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AIM: To evaluate the potential improvement of fall prevention awareness and home modification behaviors and to decrease indoor falls by applying a home hazard modification program (HHMP) in community-dwelling older adults followed up to 1 year in this randomized controlled trial. METHODS: The present authors randomly assigned 130 older adults living in the Tokyo metropolitan region to either the HHMP intervention group (n = 67) or the control group (n = 63). Both groups received four, 2 h fall prevention multifactorial programs including education regarding fall risk factors, food and nutrition, foot self-care, and exercise sessions. However, only the HHMP group received education and practice regarding home safety by using a model mock-up of a typical Japanese home. RESULTS: The mean age of the HHMP group was 75.7 years and the control group 75.8. The HHMP group showed a 10.9% reduction in overall falls, and falls indoors showed an 11.7% reduction at 52 weeks. Those aged 75 years and over showed a significant reduction in both overall falls and indoor falls at 12 weeks. Fall prevention awareness and home modifications were significantly improved in the HHMP group. CONCLUSION: HHMP has the potential to improve fall prevention awareness and home modification behaviors, and specifically decreased overall and indoor falls in 12 weeks in those aged 75 years and older in community-dwelling older adults. Language: en

Falls are a major public health problem and the second leading cause of death due to unintentional accidental injury after road traffic accidents. Inactive, older individuals with several chronic illnesses fall more frequently than older individuals who are active and healthy. No population-based study has addressed the association of stroke, arthritis, hypnotic and other prescription medications with falls among the elderly simultaneously in a single population in Japan. We examined the prevalence of falls among community-dwelling elderly Japanese individuals, whom we randomly selected from a list of inhabitants aged ? 65 years compiled from the resident registration, and the associations between falls and each of stroke, arthritis, and hypnotic and other prescription medications. We interviewed 295 men and 307 women, and collected information about the number of falls during the latest one year, hemiplegia due to stroke, arthritis in the legs, and the number of hypnotic and other medications. We found that 46 men (16%) and 67 women (22%) had fallen at least once during the latest one year. Logistic regression analysis adjusted for age showed that hemiplegia due to stroke (p < 0.001), arthritis in the legs (p < 0.001), and taking at least four daily prescription medications (p < 0.05) were significantly associated with falls in men. Arthritis in the legs (p = 0.05) and taking at least four daily prescription medications (p < 0.05) were associated with falls in women. Treatment of fall-related diseases and medication management are important strategies for reducing falls among elderly persons., The Tohoku Journal of Experimental Medicine, 231(4), pp.299-303; 2013

四訂日本食品成分表を用いて算出した栄養素等摂取量推定値 (四訂栄養素摂取量) と, 五訂日本食品成分表を用いて算出した栄養素等摂取量推定値 (五訂栄養素摂取量) とを比較し, 食品成分表改訂が栄養素等摂取量に与える影響を検討した。40-82歳の地域住民2,110名の食物摂取量を3日間食事記録調査により把握し, 四訂栄養素摂取量を算出した。四訂食品番号を五訂食品番号に変換後再計算し, 四訂, 五訂栄養素摂取量の差と関連について検討した。五訂栄養素摂取量から四訂栄養素摂取量を引いた値と, その値が四訂栄養素摂取量に占める割合は, 鉄の-2.1mg (-16%) からカロテンの+1,132μg (+31%) までで, タンパク質, レチノール以外は有意差がみられた。四訂と五訂の栄養素等摂取量の相関は0.934 (カロテン) から0.996 (エネルギー, タンパク質) と高かったが, 回帰分析の結果タンパク質以外は四訂栄養素摂取量と五訂栄養素摂取量に系統的な誤差が存在することが示唆された。

The purpose of this longitudinal study was to examine the moderating effects of age and social support from family members in the relationship between the bereavement of friends and depression. The participants were 1 402 Japanese community-dwelling men and women aged between 40 and 79 years, who had done the baseline and the two-year follow-up surveys of the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA). By using hierarchical multiple regression analysis, we detected a significant interaction between age, social support from family members, and the bereavement of friends. Younger participants who were receiving less support from family members after the loss of friends showed significantly higher depression scores.

Genetic variants of the androgen receptor and klotho protein may contribute to variation in bone mass as well as to predisposition to osteoporosis. The relationship of a CAG repeat polymorphism of the androgen receptor gene (AR) and of a -395G--A polymorphism of the klotho gene (KL) to bone mineral density (BMD) in Japanese women was examined in a population-based study. The subjects (1,101 and 1,110 women for AR and KL polymorphisms, respectively) were aged 40-79 years and were randomly recruited to a population-based prospective cohort study of aging and age-related diseases. BMD for the total body, lumbar spine, right femoral neck, right trochanter, and right Ward's triangle was measured by dual-energy X-ray absorptiometry. Genotypes for the AR and KL polymorphisms were determined by polymerase chain reaction based assays. The number of CAG repeats of AR was inversely correlated with BMD for the lumbar spine in premenopausal women but not in postmenopausal women. The (CAG)(n/=22) and (CAG)(n/=23) alleles were designated S and L, respectively. Among premenopausal women, BMD for the total body was significantly lower in subjects with the LL genotype than in those with the SS genotype or those in the combined group of SS and SL genotypes. In contrast, BMD was not associated with AR genotype in postmenopausal women. Among all women, BMD for the lumbar spine was significantly lower in subjects with the GG genotype of the -395G--A polymorphism of KL than in those with the AA genotype. BMD was not associated with -395G--A genotype among premenopausal women. In postmenopausal women, BMD for the total body or lumbar spine tended to be lower in subjects with the GG genotype than in those with the AA genotype or those in the combined group of GA and AA genotypes. These results suggest that AR is a susceptibility gene for reduced BMD in premenopausal Japanese women, and that KL is a susceptibility gene for reduced BMD in all women.

A -521C--T polymorphism in the promoter of the dopamine receptor D4 gene (DRD4) has been associated with novelty-seeking behavior in Japanese. Given that the dopaminergic system might also play an important role in bone metabolism, the relation of the -521C--T polymorphism of DRD4 to bone mineral density (BMD) was examined in 2,228 Japanese subjects (1,123 men; 1,105 women) who were randomly recruited to a population-based, prospective cohort study. BMD at the radius was measured by peripheral quantitative computed tomography, and that for the total body, lumbar spine, right femoral neck, right trochanter, and right Ward's triangle was measured by dual-energy X-ray absorptiometry. Genotype was determined with a fluorescence-based allele-specific DNA primer assay system. For men, BMD for the distal radius, total body, lumbar spine, trochanter, or Ward's triangle was lower in individuals with the CC genotype than in the combined group of TT and TC genotypes or in those with the TT genotype or with the TC genotype. The urinary concentration of deoxypyridinoline was slightly, but significantly, greater in men with the CC genotype than in those with the TT or TC genotypes or with the TT genotype. For women, there were no differences in BMD among -521C--T genotypes. These results implicate DRD4 as a candidate locus for reduced BMD in Japanese men.

Although polymorphism of the mitochondrial DNA 15497guanine/adenine (Mt15497G-->A) leads to the Gly251Ser amino acid replacement on human cytochrome b, it is unknown whether functional alteration of the mitochondrion is induced by the Gly251Ser replacement. To see if an association exists between the Mt15497G-->A polymorphism and obesity, we examined differences in body size, body composition, and regional body fat distribution between the two genotypes in middle-aged and elderly Japanese individuals (825 women and 906 men). The Mt15497 genotype was determined with an automated colorimetric allele-specific DNA probe assay system using the polymerase chain reaction (PCR) method. The Mt15497G-->A polymorphism was detected in 3.5% ( n=60) of all subjects: 2.8% ( n=23) among women and 4.1% ( n=37) among men. After adjusting for age and smoking, we found that body weight, body mass index, waist and hip circumferences, fat mass, fat-free mass, intra-abdominal fat and triglycerides were significantly greater in women with the A allele compared with the G allele ( p=0.001-0.025). For men, waist to hip ratio was significantly greater ( p=0.032), and waist circumference, intra-abdominal fat and triglycerides had a trend to be significantly greater ( p=0.062-0.087) in subjects with the A allele compared with the G allele. These data suggest that the Mt15497 polymorphism may be associated with obesity-related variables and lipid metabolism.

Mitochondrial aldehyde dehydrogenase 2 (ALDH2) plays a major role in acetaldehyde detoxification. The alcohol sensitivity is associated with a genetic deficiency of ALDH2. We and others have previously reported that such a deficiency influences the risk for late-onset Alzheimer's disease (LOAD), hypertension, and myocardial infarction. Then we tried to find phenotypes to which the ALDH2 polymorphism contributes by conducting several evaluations including biochemical and functional analyses of various tissues in a community-dwelling population. Several serum proteins, lipids, and lipid peroxides (LPO) levels showed differences between the nondefective (ALDH2*1/1) and defective (ALDH2*1/2 and ALDH2*2/2) ALDH2 individuals. However, alcohol-drinking behavior is known to affect these evaluations. Thus, we excluded the effects of alcohol-drinking behavior from the association with the ALDH2-deficient genotype through correction and found that the concentration of LPO was significantly lower in the nondefective ALDH2 females than the defective females. The effect of frequent alcohol-drinking behavior in males seems to override the phenotype of the high serum LPO level. These results indicate that the ALDH2 deficiency may enhance oxidative stress in vivo. Thus, these findings suggest that ALDH2 functions as a protector against oxidative stress and the decrease in protection may influence the onset of AD, hypertension, and myocardial infarction.

We examined whether the −634C→G, 298C→T, and 2C→T polymorphisms of the IL-6, osteocalcin, and vitamin D receptor (VDR) genes, respectively, were associated, alone or in combination, with bone mineral density (BMD) in community-dwelling Japanese women (between 1108 and 1113) or men (between 1116 and 1130) aged 40–79 yr. The −634C→G polymorphism of the IL-6 gene and the 298C→T polymorphism of the osteocalcin gene were associated with BMD in postmenopausal women, with the respective GG and TT genotypes representing risk factors for reduced bone mass. IL-6 and osteocalcin genotypes showed additive effects on BMD for postmenopausal women. The 2C→T polymorphism of the VDR gene was associated with BMD in men, with the CT genotype contributing to reduced BMD. These results suggest that the IL-6 and osteocalcin genes are susceptibility loci for reduced BMD in postmenopausal women and that the VDR gene constitutes such a locus in men. The combined IL-6 and osteocalcin genotypes may prove informative for the assessment of osteoporosis in women.

Background and Purpose— Silent brain infarcts (SBI) and white matter lesions are relatively common neuroimaging findings, especially in the elderly population. The genetic background for SBI and white matter lesions in a large Japanese general population was investigated. Methods— Subjects were recruited from participants in the National Institute for Longevity Sciences, Longitudinal Study of Aging. Genotyping of methylenetetrahydrofolate reductase (MTHFR) C677T gene mutation and brain MRI examination were performed in 1721 subjects free of any history of stroke. SBI and white matter lesions were diagnosed from MRI findings. Results— Of 1721 MRI examinations, SBI was observed in 178 (10.3%). The prevalence of SBI and white matter lesions increased with age. The prevalence of SBI was significantly higher in subjects with the MTHFR TT genotype compared with the TC+CC genotype (14.6% versus 9.5%; 42 of 288 versus 136 of 1433; χ 2 =6.71; P =0.010). The stage of white matter lesions was not significantly different. In subjects ≥60 years of age (n=849), the prevalence of SBI was significantly higher in TT than TC+CC (27.7% versus 16.6%; 36 of 130 versus 119 of 719; χ 2 =9.16; P =0.002). The prevalence of moderately advanced white matter lesions was also significantly higher in TT than TC+CC (60.7% versus 49.0%; 79 of 130 versus 352 of 719; χ 2 =9.16; P =0.002). After correction for other risk factors, the MTHFR TT genotype was independently associated with SBI (odds ratio [OR], 1.72; 95% CI, 1.10 to 2.68; P =0.018) and moderately advanced white matter lesions (OR, 1.58; 95% CI, 1.07 to 2.33; P =0.02). Conclusions— These findings indicate that the MTHFR TT genotype is an independent risk factor for SBI and white matter lesions in the general Japanese population, especially in elderly subjects.

Purpose: The purpose of this study was to investigate the relationship between social contact, life satisfaction (LSIK) and mental health (GDS) among rural elderly. Methods: Subjects were 1, 019 elderly people aged 65 years and older living in Nakijin-son, Okinawa. Of these subjects, we analyzed data from 767 persons who responded to an interview survey conducted in 1998. Social contact was assessed by frequency of contact with children living separately, relatives, friends, and neighbors. Multiple regression analysis was conducted in order to investigate the relationship between social contact, LSIK and GDS based on IADL levels. Results: Those with higher LSIK scores tended to have more frequent contact with relatives, friends, and neighbors in the higher IADL group. In the lower IADL group, however, only contact with neighbors contributed significantly to life satisfaction. GDS was significantly related to frequency of contact with relatives, friends, and neighbors in the higher IADL group. Moreover, GDS was significantly associated with contact with children living separately in the lower IADL group. Conclusions: The present findings suggest that the relationship between social contact, life

Body fat distribution and abdominal fatness are indicators of risks for coronary heart disease. However, the relationships between resting energy expenditure (REE) and the body fat distribution or the abdominal fatness are unclear. We examined the relationships of REE with whole-body fat distribution (waist, hip and waist-to-hip ratio: WHR) and abdominal fatness (intra-abdominal fat: IF and subcutaneous fat: SF) after adjustment for body composition. 451 men and 471 women were subdivided into two groups, 40-59 years: middle-aged group and 60-79 years: elderly group. REE was measured by an indirect calorimetry system. Percentage of fat mass (%FM), fat mass (FM) and fat-free mass (FFM) were assessed by a dual-energy x-ray absorptiometry method. The IF area (IFA) and SF area (SFA) at the level of the umbilicus were measured using computed tomography. Circumference of waist and hip were measured in a standing position. The WHR, waist circumference and SFA did not significantly (p>0.05) associate with the REE after adjusting for FM, FFM and age in any of the groups. The adjusted REE was significantly and inversely correlated with hip (r=-0.159, p

Transforming growth factor-beta1 (TGF-beta1) is an important regulator of blood pressure (BP) and vascular remodeling, and thus may contribute to the pathogenesis of hypertension. A T--C transition at nucleotide 869 of the TGF-beta1 gene results in a Leu--Pro substitution at amino acid 10 of the signal peptide. We have now examined the possible association of the 869T--C polymorphism of the TGF-beta1 gene with BP and the prevalence of hypertension in 2241 community-dwelling Japanese individuals (1126 men and 1115 women). TGF-beta1 genotype was determined by an allele-specific polymerase chain reaction method. For women, both systolic and diastolic BP was significantly higher in individuals with the CC genotype than in those with the TT or TC genotype. No significant association between TGF-beta1 genotype and BP was detected in men. The frequency of the CC genotype was significantly higher in women with hypertension than in those with normal BP. These results suggest that the TGF-beta1 gene at chromosome 19q13.1 may be a candidate susceptibility locus for hypertension in Japanese women.

Objective Recent studies reported that hyperesthesia may be an indicator of early diabetic polyneuropathy. Using the current perception threshold (CPT) test, which stimulates peripheral sensory nerve fibers by three different frequencies (2, 000, 250, and 5 Hz), we investigated the relationship between hyperesthesia and glucose metabolic impairment in a community. Methods The number of subjects, aged 40 to 79 years, was 2, 074. The CPT values at each frequency were classified into three categories (hyperesthesia, normal, and hypoesthesia). Subjects were also subgrouped into three groups (normal, insulin resistance, and diabetes) according to glucose metabolic status, and those with hypoesthesia at each frequency were excluded in the analyses. Results The prevalence of hyperesthesia at 2, 000, 250, and 5 Hz in male diabetic subjects were 14.1, 15.6, and 7.7%, respectively, and 22.2, 24.5, and 16.4% respectively in female diabetic subjects. In logistic regression analysis adjusted for age, females with diabetes showed a significantly high odds ratio (OR) for hyperesthesia at 2, 000 Hz (OR, 2.42; 95% confidence interval (95%CI), 1.18 to 4.97) and 250 Hz (OR, 2.65; 95%CI, 1.31 to 5.37). In male diabetic subjects, a significantly high odds ratio for hyperesthesia was seen at 250 Hz (OR, 2.09; 95%CI, 1.07 to 4.05). Conclusion Our results suggested that hyperesthesia may emerge coupled with developing diabetes, supporting the precedent hypothesis.(Internal Medicine 41:1124-1129, 2002)

The aim of this study was to clarify the percentages of elderly people living in a rural community of Japan who were able to and those who were not able to maintain active independence in instrumental activities of daily living (IADL) over a period of 8 years and the lifestyle factors that influence the maintenance of active independence. The subjects were 410 elderly people (aged 65 years or over) living in Nangai, Akita Prefecture who were independent in all IADL in the baseline survey conducted in 1988. The survey was conducted by interviews. There were 25 items related to lifestyle in the survey, including 17 items concerning daily habits and 8 items concerning frequency of food intake. A follow-up survey of the 410 subjects was conducted 8 years later, in 1996. The percentages of men and women subjects who were still independent in IADL at the time of the follow-up survey were 54.2% and 55.1%, respectively. Multiple logistic regression analysis controlling for age and education was carried out to determine the degrees to which lifestyles influence active self-maintenance. It was found that de-grees of active self-maintenance were high significantly in men who slept 6-8 hours daily and ate seaweed almost every day and in women who read newspapers/magazines and ate seafood and fruit almost every day. These findings show that efforts to maintain intellectual interests and efforts to maintain a diet that includes sufficient vegetables and protein, especially protein from fishes, may be useful to maintain active independence in the elderly.

Air displacement plethysmography (ADP) is a method for the determining percent body fat (%BF) using the two-compartment model, in which the body is partitioned into body-fat mass and fat-free mass (FFM). Although this model assumes a constant density of FFM as 1.10 g/ml, its density may depend upon the bone mineral content (BMC) and total body water (TBW) which vary with age, gender, and race/ethnicity. This study compared %BF determined from ADP (ADP%BF) with %BF obtained by dual-energy x-ray absorptiometry (DXA%BF), and also investigated the effects of BMC, TBW, and other factors on its value. The subjects were 721 female and male Japanese aged 40 to 79 years. Body density was measured by ADP and %BF was calculated using Brozek et al's equation. BMC and body-fat volume were measured using DXA, and TBW was measured by multifrequency bioelectrical impedance. A series of anthropometric measurements was taken. Although ADP%BF was highly correlated with DXA%BF (female: r = 0.89, male: r = 0.90) (p0.001), ADP%BF differed significantly from DXA%BF (female: -1.30 +/- 0.14% (mean +/- s.e.m.), male: 1.22 +/- 0.13%) (p0.001). The difference in %BF (ADP%BF-DXA%BF) was negatively associated with BMC/FFM but not with TBW/FFM in both genders. The difference in %BF was also positively correlated with waist circumference. Considering previous studies, this result may be explained by the underestimation of DXA%BF, rather than by the overestimation of ADP%BF. In conclusion, ADP may be a useful method to measure %BF. However, BMC should be taken into consideration. Furthermore, DXA%BF may be underestimated in people with large waists.

This study observed the status of independence in behavioral competence among older people who have any disability in basic activities of daily living (BADL) living in a rural community in Japan. Study participants (N = 76) who were regarded as bedridden were surveyed by means of a questionnaire in July to August 1996. The independence variables were age, sex, BADL status, hearing impairment, visual impairment, history of stroke, and cognitive impairment. The dependent variable was each item of the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence, which is a multidimensional 13-item index of behavioral competence. Percentages of subjects who were independent in each item of the TMIG Index of Competence varied from 1% to 36%. Multiple logistic regression analyses revealed that BADL status was independently associated with independence in using a telephone, being interested in news stories or programs dealing with health, being called on for advice, and initiating conversations with young people, after adjustment for age, sex, hearing impairment, visual impairment, history of stroke, and cognitive impairment. These findings suggest that programs for preventing decline in behavioral competence of older people with BADL disability might be important as well as physical therapy for them.

The National Institute for Longevity Sciences--Longitudinal Study of Aging (the NILS-LSA) started in 1997, and involves many kinds of examination. The objective of this paper is to outline the eye examinations in the NILS-LSA. The eye examinations consist of checks on refractometry, visual acuity, intraocular pressure, contrast sensitivity, kinetic visual acuity, visual fields, fundus photography, and lens estimation. The subjects were 1,077 men and women aged 40-79 years who participated in the first year examination of the NILS-LSA. All subjective measurements (distant visual acuity, kinetic visual acuity, contrast sensitivity, and mean sensitivity of visual field) declined significantly from the 50s. Age-related structural changes in the lens or hypertensive and arteriosclerotic changes in retinal vessels began at least in the 40s. It is suspected that aging affects the subjective visual functions from the 50s. However, changes in the structure of eye may begin before the 40s. The data from the eye examinations of the NILS-LSA are useful to assess the aging effects on vision and to investigate the relationship between visual function and physical or psychosocial health problems among the elderly.

To prevent a decline in gait with age, it is necessary to investigate age-related changes in gait performance and detect related factors. The purpose of this study was to assess the association between gait ability and leg extension power among middle-aged and elderly people. Height, weight, maximum gait velocity (MGV) and leg extension power (LEP) were measured in 752 males and females who participated in the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA). Age-related changes in MGV and LEP and the association between MGV and LEP were assessed. There were significant decline trends in height, weight, MGV and LEP with advancing age (p

We examined the relationship among social support, self-esteem, and depression. The subjects were 1,116 Japanese community-dwelling adults aged between 40-79, who were the first wave participants of the National Institute for Longevity Sciences--Longitudinal Study of Aging (NILS-LSA). Exploratory and confirmatory factor analyses were performed on the Rosenberg's self-esteem scale that supported the superiority of the bi-dimensional structure of the scale marked by self-confidence and self-deprecation subscales. The subsequent causal analyses, using structural equation modeling, demonstrated that social support reduced depressed affect through an increase in self-confidence and a decrease in self-deprecation. By contrast, social support did not show a direct effect on depressed affect. The findings suggest the importance of esteem-improving elements of social support in reducing depressive symptoms.

The purpose of this study was to investigate age and gender differences in current perception thresholds (CPT) in Japanese citizens. CPT values at frequencies of 2000, 250 and 5 Hz reflect different types of peripheral sensory nerve functions. Since there have been only a limited number of reports which investigated CPT values in community-dwelling people, little is known about variations with age and gender. The present study therefore concentrated on a large population of 1632 individuals (men; 818 mean ageq•standard deviation 59.4±10.9, women; 814, 59.4±11.1) in a Japanese community. Significant gender differences in CPT values at 250 and 5 Hz were observed. Multiple comparisons among 4 age groups (40s, 50s, 60s and 70s) showed age-related differences in CPT values at 2000 and 250 Hz in both genders. However, age and gender interactions with reference to CPT values appeared to be different between these latter two frequencies. At 5 Hz, only men showed age-related variations. These results indicated gender differences in fiber-specific aging changes. J Epidemiol, 2000 ; 10 : S33-S38.

A new comprehensive longitudinal study of aging, the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA) started in November 1997. The participants of this study will be 2,400 residents aged 40 to 79 years who were age- and gender-stratified random samples selected from the NILS area. All participants provided written informed consent after a detailed explanation of the study. They will be examined at the NILS-LSA Examination Center every two years. Their first wave examinations will be finished by the end of March 2000. The examined variables number over 1,000, including clinical evaluations, medical examinations, anthropometry, body composition, physical functions, physical activities, psychological assessments, nutritional analysis and molecular epidemiology. By the end of September 1999, 1,643 men and women had completed their first wave examinations.

The circumstances and factors related to falls among the elderly living in a nursing home were investigated. Information on falls was obtained from the fall assessment form recorded by the staff of the institution. During the 1-year study period, 65 (37%) of 174 subjects experienced at least one fall. Most falls occured in the subjects' own rooms and during the daytime. In the subsample of 52 elderly whose data on age, sex, gait, grip strength and standing on one leg at tha beginning of this study were available, week grip strength was significantly associated with increasing risk of falling by chi-square test. After adjusting for other factors, weak grip strength remained a significant and independent predictor of falls. Measuring of grip strength may be useful for screening elderly who are at a high risk of falling.

A case-control study was conducted on 31 patients with clinically diagnosed Alzheimer type dementia, and 32 hospital and 373 community controls. Information was obtained from the next-of-kin for all subjects concerning life histories, health practice, eating habits, life events, family histories and past medical events. After adjusting for the effects of other factors, "intake of sweets" was significantly associated with dementia of the Alzheimer type. Those who had restricted intake of sweets were less common in the case group than in two control groups. Other factors examined in this study did not reach statistical significance.

Genetic variants that affect collagen Ialpha1 metabolism may be important in the development of osteoporosis or osteoporotic fractures. A -1997G-->T polymorphism in the promoter of the collagen Ialpha1 gene (COL1A1) was shown to be associated with bone mineral density (BMD) for the lumbar spine in postmenopausal Spanish women. The relation of this polymorphism to BMD in Japanese women or men has now been examined in a population-based study. The subjects (1,110 women, 1,126 men) were 40 to 79 years of age and were randomly recruited for a population-based prospective cohort study of aging and age-related diseases. BMD for the lumbar spine, right femoral neck, right trochanter, and right Ward's triangle was measured using dual-energy x-ray absorptiometry. Genotypes for the -1997G-->T polymorphism of COL1A1 were determined with a fluorescence-based allele-specific DNA primer assay system. When all women were analyzed together, BMD for the lumbar spine and trochanter was significantly lower in subjects with the COL1A1 *G/*G genotype than in those in the combined group of COL1A1 *G/*T and COL1A1 *T/*T genotypes. When postmenopausal women were analyzed separately, BMD for the femoral neck and trochanter was also significantly lower in those with the COL1A1 *G/*G genotype than in those with the COL1A1 *G/*T genotype or those in the combined group of COL1A1*G/*T and COL1A1 *T/*T genotypes. BMD was not associated with -1997G-->T genotype in premenopausal women or in men. Multivariate regression analysis revealed that -1997G-->T genotype affected BMD at various sites with a variance of 0.46-0.62% for all women and 0.61-1.01% for postmenopausal women. The -1997G-->T genotype was not related to the serum concentration of osteocalcin, the serum activity of bone-specific alkaline phosphatase, or the urinary excretion of deoxypyridinoline or cross-linked N-telopeptides of type I collagen in men or in premenopausal or postmenopausal women. These results suggest that COL1A1 is a susceptibility locus for reduced BMD in postmenopausal Japanese women.

We investigated the relationship of polymorphisms in the cholecystokinin 1 receptor [CCK1R; G to T (n-128), A to G (n-81)] and the beta3-adrenergic receptor (beta3-AR; Trp64Arg) with midlife weight gain. The participants were 1012 Japanese men and women (40 to 59 years of age). Their weight at 18 years old was obtained from a questionnaire. Weight change was defined as the current weight minus the weight at 18 years old. Subjects were grouped into four categories by these genotypes: W/W=noncarriers, W/H=Arg64 carriers of the beta3-AR, H/W=T (n-128) or G (n-81) carriers of the CCK1R, H/H=T (n-128) or G (n-81) and Arg64 carriers. In men, the interaction between the CCK1R and beta3-AR polymorphisms was significant (two-way ANOVA, p0.05), but neither the CCK1R nor the beta3-AR was individually associated with weight gain. The H/H group showed a higher possibility of weight gain of 10 kg or more compared with the W/W group in men. The odds ratio for weight gain (or =10 kg) of H/H was 2.54 (95% confidence interval: 1.50 to 4.30) compared with W/W. In women, neither main effect nor interaction was significant. These results suggest that the combination of CCK1R and the beta3-AR polymorphisms is a contributing factor for midlife weight gain in men.

Aims: Cholecystokinin (CCK), one of the most abundant neurotransmitter peptides, interacts with dopamine. Dopaminergic neurotransmission between the ventral tegmental area and the limbic forebrain is a critical neurobiological component of alcohol and drug self-administration. CCK modulates dopamine release in the nucleus accumbens via the CCK-A receptor (R). We recently determined the transcriptional start site of the human CCK-AR gene, and detected two sequence changes (-81A/G and -128G/T) in the promoter region. The aims of the present study were to determine the prevalence of the -81A/G and -128G/T polymorphism of the CCK-AR gene between alcoholics and normal control subjects and the occurrences of the polymorphisms in subtypes of alcoholics. Methods: The above polymorphisms were examined in 435 alcoholics and 1490 control subjects. We excluded subjects with inactive ALDH2 and employed the subjects with ALDH2*1/2*1 (384 alcoholics and 792 controls). Results: The allelic frequency of -81G in the CCK-AR gene polymorphism (-81A/G) was significantly higher in alcoholics than in control subjects. However, there were no differences between the two groups with respect to the frequency of -128G/T. Alcoholic patients with antisocial personality disorder and with first-degree alcoholic relatives were significantly associated with a higher frequency of the -81G allele. In addition, the age of onset of alcohol dependence was significantly earlier in patients with this allele. Conclusions: The CCK-AR gene -81A/G polymorphism, especially in the -81G allele, may be associated with intractable alcoholism.

The purpose of the present study was to report the prevalence and circumstances of falls among community-dwelling elderly people in order to contribute to prevention of falls in the community. The subjects were 2,774 elderly people who participated in health examinations conducted by Tokoname-shi, Aichi Prefecture in 2002. The variables investigated in the present study were demography and history of falls in the past one-year. Circumstances of falls, e.g. time, location, activities associated with falls, cause of falls and degree of injury due to falls were asked when the subjects experienced a fall. The prevalence of falls among 2,774 subjects was 13.7%. It was significantly higher among women (17.2%) than men (8.3%, chi 2 = 48.1, p < 0.001). Prevalence increased as subjects get older. Circumstances of falls were assessed in 655 subjects. The distribution of time, location, activity associated with falls, cause and injury due to falls corresponded with previous fall studies among community dwelling elderly people. The incidence of falls was extremely high during the daytime and outdoors. Falls occurred most frequently while walking. The majority of falls were due to extrinsic factors. About 10% of all falls caused fracture.

Oxidative stress may affect cellular functions in various pathological conditions, including osteoporosis. Paraoxonase 1 confers antioxidant properties on high-density lipoprotein, with which it is associated, by reducing the accumulation of lipid peroxidation products. We have now examined whether the 584A--G (Gln192Arg) and 172T--A (Leu55Met) polymorphisms of the paraoxonase 1 gene and the 959G--C (Cys311Ser) polymorphism of the paraoxonase 2 gene are associated with bone mineral density (BMD) in community-dwelling Japanese (1,087-1,094 women and 1,112-1,125 men). The subjects were aged 40-79 years and were randomly recruited to a population-based prospective cohort study of aging and age-related diseases. BMD for the lumbar spine and right femoral neck was measured by dual-energy X-ray absorptiometry. Genotypes were determined with a fluorescence- or colorimetry-based allele-specific DNA primer-probe assay system. The 584A--G and 172T--A polymorphisms of the paraoxonase 1 gene and the 959G--C polymorphism of the paraoxonase 2 gene were associated with BMD for the lumbar spine or femoral neck in postmenopausal women, with the 584 GG, 172 TT, and 959 CC genotypes representing risk factors for reduced bone mass. None of these three polymorphisms was associated with BMD in premenopausal women or in men. Our results suggest that the paraoxonase 1 and 2 genes are candidate loci for reduced bone mass in postmenopausal Japanese women.

The possible association of the 190G--A (Val64Ile) polymorphism of the CC chemokine receptor-2 gene (CCR2) with bone mineral density (BMD) was examined in 2215 subjects (1125 men, 1090 women), all of whom were community-dwelling individuals aged 40 to 79 years. Among men aged60 years, BMD for the distal radius, lumbar spine, or Ward's triangle was significantly greater in those with the AA genotype than in those with the GG or GA genotypes. For postmenopausal women, BMD for the distal radius or femoral neck was significantly greater in those with the AA genotype than in those with the GG or GA genotypes. In contrast, for men agedor =60 years and for premenopausal women, BMD was not associated with the CCR2 genotype. These results suggest that CCR2 may be a new candidate for a susceptibility locus for bone mass in middle-aged men and postmenopausal women.

The estrogen receptor alpha gene is a candidate locus for genetic influence on bone mass. The possible association between two polymorphisms in the first intron of this gene, alone or in combination, and bone mineral density at various sites was examined in participants in the National Institute for Longevity Sciences Longitudinal Study of Aging, a population-based prospective cohort study of aging and age-related diseases. The relationship of the TC ( PvuII) and AG ( XbaI) polymorphisms in the first intron of the estrogen receptor alpha gene to bone mineral density was determined in 2230 subjects (1120 men, 1110 women) and in 2238 subjects (1128 men, 1110 women), respectively, all of whom were community-dwelling individuals aged 40-79 years. Bone mineral density at the radius was measured by peripheral quantitative computed tomography and that for the lumbar spine, right femoral neck, right trochanter, right Ward's triangle, and total body was measured by dual-energy X-ray absorptiometry. Estrogen receptor alpha genotypes were determined with an automated fluorescent allele-specific DNA primer assay system. Analysis of the TC ( PvuII) polymorphism revealed that bone mineral density for the total body, femoral neck, and trochanter was significantly lower in women aged 60 years or over with the CC genotype than in those with the TT genotype, but statistical significance was not achieved after adjustment for age, body mass index, and smoking status. Analysis of the AG ( XbaI) polymorphism revealed that bone mineral density for the femoral neck was significantly lower in women aged 60 years or over with the GG genotype than in those with the AA genotype. After adjustment for age, body mass index, and smoking status, bone mineral density for the femoral neck was significantly lower in women aged 60 years or over with the GG genotype than in those with the AA or AG genotypes. Analysis of combined genotypes in women aged 60 years or over revealed that bone mineral density for the femoral neck was significantly lower in women with the CC/ GG genotype than in those with the TT/ AA or TC/ AA genotypes. After adjustment for age, body mass index, and smoking status, bone mineral density for the femoral neck was significantly lower in women aged 60 years or over with the CC/ GG genotype than in those with other genotypes. No differences in bone mineral density at the various sites were detected among TC ( PvuII), AG ( XbaI), or combined genotypes in women aged under 60 years or in men. These results suggest that the estrogen receptor alpha gene is a susceptibility locus for bone mass, especially for the femoral neck, in elderly Japanese women.

Since the Labor Safety and Health Law of Japan provides that the employer is responsible for taking custody of personal information obtained in periodic health examinations, we are anxious about infringement of privacy. This study was conducted to investigate the present condition of health information control in each workplace and attitudes of occupational health professionals in collecting and utilizing personal health information by means of self-administered mail questionnaires. The numbers of respondents were a total of 549 (physicians: 237, public health nurses: 175, nurses 122, others & unknown: 15). The major results were as follows. 1. Percentage of workplaces in which only health professionals can know personal health data from periodic health examinations was 24% altogether, but it was 39% in large workplaces where full-time occupational physicians were working. 2. More than half of the respondents were of the opinion that the results of routine health activities could be presented in academic conferences unconditionally or under comprehensive approval of the representative of each workplace. 3. About a half of the respondents believed that it was necessary to consider the intention of each examinee in utilizing blood specimen collected at health examinations for research purposes, even though personal identification had been erased. 4. There were many differences among types of occupation or age groups in the attitude to changing the procedure for health examination. And it was the majority opinion that personal health data provided to the employer should be the minimum in order to protect individual benefits. 5. The proportion of physicians who felt it necessity to ask about the occupational history at the employment health examination was significantly higher than that of public health nurses. 6. When a disease was discovered, there were great differences among types of disease in the attitude to give the name or condition of the disease to the employer without the consent of the patient or his family. In view of these results, we feel that occupational health professionals are in a dilemma in introducing modern ideas which lay stress on privacy into the Japanese occupational health care system which is still operating on the basis of traditional paternalism.

Ultrasonic evaluation of the intima-media thickness in the common carotid artery (IMT-CCA) has been widely used as a marker of atherosclerosis. However, the definition of IMT-CCA is not uniform and it includes two quite different pathological changes; a general intima-media thickening and a local atherosclerotic change (plaque formation). The aim of this paper was to evaluate the IMT-CCA and local atherosclerosis separately, and to clarify how the IMT-CCA itself changes with age and how local plaques influence the relationship between the IMT-CCA and age. The subjects were 979 men and women aged 40 to 79 years who participated in the first wave examination of the National Institute for Longevity Sciences--Longitudinal Study of Aging (NILS-LSA). The IMT-CCA measured at the thinnest point was significantly higher in men (0.61 +/- 0.15 mm) than in women (0.58 +/- 0.14 mm, p < 0.01) and it increased with age (trend p < 0.0001) in both genders. The IMT-CCA was higher with the presence of plaque in the bulbs (PLQ-BLB) than without PLQ-BLB (p < 0.0001). Although this was a cross-sectional study, the IMT-CCA increased 0.06 mm/10 years with PLQ-BLB and 0.04 mm/10 years without PLQ-BLB. The IMT-CCA could be partially explained by age, gender and PLQ-BLB (r2 = 0.317). In this middle-aged and elderly population, an increase in the IMT-CCA showed a moderate relationship with local atherosclerosis and age.

Phenotypes of various genes related to geriatric diseases and the aging process were assessed in the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA). The subjects were 1,297 participants in the NILS-LSA. They were community-living males and females aged 40 to 79 years who were randomly selected from the area of the NILS. Genotypic and allelic frequencies of genes in the subjects were analyzed. Age and gender differences in the distribution of genotypes were also tested. The genotypic frequencies were as follows: (1) Angiotensin I-converting enzyme (ACE) genotype was I/I 46.2%, I/D 38.3% and D/D 15.5%. (2) alpha 1-adrenoreceptor genotype was C/C 84.4%, C/T 12.7%, and T/T 3.0%. (3) Apolipoprotein E genotype was epsilon 2/epsilon 2 0%, epsilon 2/epsilon 3 7.9%, epsilon 3/epsilon 3 70.0%, epsilon 3/epsilon 4 20.8%, epsilon 2/epsilon 4 0%, and epsilon 4/epsilon 4 1.4%. (4) Cholecystokinin type-A receptor (CCKAR) nucleotide-81 (nt-81) genotype was A/A 59.1%, A/G 35.1%, and G/G 5.9%. The CCKAR nucleotide-128 genotype (nt-128) was G/G 74.3%, G/T 23.6%, and T/T 2.2%. The combination of nucleotide (nt-81, nt-128) was (A/A, G/G) 59.1%, (A/G, G/G) 14.1%, (G/G, G/G) 1.1%, (A/G, G/T) 21.0%, (G/G, G/T) 2.6%, and (G/G, T/T) 2.1%. There were no subjects with (A/A, G/T), (A/A, T/T) or (A/G, T/T) genotypic combinations. (5) beta 3-adrenoreceptor genotype was T/T 66.8%, T/A 28.5%, and A/A 4.7%. (6) Dihydrolipoamide succinyltransferase (DLST) nucleotide 19117 genotype was A/A 25.1%, A/G 49.7%, and G/G 25.1%. The DLST nucleotide 19183 genotype was C/C 55.8%, C/T 38.2%, and T/T 5.9%. The combination of nucleotide (nt19117, nt19183) was (A/A, C/C) 6.7%, (A/G, C/C) 24.1%, (G/G, C/C) 25.1%, (A/G, C/T) 25.6%, (A/A, T/T) 5.9%, and (A/A, C/T) 12.6%. There were no subjects with (A/G, T/T), (G/G, T/T) or (G/G, T/C) genotypic combinations. (7) Transforming growth factor-beta 1 genotype T/T 35.2%, T/C 44.6%, and C/C 20.2%. (8) The platelet-activating factor acetylhydrolase genotype was M/M 71.7%, M/m 27.2%, and m/m 1.2%. The mitochondria DNA 5178 genotype A was 42.1% and C was 57.9%. There were no significant gender or age differences in tested genotypic and allelic distribution except for the DLST and apolipoprotein E. Differences in the genotypic frequencies of distribution using the Hardy-Weinberg equilibrium were significant in the ACE and alpha 1-adrenoreceptor genotypes.

The purpose of this article was to expand past research by examining relationships between age awareness and related factors in Japanese middle-aged and elderly people. The subjects were 1, 129 participants (575 men and 554 women, aged 40 to 79 years) of the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA). They were examined with a questionnaire and interview. As a result, chronological age, self-rated health, and visual and hearing ability tend to be the related factors for awareness of aging. Comparing the demographic and physiological factors, however, major life events, difficulties and daily life experiences showed a stronger influence on age awareness. These results provide an interesting basis for the future understanding of adult development and the meaning of aging. J Epidemiol, 2000 ; 10 : S56-S62.

Audiometric test results from 933 community dwelling males and females were presented to obtain the norm for each generation after middle age. Three aspects were adopted in this analysis ; the cross-sectional aging transition of pure tone thresholds, the comparison in the self- perceived hearing difficulty among generations and the evaluation of middle ear function using multifrequency tympanometry. Subjects were divided into four age groups ; 40s, 50s, 60s and 70s. There were statistically significant differences in pure tone thresholds between almost any two age groups at each frequency in both genders, especially at higher frequencies. The pure tone thresholds were also discussed in regard to gender difference and laterality. A contradiction between self-perceived hearing difficulty and auditory accuracy was observed in the elderly generation. Analysis of tympanometric measurements was performed on static admittance at 226 Hz, tympanometric peak pressure at 226 Hz and resonance frequency of the middle ear. These variables did not show any systematic aging change. However, it was considered they represented the reference values of each generation. J Epidemiol, 2000 ; 10 : S26-S32.

Frequencies and circumstances of falls were assessed among 1030 middle-aged and elderly people who participated in the NILS-LSA (National Institute for Longevity Sciences, Longitudinal Study of Aging) from November, 1997 to March, 1999 and responded to the questionnaires. The variables analyzed in the present study were demography and history of falls in the past one year. Circumstances of falls, e.g. time, location, activities associated with falls, cause of falls and degree of injury due to falls were asked when the subjects experienced a fall. Fear of falling was also investigated in all subjects. The prevalence of falls was 12.9% in the middle-aged group (40-59 yr.) and 16.5% in the elderly group (60-79 yr.). The distribution of time, location, activity associated with falls, cause and injury due to falls corresponded with previous fall studies among community-dwelling elderly people. The incidence of falls was extremely high during the daytime and outdoors. Falls occurred most frequently while walking. The majority of falls were due to extrinsic factors. About 40% of all falls caused no injury. As to the fear of falling, about 30% of the middle-aged subjects and about 60% of the elderly subjects reported that they were fearful. Our results suggested that fall accidents are not rare, even in middle-aged people.

Food and nutrient intake of NILS-LSA participants 40 to 79 years of age were assessed through 3-day weighed dietary records by gender and age. The results were as follows. The intake of fats and oils, meats and beverages tended to decrease, but fruits increased with age in both males and females. Regarding nutrient intake, energy, protein, fat, and cholesterol showed a decrease as individuals aged. The nutrient intake in the 70 to 79 yr group was significantly lower than other age groups of both genders. The total dietary fiber and vitamin C intake increased. Salt intake exceeded 10 g/day in every group. The percentage of energy from fat to total energy was higher than 25% in most age groups. The proportion of fatty acids was almost appropriate in all groups.

An external protector (EHP) which was developed in Europe to protect the femoral neck from direct impact on falling is available but has not been examined sufficiently in Japan. In order to explore the compliance of use of the EHP among the institutionalized elderly with in case of hip fracture who are at high risk of falling, we conducted the four-week intervention study using two types of a EHP. The subjects of a study consisted of 10 elderly people (2 men, 8 women) with a mean age 85.7 living in nursing home in a village. Informed consent was obtained from all participants. At the end of the study, rate of subjects who wore EHP was relatively high for the Finnish EHP (Safety Pants) group compared to the Danish EHP (Hip Protector) group. There were no significant differences between variables in age, sex, fall experience during the previous year, history of diseases etc. The reasons for dropout were first: difficult in wearing EHP and accompanying delay in toilet, secondly: taking much time to wear, thirdly: a sense of incongruity, too small or too tight'. If the EHP is redesigned to suit Japanese elderly, the compliance might increase. Thorough explanation to institutionalized elderly who may have cognitive impairment, physical problems, or both, is required.

軽費・養護老人ホーム入所者369名, 内科外来患者346名, 老人健診受診者181名, 老人大学受講者370名, 老人センター利用者98名計1,364名 (全員60歳以上) を対象に, Zung の自己評価式抑うつ尺度 (SDS) による調査を実施した. 完全回答の得られた1,031名 (男性384名, 平均年齢73.7±7.7歳, 女性647名, 平均年齢73.3±7.3歳) に関して, 抑うつ症状の有症率 (SDS得点48点以上の人の割合) を求め, 性・年齢・対象群の種類による有症率の差について検討した.その結果, 完全回答者の抑うつ症状有症率は11.1%であった. 性別では, 女性の方が男性より有症率が高い傾向がみられたが, 有意な差ではなかった. 年齢別では, 70歳代, 80歳代が有意に高い有症率を示した. 有症率に最も大きな影響を与えたのは対象群の種類であり, 年齢をコントロールしたところ, 養護ホーム入所者が著明に高い有症率を, 老人大学受講者が著明に低い有症率を示した.老人ホームにおける健康対策は, 身体機能に関するものが主となる傾向が強いといわれるが, 精神的側面の対応の強化も重要であると考えられた.

優位側前内側部視床梗塞により急性発症の痴呆を呈した症例を報告した.症例は82歳女性.右利き.左前内側部視床の梗塞により記銘力障害, 自発性低下, 失見当識, 失計算が突発した.失見当識, 失計算は, その後やや改善したが, 記銘力障害, 自発性低下, 性格変化などは, 半年以上経過しても依然として認められた.82歳という高齢も関与し, 優位側前内側部視床の限局性病変により痴呆を呈した1例と考えられた.