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.

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.

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.

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.

[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.

Lifestyle and psychosocial factors and a decline in competence in daily living among Japanese early elderly people: from an age-specified community-based cohort study (NISSIN project).

BACKGROUND: To let the early elderly live well, understanding how lifestyle and psychosocial factors related to a decline in competence in daily living is important. METHODS: We investigated the associations between lifestyle and psychosocial factors at age 64 years and a decline in the Tokyo Metropolitan Institute of Gerontology Index of Competence score of ≥ 2 points at age 70 years among the participants in comprehensive medical check-ups living in a city in Japan. Multivariable logistic regression analyses were performed separately for men and women. RESULTS: Of the 1113 eligible men and 1203 eligible women, 110 men and 80 women showed a deteriorated competence in daily living during the 6 years. In men, risk was increased with ≥ 2 nighttime awakenings (multivariable odds ratio [mOR] 2.14, 95% confidence interval [CI] 1.19-3.86) and living alone (mOR 4.68, 95% CI 1.22-18.0), whereas risk was significantly decreased with a medium or fast gait (mOR 0.37 and 0.21, 95% CI 0.21-0.67 and 0.08-0.58) and high academic achievement (mOR 0.32 and 0.43, 95% CI 0.19-0.53 and 0.25-0.72). In women, risk was decreased with high life satisfaction (mOR 0.39, 95% CI 0.16-0.91) and participation in community activities (mOR 0.50, 95% CI 0.29-0.86) but increased with depressive mood (mOR 1.86, 95% CI 1.09-3.18). CONCLUSION: Living alone for men and low life satisfaction for women at age 64 years were markedly associated with the risk of a subsequent declining competence in daily living.

Association of Adiponectin With Cancer and All-Cause Mortality in a Japanese Community-Dwelling Elderly Cohort: A Case-Cohort Study.

BACKGROUND: Most studies of plasma adiponectin (APN) and mortality among community-dwelling elderly focus on cardiovascular disease, but data on the relationship between plasma APN and cancer mortality is exiguous. We investigated whether APN is associated with cancer mortality in community-dwelling elderly people. METHODS: We conducted a case-cohort study within the New Integrated Suburban Seniority Investigation (NISSIN) Project using a randomly drawn sub-cohort of 697 subjects (351 men and 346 women; mean age 64.5 [standard deviation, 0.5] years) among whom we compared cases of all-cause death (n = 269) and cancer death (n = 149) during a mean follow-up duration of 10.8 (standard deviation, 3.7) years. Associations between APN and mortality were assessed using weighted Cox regression analyses. RESULTS: We observed significant positive associations between the APN concentration and cancer death in the first and third APN tertiles compared with the second APN tertile (hazard ratio [HR]T1 vs T2, 1.67; 95% confidence interval [CI], 1.00-2.79 and HRT3 vs T2, 2.10; 95% CI, 1.30-3.40). Further adjustment for possible confounders attenuated the association (HRT1 vs T2, 1.63; 95% CI, 0.93-2.84 and HRT3 vs T2, 2.10; 95% CI, 1.26-3.50). A similar but weaker association was seen for all-cause mortality (multivariate HRT1 vs T2, 1.45; 95% CI, 0.95-2.21 and HRT3 vs T2, 1.51; 95% CI, 1.01-2.25). CONCLUSION: Plasma APN and cancer mortality have a significant relationship among community-dwelling elderly people, which warrants further study.

Trace proteinuria by dipstick screening is associated with metabolic syndrome, hypertension, and diabetes.

BACKGROUND: The purpose of this study is to determine the association of dipstick-determined trace proteinuria with metabolic syndrome (MetS) and its components in each age, gender, and eGFR category among a large general population. METHODS: A total of 270,190 people (102,223 men and 167,967 women) aged 40-74 years were included. Subjects were categorized as having negative, trace, and positive proteinuria by the dipstick method. RESULTS: The prevalence of MetS increased with increasing levels of proteinuria in any estimated glomerular filtration rate (eGFR) category (odds ratios for MetS relative to negative proteinuria: 1.22, 1.23, and 1.25 for trace proteinuria, and 2.19, 1.81, and 1.80 for positive proteinuria among subjects with eGFR of ≥ 90, 60-89, and 45-59 ml/min/1.73 m2, respectively). These associations were statistically significant in each age and sex category. Among MetS components, the prevalence of hypertension and diabetes increased with increasing levels of proteinuria (odds ratios for hypertension: 1.23 and 1.87, and odds ratios for diabetes: 1.28 and 2.18 for trace and positive proteinuria, respectively), which were similarly observed in any eGFR category. There were little or no differences in the prevalence of abdominal obesity and dyslipidemia (reduced HDL-cholesterol and/or elevated triglycerides) between the levels of proteinuria. CONCLUSION: Subjects with dipstick-determined trace proteinuria showed intermediate risk of having MetS, hypertension, and diabetes between negative and positive proteinuria in any eGFR category in a large general population. Thus, MetS components should be checked for subjects with trace proteinuria even in those with normal eGFR for the early prevention of cardiovascular diseases.

Awareness and health consciousness regarding the national health plan "Health Japan 21" (2nd edition) among the Japanese population in 2013 and 2014.

Objectives To examine the prevalence of health consciousness regarding "Health Japan 21" (2nd edition) among the Japanese population, we conducted a telephone survey of a sample extracted randomly from the whole nation in 2013 and 2014.Methods We extracted 1800 men and women with 150 persons for each gender and 10-year age group (6 age groups ranging from 20 years to 70 years and older) using Random Digital Dialing sampling. Each participant was asked about 1) recognition of the following items: "Health Japan 21," "healthy life expectancy," "metabolic syndrome (MetS)," "chronic obstructive pulmonary disease (COPD)," "locomotive syndrome," "Active Guide," "WHO Framework Convention on Tobacco Control," and "Smart Life Project" and 2) health consciousness toward the following: "health examination taken within the past one year," "smoking status," and "the amount of vegetables considered desirable to consume per day for health." We performed simple tabulation of the collected answers and cross-tabulation by sex and age groups, respectively. For each question about recognition, we categorized "I know the name and meaning" and "I know the name but not the meaning" as "awareness." We compared data between 2013 and 2014, sexes, and age groups, using chi-squared test.Results In 2013, the top 5 items with high awareness were "MetS" (96.2%), "COPD" (51.1%), "healthy life expectancy" (34.2%), "locomotive syndrome" (30.2%), and "WHO Framework Convention on Tobacco Control" (28.0%). Moreover, awareness of "healthy life expectancy," "locomotive syndrome," and "Active Guide" were significantly higher in 2014 than in 2013. Meanwhile, the proportion of participants who correctly chose "350 grams" as "the desirable amount of vegetables to consume per day" was 41.6% in 2013 and became significantly higher at 50.1% in 2014. In 2013, awareness of "healthy life expectancy," "COPD," and "locomotive syndrome" and the proportion of correct answers for "the desirable amount of vegetables to consume per day" were significantly higher among women than among men. In 2013, there were significant differences among age groups in awareness of "MetS," "COPD," "healthy life expectancy," and "locomotive syndrome" and the proportion of correct answers for "the desirable amount of vegetables to consume per day."Conclusion Awareness of "healthy life expectancy," "locomotive syndrome," and health consciousness of "the desirable amount of vegetables to consume per day" were significantly higher in 2014 than in 2013. There were discrepancies on respective items among both sexes and age groups. Therefore, interventions for groups with lower awareness or health consciousness may be required.

Health Benefits of Daily Walking on Mortality Among Younger-Elderly Men With or Without Major Critical Diseases in the New Integrated Suburban Seniority Investigation Project: A Prospective Cohort Study.

BACKGROUND: Regular physical activity contributes to the prevention of cancer, cardiovascular disease, and other chronic diseases. However, the frequency of physical activity often declines with age, particularly among the elderly. Thus, we investigated the effects of daily walking on mortality among younger-elderly men (65-74 years) with or without major critical diseases (heart disease, cerebrovascular disease, or cancer). METHODS: We assessed 1239 community-dwelling men aged 64/65 years from the New Integrated Suburban Seniority Investigation Project. We estimated hazard ratios (HRs) of all-cause mortality and 95% confidence intervals (CIs) according to daily walking duration and adjusted for potential confounders, including survey year, marital status, work status, education, smoking and drinking status, BMI, regular exercise, regular sports, sleeping time, medical status, disease history, and functional capacity. RESULTS: For men without critical diseases, mortality risk declined linearly with increased walking time after adjustment for confounders (Ptrend = 0.018). Walking ≥2 hours/day was significantly associated with lower all-cause mortality (HR 0.49; 95% CI, 0.27-0.90). For men with critical diseases, walking 1-2 hours/day showed a protective effect on mortality compared with walking <0.5 hours/day after adjustment for confounders (HR 0.29; 95% CI, 0.06-1.20). Walking ≥2 hours/day showed no benefit on mortality in men with critical diseases, even after adjustment for confounders. CONCLUSIONS: Different duration of daily walking was associated with decreased mortality for younger-elderly men with or without critical diseases, independent of sociodemographic and lifestyle factors, BMI, medical status, disease history, and functional capacity. Incorporating regular walking into daily lives of younger-elderly men may improve longevity and successful aging.

Association of gait speed with mortality among the Japanese elderly in the New Integrated Suburban Seniority Investigation Project: a prospective cohort study.

BACKGROUND: gait speed is associated with mortality among the elderly, but evidence for this in Japan is lacking. We investigated the impact of gait speed on mortality among younger-elderly people and determined whether daily walking modifies that association. SUBJECTS: data were obtained from 2,105 community-dwelling individuals (990 men, 1,025 women) approaching age 65 who were free of heart disease, cerebrovascular disease and cancer, and who were enrolled in the New Integrated Suburban Seniority Investigation Project between 1996 and 2003. METHODS: Cox proportional hazard regression was applied to estimate hazard ratios (HRs) of all-cause mortality and 95% confidence intervals (CIs) according to gait speed and daily walking. We adjusted for potential confounders, including survey year, marital status, work status, education, smoking and drinking status, body mass index and medical history. RESULTS: during the total 21,192 person-year follow-up to age 75, 188 participants (140 men, 48 women) died. Slow gait speed was significantly associated with increased all-cause mortality among men after full adjustment (HR, 1.72; 95% CI, 1.08-2.63). This association disappeared when men with slow gait speed walked ≥1 h/day (HR, 0.98; 95% CI, 0.34-2.25) compared with subjects with normal or fast gait speed walking >1 h/day. Slow gait speed yielded a threefold greater risk of mortality when women walked ≥1 h/day (HR, 3.04; 95% CI, 1.34-6.49), compared with the normal- or fast-gait group. CONCLUSION: slow gait speed is associated with an increased risk of all-cause mortality among younger-elderly people. Daily walking was found to modify this association among men.

Cross-calibration of pencil-beam (DPX-NT) and fan-beam (QDR-4500C) dual-energy X-ray absorptiometry for sarcopenia.

Sarcopenia, defined as the loss of muscle mass accompanied by weakness, is an important factor leading to frailty and is a growing concern in the aging Japanese society. Muscle mass can be calculated by dual-energy X-ray absorptiometry (DXA), but results differ between devices produced by different manufactures. Thus, cross-calibration is needed to compare body composition results in multicenter trials or when scanners are replaced. The purpose of this study was to perform an in vivo calibration of total body scans between pencil-beam (DPX-NT, GE Healthcare) and fan-beam (QDR-4500C, Hologic Inc.) DXA units. A total 30 subjects (15 women, 15 men, mean age = 35 years, range 22-49 years) were recruited. The lumbar bone mineral density (BMD), femoral neck BMD, appendicular fat and lean body mass, and the appendicular skeletal muscle mass index (ASMI) were highly correlated (r = 0.979-0.993, r(2) = 0.889-0.977). The conversion formulas were as follows: lumbar BMD, Y = -0.08 + 1.16X (X = QDR-4500C, Y = DPX-NT), femoral neck BMD, Y = -0.015 + 1.11X, and ASMI Y = 0.92 + 0.90X. There is excellent comparability between the DPX-NT and the QDR-4500C DXA units. However, cross-calibration equations are required to assess muscle volume, fat, and ASMI in multicenter studies investigating sarcopenia.

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.

Why not use your own body weight to prevent falls? A randomized, controlled trial of balance therapy to prevent falls and fractures for elderly people who can stand on one leg for ≤15 s.

BACKGROUND: Maintaining or improving motor (balance) ability is essential to extending the healthy lifespan of elderly people, and developing effective and efficient strategies to prevent falls of elderly people is an urgent. The purpose of this study was to determine the effects of balance exercise on fall and fracture prevention for elderly people with poor balance. METHODS: A 6-month, randomized controlled trial was conducted to verify whether one-leg standing with eyes open for a total of 1 min, three times a day (dynamic flamingo exercise) prevents falls and fractures. Setting and participants were elderly people ≥75 years of age and one-leg standing time ≤15.0 s living in their own home. They were visiting orthopaedic clinics for orthopaedic handicaps. Subjects with poor balance were allowed to hold on to something. If a subject's lifted leg touched the ground during the exercise, they were allowed to lift it again and continue so that they stood on one leg for a total of 60 s. RESULTS: The dynamic flamingo exercise group (410 people; 86 men, 324 women) and the no exercise group (455 people; 78 men, 377 women) were compared. After dynamic flamingo exercise for 6 months, significant differences were seen in the increase in one-leg standing time with eyes open (men right/left, women right/left), in the improvement in independence in daily living (women), number of people who fell during the 6 months (women), and adverse events (women). The number of fractures was not significantly different for men or women. CONCLUSIONS: Dynamic flamingo exercise prevents falls but no significant difference was demonstrated in fracture prevention in elderly women with poor balance.

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.

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.

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.

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.

Glomerular hyperfiltration in prediabetes and prehypertension.

BACKGROUND: This study aimed to investigate the associations of hyperfiltration and hypofiltration with prediabetes and prehypertension. METHODS: The study subjects included 99 140 people aged 20-89 years who underwent health checkups in Aichi Prefecture, Japan. The prevalence of hyperfiltration [estimated glomerular filtration rate (eGFR) above the age-/sex-specific 95th percentile] and hypofiltration (eGFR below the age-/sex-specific 5th percentile) was compared among stages of prediabetes (fasting plasma glucose <100, 100-109, 110-125 and ≥126 mg/dL for no prediabetes, Stage 1 prediabetes, Stage 2 prediabetes and diabetes, respectively) and prehypertension [blood pressure (BP) <120/80, 120-129/80-84, 130-139/85-89 and ≥140/90 mmHg for no prehypertension, Stage 1 prehypertension, Stage 2 prehypertension and hypertension, respectively). RESULTS: The prevalence of hyperfiltration increased with increasing stage of prediabetes [odds ratios (ORs): 1.29, 1.58 and 2.47 for Stage 1 prediabetes, Stage 2 prediabetes and diabetes, respectively] and prehypertension (ORs: 1.10, 1.33 and 1.52 for Stage 1 prehypertension, Stage 2 prehypertension and hypertension, respectively). Hypofiltration was not associated with prediabetes or prehypertension. CONCLUSIONS: The prevalence of glomerular hyperfiltration increased with increasing stages of prediabetes and prehypertension. Therefore, kidney function should be monitored in subjects with prediabetes or prehypertension. In subjects with hyperfiltration, earlier treatment of hyperglycemia and high BP may be necessary to prevent the development of kidney damage.