Decreased bone mineral density and osteoporotic fractures are associated with the development of echogenic plaques in the carotid arteries over a 10-year follow-up period: The Japanese Population-based Osteoporosis (JPOS) Cohort Study.

OBJECTIVES: To investigate whether low bone mineral density (BMD) and history of fracture at baseline are associated with the development of echogenic carotid plaques over a 10-year follow-up period. STUDY DESIGN: A prospective cohort study. MAIN OUTCOME MEASURES: Development of echogenic plaques identified by ultrasonography of the carotid arteries. METHODS: Among 1048 women aged 40 or more who completed the baseline survey of the Japanese Population-based Osteoporosis (JPOS) cohort study, 500 women who completed the first decade of follow-up and 267 women who completed the second decade of follow-up were included. We identified history and incidence of clinical osteoporotic fracture during the follow-up through medical interviews, and determined vertebral fractures by morphometry of absorptiometric images. RESULTS: We identified 67 (13.4%) and 31 (11.6%) women with echogenic plaques at the end of first and second decade of follow-up, respectively. Participants with echogenic plaques were significantly older, exhibited lower spine BMD, and had a higher prevalence of osteoporotic fracture, diabetes, and hypertension. A generalized estimating equation analysis was used to combine the participants from the two follow-up periods into a single cohort, and showed that osteoporotic BMD and osteoporotic fractures were significantly associated with the development of echogenic plaques, after adjusting for atherosclerosis risk factors (odds ratio (OR): 2.15, 95% confidence interval (95% CI): 1.04, 4.44; OR: 1.84, 95% CI: 1.03, 3.28, respectively). CONCLUSION: Osteoporotic BMD and osteoporotic fracture history were significantly, and independently, associated with an increased occurrence of echogenic plaques. Ultrasonographic screening of the carotid artery may benefit patients with osteoporosis.

[Validation of the Kihon Checklist for predicting the risk of 1-year incident long-term care insurance certification: the Ohsaki Cohort 2006 Study].

OBJECTIVE: The "Kihon Checklist" (a frailty checklist), consisting of 25 items, is used for screening frail elderly, based on the Japanese long-term care insurance system. However, few reports have investigated predictive ability of incident long-term care insurance certification in the Kihon Checklist. The purpose of this study was to investigate inter-relationships and accuracy as a screening test of individual items and criteria in the Kihon Checklist for incident long-term care insurance certification. METHODS: In December 2006, we distributed a questionnaire including the Kihon Checklist to individuals older than 65 years living in Ohsaki City, Japan. Among the valid respondents, we followed those who gave informed consent to follow-up, had more than 1 item of response on the Kihon Checklist, and were not qualified for long-term care insurance certification at the baseline. We further excluded individuals who died or moved away in the one year follow-up, analyzing 14,636 elderly. The age- and sex-adjusted odds ratio (OR) and 95% confidence interval (95%CI) for newly incident long-term care insurance certification were estimated by logistic regression analysis. Independent variables were each of the items and criteria in the Kihon Checklist used for screening of "frail elderly". In addition, we estimated the sensitivity and specificity, and conducted receiver operating characteristic (ROC) analysis for each criteria domain. RESULTS: 5,560 (38.0%) matched the criteria of "frail elderly". During the one year of follow-up, 483 (3.3%) required newly incident long-term care insurance certification. All of the items in the Kihon Checklist were significantly associated with incident long-term care insurance certification (range of ORs: 1.45-4.67). In addition, all of the criteria also significantly predicted the risk of incident long-term care insurance certification (range of OR: 1.93-6.54). The OR (95%CI) for "frail elderly" was 3.80 (3.02-4.78). Among the various domains, "20 items other than five related to prevention and support for depression" had the largest area under the ROC curve. CONCLUSION: All items and criteria used for screening frail elderly in the Kihon Checklist are useful for predicting the risk of incident long-term care insurance certification during a one-year period. However, the strength of the relation and accuracy for screening test were variable among items or domains, and criteria values could be improved.

Relationship between peripheral arterial disease and incident disability among elderly Japanese: the Tsurugaya project.

AIM: The aim of this study was to investigate whether peripheral arterial disease (PAD) is predictive of disability and whether the relationship between PAD and disability can be fully explained by baseline physical functions. METHODS: We followed for five years 783 Japanese aged 70 years or older without a disability at baseline in 2003. We defined participants certificed as requiring long-term care as having incident disability. The hazard ratio (HR) and 95% confidence interval (95% CI) for incident disability were calculated using the Cox proportional hazards model. RESULTS: After adjusting for possible confounders other than physical function, the HR of incident disability among participants with PAD was 1.86 (95%CI: 1.06 to 3.26).Although the risk was attenuated (HR=1.63, 95%CI: 0.92 to 2.86) after adding baseline physical function as a covariate, the HR was still high. Furthermore, the relation was not statistically significant, but the group with higher physical function and PAD also had a higher HR of incident disability than those who had higher physical function without PAD. CONCLUSION: PAD is an important predictor of disability even if the level of baseline physical function is high.

Participation in health check-ups and mortality using propensity score matched cohort analyses.

OBJECTIVE: All Japanese aged ≥40 years are eligible for free annual health check-ups including blood pressure and cholesterol measurements. It is well known that health check-up screenees are more likely to have healthy lifestyles and better health conditions than non-screenees. Therefore, controlling these factors is required to investigate whether screenees have a lower mortality risk than non-screenees independent of their lifestyles or health conditions. METHODS: We followed 48,775 Japanese National Health Insurance beneficiaries aged 40-79 years since 1994 for 11 years. We used Cox proportional hazard models adjusted for possible confounding factors. We also performed propensity for use of the health check-up matched cohort analyses. RESULTS: Compared to non-screenees, multiple-adjusted hazard ratios (95% confidence intervals) for all-cause and cardiovascular disease mortality among screenees were 0.74 (0.62-0.88) and 0.65 (0.44-0.95) for men and 0.69 (0.52-0.91) and 0.61 (0.36-1.04) for women, respectively. These relations were also observed when we used propensity matched cohort analyses. CONCLUSION: This is the first study to show that mortality rates are lower among screenees than non-screenees in Japanese health check-ups when propensity matched cohort analyses were used for adjusting confounding factors. Further prospective studies, including randomized controlled trials, are required to confirm whether screening lowers mortality.

Green tea consumption is associated with lower psychological distress in a general population: the Ohsaki Cohort 2006 Study.

BACKGROUND: Although green tea or its constituents might reduce psychological stress, the relation between green tea consumption and psychological distress has not been investigated in a large-scale study. OBJECTIVE: Our aim was to clarify whether green tea consumption is associated with lower psychological distress. DESIGN: We analyzed cross-sectional data for 42,093 Japanese individuals aged > or =40 y from the general population. Information on daily green tea consumption, psychological distress as assessed by the Kessler 6-item psychological distress scale, and other lifestyle factors was collected by using a questionnaire. We used multiple logistic regression analyses adjusted for age, sex, history of disease, body mass index, cigarette smoking, alcohol consumption, time spent walking, dietary factors, social support, and participation in community activities to investigate the relation between green tea consumption and psychological distress. RESULTS: We classified 2774 (6.6%) of the respondents as having psychological distress (Kessler 6-item psychological distress scale > or =13/24). There was an inverse association between green tea consumption and psychological distress in a model adjusted for age and sex. Although the relation was largely attenuated when possible confounding factors were adjusted for, a statistically significant inverse association remained. The odds ratio (with 95% CI) of developing psychological distress among respondents who consumed >/=5 cups of green tea/d was 0.80 (0.70, 0.91) compared with those who consumed <1 cup/d. These relations persisted when respondents were stratified by social support subgroups or by activities in communities. CONCLUSION: Green tea consumption was inversely associated with psychological distress even after adjustment for possible confounding factors.