Time Trends in Income-related Differences in Food Group Intakes: The National Health and Nutrition Survey, Japan in 2010, 2014, and 2018.

BACKGROUND: We aimed to clarify whether differences in food group intake according to household income have changed over the last decade in Japanese people aged 20 years or older. METHODS: This cross-sectional study was based on the 2010, 2014, and 2018 National Health and Nutrition Surveys in Japan. Food intake was assessed using a 1-day semi-weighed household dietary record. The participants were categorized into three groups based on their income. The mean of each food intake according to the income group was estimated by adjusting for age, occupation, and number of participants from the same household. The significance of the interaction terms between income and survey year was evaluated to assess the change in income-related differences in food intake over time. RESULTS: Cereal intake was lower in the middle- and the highest-income groups than in the lowest-income group, regardless of sex, and the interaction between income and year was nonsignificant for cereal intake. In the former two surveys, vegetable intake was higher among the highest-income women, while in the 2018 survey, the vegetable intake decreased in the women in the middle- and the highest-income groups. The interaction between income and year was significant for vegetable intake among the women. For other foods, the differences in intake among the income groups did not significantly change over time. CONCLUSION: The tendency for lower cereal intake in the higher-income groups was consistent over time in both the sexes, and the tendency for higher vegetable intake in the highest income women disappeared over time.

Adherence to the food-based Japanese dietary guidelines and prevalence of poor oral health-related quality of life among older Japanese adults in the Kyoto-Kameoka study.

Although better diet quality is inversely related to the risk of geriatric disorders, the association of adherence to dietary guidelines with oral health-related quality of life (OHRQoL) is unclear. We aimed to investigate this association in older Japanese adults. This cross-sectional study included 7984 Japanese participants aged ≥ 65 years from the population-based Kyoto-Kameoka study. Dietary intake was estimated using a validated self-administered FFQ. The scores for adherence to the Japanese Food Guide Spinning Top (range: 0 (worst) to 80 (best)) were calculated. These scores were stratified into quartiles (Qs). Poor OHRQoL was defined as a score ≤ 50 using a 12-item Geriatric Oral Health Assessment Index. The OR and 95 % CI were calculated using multivariable logistic regression and the spline model. Higher adherence score was associated with a lower prevalence of poor OHRQoL (Q1-Q4:36·0 %, 32·1 %, 27·9 % and 25·1 %, respectively). An inverse association was found between the score for adherence to the food-based Japanese dietary guidelines and the OR of poor OHRQoL among all the participants (Q1: reference; Q2: OR, 0·87 (95 % CI: 0·75, 1·00); Q3: OR, 0·77 (95 % CI: 0·66, 0·90); Q4: OR, 0·72 (95 % CI: 0·62, 0·85); Pfor trend < 0·001). These relationships were similar to the results in the spline model. Higher adherence to the food-based Japanese dietary guidelines is inversely associated with the prevalence of poor OHRQoL in older adults. Our results may provide useful insights to improve and maintain oral health.

Diet quality and physical or comprehensive frailty among older adults.

PURPOSE: While the association between diet quality and mortality has been previously demonstrated, the association between frailty and diet quality has not been evaluated well. This study aimed to investigate the association between diet quality and prevalence of both physical and comprehensive frailty, using two validated tools, in a community-based cohort of older adults. METHODS: We conducted cross-sectional analyses using baseline data of 7022 participants aged ≥ 65 years in the Kyoto-Kameoka study. Diet quality was assessed by calculating the adherence scores to the Japanese Food Guide Spinning Top using a validated questionnaire; the participants were stratified into quartile groups based on these scores. Physical and comprehensive frailty was assessed using the Fried phenotype model-based Frailty Screening Index and the Kihon Checklist, respectively. Multivariable logistic regression and the restricted cubic spline model were used to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for associations between adherence scores and frailty prevalence. RESULTS: Higher adherence scores signified a higher intake of vitamin C, vegetables, dairy products, and fruits. Physical and comprehensive frailty prevalence was 14.2 and 35.8%, respectively. In a multivariable adjusted model, compared with the bottom adherence score quartile, the top quartile was associated with lower ORs of physical (OR 0.64; 95% CI 0.52-0.80) and comprehensive frailty (OR 0.60; 95% CI 0.51-0.71). These relationships were similar to results in the spline model. CONCLUSIONS: This study shows an inverse dose-response relationship between diet quality and prevalence of both physical and comprehensive frailty in older adults.

[Situation of food assistance users and the association with change in socioeconomic status during COVID-19 pandemic in Japan].

Objective　This study aimed to understand the situation of the users of food assistance activities during the COVID-19 pandemic, and to examine the relationship with the changes in socioeconomic conditions.Methods　A total of 33,004 (16,065 men and 16,939 men) people aged 20 or older who cooperated with an online survey in February 2021 were included in the analysis. The analysis was conducted by classifying users of one of the following types of food assistance as food assistance users and other users as non-users: eating on site (e.g., children's cafeteria), receiving food at a specific location (e.g., food pantry), or having food delivered to their home (e.g., emergency home food delivery). A multiple logistic regression analysis was used to calculate the adjusted odds ratios (95% confidence interval (CI)) for the association between food assistance use and changes in socioeconomic status, which was assessed based on the employment status and household monthly income just before and during the COVID-19 pandemic.Results　The number of users of food assistance was 3,071 (9.3%). Of these, 1,549 (4.7%) were users of children's cafeterias, 1,296 (3.9%) were users of food pantries, and 2,236 (6.8%) were users of emergency home food delivery (with duplicate responses). The adjusted odds ratio for food assistance use was 1.47 (95% CI 1.28-1.70) for those with changes in employment status compared to those with no changes. The adjusted odds ratio for food assistance use was 1.89 (1.65-2.15) for those with reduced income and 1.67 (1.37-2.03) for those with increased household income compared to those with no changes. The adjusted odds ratios for food assistance use were higher for those with changes in employment status and/or household income than those with no changes in both.Conclusions　One in ten individuals used food assistance during the COVID-19 pandemic. It was suggested that many of the users of food assistance had changed their employment status or household income during the COVID-19 pandemic. In the future, it will be necessary to establish a public-private system that can provide information on local food assistance to people whose socioeconomic status has changed rapidly.

[A descriptive study on volunteer activities of providing meals during the early phase of the COVID-19 pandemic: clarifying the activities process and a preliminary investigation of the effect of activities on residents].

Objective　Although volunteer activities of providing meals have been conducted as measures to prevent isolation and loneliness and to secure meals, evidence is lacking regarding how to implement such activities. In this study, we describe the activities process at a community cafeteria located within a housing complex and operated by resident volunteers during the COVID-19 pandemic to provide inexpensive meals. We also report the preliminary results of the impact of such activities on the residents.Method　This case study was conducted at the community cafeteria Tate Kitchen 'Sakura' located within a Tokyo housing complex with a high ageing population. We collected data on the cafeteria activities during February to May, 2020. The data sources were daily activity records of the cafeteria, dialogues between volunteers and residents, and photos of activities. We qualitatively assessed the effects of the activities on the residents by classifying interviews with ten users and six volunteer staff based on the Kawakita Jiro (KJ) method.Results　During the observation period, regular meetings were held among board members and volunteers, and operations of the cafeteria were verified and modified by referring to the COVID-19 prevention guide for citizens, advice from health professionals, and residents' opinions. It was determined that activities would continue without cessation; the cafeteria, managed mainly by volunteers under the food hygiene control system required for commercial restaurants, was open five days a week to maintain food security and ensure the health of the residents. The number of meals sold at the cafeteria was halved in May (n = 2,149) as a result of the modification in operations. However, the number of meals delivered to each household increased from March because of increased demand. Qualitative analyses using KJ method showed that users perceived that these continued activities were effective in securing food, maintaining social interaction and promoting health, and health promotion, while volunteers perceived that the activities were effective in promoting social interaction and health.Conclusion　The resident volunteers continually confirmed their commitment to the principle of protecting food security and health within the community. They continued to operate the cafeteria by referring to available information on COVID-19 preventive measures, adopting the COVID-19 preventive measures, and involving all stakeholders. Qualitative analyses suggested that these continued efforts were useful for securing food and supporting health of the residents, looking after one other, and maintaining ties among residents.

[A literature review on the relationship between questionnaires for assessing minor health complaints and health status indices among Japanese people].

Objectives　Minor health complaints related to stress, mental health, sleep, and fatigue are closely associated with each other, and their deterioration may cause lifestyle diseases. The health status of people can be predicted through a questionnaire by exploring the relationship between their state of minor health complaints and objective health status indices. Therefore, we conducted a systematic review of the relationship between a questionnaire on the state of minor health complaints and health status indices among Japanese people who have a high level of stress, which they experience on a daily basis, using epidemiological literature. Additionally, we considered items for the questionnaire which were necessary for an index development.Methods　The PubMed database was searched for papers on "autonomic nervous system," "sleep disorders," "mental health and stress," and "fatigue," using keywords mentioned in previous studies on minor health complaints.　The extracted research papers were screened according to the following inclusion criteria: 1) the participants were healthy Japanese people; 2) descriptions included characteristics of the target population; 3) use of analytic epidemiological study design, intervention studies, and systematic reviews; 4) minor health complaints assessed by a questionnaire; 5) evaluation of the relationship between the questionnaires for minor health complaints and the health index; and 6) written in Japanese or English. Based on this, ten papers were adopted.Results　Of the 10 papers collected, one was a cohort study, three were case-control studies, and six were cross-sectional studies. The participants in five of them were working adults. Reports on three out of six questionnaires on stress, four out of seven on sleep, and all two on comprehensive health status showed significant associations between minor health complaints assessed by the questionnaires and the index for health status. The increase in responses about work-related stress from the questionnaire was associated with an increase in the "risk of developing depression" [odds ratio 2.96 (confidence interval: 1.04-8.42)]. Poor sleep quality was associated with an increase in "changes in autonomic index," "number of comorbidities and the rate of depression," and the "risk of work-related injuries." Moreover, the health score was associated with the "autonomic nervous system index".Conclusion　These results suggest that a questionnaire evaluating minor health complaints should include questions about "stress," "sleep quality," and "comprehensive health status." Since studies that appropriately adopted for risk of bias were limited, it is necessary to further examine these relationships by applying prospective studies such as cohort studies and intervention studies.

Frequency of meals that includes staple, main and side dishes and nutrient intake: findings from the 2012 National Health and Nutrition Survey, Japan.

OBJECTIVE: To investigate the relationship between nutrient intake and a straightforward Japanese nutritional goal of consuming a meal that includes staple, main and side dishes (SMS meal) more than twice a day. DESIGN: This was a cross-sectional, observational study using the data from de-identified records of the 2012 National Health and Nutrition Survey. Dietary assessment was conducted using semi-weighed dietary records that were completed on one weekday. SETTING: A home-based setting in Japan. PARTICIPANTS: 30 269 subjects (male n 14 284; female n 15 985) aged ≥6 years (6-103 years, mean 50·4 (sd 22·3) years). RESULTS: As the frequency of SMS meals increased, we found a higher intake of most nutrients and each food group. Subjects who consumed SMS meals at least twice a day were more likely to meet the Dietary Reference Intakes (DRI) for Japan compared with subjects who consumed an SMS meal once a day or less. However, the frequency of SMS meals did not necessarily ensure that DRI for Japan for saturated fatty acid, vitamin A, vitamin B1, calcium, iron and salt were met. CONCLUSIONS: Consuming SMS meals at least twice a day is a useful and straightforward nutrition goal to achieve adequate intake of some nutrients. However, it is necessary to provide the public with more information on foodstuff choice to ensure an adequate intake of all nutrients.

Factors associated with sarcopenia screened by finger-circle test among middle-aged and older adults: a population-based multisite cross-sectional survey in Japan.

BACKGROUND: Previous epidemiological studies have demonstrated the prevalence and relationship of various factors associated with sarcopenia in older adults; however, few have examined the status of sarcopenia in middle-aged adults. In this study, we aimed to, 1) evaluate the validity of the finger-circle test, which is potentially a useful screening tool for sarcopenia, and 2) determine the prevalence and factors associated with sarcopenia in middle-aged and older adults. METHODS: We conducted face-to-face surveys of 525 adults, who were aged 40-91 years and resided in Settsu City, Osaka Prefecture, Japan to evaluate the validity of finger-circle test. The finger-circle test evaluated calf circumference by referring to an illustration printed on the survey form. The area under the receiver operating characteristic curves (AUROC) was plotted to evaluate the validity of the finger-circle test for screening sarcopenia and compared to that evaluated by skeletal muscle mass index (SMI) measured using bioimpedance. We also conducted multisite population-based cross-sectional anonymous mail surveys of 9337 adults, who were aged 40-97 years and resided in Settsu and Hannan Cities, Osaka Prefecture, Japan. Participants were selected through stratified random sampling by sex and age in the elementary school zones of their respective cities. We performed multiple logistic regression analysis to explore associations between characteristics and prevalence of sarcopenia. RESULTS: Sarcopenia, defined by SMI, was moderately predicted by a finger-circle test response showing that the subject's calf was smaller than their finger-circle (AUROC: 0.729, < 65 years; 0.653, ≥65 years); such subjects were considered to have sarcopenia. In mail surveys, prevalence of sarcopenia screened by finger-circle test was higher in older subjects (approximately 16%) than in middle-aged subjects (approximately 8-9%). In a multiple regression model, the factors associated with sarcopenia were age, body mass index, smoking status, self-reported health, and number of meals in all the participants. CONCLUSIONS: Sarcopenia, screened by the finger-circle test, was present not only among older adults but also among middle-aged adults. These results may provide useful indications for developing public health programs, not only for the prevention, but especially for the management of sarcopenia. TRIAL REGISTRATION: UMIN000036880, registered prospectively May 29, 2019,  https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042027.

[Prevalence of frailty and its related factors in community-dwelling middle-aged and elderly adults in Settsu and Hannan cities in Osaka prefecture].

Objectives　The purpose of this study was to examine the prevalence of frailty and its associated factors in community-dwelling middle-aged and elderly adults in Settsu and Hannan cities, which are located in the north and south of Osaka prefecture, respectively.Methods　We conducted a mailed, self-administered, questionnaire survey of individuals aged 40 years and older in Settsu city in 2019 and Hannan city in 2020. There are 10 primary school districts in Settsu city and 8 districts in Hannan city, from each of which 1,000 people were selected according to the age and sex structures of the districts. We included 5,134 individuals from Settsu city and 3,939 individuals from Hannan city. We defined frailty using self-reported questionnaires, the Kihon Checklist (KCL), and Simple Frailty Index (SFI). Multivariate logistic regression analysis was performed for each city to examine the association of frailty with age, sex, body mass index (BMI), family structure, subjective health, economic status, subjective physical fitness, sleeping status, smoking history, alcohol use, meal frequency and awareness of the word "frailty."Results　The average age (standard deviation) of participants was 62.7 (12.5) years in Settsu city and 63.4 (12.2) years in Hannan city. The prevalence of frailty by KCL was 18.7% and 17.9% for participants in their 40s, 18.2% and 14.6% for those in their 50s, 17.0% and 15.7% for those in their 60s, 25.4% and 20.8% for those in their 70s, 39.7% and 36.1% for those 80 years and older from Settsu and Hannan cities, respectively. Using SFI, the prevalence of frailty was 16.2% and 13.5% for participants in their 40s, 15.0% and 11.9% for those in their 50s, 12.5% and 10.0% for those in their 60s, 14.6% and 12.3% for those in their 70s, and 24.7% and 22.3% for those aged 80 years and older in Settsu and Hannan cities, respectively. Significant common independent variables associated with frailty as defined using the KCL and SFI in Settsu and Hannan cities were age, subjective health, economic status, subjective physical fitness, sleeping status, and awareness of the word "frailty."Conclusion　This study found some participants to be frail as early as their 40s or 50s. Thus, efforts must be made to prevent frailty in working-age populations, including those aged 40 years and older. Six factors were associated with frailty. Longitudinal or interventional studies are required to examine their causal relationships and public health significance.

Prospective Study on the Association Between Adherence to Healthy Lifestyles and Depressive Symptoms Among Japanese Employees: The Furukawa Nutrition and Health Study.

BACKGROUND: While a growing body of research suggests a protective role of healthy lifestyle against depression, evidence from prospective studies is scarce. We constructed a healthy lifestyle index (HLI) and examined its prospective association with depressive symptoms in a Japanese working population. METHODS: Participants were 917 employees (19-68 years old) who were free from depressive symptoms at baseline in 2012-2013 and attended the 3-year follow-up survey. The HLI (range: 0-7 points) was constructed by assigning 1 point to each healthy lifestyle factor, namely, (1) normal body mass index (18.5-24.9 kg/m2), (2) non-smoking, (3) no or moderate alcohol intake (≤23 g ethanol/day), (4) adequate physical activity (≥7.5 metabolic equivalent-hours/week), (5) high vegetable intake (≥350 g/day), (6) high fruit intake (≥200 g/day), and (7) adequate sleep duration (6-8.9 hours/day), which was categorized into three groups (low: 0-2 points; middle: 3-4 points; and high: 5-7 points). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. RESULTS: A total of 155 incident cases (17.0%) of depressive symptoms were identified at the follow-up survey. Compared with the low HLI group, multivariable-adjusted odds ratios of depressive symptoms were 0.74 (95% confidence interval, 0.48-1.15) and 0.55 (95% confidence interval, 0.31-0.99) for the middle and high HLI groups, respectively (P-trend = 0.041). CONCLUSION: The present study suggests the importance of adherence to multiple healthy lifestyle factors in prevention of depressive symptoms.

Diet quality of Japanese adults with respect to age, sex, and income level in the National Health and Nutrition Survey, Japan.

OBJECTIVE: Although several studies in Western countries show that higher socioeconomic status is associated with higher diet quality, no study has observed this association in Japan. In the current study, we examined the association between diet quality and the combinations of age, sex, and household income, and also compared the dietary intake between diet quality levels according to household income. DESIGN: Cross-sectional study. SETTING: National Health and Nutrition Survey, Japan in 2014. PARTICIPANTS: 2785 men and 3215 women. RESULTS: Higher Japanese Food Guide Spinning Top scores (better diet quality) were observed in older women, especially those with higher household income, whereas lower scores were observed in younger men with lower household income. Those having low quality diet, especially in low income households, had higher odds of not meeting the recommended amounts of the Japanese dietary guidelines, than those having high quality diet. CONCLUSIONS: Diet quality in Japanese adults differed by age and sex as well as by household income level. A different approach to diet quality improvement is needed according to population characteristics including not only age and sex but also social economic status.

The Validity and Reproducibility of Dietary Non-enzymatic Antioxidant Capacity Estimated by Self-administered Food Frequency Questionnaires.

BACKGROUND: High dietary non-enzymatic antioxidant capacity (NEAC) has been inversely related to the incidence of degenerative diseases. However, few studies have investigated the validity and reproducibility of dietary NEAC estimated from a food frequency questionnaire (FFQ). We assessed the validity and reproducibility of FFQ-based dietary NEAC against a dietary record (DR). METHODS: Participants were 244 men and 253 women who completed a 28-day DR and FFQs. NEAC for each food item was estimated according to available databases of antioxidant capacity, as measured by ferric reducing-antioxidant power (FRAP), oxygen radical absorbance capacity (ORAC), and total radical-trapping antioxidant parameter (TRAP). Using Spearman's rank correlation coefficients (CCs), we assessed the validity for dietary NEACs from a 28-day DR and a FFQ, and the reproducibility for them from two FFQs administered at a 1-year interval. Additionally, joint classification and the Bland-Altman method were applied to assess agreement between the two methods. RESULTS: Regarding validation, deattenuated CCs for the energy-adjusted overall dietary NEACs between FFQ and DR for FRAP, ORAC, and TRAP were 0.52, 0.54, and 0.52, respectively, for all subjects. Extreme miscategorization rates by joint classification analysis were 2% for FRAP and ORAC and 1% for TRAP. Regarding reproducibility, CCs between the energy-adjusted dietary NEACs from two FFQs were 0.64 for FRAP and 0.65 for ORAC and TRAP. CONCLUSION: The validity and reproducibility of dietary NEAC of total food from the FFQ were moderate. Estimations of dietary NEAC using FFQ would be useful in studying disease relationships by categorizing habitual dietary NEAC.

High Serum Phospholipid Dihomo-γ-Linoleic Acid Concentration and Low Δ5-Desaturase Activity Are Associated with Increased Risk of Type 2 Diabetes among Japanese Adults in the Hitachi Health Study.

Background: The association between the circulating fatty acid (FA) composition and type 2 diabetes (T2D) has been reported in Western populations, but evidence is scarce among Asian populations, including Japanese, who consume large amounts of fish.Objective: The objective of the present study was to prospectively examine the association between circulating concentrations of individual FAs and T2D incidence among Japanese adults.Methods: We conducted a nested case-control study in a cohort of 4754 employees, aged 34-69 y, who attended a comprehensive health checkup in 2008-2009 and donated blood samples for the Hitachi Health Study. During 5 y of follow-up, diabetes was identified on the basis of plasma glucose, glycated hemoglobin, and self-report. Two controls matched to each case by sex, age, and date of checkup were randomly chosen by using density sampling, resulting in 336 cases and 678 controls with FA measurements. GC was used to measure the FA composition in serum phospholipids. Cox proportional hazards regression was used to estimate the HRs and 95% CIs after adjusting for potential confounders. We examined the association of T2D risk with 25 different individual and combinations of FAs.Results: T2D risk was positively associated with serum dihomo-γ-linoleic acid concentration (highest compared with the lowest quartile-HR: 1.49; 95% CI: 1.04, 2.11; P-trend = 0.02) and inversely associated with Δ5-desaturase activity (highest compared with the lowest quartile-HR: 0.72; 95% CI: 0.52, 0.99; P-trend = 0.02), independent of body mass index (BMI). There were also inverse associations between T2D risk with serum total n-6 (ω-6) polyunsaturated fatty acids (PUFAs), linoleic acid, and cis-vaccenic acid, but these were attenuated and became nonsignificant after adjustment for BMI. Serum n-3 (ω-3) PUFAs and saturated fatty acids (SFAs) were not associated with T2D risk.Conclusions: T2D risk was associated with circulating concentrations of the n-6 PUFA dihomo-γ-linoleic acid and Δ5-desaturase activity but not with n-3 PUFA or SFA concentrations in Japanese adults.

Circulating ferritin concentrations are differentially associated with serum adipokine concentrations in Japanese men and premenopausal women.

PURPOSE: Increased iron storage, as measured by circulating ferritin, has been linked to an increased risk of various diseases including diabetes. We examined the association of circulating ferritin with serum adiponectin, leptin, resistin, plasminogen activator inhibitor-1 (PAI-1), and visfatin levels. METHODS: We conducted a cross-sectional study among 429 Japanese employees (284 men and 145 premenopausal women, mean age: 42.5 ± 10.5 years). Serum adipokines were measured using Luminex suspension bead-based multiplexed array, and serum ferritin was determined using a chemiluminescence immunoassay. Multivariable regression analysis was performed to calculate mean concentrations of adipokine according to the tertile of ferritin concentrations with adjustment for potential confounders. RESULTS: Leptin and visfatin concentrations increased with increasing ferritin concentrations in men after multivariable adjustment of physical activity, smoking, alcohol use, and body mass index (P for trend = 0.02 and 0.01 for leptin and visfatin, respectively). Serum ferritin concentrations were inversely and significantly associated with adiponectin in women (P for trend = 0.01). Resistin and PAI-1 were not appreciably associated with ferritin concentration. CONCLUSIONS: Increased iron storage may be associated with higher circulating concentrations of leptin and visfatin in men and with lower concentrations of adiponectin in women.

Metabolic syndrome components and diabetes incidence according to the presence or absence of impaired fasting glucose: The Japan Epidemiology Collaboration on Occupational Health Study.

BACKGROUND: We prospectively examined the association of diabetes risk with the number of metabolic abnormalities, as well as their combinations, according to the presence or absence of impaired fasting glucose (IFG) in a large-scale Japanese working population. METHODS: Participants included 55,271 workers at 11 companies who received periodic health check-ups between 2008 and 2013. The metabolic syndrome (MetS) components were defined using the 2009 Joint Interim Statement. IFG was defined as fasting plasma glucose 5.6-6.9 mmol/L. Diabetes newly diagnosed after the baseline examination was defined according to the American Diabetes Association criteria. We calculated the hazard ratios (HRs) for diabetes incidence using the Cox proportional hazards model. RESULTS: During the follow-up period (median 4.95 years), 3183 subjects developed diabetes. In individuals with normal fasting glucose levels, the risk of diabetes increased steadily with the increasing number of MetS components; the multivariable-adjusted HRs for incident diabetes for the number of MetS components were 2.0, 4.3, 7.0, and 10.0 for one, two, three, or four MetS components, respectively, compared with the absence of components. A similar association was observed among individuals with IFG; the corresponding HRs were 17.6, 23.8, 33.9, and 40.7. The combinations that included central obesity appeared to be more strongly associated with diabetes risk than other combinations with the same number of MetS components within the same glucose status. CONCLUSIONS: Our findings indicate that risk stratification of individuals by the presence or absence of IFG and the number of MetS components can detect individuals with a high risk of diabetes.

High Dietary Acid Load Score Is Associated with Increased Risk of Type 2 Diabetes in Japanese Men: The Japan Public Health Center-based Prospective Study.

BACKGROUND: Diet-induced metabolic acidosis has been linked to cardiometabolic abnormalities in Westerners, but the evidence on this issue is scarce in Asians. OBJECTIVE: The present study prospectively examined the association between dietary acid load and type 2 diabetes (T2D) in Japanese adults. METHODS: Study participants were 27,809 men and 36,851 women, aged 45-75 y, who completed a dietary questionnaire of the second survey of the Japan Public Health Center-based Prospective Study and had no previous history of T2D. Dietary intake was assessed by using a validated 147-item food-frequency questionnaire. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores were derived from the nutrient intake. A multilevel logistic regression model was used to estimate ORs and 95% CIs of self-reported, physician-diagnosed T2D over 5 y, with adjustment for potential confounding variables. RESULTS: A total of 1191 cases of newly diagnosed T2D were reported. PRAL score was positively associated with T2D in men; the multivariable-adjusted ORs (95% CIs) for the lowest through the highest quartiles of PRAL were 1.00, 1.09 (0.87, 1.36), 1.10 (0.88, 1.37), and 1.25 (1.01, 1.55) (P-trend = 0.047). Further adjustment for dietary intake strengthened the association. NEAP score was not associated with the risk of T2D (P-trend = 0.20). In stratified analyses, the positive association between PRAL and T2D was confined to younger men (age <50 y; P-trend = 0.046). There was no association between dietary acid load score and T2D in women. CONCLUSION: A high dietary acid load score is associated with an increased risk of T2D in Japanese men.

School-based intervention to enable school children to act as change agents on weight, physical activity and diet of their mothers: a cluster randomized controlled trial.

BACKGROUND: School health promotion has been shown to improve the lifestyle of students, but it remains unclear whether school-based programs can influence family health. We developed an innovative program that enables school children to act as change agents in promoting healthy lifestyles of their mothers. The objective of this study was to examine the effect of the child-initiated intervention on weight, physical activity and dietary habit of their mothers. METHODS: A 12-month cluster randomized trial was conducted, with school as a cluster. Participants were mothers with grade 8 students, aged around 13 years, of 20 schools in Homagama, Sri Lanka. Students of the intervention group were trained by facilitators to acquire the ability to assess noncommunicable disease risk factors in their homes and take action to address them, whereas those of the comparison group received no intervention. Body weight, step count and lifestyle of their mothers were assessed at baseline and post-intervention. Multi-level multivariable linear regression and logistic regression were used to assess the effects of intervention on continuous and binary outcomes, respectively. RESULTS: Of 308 study participants, 261 completed the final assessment at 12 month. There was a significantly greater decrease of weight and increase of physical activity in the intervention group. The mean (95% confidence interval) difference comparing the intervention group with the control group was -2.49 (-3.38 to -1.60) kg for weight and -0.99 (-1.40 to -0.58) kg/m(2) for body mass index. The intervention group had a 3.25 (95% confidence interval 1.87-5.62) times higher odds of engaging in adequate physical activity than the control group, and the former showed a greater number of steps than the latter after intervention. The intervention group showed a greater reduction of household purchase of biscuits and ice cream. CONCLUSIONS: A program to motivate students to act as change agents of family's lifestyle was effective in decreasing weight and increasing physical activity of their mothers. TRIAL REGISTRATION: Sri Lanka Clinical Trials Registry SLCTR/2013/011 .

Optimal waist circumference cut-off points and ability of different metabolic syndrome criteria for predicting diabetes in Japanese men and women: Japan Epidemiology Collaboration on Occupational Health Study.

BACKGROUND: We sought to establish the optimal waist circumference (WC) cut-off point for predicting diabetes mellitus (DM) and to compare the predictive ability of the metabolic syndrome (MetS) criteria of the Joint Interim Statement (JIS) and the Japanese Committee of the Criteria for MetS (JCCMS) for DM in Japanese. METHODS: Participants of the Japan Epidemiology Collaboration on Occupational Health Study, who were aged 20-69 years and free of DM at baseline (n = 54,980), were followed-up for a maximum of 6 years. Time-dependent receiver operating characteristic analysis was used to determine the optimal cut-off points of WC for predicting DM. Time-dependent sensitivity, specificity, and positive and negative predictive values for the prediction of DM were compared between the JIS and JCCMS MetS criteria. RESULTS: During 234,926 person-years of follow-up, 3180 individuals developed DM. Receiver operating characteristic analysis suggested that the most suitable cut-off point of WC for predicting incident DM was 85 cm for men and 80 cm for women. MetS was associated with 3-4 times increased hazard for developing DM in men and 7-9 times in women. Of the MetS criteria tested, the JIS criteria using our proposed WC cut-off points (85 cm for men and 80 cm for women) had the highest sensitivity (54.5 % for men and 43.5 % for women) for predicting DM. The sensitivity and specificity of the JCCMS MetS criteria were ~37.7 and 98.9 %, respectively. CONCLUSION: Data from the present large cohort of workers suggest that WC cut-offs of 85 cm for men and 80 cm for women may be appropriate for predicting DM for Japanese. The JIS criteria can detect more people who later develop DM than does the JCCMS criteria.

Low serum 25-hydroxyvitamin D concentrations are associated with increased likelihood of having depressive symptoms among Japanese workers.

BACKGROUND: Accumulating evidence suggests a protective role of vitamin D against mood disorders; however, epidemiologic studies are scarce in working populations. OBJECTIVE: We investigated cross-sectionally the association of serum vitamin D status and depressive symptoms among Japanese workers. METHODS: Participants were 1786 employees (9% women), aged 19-69 y, who received health check-ups and participated in a nutrition and health survey. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured with the use of a competitive protein binding assay. Depressive symptoms were assessed by using the Center for Epidemiologic Studies Depression (CES-D) scale. Logistic regression was used to estimate ORs with adjustment for potential confounding variables including dietary factors. RESULTS: Overall, 92% of study participants had suboptimal vitamin D status [25(OH)D <30 µg/L]. Depressive symptoms were inversely associated with 25(OH)D. Compared with those with a 25(OH)D concentration of <20 µg/L, multivariable-adjusted ORs (95% CIs) for depressive symptoms (CES-D scale score ≥16) were 0.75 (0.59, 0.95) and 0.66 (0.41, 1.06) for those with a 25(OH)D concentration of 20-29 µg/L and ≥30 µg/L, respectively (P-trend = 0.01). After further adjustment for leisure-time physical activity and shift work (factors closely related to photo-initiated vitamin D production), the OR (95% CI) for the highest category of 25(OH)D was 0.70 (0.43, 1.14). The association between 25(OH)D and depressive symptoms appears to be linear, according to restricted cubic spline regression. CONCLUSION: Results suggest that lower concentrations of circulating vitamin D are associated with increased likelihood of having depressive symptoms among apparently healthy workers.

Habitual consumption of coffee and green tea in relation to serum adipokines: a cross-sectional study.

PURPOSE: Coffee and green tea consumption may be associated with circulating adipokines, but data are inconsistent, scarce or lacking. We examined the association of coffee and green tea consumption with serum adiponectin, leptin, visfatin, resistin and plasminogen activator inhibitor-1 (PAI-1) among a Japanese working population. METHODS: The authors analyzed data (n = 509) from a cross-sectional survey among Japanese workers aged 20-68 years. Serum adipokines were measured using a Luminex suspension bead-based multiplexed array. Coffee and green tea consumption was assessed using a validated diet history questionnaire, and caffeine consumption from these beverages was estimated. Multiple regression analysis was performed with adjustment for potential confounding variables. RESULTS: Coffee consumption was significantly, inversely associated with leptin and PAI-1 (P for trend = 0.007 and 0.02, respectively); compared with subjects consuming <1 cup per day, those consuming ≥4 cups per day had 13 and 10 % lower means of leptin and PAI-1, respectively. Similar associations were observed for caffeine consumption (P for trend = 0.02 for both leptin and PAI-1). Additionally, we noted a significant positive association between coffee consumption and adiponectin in men (P for trend = 0.046), but not in women (P for trend = 0.43, P for interaction = 0.11). Moreover, there was a positive association between coffee consumption and resistin in current male smokers (P for trend = 0.01), but not in male non-smokers (P for trend = 0.35, P for interaction = 0.11). Green tea consumption was not associated with any adipokine. CONCLUSIONS: Higher consumption of coffee and caffeine but not green tea was associated with lower serum levels of leptin and PAI-1 in Japanese adults.