study targeted community-dwelling older Japanese individuals (N = 891). The exposure variable was the number of teeth (edentulous, 1-9, 10-19, ≥ 20), while the outcome was all-cause mortality from 2003 to 2016. Nutritional status and systemic inflammation were evaluated as mediators and based on serum albumin and high-sensitivity C-reactive protein levels, respectively. Covariates included age, sex, smoking, alcohol consumption, medical history, educational level, depressive symptoms, cognitive impairment, and physical function. The Cox proportional hazards model was applied to calculate hazard ratios (HRs) for the association between tooth loss and mortality and the contributions of systemic inflammation and nutritional status to this association. RESULTS: Edentulous participants (HR, 1.84; 95 % confidence interval [CI], 1.30-2.59) and those with 1-9 teeth (HR, 1.75; 95% CI, 1.28-2.40) groups exhibited a significantly higher risk of mortality than did those with ≥ 20 teeth. Mediation analyses showed that nutritional status contributed to the association between tooth loss and mortality in participants with 1-9 teeth, whereas systemic inflammation played no role in this association. CONCLUSIONS: Nutritional status may contribute to the association between tooth loss and mortality in community-dwelling older Japanese individuals with fewer remaining teeth. CLINICAL RELEVANCE: The data from this prospective cohort study help in elucidating parts of the biological mechanism underlying tooth loss and all-cause mortality in older individuals.

Verification of the criteria for reduced occlusal force to diagnose oral hypofunction in older Japanese people: A prospective cohort study on incident functional disability.

In 2016, the Japanese Society of Gerodontology (JSG) proposed the concept of "oral hypofunction (OHF)," and recommended two initial criteria for reduced occlusal force (ROF): <200 N of maximum occlusal force (MOF) and < 20 remaining teeth. However, the JSG stated that these criteria need to be reviewed by accumulating further evidence. To examine the validity and equivalence of the two criteria for ROF in the diagnostic criteria for OHF by using the incidence of functional disability as the outcome. This study enrolled 815 community-dwelling Japanese individuals ≥ 70 years. They underwent examinations for physical, mental and social functions; MOF; and number of teeth at baseline. The incidence of functional disability (a condition that requires at least partial assistance with daily activities) based on the first certification of long-term care insurance was followed up. The Cox proportional hazard model revealed that MOF < 200 N (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.04-1.72) and < 20 teeth (HR, 1.40; 95% CI, 1.07-1.84) were significantly associated with increased risk of functional disability. Receiver operating characteristic curve analyses revealed that the optimal cut-off values of MOF and number of teeth that best predicted incident functional disability were 264.6 N and 19 teeth, respectively. Twelve teeth were the optimal threshold that best predicted < 200 N of MOF. The two criteria for ROF in the diagnostic criteria for OHF had some degree of validity. However, further studies are needed to develop appropriate and reliable criteria for a decision of ROF.

[Current status and issues around the process of health promotion program implementation by the municipal office of health and welfare: Survey results of all municipalities of six prefectures].

Objectives We aimed to investigate the progress of health promotion program implementation. This included an examination of the current status of and issues around planning, implementation, and evaluation of health and welfare services at the municipal level; further progress through focus on the population approach emphasized in Health Japan 21 (2nd) was also discussed.Methods A questionnaire survey on health promotion and welfare services was conducted among municipal offices in charge of health promotion. The status of health promotion program implementation was classified by types and fields. For focused health and welfare services, respondents were asked to answer a self-administered questionnaire about the process of planning, implementation, and evaluation. The details of services were confirmed by browsing reference materials or website information. We distributed the questionnaires to all 260 municipalities of 6 prefectures (Miyagi, Saitama, Shizuoka, Aichi, Osaka, and Wakayama); of which, 238 municipalities responded (response rate: 91.5%).Results Health promotion programs on nutrition and diet, physical activity, dental and oral health, prevention of lifestyle-related diseases, and promotion of regular health checkups were implemented with a high rate. Among the 238 municipalities, 85.2% responded that they focused on educational activities targeting the general population; of which 27.4% were considering using incentives to promote greater health awareness. Our survey indicated that 14.8% of municipalities focused on health education and classroom-style programs. While planning programs, 52.1% of municipalities used "materials from other municipalities where such programs were already implemented" and 89.1% of municipalities used them in incentive-related programs. Although 70% of municipalities were aware of health discrepancies among the local population, approximately 90% did not consider discrepancies between different economic, living environment, and occupation groups when planning programs. Although 87.3% of municipalities used number of participants as the main indicator in evaluating the programs, approximately 30% of municipalities used coverage rate and before-and-after assessments of health conditions as the main indicators.Conclusion Findings from this study suggest that improvements in the process of health promotion program planning and implementation, reference materials, and the perspective of health discrepancies are needed, along with an evaluation in programs focusing both on educational activities targeting the general population and incentive-related programs. It is also recommended that the central government and prefectures should not only introduce precedents, but also provide information. Using this, municipalities can demonstrate applied skills, such as the rationale and preparation status of the program, and propose evaluations based on the plan-do-check-act cycle.