Relative Importance of Central and Peripheral Adiposities on Cardiometabolic Variables in Females: A Japanese Population-Based Study.

In epidemiological studies, there is little evidence regarding the relative impact of central adiposity and peripheral adiposity on cardiometabolic risk factors, especially in Asian populations. This study investigated associations between central-to-peripheral fat ratios and cardiometabolic variables using data from a population-based study of Japanese women. The source population was composed of 1800 women aged 50 yr or older at the 15th- to 16th-yr follow-up survey of the Japanese Population-Based Osteoporosis Cohort Study. This study analyzed cross-sectional data from 998 women for whom complete information about body fat variables according to dual-energy X-ray absorptiometry, cardiometabolic variables, and potential confounding factors was available. Both before and after adjusting for potential confounding factors, trunk-to-appendicular fat ratios showed significant (p < 0.05) correlations with brachial-ankle pulse wave velocity, serum lipids, and hemoglobin A1c levels. Relationships between fat ratios and cardiometabolic variables were independent of relationships between fat volumes (in whole body or in trunk) and cardiometabolic variables. Furthermore, relationships between trunk-to-appendicular fat ratios and cardiometabolic variables were observed among women in the lowest tertile of total body fat (brachial-ankle pulse wave velocity, ß = 0.08; high-density lipoprotein cholesterol, ß = -0.32; low-density lipoprotein cholesterol, ß = 0.15; and hemoglobin A1C, ß = 0.16; p < 0.05, respectively). Central adiposity is more related to cardiometabolic variables than peripheral adiposity. Information on central-to-peripheral fat ratios is particularly valuable for the evaluation of relatively thin Japanese women.

Effect of distributing an evidence-based guideline for prevention of osteoporosis on health education programs in municipal health centers: a randomized controlled trial.

BACKGROUND: Current health education programs for osteoporosis prevention are not strictly evidence-based. We assessed whether distribution of an evidence-based guideline improved such programs at municipal health centers. METHODS: This randomized controlled trial evaluated 100 municipal health centers throughout Japan that were randomly selected from those that planned to revise osteoporosis prevention programs. The implementation status of educational items recommended by the guideline was assessed before and after the intervention by evaluators blinded to the allocation. After the pre-intervention assessment, centers were randomly allocated in a 1:1 ratio to intervention and control groups by a minimization method defining region and city/town as stratification factors. Centers in the intervention group were given copies of the guideline; centers in the control group were instructed to use any information except the guideline. Analyses were performed on an intention-to-treat basis. RESULTS: The guideline was used by 50% of the intervention group. Before the intervention, there was no significant difference in the evidence-based status of health education between the groups. The post-intervention assessment showed that the implementation rates of health education on dietary calcium intake for postmenopausal women and exercise for elderly persons were higher in the intervention group. Specific advice on intakes of calcium and vitamin D and exercise became more evidence-based in the intervention group. CONCLUSIONS: The findings suggest that the guideline helped healthcare professionals to improve health education programs by making them more evidence-based. However, the improvements seemed to be limited to items that the professionals felt prepared to improve.

HDL subclasses are heterogeneous in their associations with body fat, as measured by dual-energy X-ray absorptiometry: the Kitakata Kids Health Study.

BACKGROUND: Obesity, defined as the excessive accumulation of body fat, is frequently associated with low concentrations of high-density lipoprotein (HDL) cholesterol. However, HDL particles are heterogeneous in size and composition. HDL subclasses may be differentially associated with body fat. METHODS: This study investigated associations between the cholesterol concentrations of HDL subclasses, as determined by high-performance liquid chromatography, and body fat variables, as measured by dual-energy X-ray absorptiometry. The source population was all ninth grade students who attended Shiokawa Junior High School in Japan. RESULTS: Cross-sectional data on body fat and serum HDL subclasses were obtained for 87 students (72.5% of the source population). The cholesterol concentration of the large HDL subclass showed a significant (P<0.05) inverse relationship with whole body fat and trunk fat (r=-0.24 and -0.30), whereas the concentration of the small HDL subclass showed a significant positive relationship with these body fat variables (r=0.25 and 0.31). After adjusting for potential confounding factors, the mean concentration of small HDL significantly increased from the lowest to highest tertiles of trunk fat mass index. CONCLUSION: These results indicate that HDL subclasses are heterogeneous in their associations with body fat variables that were accurately measured by dual-energy X-ray absorptiometry among Japanese students.

Seismic intensity and risk of cerebrovascular stroke: 1995 Hanshin-Awaji earthquake.

INTRODUCTION: No epidemiological data exist concerning the influence of an earthquake on the risk of stroke. Whether the incidence of cerebrovascular stroke increased after the 1995 Hanshin-Awaji earthquake (EQ) in Japan and whether seismic intensity affected stroke risk dose-dependently was examined. METHODS: A retrospective cohort study was conducted among residents, who were living in two towns on the island of Awaji and were participants of the National Health Insurance (NHI) program. The two towns were divided into 11 districts and their respective damage and socioeconomic states were investigated. Reviewing the NHI documents issued before and after the EQ, people who had strokes (9th International Classification of Diseases, codes 430-431 or 433-434.9) were identified. Risk of stroke in relation to the seismic intensities, was assessed with the Cox proportional hazard model. RESULTS: Among subjects aged 40 to 99 years, 45 of 8,758 (0.514%) had a stroke the year before the EQ 72 of 8,893 (0.810%) had a stroke in the first year following the EQ, and 49 of 8,710 (0.566%) had a stroke in the second year following the EQ. In districts where the earthquake's intensity was < or = 9.5 on the modified Mercalli intensity (MMI), compared with the year prior to the EQ, the relative risk (RR) of stroke was 2.4 (95% confidence interval (CI) = 1.1, 5.0) in the first year following the EQ, after adjusting for age, gender, and income. In that year, compared with MMI of < 8.5-9.0, RRs for 9.0-9.5 and > or = 9.5 were 1.6 (CI = 0.9, 2.1) and 2.0 (CI = 1.1, 3.7), respectively (p for trend 0.02). No trend for the RR was observed in the year before the EQ or in the second year following the EQ. CONCLUSION: The incidence of stroke increased in the first year following the EQ. The increase was associated with seismic intensity in a dose-response manner. Results suggest a potential threshold for RR of > or = 2.0 in areas near 9.5 on the MMI scale.

A cohort study on the active life expectancy of stroke patients using a community-based stroke registry in a Japanese rural district.

In order to support patients with a history of stroke, public health nurses, hospitals and ambulance stations in and around the Oyabe Health District (49 000 population, rural area) provided initial information for a community-based stroke registry starting from 1966. This stroke registry was established by the present authors to record the patients' status and provide social services at home. The information from 1032 stroke patients was compiled into a register during the period 1966-79. Of 494 patients identified as living at home in 1980, we were able to maintain contact with 452 patients (91.5%) and these 452 stroke patients were defined as the study cohort. They were asked several questions on physical status, mobility status, central nervous function, emotional problems and living conditions. These data were used to construct the baseline of this study cohort and we gathered information on mobility status every year until 1993. The risk factors reducing their active life expectancy were investigated using Kaplan-Meier's method, log-rank test and Cox's proportional hazard model. For active life expectancy, the end point was defined as commencement of immobile status or death. Emotional problems (P < 0.01), difficulty in bathing (P < 0.05) and disorder of memory function (P < 0.05) were shown to contribute to a reduction in their active life expectancy after adjustment for age, sex, years after stroke, types of stroke, mobility status and living with spouse.