High-sensitivity C-reactive protein is a predictor of all-cause mortality in a rural Japanese population.

BACKGROUND: High-sensitivity C-reactive protein (hsCRP) is a sensitive marker of inflammation. This study aimed to determine whether increased hsCRP levels are associated with all-cause mortality rate. METHODS: We examined data for participants from the 2002 Nomura Cohort Study who attended follow-ups for 20 years (follow-up rate: 93.3%). Of these, 793 were male (aged 61 ± 14 years) and 1040 were female (aged 63 ± 11 years). The Japanese Basic Resident Registry provided data on adjusted relative hazards for all-cause mortality. The data were subjected to a Cox regression analysis using a time variable of age and confounding risk factors. RESULTS: The median (interquartile range) follow-up period was 6548 days (6094-7452 days). The follow-up confirmed that there were 632 (34.8%) deaths, of which 319 were male (40.2% of all males) and 313 were female (30.6% of all females). Multivariable-adjusted hazard ratio (1.27; 95% confidence interval, 1.01-1.59) in the highest hsCRP category was also significantly higher compared with reference. A higher hsCRP was associated with a greater risk of all-cause mortality in male participants aged ≥65 years, a BMI < 25 kg/m2 , and no history of CVD or diabetes, and this association was particularly significant among participants with both of the latter two risk factors (p = 0.004 and 0.022 for interaction, respectively). CONCLUSIONS: Our results indicate a significant association between hsCRP levels and all-cause mortality in a rural Japanese population. Specifically, hsCRP appears to be a crucial biomarker for predicting long-term survival, particularly among older persons.

Underactive bladder as defined by the International Continence Society in the 2023 Japan Community Health Survey.

OBJECTIVE: To investigate the characteristics of underactive bladder (UAB) in participants of the 2023 Japan Community Health Survey (JaCS 2023). METHODS: The JaCS 2023 was conducted among individuals aged 20-99 years old who had anonymously registered with a Japanese online research company. We divided the 6210 participants of JACS 2023 into UAB and non-UAB groups as defined by the International Continence Society Working Group (ICS-WG) and evaluated the prevalence of UAB as well as concomitant lower urinary tract symptoms. In addition, an association between UAB and vulnerability-related factors, namely participants' characteristics including frailty and comorbidities, was explored by univariable and multivariable analyses. RESULTS: The prevalence of UAB in Japanese community-dwelling men and women aged 20 years or older was 9.3% and 4.0% overall (p < 0.0001), respectively, and when excluding benign prostatic hyperplasia or pelvic organ prolapse, 7.0% and 3.7%, respectively, (p < 0.0001). A significant increase in the prevalence of UAB with age was observed (p < 0.0001). In addition, storage symptoms including overactive bladder were more frequent in the UAB group than the non-UAB group (p < 0.0001). Frailty and several comorbidities were independently associated with UAB. CONCLUSIONS: According to the definition proposed by the ICS-WG, the JaCS 2023 demonstrated that UAB was more prevalent in men than in women and increased in prevalence with age. Storage symptoms including overactive bladder sometimes coexisted with UAB. Vulnerability-related factors were associated with UAB.

Low density lipoprotein cholesterol and all-cause mortality rate: findings from a study on Japanese community-dwelling persons.

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) independently impacts aging-related health outcomes and plays a critical role in cardiovascular diseases (CVDs). However, there are limited predictive data on all-cause mortality, especially for the Japanese community population. In this study, it was examined whether LDL-C is related to survival prognosis based on 7 or 10 years of follow-up. METHODS: Participants included 1610 men (63 ± 14 years old) and 2074 women (65 ± 12 years old) who participated in the Nomura cohort study conducted in 2002 (first cohort) and 2014 (second cohort) and who continued throughout the follow-up periods (follow-up rates: 94.8 and 98.0%). Adjusted relative risk estimates were obtained for all-cause mortality using a basic resident register. The data were analyzed by a Cox regression with the time variable defined as the length between the age at the time of recruitment and that at the end of the study (the age of death or censoring), and risk factors including gender, age, body mass index (BMI), presence of diabetes, lipid levels, renal function, serum uric acid levels, blood pressure, and history of smoking, drinking, and CVD. RESULTS: Of the 3684 participants, 326 (8.8%) were confirmed to be deceased. Of these, 180 were men (11.2% of all men) and 146 were women (7.0% of all women). Lower LDL-C levels, gender (male), older age, BMI under 18.5 kg/m2, and the presence of diabetes were significant predictors for all-cause mortality. Compared with individuals with LDL-C levels of 144 mg/dL or higher, the multivariable-adjusted Hazard ratio (and 95% confidence interval) for all-cause mortality was 2.54 (1.58-4.07) for those with LDL-C levels below 70 mg/dL, 1.71 (1.15-2.54) for those with LDL-C levels between 70 mg/dL and 92 mg/dL, and 1.21 (0.87-1.68) for those with LDL-C levels between 93 mg/dL and 143 mg/dL. This association was particularly significant among participants who were male (P for interaction = 0.039) and had CKD (P for interaction = 0.015). CONCLUSIONS: There is an inverse relationship between LDL-C levels and the risk of all-cause mortality, and this association is statistically significant.

Chronic kidney disease: prevalence and association with handgrip strength in a cross-sectional study.

BACKGROUND: Poor physical function is strongly associated with mortality and poor clinical outcomes in adults with chronic kidney disease (CKD). Handgrip strength (HGS) is an important index for physical function in the general population, and the association between HGS and CKD is worth investigating. METHODS: From September to November 2015, we conducted a cross-sectional study consisting of 10,407 participants in Jurong City, China. Age-related and sex-specific HGS percentile curves were constructed using the GAMLSS method. In addition, logistic regression was applied to estimate the association between HGS and the presence of CKD with odds ratios (ORs) and 95 % confidence intervals (CIs). RESULTS: Participants with low HGS tended to be older and were more likely to have CKD (8.73 %). Smoothed centile curves of HGS showed a similar shape in both sexes: participants peaked at approximately 20-35 years old and gradually decreased after the age of 50. In addition, independent of age and other factors, the decreased presence of CKD was significantly identified in individuals with moderate (OR: 0.64, 95 % CI: 0.49-0.83) and high HGS (OR: 0.37, 95 % CI: 0.23-0.58). CONCLUSIONS: We concluded that HGS was significantly negatively associated with CKD in Chinese community-dwelling persons.

Interaction between gender and uric acid on hemoglobin A1c in community-dwelling persons.

INTRODUCTION: Higher glycated hemoglobin (Hb) (HbA1c) is significantly associated with an increased risk of cardiovascular disease (CVD). Serum uric acid (SUA) levels are associated with glucose intolerance and type 2 diabetes. Whether gender-specific differences regarding the relationship between SUA levels and HbA1c exist is unknown. AIM: We recruited 1636 (men, 696 aged of 70 ± 10 years; women, 940 aged of 70 ± 9 years) participants and enrolled in the study during their annual health examination from a single community. We investigated the association between SUA levels and HbA1c within each gender. RESULTS: Multiple linear regression analysis showed that in men, SUA (ß = -0.091, p = 0.014) with prevalence of antidiabetic medication (ß = 0.428, p < 0.001) and eGFR (ß = 0.112, p = 0.016) were significantly and negatively associated with HbA1c, and in women, SUA (ß = 0.101, p = 0.002) with prevalence of antidiabetic medication (ß = 0.458, p < 0.001) were significantly and positively associated with HbA1c. Moreover, the interaction between gender and SUA (ß = 0.445, p < 0.001) as well as gender (ß = -0.465, p < 0.001), prevalence of antidiabetic medication (ß = 0.444, p < 0.001), eGFRCKDEPI (ß = 0.074, p = 0.014), and SUA (ß = -0.356, p < 0.001) was a significant and independent determinant of HbA1c. A significant interactive effect of gender and SUA on determinants of HbA1c was noted in patients not on antidiabetic medications, regardless of age, HbA1c, and renal function. CONCLUSIONS: The interaction between gender and SUA was associated with HbA1c independent of other metabolic factors in community-dwelling persons.

Can Serum Gamma-Glutamyl Transferase Predict All-Cause Mortality in Hypertensive Patients?

Introduction In this investigation, the focus was on exploring the connection between serum gamma-glutamyl transferase (GGT), a vital element that influences health and mortality in relation to aging, and all-cause mortality. The study was conducted using a follow-up approach at eight- and 20-year intervals. Methods The study involved 1,101 female participants, with an average age of 69 years (± 9), and 916 male participants, with an average age of 67 years (± 11), who were all diagnosed with hypertension. These individuals were drawn from the Nomura cohort study, which consisted of two separate cohorts: the initial cohort established in 2002 and the subsequent cohort in 2014. We used a Cox proportional hazards model to calculate the hazard ratios (HRs), adjusted for multiple variables, for mortality risk from the initial health examination until the conclusion of the follow-up periods. Results The study followed the participants for a median period of 13.9 years (interquartile range: 8.5-20.2 years). During this follow-up period, 716 deaths were recorded in this population (360 in men and 356 in women), resulting in a mortality rate of 25.5 deaths per 1,000 person-years. Male participants categorized with serum GGT levels ranging from 42 to 86 IU/L showed a 64% increased risk of all-cause mortality (HR: 1.64; 95% confidence interval (CI): 1.11-2.40), while those with GGT levels of 87 IU/L or higher exhibited a 93% elevated risk (HR: 1.93; 95% CI: 1.18-3.16) compared to individuals with GGT levels below 19 IU/L. The association between higher GGT levels and increased all-cause mortality was more evident in men than in women, with a significant interaction between gender and baseline serum GGT (p = 0.020). Conclusions Our findings suggest a notable correlation between irregular GGT levels and the overall mortality rate among Japanese individuals with hypertension living in community settings. Notably, especially in older males, GGT activity turns out to be a critical biomarker for predicting long-term survival.

Smoking Status and Premature Death Among Japanese Rural Community-Dwelling Persons.

Background: Smoking status is known to be an independent and significant predictor of health outcomes related to aging and plays a crucial role in overall mortality rates. This cohort study investigated the relationship between smoking status and survival outcomes over follow-up periods of 9 and 21 years. Methods: The sample consisted of 3526 participants with a mean age of 64 ± 12 years, 44.1% of whom were male. The median follow-up duration was 6315 days, with an interquartile range of 3441 to 7727 days. Smoking status [i.e., Brinkmann index (BI)] was calculated by multiplying the number of years smoked by the number of cigarettes smoked daily. Based on this, participants were categorized into non-smokers, former smokers, and current smokers. The data were analyzed using Cox regression, employing age as the time variable and accounting for various risk factors. Results: A total of 1111 participants (49.2%) were confirmed to have died. Among these, 564 were male (36.2% of all male participants), and 547 were female (27.8% of all female participants). The multivariate-adjusted odds ratio (95% confidence interval) for all-cause mortality compared with never-smokers was 1.51 (1.17-1.96) for former smokers with BI > 800, 1.61 (1.20-2.17) for current smokers with BI of 400-799 and 1.62 (95% CI, 1.24-2.10) with BI of ≥800 (P for trend <0.001). Participants who died within three years of follow-up were excluded to avoid the possibility of reverse causation, but the results were essentially unchanged. Conclusion: We found that the BI is a valid predictor of future mortality risk and that BI 800 for former smokers and BI 400 for current smokers were useful cutoff values. Efforts to control smoking should focus not only on current smokers but also on former smokers to reduce the risk of premature death associated with smoking.

Physical Activity and Trajectory of Cognitive Change in Older Persons: Mayo Clinic Study of Aging.

BACKGROUND: Little is known about the association between physical activity (PA) and cognitive trajectories in older adults. OBJECTIVE: To examine the association between PA and change in memory, language, attention, visuospatial skills, and global cognition, and a potential impact of sex or Apolipoprotein E (APOE) ɛ4 status. METHODS: Longitudinal study derived from the population-based Mayo Clinic Study of Aging, including 2,060 cognitively unimpaired males and females aged ≥70 years. Engagement in midlife (ages 50-65) and late-life (last year) PA was assessed using a questionnaire. Neuropsychological testing was done every 15 months (mean follow-up 5.8 years). We ran linear mixed-effect models to examine whether mid- or late-life PA at three intensities (mild, moderate, vigorous) was associated with cognitive z-scores. RESULTS: Light intensity midlife PA was associated with less decline in memory function compared to the no-PA reference group (time x light PA; estimate [standard error] 0.047 [0.016], p = 0.004). Vigorous late-life PA was associated with less decline in language (0.033 [0.015], p = 0.030), attention (0.032 [0.017], p = 0.050), and global cognition (0.039 [0.016], p = 0.012). Females who were physically inactive in midlife experienced more pronounced cognitive decline than females physically active in midlife and males regardless of PA (p-values for time interaction terms with midlife PA levels and sex were all p < 0.05 for global cognition). APOE ɛ4 carriership did not moderate the association between PA and cognition. CONCLUSION: Engaging in PA, particularly of vigorous intensity in late-life, was associated with less pronounced decline in global and domain-specific cognition. This association may differ by sex.

Mildly elevated serum total bilirubin is negatively associated with hemoglobin A1c independently of confounding factors among community-dwelling middle-aged and elderly persons.

Abnormally high glycated hemoglobin (Hb) (HbA1c) is significantly associated with oxidative stress and an increased risk of cardiovascular disease (CVD). Serum total bilirubin (T-B) may have a beneficial role in preventing oxidative changes and be a negative risk factor of CVD. Limited information is available on whether serum T-B is an independent confounding factor of HbA1c. The study subjects were 633 men aged 70 ± 9 (mean ± standard deviation (SD)) years and 878 women aged 70 ± 8 years who were enrolled consecutively from among patients aged ≥40 years through a community-based annual check-up process. We evaluated the relationship between various confounding factors including serum T-B and HbA1c in each gender. Multiple linear regression analysis pertaining to HbA1c showed that in men, serum T-B (ß = -0.139) as well as waist circumference (ß = 0.099), exercise habit (ß = 0.137), systolic blood pressure (SBP) (ß = 0.076), triglycerides (ß = 0.087), and uric acid (ß = -0.123) were significantly and independently associated with HbA1c, and in women, serum T-B (ß = -0.084) as well as body mass index (ß = 0.090), smoking status (ß = -0.077), SBP (ß = 0.117), diastolic blood pressure (DBP) (ß = -0.155), low-density lipoprotein cholesterol (ß = 0.074), prevalence of antidyslipidemic medication (ß = 0.174), and uric acid (ß = 0.090) were also significantly and independently associated with HbA1c. Multivariate-adjusted serum HbA1c levels were significantly high in subjects with the lowest serum T-B levels in both genders. Serum T-B is an independent confounding factor for HbA1c among community-dwelling middle-aged and elderly persons.

Effects of background factors on subjective health and survival rate among community-dwelling persons / 日本プライマリ・ケア連合学会誌

<b>Background</b> : With the recent progression of the aging society in Japan, what is now seen as important is not simply treatment of disease alone, but also increased quality of life. We have investigated the correlation between the feeling of subjective health and mortality after mean 3.8 year among local residents.<br><b>Methods</b> : In fiscal 2008, a self-recording questionnaire survey was conducted by mailing the questionnaire to 2,657 local residents. Correlation with deaths after mean 3.8 years was investigated based on the Resident Register. With regard to the evaluation items, as background factors related to death, social life conditions (gender·age), health conditions (history of cardiovascular disease, state of depression, subjective happiness, subjective health)and basic activities of daily living (BADL : walking, diet, excretion, bathing, dressing, and ambulation)were evaluated using a 4-point scale ranging from total assistance to completely independent. The Tokyo Metropolitan Institute of Gerontology (TMIG : instrumental independence, intellectual activity, and social role)was used to evaluate the lifestyle factors.<br><b>Results</b> : Of 1825 subjects, 767 males (mean age : 67±13 years)and 1058 females (mean age : 68±11 years), could be analyzed. There were 91 deaths from 2008 to 2012. Investigation of factors that increased subjective health revealed that age, cardiovascular disease, state of depression, intellectual activities, and subjective happiness were items that showed significant correlation. Multivariate logistic regression analysis revealed that subjective health was a significant explanatory variable of death.<br><b>Conclusion</b> : How one personally feels about one's state of health and how one recognizes that, are important. Though not seen physically, they can be considered as important parameters that predict prognosis.