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Background To clarify the association between psychosocial problems and frailty in the areas affected by the Great East Japan Earthquake, and to develop strategies for preventive long-term care in the community, we launched the Kesennuma Study in 2019. This report describes the study design and the participants' profiles at baseline. Methods The prospective study comprised 9,754 people (4,548 men, 5,206 women) randomly selected from community-dwelling independent adults aged 65 to 84 who were living in Kesennuma City, Miyagi. The baseline survey was conducted in October 2019. It included information on general health, socio-economic status, frailty, lifestyle, psychological factors (e.g. personality, depressive moods), and social factors (e.g. social isolation, social capital). A follow-up questionnaire survey is planned. Mortality, incident disability, and long-term care insurance certifications will also be collected. Results A total of 8,150 questionnaires were returned (83.6% response rate), and 7,845 were included in the analysis (80.4%, mean age [SD] 73.6 [5.5] years; 44.7% male). About 23.5% were considered frail. Regarding psychological and social functions, 42.7% had depressive moods, 29.1% were socially isolated, and only 37.0% participated in social activities at least once a month. However, 82.5% trusted their neighbours. Conclusions While local ties were strong, low social activity and poor mental health were revealed as issues in the affected area. Focusing on the association between psychological and social factors and frailty, we aim to delay the need for long-term care for as long as possible, through exercise, nutrition, social participation, and improvement of mental health.

Aim We aimed to examine the impact of high-risk levels of cardiovascular risk factors on the incidence of cardiovascular disease (CVD) in overweight and non-overweight individuals without treatment for the risk factors. Methods A total of 8,051 individuals aged 40-74 years without a history of CVD and/or without treatment for hypertension, diabetes, hyperlipidemia, and kidney disease at baseline in 1995-2000 were followed up for a median of 14.1 years. We classified the participants into three risk categories (low-, intermediate-, and high-risk groups) on the basis of individual risk factors (blood pressure, serum glucose, low-density lipoprotein cholesterol [LDL-C], and urinary protein) according to the guidelines of Japanese clinical societies. The high-risk group (systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 100 mmHg, fasting serum glucose ≥ 130 mg/dL or non-fasting serum glucose ≥ 180 mg/dL, LDL-C ≥ 180 mg/dL, proteinuria ≥ 2+) needed to refer to physicians or start treatment immediately. Overweight was defined as a body mass index of ≥ 25 kg/m2. Results Compared with those in the non-overweight low-risk group, the hazard ratios (HRs) (95% confidence intervals, population-attributable fractions [PAFs]) of CVD in the high-risk categories of blood pressure were 2.0 (1.4-2.9, 7.0%) in the non-overweight high-risk group and 2.9 (1.9-4.3, 6.8%) in the overweight high-risk group. The corresponding HRs (95% confidence intervals, PAFs) of serum glucose were 2.0 (1.2-3.4, 2.5%) and 2.2 (1.1-4.3, 1.5%) in the non-overweight and overweight high-risk groups, respectively. Such associations were not observed for the high-risk group of LDL-C and proteinuria. Conclusions The present long-term observational study implies that targeting persons with non-treated severe hypertension and diabetes is prioritized to prevent CVD regardless of overweight status.

Objectives To examine the longitudinal association between participation in social activities and healthy lifestyle behaviours. Study design This 2-year follow-up study used data from 6168 older adults (73.5 ± 5.3 years; 49% men). We studied participation in five types of social activities at baseline: participation in volunteer, sports, hobbies, senior clubs, and neighbourhood-association groups. Main outcome measures The healthy lifestyle behaviours were physical activity (time spent walking: ≥150 min/week; or less), eating habits (dietary variety score: ≥4 points; or less), and intellectual activity (subcomponents of the Tokyo Metropolitan Institute of Gerontology Index of Competence: 4 points; or less). Results In the follow-up survey, 19% of participants were physically inactive, 53% had unfavourable eating habits, and 34% had diminished intellectual activity. Multilevel modified Poisson regression analysis showed that participation in sports groups was associated with a lower relative risk (RR) of physical inactivity (RR=0.82 [0.72, 0.93]) and unfavourable eating habits (RR=0.95 [0.90, 1.00]). Participation in hobby groups reduced the RR of unfavourable eating habits (RR=0.93 [0.90, 0.97]) and diminished intellectual activity (RR=0.90 [0.85, 0.96]). Participation in volunteering was associated with a lower RR of diminished intellectual activity (RR=0.84 [0.75, 0.95]). Relative to non-participation, participating in two or more social activities was associated with a 9% (95% CI: 0.83, 1.00) lower RR for physical inactivity, a 12% (95% CI: 0.82, 0.95) lower RR for unfavourable eating habits, and a 17% (95% CI: 0.77, 0.89) lower RR for diminished intellectual activity. Conclusions Both the nature and the number of social activities determine the longitudinal effects of social participation on healthy lifestyle behaviours.

Aim Seaweed contains soluble dietary fibers, potassium, and flavonoids and was recently reported to be inversely associated with the risk of coronary heart disease and mortality from stroke. However, epidemiological evidence on this issue has remained scarce. Methods At the baseline survey of four Japanese communities between 1984 and 2000, we enrolled 6,169 men and women aged 40-79 years who had no history of cardiovascular disease. We assessed their seaweed intake using the data from a 24 h dietary recall survey and categorized the intake into four groups (0, 1-5.5, 5.5-15, and ≥ 15 g/day). We used sex-specific Cox proportional hazards models to examine the association between seaweed intake and risk of cardiovascular disease (stroke, stroke subtypes, and coronary heart disease). Results During the 130,248 person-year follow-up, 523 cases of cardiovascular disease occurred: 369 cases of stroke and 154 cases of coronary heart disease. Seaweed intake levels were inversely associated with the risk of total stroke and cerebral infarction among men but not among women. Adjustment for cardiovascular risk factors did not change the associations: the hazard ratios (95% confidence intervals; P for trend) for the highest versus lowest categories of seaweed intake were 0.63 (0.42-0.94; 0.01) for total stroke and 0.59 (0.36-0.97; 0.03) for cerebral infarction. No associations were observed between seaweed intake and risks of intraparenchymal hemorrhage, subarachnoid hemorrhage, or coronary heart disease among men or women. Conclusions We found an inverse association between seaweed intake and risk of total stroke, especially that from cerebral infarction, among Japanese men.

Background: The association between overweight and chronic musculoskeletal pain may vary by anatomical site and be modified by hypertension status. This study examined the associations between overweight and low back and knee pains and their effect modification by hypertension status. Methods: We conducted a community-based cross-sectional study involving 2,845 adults (1,080 men and 1,765 women) aged 40–89 years. Chronic knee pain (CKP) and low back pain (CLBP) lasting more than 3 months were categorized into more or less severe pain. Odds ratios (ORs) and 95% confidence intervals (CIs) of the association between overweight and more or less severe CKP and CLBP were determined using logistic regression and stratified by hypertension status. Adjustment variables were age, sex, area, hypertension, smoking and drinking status, inactivity, job category, mental stress, depression, and overall CKP or CLBP. Results: Overall, 288 (10.1%) and 631 (22.2%) adults had more and less severe CKP, respectively, and 284 (10.0%) and 830 (29.2%) had more and less severe CLBP, respectively. Overweight was associated with overall CKP and more or less severe CKP, regardless of hypertension status. Overweight was not associated with overall CLBP; its association was more pronounced for more severe CLBP. The association between overweight and more severe CLBP was evident among non-hypertensives (multivariable OR 1.72; 95% CI, 1.09–2.71); however, that between overweight and less severe CLBP was not evident (multivariable OR 1.07; 95% CI, 0.73–1.56). Conclusions: As hypertension may attenuate the association between overweight and CLBP, we should consider hypertension status for proper management of CLBP among overweight individuals.

The present study investigated associations between occupation, job stress, and salivary cortisol levels after psychological tasks. We examined 766 (273 men and 493 women) healthy employed Japanese participants aged 21 to 68 years (mean age = 46.4 years, standard deviation = 8.5) with three types of occupation: manager, teacher, and general worker. The Brief Job Stress Questionnaire was used to evaluate participants’ job stress levels, including job demand, job control, support from supervisors, and support from coworkers. Salivary cortisol levels were measured at pre-session, post-stressful tasks, and post-relaxation. All samples were assayed using an enzyme-linked immunosorbent assay test. Natural log transformation was applied before statistical analyses. A multiple regression analysis and a repeated measures analysis of covariance were conducted to test associations between occupation and salivary cortisol levels, adjusting for confounding factors. Statistical analyses were conducted separately for men and women. Among both men and women, general workers had higher cortisol levels than managers throughout the experimental session (men 0.6 μg/dL and 0.4 μg/dL, respectively; women 0.5 μg/dL and 0.4 μg/dL, respectively). Job control was positively associated with cortisol levels measured in all sessions, after adjusting for confounding factors (standardized beta 0.15, 0.21, and 0.18 for pre-session, post-stressful-tasks, and post-relaxation, respectively, all p

Aims Although aging is strongly associated with both heart failure and a decline in gait speed, a definition of slowness incorporating an age‐related decline has yet to be developed. We aimed to define an event‐driven cut‐off for the relative decline in gait speed against age‐adjusted reference values derived from the general population and evaluate its prognostic implications. Methods and results Standardized gait speed (SGS) was defined as the median gait speed stratified by age, sex, and height in 3777 elderly (age ≥ 65 years) individuals without a history of cardiovascular diseases (Tokyo Metropolitan Institute of Gerontology‐Longitudinal Interdisciplinary Study on Aging: general population cohort). The mortality event‐driven optimal cut‐off of the SGS ratio (actual gait speed divided by the respective SGS) was defined using FRAGILE‐HF cohort data and externally validated using Kitasato cohort data, comprising 1301 and 1247 hospitalized elderly patients with heart failure, respectively. Using FRAGILE‐HF data, the optimal SGS ratio cut‐off was determined as 0.527. In the Kitasato cohort, SGS ratio

Aims Patients with chronic kidney disease (CKD) have a higher burden of cardiovascular morbidity and mortality than the general population. Endothelial dysfunction has been suggested to play a role in both glomerular filtration rate loss and cardiovascular damage. Thus, the present study aimed to evaluate the relationship between endothelial dysfunction and the prevalence of CKD in the general Japanese population. Methods We conducted a cross-sectional study of 1042 men and women aged 30-81 years in two communities under the Circulatory Risk in Communities Study between 2013 and 2017. Endothelial function was evaluated by percent change of brachial artery flow-mediated dilation (%FMD) before and after the cuff inflation. Results Among the total 1042 participants, there were 62 cases of CKD (~6%). The multivariable odds ratios (ORs) (95% confidence intervals [CIs]) of CKD according to quartiles of %FMD were 2.02 (0.68-5.99), 3.56 (1.27-9.94), and 3.14 (1.10-8.93) for the third to lowest quartile compared with the highest %FMD quartile; p for trend=0.02. The respective multivariable ORs (95% CIs) of CKD in subjects without antihypertensive medication use (39 cases among 886 subjects) were 1.83 (0.46-7.33), 3.41 (0.92-12.61), and 4.60 (1.22-17.31); p for trend=0.01, and that for one-point decrement in %FMD was 1.16 (1.00-1.35); p for interaction with the status of antihypertensive medication use was 0.12. Conclusions Our cross-sectional study suggested the relationship between endothelial dysfunction and the higher prevalence of CKD in the general Japanese population.

Background: The frequency of laughter has been associated with cardiovascular disease and related biomarkers, but no previous studies have examined association between laughter and changes in blood pressure levels. We sought to identify temporal relationships between frequency of laughter in daily life and systolic and diastolic blood pressure changes in participants from 2010 through 2014. Methods: Participants were 554 men and 887 women aged 40–74 years who answered self-administered questionnaire quantifying frequency of laughter at baseline. We measured participant blood pressure levels twice using automated sphygmomanometers for each year from 2010 to 2014. The associations between laughter and changes in blood pressure over time were analyzed using linear mixed-effect models. Results: There was no significant difference in blood pressure according to frequency of laughter at baseline in either sex. Men with frequency of laughter 1 to 3 per month or almost never had significantly increased systolic and diastolic blood pressure levels over the 4-year period (time-dependent difference: 0.96 mm Hg (95% confidence interval [CI], −0.2 to 1.8; P = 0.05). Changes in blood pressure associated with infrequent laughter (ie, 1 to 3 per month or almost never) were evident in men without antihypertensive medication use over 4 years (0.94 mm Hg; 95% CI, −0.2 to 2.0; P = 0.09) and men who were current drinkers at baseline (1.29 mm Hg; 95% CI, −0.1 to 2.3; P = 0.04). No significant difference was found between frequency of laughter and systolic (0.23 mm Hg; 95% CI, −1.0 to 1.5; P = 0.72) and diastolic (−0.07 mm Hg; 95% CI, −0.8 to 0.7; P = 0.86) blood pressure changes in women. Conclusions: Infrequent laughter was associated with long-term blood pressure increment among middle-aged men.

Background There is limited evidence on sarcopenia in Asian populations. This study aimed to clarify the prevalence, associated factors, and the magnitude of association with mortality and incident disability for sarcopenia and combinations of its components among Japanese community‐dwelling older adults. Methods We conducted a 5.8 year prospective study of 1851 Japanese residents aged 65 years or older (50.5% women; mean age 72.0 ± 5.9) who participated in health check‐ups. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 algorithm. Appendicular lean mass index (ALMI) was measured using direct segmental multi‐frequency bioelectrical impedance analysis. A Cox proportional hazards regression model was used to identify associations of sarcopenia and the combinations of its components with all‐cause mortality and incident disability. Results The prevalence of sarcopenia was 11.5% (105/917) in men and 16.7% (156/934) in women. Significant sarcopenia‐related factors other than ageing were hypoalbuminaemia, cognitive impairment, low activity, and recent hospitalization (all P‐values

Aim N-terminal pro-B-type natriuretic peptide (NT-proBNP), frequently used as a biochemical marker for detecting and monitoring heart failure, is also a risk marker for development of coronary heart disease and total stroke. However, studies that explore subtypes of ischemic stroke with regard to NT-proBNP are scarce. Here, we examined NT-proBNP and its impact upon subtypes of ischemic stroke (lacunar stroke, large-artery occlusive stroke and embolic stroke) among Japanese. Methods We measured NT-proBNP and categorized 4,393 participants of the Circulatory Risk in Communities Study into four groups (＜55, 55-124, 125-399, and ≥ 400 pg/ml). We used a multivariable Cox proportional hazards model to examine association with risks of stroke and subtypes. Results During 4.7 years of follow-up, we identified 50 strokes, including 35 ischemic (15 lacunar, 6 largeartery occlusive, 10 embolic strokes) and 14 hemorrhagic strokes. NT-proBNP was associated with stroke risk: the multivariable hazard ratio of total strokes was 7.29 (2.82-18.9) for the highest and 2.78 (1.25-6.16) for the second highest NT-proBNP groups compared with the lowest group. The respective hazard ratios for the highest NT-proBNP group were 9.37 (3.14-28.0) for ischemic stroke and 6.81 (1.11-41.7) for lacunar stroke. Further adjustment for atrial fibrillation did not attenuate these associations. The associations were similarly observed for large-artery occlusive and embolic strokes. Conclusion We found that even moderate serum levels of NT-proBNP were associated with the risk of total and ischemic strokes among Japanese whose NT-proBNP levels were relatively low compared with Westerners.

Frailty is a dynamic condition that can worsen or improve. Although previous studies have identified demographic and intrinsic factors associated with transitions in frailty status, less evidence is available regarding associations with daily activities. This longitudinal study examined associations of behavioral factors with incident frailty, adverse events (e.g. residence in a nursing home, hospitalization, and death), and frailty improvement among older adults. The analysis included data from 3,769 independent older adults aged 65 years or more (mean age, 76.3 ± 7.2years; proportion of frail participants, 30.1%) from the Yabu cohort study (baseline, 2012; follow-up, 2017). The Kaigo-Yobo Checklist, a standardized questionnaire, was used to assess frailty status (non-frail or frail) and seven behavioral factors: farming, shopping, exercise, eating habit, intellectual activity, social participation, and smoking. At the 5-year follow-up survey, the proportions of participants transitioning from non-frail to frail, from non-frail to incident adverse events, from frail to non-frail, and from frail to incident adverse events were 16.8%, 13.9%, 15.2%, and 50.1%, respectively. In the analysis of non-frail participants, farming, exercise, intellectual activity, and social participation were associated with lower odds of becoming frail and experiencing adverse events. In the analysis for frail participants, farming, intellectual activity, and social participation were significantly associated with improvement in frailty status, and farming, shopping, and social participation were associated with lower odds of incident adverse events. These findings suggest that farming, healthy daily activities, and social participation help improve and prevent frailty/adverse events.

Background It is uncertain whether health counselling after community-based health checkups for high-risk individuals of lifestyle-related disease enhances their referral to physicians. Methods We performed a clustered randomized controlled trial of untreated high-risk individuals aged 40 to 74 years who were screened from the annual health checkup in 2014 and 2015 under the national health insurance in 43 municipalities around Japan, assigning 21 intervention and 22 usual care municipalities. The high-risk conditions were severe forms of hypertension, diabetes, dyslipidemia (for men), and proteinuria. For the intervention group, the theory-based health counselling was performed to enhance referrals to physicians, while each municipality performed its own standard counselling for the usual care group. Data on clinical visits and risk factors were collected systematically and anonymously from the databases of health insurance qualification, health insurance claims, and annual health checkups. Hypotheses are that the cumulative proportion of seeing physicians (clinical visits) is higher in the intervention than the usual care groups, and that those in the intervention group have lower cumulative incidence of composite outcomes associated with lifestyle-related diseases. Results The numbers of subjects for the analyses were 8,977 in the intervention group and 6,733 in the usual care group. Among them, 6,758 had hypertension, 2,147 had diabetes, 2,861 had dyslipidemia, and 1,221 had proteinuria in the intervention group, with corresponding numbers of 4,833, 1,517, 2,262, and 845, respectively, in the usual care group. There were no material differences in mean levels and proportions of major cardiovascular risk factors between the two groups. Conclusions We expect to provide scientific evidence on the effectiveness of health counselling.

Background Decreased masticatory performance leads to deterioration of overall health among older adults. However, maintaining and improving masticatory performance in ways other than maintenance of natural teeth and appropriate prosthodontic treatment remains unclear. If the factors related to the mixing and shearing abilities for masticatory performance are clarified, it may be possible to maintain and improve the masticatory performance of older adults. We aimed to clarify the association among mixing ability, shearing ability, and masticatory performance-related factors. Methods Of the 707 community-dwelling older adults in Kusatsu Town, Japan, 344 who had been treated for any dental defects were enrolled in this study. Masticatory performance was evaluated on the basis of mixing ability and shearing ability. The number of natural teeth and artificial teeth, occlusal force, tongue pressure, and oral diadochokinesis /ta/ were measured as masticatory performance-related factors. Their relationship with mixing ability, shearing ability, and masticatory performance-related factors was examined by means of Spearman rank correlation coefficient and path analysis. Results Among masticatory performance-related factors, the number of natural teeth, occlusal force, and tongue pressure were directly associated with both mixing ability and shearing ability. Moreover, mixing ability was also directly associated with shearing ability. Conclusions Tongue pressure, which can be improved by means of training, is a masticatory performance-related factor associated with both mixing and shearing abilities. Practical Implications Training for tongue pressure after proper prosthetic treatment may provide an effective means of maintaining and improving masticatory performance in older adults.

The role of serum uric acid as a predictor of stroke among the general Japanese population remains controversial. We conducted a prospective cohort study of 5235 men and 8185 women aged 40-79 years at baseline between 1985 and 1994 in four Japanese communities, who were initially free from stroke, coronary heart disease, and medication for hyperuricemia or gout. Cox proportional hazards models were used to estimate sex-specific hazard ratios of stroke and its types in relation to serum uric acid level. During a median follow-up of 23.1 years, we recorded 1018 (488 men and 530 women) incident strokes, including 222 (99 and 123) intraparenchymal hemorrhages, 113 (33 and 80) subarachnoid hemorrhages and 667 (347 and 320) ischemic strokes. After adjustment for age, community and known cardiovascular risk factors, the multivariable hazard ratios (95% CIs) in the highest vs. lowest quintile of serum uric acid were 1.45 (1.07-1.96) for total stroke, 1.20 (0.65-2.20) for intraparenchymal hemorrhage, 1.46 (0.69-3.09) for subarachnoid hemorrhage and 1.61 (1.07-2.41) for ischemic stroke in women. The corresponding multivariable hazard ratios (95% CIs) in men were 1.02 (0.74-1.35), 0.83 (0.40-1.72), 1.19 (0.38-3.75) and 1.00 (0.70-1.41). Furthermore, those positive associations with risks of total and ischemic strokes in women were more evident in nonusers of antihypertensive medication than the users. In conclusion, elevated serum uric acid level is an independent predictor of total stroke in women but not in men. The positive association in women was mostly attributable to ischemic stroke and was more pronounced among nonusers of antihypertensive medication.

This study aimed to investigate associations between Brief Job Stress Questionnaire (BJSQ)-measured job stress factors and sickness absence in Japanese workers. Among 551 healthy, employed Japanese men and women (age range: 21-73 years) who underwent mental health examinations at the Osaka Medical Center for Health Science and Promotion between 2006 and 2009, 197 (67 men, 130 women) consented to participate in this study. Their sickness absences until the end of March 2010 were then followed-up via postal mail survey, with 112 participants effectively responding to the question on sickness absence (56.9%). The hazard ratio (HR) and 95% confidence interval (CI) were calculated using the Cox proportional hazards model, adjusting for age, sex, and lifestyle factors. Among the 112 respondents, 12 took sickness absence after their study entry, as found during the mean 2.3 years of follow-up (258.8 person-years). Among all sickness absences, those of eight participants were because of mental illness. Physical demands were positively associated with increased risks of all sickness absence (adjusted HR: 2.78, 95% CI: 1.01-7.64). Physical demands were predictive for all sickness absence, and should be alleviated at workplaces to prevent such absence.

Objective: To examine whether age-specific prevalence of frailty in Japan changed between 2012 and 2017. Design: This study performed meta-analyses of data collected from 2012 to 2017 using the Integrated Longitudinal Studies on Aging in Japan (ILSA-J), a collection of representative Japanese cohort studies. Setting: The ILSA-J studies were conducted on community-living older adults. Participants: ILSA-J studies were considered eligible for analysis if they assessed physical frailty status and presence of frailty in the sample. Seven studies were analyzed for 2012 (±1 year; n = 10312) and eight studies were analyzed for 2017 (±1 year; n = 7010). Five studies were analyzed for both 2012 and 2017. Measurements: The study assessed the prevalence of frailty and frailty status according to 5 criteria: slowness, weakness, low activity, exhaustion, and weight loss.Results: The overall prevalence of physical frailty was 7.0% in 2012 and 5.3% in 2017. The prevalence of frailty, especially in people 70 years and older, tended to decrease in 2017 compared to 2012. Slight decreases were found in the prevalence of frailty subitems including weight loss, slowness, exhaustion, and low activity between 2012 and 2017, but change in the prevalence of weakness was weaker than other components. Conclusions: The prevalence of physical frailty decreased from 2012 to 2017. There are age- and gender-related variations in the decrease of each component of frailty.

Aim Cognitive decline increases mortality risk through dementia-related pathways and might be associated with increased healthcare costs. Using up to 12 years of repeated measures data, we identified trajectories in cognitive function among community-dwelling older Japanese adults. We then examined whether these trajectories were associated with all-cause and cause-specific mortality, and differences in healthcare costs. Methods A total of 1736 adults aged ≥65 years who were free of disabling dementia completed annual assessments during 2002-2014. Cognitive function was assessed with the Mini-Mental State Examination. The average number of follow-up assessments was 3.9, and the total number of observations was 6824 during the follow-up period. Results We identified five trajectory patterns in cognitive function (high, second, third, fourth, and low) during the 12-year follow-up period. The low (2.0%) and fourth (2.2%) trajectory groups had higher hazard ratios for cardiovascular disease mortality, and hazard ratios for other cause mortality were significantly higher for the third (16.8%) and second (38.8%) trajectory groups than for the high trajectory group (40.3%). Until 5 years of follow up, participants in the two lower-trajectory groups had higher mean combined monthly medical and long-term care costs. After 8 years of follow up, mean costs were highest for the third trajectory. Conclusions The risk of death from cardiovascular disease was higher in the two lower-trajectory groups in cognitive function, and they showed higher healthcare costs during the first 5 years of follow up. After 8 years of follow up, the third trajectory had the highest healthcare costs, perhaps because of hospitalizations attributable to gradual cognitive decline. Geriatr Gerontol Int 2019; 19: 1236-1242.

Background Lifetime risk is an informative estimate for driving lifestyle and behavioral changes especially for young adults. The impact of composite risk factors for cardiovascular disease on lifetime risk stratified by sex has not been investigated in the Japanese population, which has a much lower mortality of coronary heart disease compared with the Western population. We aimed to estimate lifetime risk of death from cardiovascular disease attributable to traditional risk factors. Methods and Results We analyzed pooled individual data from the Evidence for Cardiovascular Prevention from Observational Cohorts in a Japanese cohort study. A modified Kaplan–Meier approach was used to estimate the remaining lifetime risk of cardiovascular death. In total, 41 002 Japanese men and women with 537 126 person‐years of follow‐up were included. The lifetime risk at the index‐age of 45 years for those with optimal risk factors (total cholesterol Conclusions The magnitude and the number of risk factors were progressively associated with increased lifetime risk even in individuals in early adulthood who tend to have low short‐term risk. The degree of established cardiovascular risk factors can be converted into lifetime risk. Our findings may be useful for risk communication in the early detection of future cardiovascular disease risk.

Background We examined whether dietary variety (DV) might alleviate poor mental health (MH) of living-alone (LA) older adults. Methods Cross-sensational data from 15073 (7566 men; 7507 women) residents aged 65-84 years were assessed using the WHO-Five Well-being Index to determine poor MH (defined by a score ≤ 12) and DV (low and high DV defined by a score ≤ 3 and ≥ 4, respectively). Participants were divided into living together with high DV (G1), living together with low DV (G2), LA with high DV (G3), and LA with low DV (G4). Logistic regression analyses stratified by gender were performed to examine the association of poor MH with LA and DV. Results Prevalence of LA, low DV, and poor MH were 13.6%, 63.3%, and 26.1%, respectively, in men, and 21.2%, 54.6%, and 24.8%, respectively, in women. Compared with the G1, the multivariate-adjusted odds ratios (ORs) (95% confidence intervals) for worse MH were 1.69 (1.49-1.93) for G2, 2.04 (1.50-2.78) for G3, and 3.34 (2.70-4.11) for G4 in men. Corresponding ORs were 1.73 (1.52-1.96), 1.02 (0.83-1.26), and 1.66 (1.36-2.01) in women. Conclusions The association of poor MH with LA was more apparent in older adults with low DV than in those with high DV; however, this association differed with gender. Key message Eating a variety of food may help alleviate the negative effects of living alone on mental health in older adults.

Background Folate regulates homocysteine metabolism and high blood homocysteine level has been associated with risk of dementia. Accordingly, serum folate is hypothesized to decrease the risk of dementia but epidemiological evidence, especially for Japanese, is scant. The aim of this study was to examine associations between serum folate and risk of disabling dementia within a Japanese cohort over 20 years of follow-up. Methods We performed an intracohort case-control study nested in a community-based cohort, the Circulatory Risk in Communities Study (CIRCS), involving 13934 Japanese individuals aged 40-84 years at the baseline period of 1984-2005. Serum folate was measured in 511 cases of incident disabling dementia, and in 1022 controls whose age (±1 years), sex, area, and baseline year were matched with the cases. The diagnosis of disabling dementia was performed by attending physicians under the National Long-Term Care Insurance System in Japan. Conditional odds ratios of disabling dementia according to quintiles of serum folate were calculated using conditional logistic regression models. Results Serum folate was inversely associated with risk of disabling dementia. The multivariate odds ratios (95% confidence intervals) were 0.62(0.43-0.88), 0.71(0.49-1.00), 0.63(0.43-0.91), and 0.51(0.34-0.76) for persons with the second, third, fourth, and highest quintiles of serum folate, respectively, compared with the lowest quintiles (P for trend = 0.19). Conclusions Low serum folate level was associated with increased risk of disabling dementia among Japanese. Key messages e Low folate intake may have an adverse effect on developing dementia.

Background Although consuming a variety of foods is an internationally accepted recommendation for a healthy diet, little is known about the association between dietary variety and incident dementia. This study aimed to examine the association between dietary variety and incident disabling dementia in community-dwelling elderly Japanese adults. Methods We conducted a prospective study of 721 participants (age range: 65–97 years) of the 2012–2013 Kusatsu Longitudinal Study. Dietary variety was assessed based on a food frequency questionnaire that encompassed the 10 main food components of Japanese meals: meat, fish/shellfish, eggs, milk, soybean products, green/yellow vegetables, potatoes, fruit, seaweed, and fats/oils). Participants were then categorized into low (0–2 points), middle (3–5 points), and high (6–10 points) groups based on the scores. Data regarding incident disabling dementia were retrieved from the public Long-term Care Insurance database. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs). Results During the median follow-up of 6.5 years, the incidence of disabling dementia was 9.3%. After adjusting for confounders, the multivariate HR for incident disabling dementia was 0.52 (95% CI, 0.27–1.00) for participants in the highest category of the dietary variety score compared to that for those in the lowest category. Conclusions Greater dietary variety is associated with a reduced risk of incident disabling dementia in elderly Japanese adults. Key messages Consuming a variety of foods may be necessary for dementia prevention.

Background: Although an elevated systolic blood pressure (SBP) is associated with cognitive dysfunction, BP may decrease with advanced cognitive dysfunction; therefore, we attempted to identify the turning point in the relationship between cognitive function and SBP in elderly subjects. Methods: In pooled datasets of general populations and outpatient clinics (age>65 years), in which the risk of frailty or cognitive dysfunction was assessed (N = 4076), the relationship between SBP and the Mini Mental State Examination (MMSE) score was examined. Results: Mean age was 72.5 ± 6.2 years (male 45.1%), and SBP was 133.0 ± 19.5 mmHg. In an analysis of locally weighted scatter plot smoothing, the relationship between SBP and MMSE scores changed at an MMSE score of 24 points. In subjects with preserved cognitive function (MMSE ≥24 points), MMSE scores decreased with increases in SBP (B = −0.047 per 10 mmHg increase, P = 0.002) after adjustments for age, sex, body mass index, alcohol habit, smoking status, diabetes, a history of stroke, and the geriatric nutritional index; however, in subjects with reduced cognitive function (MMSE

Introduction: Chronic low back pain (CLBP), defined as low back pain persisting for at least 3 months, leads to limitations in the activities of daily living and decreased quality of life. Individualized self-exercise education could be a preferable treatment option, especially in community-dwelling people with CLBP. Previous studies, however, did not directly compare the effects of therapist-led self-exercise education and material-only education, and there are only a few studies investigating the effects of low-dose (comprising a few sessions) self-exercise education on CLBP. We present a protocol of community-based, randomized study to evaluate the effects of low-dose (comprising a few sessions), therapist-led self-exercise education on CLBP. Methods: Forty-eight participants with CLBP (men and women, aged 40-74 years) will be allocated to therapeutic self-exercise education programs, either a therapist-led group (2-week therapist's consultation and material use) or material-only group (material use only), in a randomized controlled trial. Pain intensity (NRS, numeric rating scale), pain disability (RDQ, Roland-Morris disability questionnaire), pain self-efficacy (PSEQ, pain self-efficacy questionnaire), and quality of life score (EQ-5D, European quality of life-5 dimensions) will be measured at baseline and at 4, 12, and 24 weeks. We will apply a repeated-measures design with mixed-effect models to estimate group differences from the baseline. Ethics/Trial registration number: The protocol was approved by the Ethics Committees of the Osaka Center for Cancer and Cardiovascular Disease Prevention and Osaka University. The trial registration number is registered on the University Hospital Medical Information Network (UMIN000024537).

Background Although meals that combine a staple food, main dish, and side dish (balanced meals) are recommended in Japan, the health effects of such meals are unclear. We investigated the association of frequency of eating balanced meals with frailty among community-dwelling older Japanese. Methods We analyzed data from 912 persons aged 65 years or older who participated in the Hatoyama Cohort Study or Kusatsu Longitudinal Study. The frequency of eating two or more balanced meals daily was self-reported as ≤1 day/week, 2 or 3 days/week, 4 or 5 days/week, and daily. Frailty was defined as the presence of at least three, and pre-frailty as the presence of one or two, of the following criteria: weight loss, muscle weakness, exhaustion, slowness, and low physical activity. Adjusted logistic regression was used to study associations of frequency of balanced-meal consumption with frailty (prefrailty and frailty combined) and frailty criteria. Results Participants reporting a frequency of balanced-meal consumption of ≤2 or 3 days/week had a higher prevalence of frailty (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.21-2.64) than did those reporting a frequency of daily. Lower frequency of balanced-meal consumption was also associated with higher prevalences of weight loss (OR, 4.10; 95% CI, 1.90-8.85), exhaustion (OR, 6.35; 95% CI, 2.49-16.17), and low physical activity (OR, 1.92; 95% CI, 1.22-3.01). Conclusions Our findings suggest that more frequent twice daily consumption of meals with a staple food, main dish, and side dish decreases the risks of prefrailty and frailty.

Background Gait measures such as gait speed, stride length, step width, and stance duration change with advanced age and are associated with adverse health outcomes among older adults. The stride-to-stride variabilities of gait measures are also related to falls and cognitive decline in older adults; however, reference values of these gait parameters in older Japanese adults do not exist. This study aimed to determine the reference values of gait parameters as measured by a plantar pressure platform in community-dwelling older Japanese adults. Methods Community-dwelling adults (N=1,212) who were independent in basic activities of daily living and aged 70-96 years (491 men, 721 women) completed the gait performance measurement in a geriatric health assessment. We assessed 10 gait performance measures with a plantar pressure platform system (P-WALK, BTS Bioengineering) and calculated means and coefficient of variations (CVs) of the gait measures as well as quintiles for those gait parameters per age group among men and women. Results Mean (SDs) of gait speed, stride length, step width, and stance durations were 1.26 (0.24) meters per second (m/s), 121.9 (19.8) cm, 24.0 (3.2) cm, and 552.4 (60.4) milliseconds (ms), respectively, in men, and 1.27 (0.21) m/s, 115.7 (16.3) cm, 17.9 (2.8) cm, and 517.6 (59.8) ms, respectively, in women. Mean of CVs (SD) of stride length, step width, and single-stance duration were 2.76 (1.35), 12.06 (3.98), and 5.74 (2.66), respectively, in men and 2.69 (1.24), 15.65 (4.53), and 5.77 (2.40), respectively, in women. Gait parameters (except CVs of step width) declined significantly with age regardless of gender (P< 0.01 for trends). Conclusion This study determined age group dependent gait parameter reference values, presented as means with quintile ranges, in community-dwelling older Japanese adults. These reference values may be useful metrics for gait assessment in the elderly.

Supplemental digital content is available in the text., Purpose Although exercising with others might have health benefits, no previous study has comprehensively examined associations of exercise arrangement with physical activity (PA), physical function (PF), and mental health (MH). We examined whether PA, PF, and MH are better when exercising with others than when exercising alone or not exercising. Methods We analyzed cross-sectional data from 7759 (4007 men and 3752 women) nondisabled residents age 65 to 84 yr. PA, PF, and MH were assessed with the International Physical Activity Questionnaire-Short Form (PA sufficiency defined as ≥150 min·wk−1 of moderate-to-vigorous PA), Motor Fitness Scale (higher PF defined as total score ≥12 in men and ≥10 in women), and World Health Organization-Five Well-Being Index (better MH defined as a total score ≥13), respectively. Exercise arrangement was classified as “nonexerciser,” “exercising alone,” and “exercising with others.” Using multilevel logistic regression analyses, we examined independent associations of exercise arrangement with PA, PF, and MH. Results Compared with exercising alone, the multivariate-adjusted odds ratios (95% confidence interval) among nonexercisers and those exercising with others were 0.21 (0.17–0.25) and 1.32 (1.04–1.67), respectively, for PA sufficiency, 0.47 (0.40–0.57) and 1.12 (0.94–1.34) for higher PF, and 0.69 (0.58–0.82) and 1.45 (1.17–1.79) for better MH, respectively, in men. In women, the corresponding odds ratios were 0.37 (0.30–0.46) and 1.31 (1.01–1.70) for PA sufficiency, 0.66 (0.54–0.80) and 1.08 (0.88–1.32) for higher PF, and 0.70 (0.58–0.85) and 1.27 (1.03–1.56) for better MH, respectively. Conclusions Exercising alone and with others were better than no exercise for maintaining better PA, PF, and MH in both sexes. Although exercise arrangement had little effect on maintaining PF, exercising with others appears to enhance PA levels and MH in both sexes.

Aim Evidence is limited on how frailty affects the association between diabetes and adverse outcomes at the population level. The present community-based study aimed to clarify the relative risks of death and disability in older Japanese adults with diabetes, frailty, both or neither. Methods The present prospective study analyzed data from 1271 Japanese residents aged ≥65 years in Kusatsu town in Gunma Prefecture, Japan, who participated in annual health checkups carried out between 2002 and 2011, and were initially free of disability. A Cox proportional hazards regression model was used to identify associations of diabetes and frailty with all-cause mortality and incident disability. Results Among the 1271 participants, 176 (14%) had diabetes (mean hemoglobin A1c 7.5%, body mass index 24.2 kg/m2 , 45% using diabetes medications) and 151 (12%) had frailty at baseline. Compared with non-frail participants without diabetes, those with diabetes and frailty had higher risks of mortality (multivariable hazard ratio 5.0, 95% CI 2.4-10.3) and incident disability (hazard ratio 3.9, 95% CI 2.1-7.3). In contrast, non-frail participants with diabetes did not have a significantly increased risk of mortality, although they had a higher tendency for the incidence of disability, as compared with non-frail participants without diabetes. Conclusions At the population level, the risks of death and disability in persons with mild diabetes were strongly affected by the presence of frailty. From a community-based perspective, diabetes-related mortality and disability incidence might be reduced by preventing or improving frailty in conjunction with glycemic control. Geriatr Gerontol Int 2019; 19: 423-428.

Background Preventing and reducing frailty is an important challenge for Japan in the next decade, especially in metropolitan areas. We launched a community-wide intervention trial (the Ota Genki Senior Project) in 2016 to develop effective community-based strategies for frailty prevention in metropolitan areas. This report describes the study design and baseline survey. Methods This study is a community-wide intervention trial that integrates participatory action research into a cluster non-randomized controlled trial for adults aged 65 years or older living in Ota City, Tokyo. We allocated 3 of 18 districts to an intervention group and the other 15 to a control group. Using a mailed self-administered questionnaire, we conducted a baseline survey of 15,500 residents (8,000 and 7,500 in the intervention and control groups, respectively) from July through August 2016. In addition to socioeconomic status and lifestyle variables, we assessed frailty status (primary outcome) and physical, nutritional, and psychosocial variables (secondary outcomes). Based on the baseline findings, an intervention to improve outcomes will be implemented as participatory action research. Follow-up surveys will be conducted in the same manner as the baseline survey. Results A total of 11,925 questionnaires were returned (76.9% response rate; 6,105 [76.3%] and 5,820 [77.6%] in the intervention and control groups, respectively), and 11,701 were included in the analysis (mean age, 74.3 [standard deviation, 5.5] years; 48.5% were men). Conclusions This study is expected to contribute to development of a prototype of a community-wide frailty prevention strategy, especially in metropolitan areas in Japan. Trial registration UMIN Clinical Trials Registry (UMIN000026515).

Aims: The frequency of breakfast intake has been reported to be inversely associated with the risk of cardiovascular events; however, it is uncertain what the impact of the energy and nutrient intakes from breakfast are. We assessed the association between these intakes from breakfast and the risk of stroke prospectively. Methods: In a baseline survey of four Japanese communities between 1981 and 1990, we enrolled 3 248 residents (1 662 men and 1 586 women) aged 40–59 years who were free from stroke and heart disease and who responded to the 24-hour dietary recall survey. We assessed the dietary intake at breakfast, lunch, dinner, and other times separately. Results: During the median 25-year follow-up, 230 individuals (147 men and 83 women) developed stroke. After adjustment for age, community, other dietary intakes, and lifestyle and physiological factors, the multivariable-adjusted hazard ratios (95% confidence intervals) of intracerebral hemorrhage for the highest versus lowest quartiles of energy intake from breakfast were 0.38 (0.15–0.99) in men and 1.36 (0.36–5.10) in women. For the major nutrients, a higher saturated or monounsaturated fat intake at breakfast was associated with a reduced risk of intracerebral hemorrhage in men, and remained statistically significant after further adjustment for intake of other major nutrients from breakfast. Conclusions: A higher intake of energy from breakfast, primarily saturated or monounsaturated fat, was associated with a reduced risk of intracerebral hemorrhage in Japanese men.

Background: Serum albumin and hemoglobin levels are independently associated with subsequent cognitive deterioration in older adults. This prospective study used repeated measures analysis to identify aging trajectories in serum albumin and hemoglobin levels and investigated if these trajectories were associated with incident disabling dementia among community-dwelling older Japanese. Methods: A total of 2,005 adults aged 65–90 years participated in annual geriatric health assessments during the period from June 2002 through July 2017; the total number of observations was 9,330. A review of a municipal database of the Japanese public long-term care insurance system identified 1,999 of 2,005 adults without dementia at baseline, 278 (13.9%) of whom developed disabling dementia during the follow-up period (June 2002 through December 2017). Results: We identified three trajectory patterns (high, moderate, and low) for serum albumin and hemoglobin levels for the age period 65 through 90 years. After controlling for potential confounders, participants with moderate and low trajectories for serum albumin level had hazard ratios of 1.27 (95% confidence interval 0.94–1.72) and 2.07 (1.37–3.11), respectively, for the development of incident disabling dementia, with the high trajectory group as reference. The respective hazard ratios for hemoglobin level were 1.31 (0.93–1.85) and 1.58 (1.04–2.40), respectively. Conclusion: Dementia risk was higher for individuals with low trajectories for serum albumin and hemoglobin levels. This finding highlights the importance of interventions that improve nutritional status and control relevant diseases in middle-aged and older adults with low serum albumin and hemoglobin levels.

Background Few prospective studies have explored the association between fatty acids (FA) and risk of CAD. Understanding of the role of each individual serum FA as a coronary risk or protective factor is still limited. The aim was to investigate which serum FA are associated with the incidence of CAD in Japanese subjects. Methods and Results: A prospective nested case-control study of 40-85-year-old Japanese subjects was undertaken using frozen serum samples collected from 12,840 participants who participated in cardiovascular risk surveys from 1984 to 1998 for 1 community and 1989-1997 for 2 other communities. Three control subjects per case were matched by sex, age, community, year of serum storage and fasting status. By 2005 we had identified 152 incident cases of CAD. Mean n-3-polyunsaturated and saturated FA did not differ between cases and controls, while mean n-6-polyunsaturated FA was higher in controls compared with cases. The multivariable OR of CAD for the highest vs. lowest quartiles of miristic acid (14:0), palmitic acid (16:0), palmitoleic acid (16:1), and linoleic acid (18:2) were 2.8 (95% CI: 1.5-5.2), 2.7 (95% CI: 1.4-5.5), 3.2 (95% CI: 1.7-6.1) and 0.4 (95% CI: 0.2-0.7), respectively. Conclusions High serum miristic acid, palmitic acid and palmitoleic acid have an adverse effect, and high serum linoleic acid had a protective effect, on the risk of CAD.

Background Generalized loss of skeletal muscle mass (SMM) may modulate or otherwise affect the loss of masseter muscle mass and be responsible for low masseter muscle performance and strength (i.e., low oral function). Moreover, dentition status can affect oral function independent of the muscle state. This cross-sectional study aimed to simultaneously investigate the relationships among whole-body SMM, masseter muscle mass, oral function (masseter muscle performance and strength), and dentition status in 1349 Japanese adults (mean age = 73.6 years). Methods We determined the estimated masseter muscle mass (e-MMM) based on morphological measurements of the masseter muscle. Masseter muscle performance was assessed via masticatory performance evaluation scores using gum, and strength was assessed as the maximal occlusal force. Dentition status was assessed as the number of functional teeth. SMM was measured by bioelectrical impedance analysis. Structural equation modeling stratified by sex was employed to investigate associations among SMM, e-MMM, gum score, occlusal force, and number of functional teeth. Results The direct path from SMM to e-MMM was statistically significant, as was the direct path from e-MMM to oral function (gum score and maximum occlusal force) for both sexes. We additionally confirmed that SMM indirectly affected gum score and maximum occlusal force via e-MMM (men; standardized coefficient [95% CI] = 3.64 [1.31 to 5.96] for maximum occlusal force and 0.01 [0.01 to 0.02] for gum score, women; 2.01 [0.38 to 3.81] for maximum occlusal force and 0.01 [0.002 to 0.01] for gum score). The number of functional teeth had direct effects on e-MMM, gum score, and maximum occlusal force. Conclusions Low SMM was significantly indirectly associated with poor oral function through a low masseter muscle mass, and dentition status was independently associated with oral function.

Aim This study aimed to investigate the associations of leukocyte count with the risks of stroke and coronary heart disease among the general Japanese population. Methods A total of 5,242 residents aged 40-69 years living in two Japanese communities underwent leukocyte count measurements between 1991 and 2000, and the data were updated using 5- or 10-year follow-ups or both. Participants who had histories of stroke, coronary heart disease, or high values of leukocyte count (＞130×102 cells/mm3) were excluded. Hazard ratios with 95% confidence intervals (CIs) were calculated according to quartiles of cumulative average leukocyte count. Results During follow-up of 21 years, 327 stroke and 130 coronary heart disease cases were determined. After adjustments for age, sex, community, and updated cardiovascular risk factors, the multivariable hazard ratio (95% CI) for the highest versus lowest quartile of leukocyte count was 1.50 (1.08-2.08) for ischemic stroke, 1.59 (1.00-2.51) for lacunar infarction, 1.42 (0.90-2.26) for non-lacunar infarction, 2.17 (1.33-3.55) for coronary heart disease, and 1.40 (1.11-1.76) for total cardiovascular disease. In smoking status-stratified analyses, the corresponding multivariable hazard ratio (95% CI) was 2.45 (1.11-5.38) for ischemic stroke, 2.73 (1.37-5.44) for coronary heart disease in current smokers, 2.42 (1.07-5.46), 1.55 (0.58-4.15) in former smokers, and 1.17 (0.75-1.82), 1.78 (0.83-3.82) in never smokers. Conclusion Leukocyte count was positively associated with the risks of ischemic stroke and coronary heart disease among the general Japanese population, especially in current smokers.

Aim To categorize the age-related trajectories of dietary variety score (DVS) in the community-dwelling elderly and to examine the associated factors. Methods The study population included 1,195 people who underwent a medical checkup for the elderly in Kusatsu-town, Gunma Prefecture in 2012 to 2017. A multinomial logistic regression analysis was performed to examine the factors associated with the age-related trajectories of DVS. The dependent variables were sex, age, family structure, years of education, BMI, subjective chewing ability, TMIG-IC, GDS-15, MMSE, smoking, alcohol consumption, and history of hypertension, dyslipidemia, diabetes mellitus, and stroke. Results The adjusted odds ratio (95% confidence intervals) of the low trajectory group in comparison to the medium trajectory group were 2.69 (1.02-7.08) for subjective chewing ability (no chewing), 1.11 (1.06-1.17) for GDS-15, 1.76 (1.14-2.73) for current smoking, and 1.70 (1.19-2.43) for past smoking. In contrast, the adjusted odds ratio of the high trajectory group in comparison to the medium trajectory group were 0.61 (0.37-1.00) for men, 1.04 (1.01-1.07) for age, 0.58 (0.38-0.89) for subjective masticatory ability (difficult to chew), 0.88 (0.82-0.96) for GDS-15, and 0.55 (0.37-0.83) for a history of hypertension. Conclusions The age-related trajectory patterns of DVS in the community-dwelling elderly can be categorized into three types. In order to maintain a high quality of food intake, it was shown that, in addition to subjective masticatory ability and mental health factors, such as depression, we should pay attention to the control of hypertension, which is a risk factor for lifestyle diseases, and lifestyle habits such as smoking.

To examine the association between the severity of oral frailty (OF), which is one of the comprehensive oral functions evaluated, and dietary variety in community-dwelling older persons.Cross-sectional study.Community-based.A total of 769 community-dwelling older persons aged 65 and over.We examined basic demographic information, functional status, cognitive status, depressive symptoms, medical history, and oral functions of the participants.OF was defined by 1-2 and 3 or more of 6 items of oral function evaluation in the pre-oral frailty and oral frailty groups, respectively. Dietary variety was assessed using the dietary variety score (DVS). The participants were categorized into 3 groups for evaluation: those with a low score (0-2), medium score (3-5), and high score (≥6). Ordinal logistic regression analysis was performed to examine the association between OF and DVS.The rate of OF in the participants was 21.6%, and its severity was significantly associated with DVS after adjusting for potential confounders (Pre-OF; adjusted odds ratio [OR] = 1.687, 95% confidence interval [CI] = 1.219-2.335, OF; adjusted OR = 2.857, 95% CI = 1.489-5.484).The severity of OF was significantly associated with DVS in community-dwelling older persons. This suggests that DVS may be useful in understanding the effects of OF on the nutritional status. Further longitudinal studies are needed to elucidate the association between OF and DVS.

There is currently no tool to predict incident frailty despite various frailty assessment tools. This study aimed to develop risk prediction models for incident frailty and evaluated their performance on discrimination, calibration, and internal validity. This 2-year follow-up study used data from 5076 non-frail older adults (51% women) living in Tokyo at baseline. We used the Kaigo-Yobo checklist, a standardised assessment instrument, to determine frailty. Twenty questionnaire-based variables that include sociodemographic, medical, behavioural, and subjective factors were entered into binary logistic regression analysis with stepwise backward elimination (p 0.1 for retention in the model). Discrimination and calibration were assessed by area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow test, respectively. For the assessment of internal validity, we used a 5-fold cross-validation method and calculated the mean AUC. At the follow-up survey, 15.0% of men and 10.2% of women were frail. The frailty risk prediction model was composed of 10 variables for men and 11 for women. AUC of the model was 0.71 in men and 0.72 in women. The P-value for the Hosmer-Lemeshow test in both models was more than 0.05. For internal validity, the mean AUC was 0.71 in men and 0.72 in women. Probability of incident frailty rose with an increasing risk score that was calculated from the developed models. These results demonstrated that the developed models enable the identification of non-frail older adults at high risk of incident frailty, which could help to implement preventive approaches in community settings.

This cluster nonrandomized controlled trial examined the effectiveness of a 2-year community-wide intervention (CWI) on population-level frailty and functional health among older adults. We allocated 18 districts in Ota City, Tokyo, Japan, to intervention (3 districts, A–C) and control (15 districts) groups. Of the 15,500 stratified randomly sampled residents aged 65–84 years, 11,701 (6009 in intervention and 5692 in control groups) gave valid responses to the baseline survey and were followed for 2 years. Using participatory action research framework, we developed an evidence-based CWI to promote frailty prevention. The outcomes were changes in frailty (primary), functional health (secondary, i.e., physical, nutritional, and psychosocial variables), and awareness. Primary analyses showed no significant group by time interactions in frailty prevalence (difference in multivariate-adjusted change between groups, 1.8 percentage points [PP] [95% CI, −0.1, 3.6]). Although changes in functional health were similar between groups, prespecified subgroup analyses showed a benefit for ≥150 min/week of walking (3.9 PP [1.9–5.8]) in district A, and for exercise ≥1 time/week (2.1 PP [0.1–4.0]), Motor Fitness Scale (0.10 points [0.01–0.20]), Dietary Variety Score (DVS) (0.10 points [0.01–0.18]), DVS of ≥7 (2.0 PP [0.01–4.1]), and going outdoors ≥1 time/day (2.1 PP [0.1–4.1]) in district C. Awareness of our CWI was significantly higher in the intervention group (multivariate-adjusted difference between groups, 5.8 PP [3.9–7.8]). This CWI increased awareness in intervention group and improved population-level functional health in intervention subgroups in the short term but was not effective for population-level frailty prevention at 2 years. Trial registration: UMIN-CTR (UMIN000026515).

Background Evidence on the associations of carotid intima‐media thickness and carotid plaque characteristics with stroke subtypes and coronary artery disease risks in Asians is limited. This study investigated these associations in the Japanese general population. Methods and Results Maximum intima‐media thicknesses of both the common carotid artery and internal carotid artery and carotid plaque characteristics were evaluated in 2943 Japanese subjects aged 40 to 75 years without history of cardiovascular disease. Subjects were followed up for a median of 15.1 years. Using a multivariate Cox proportional hazard model, we found that hazard ratios (HRs) and 95% CIs for the highest (≥1.07 mm) versus lowest (≤0.77 mm) quartiles of maximum intima‐media thicknesses of the common carotid artery were 1.97 (1.26–3.06) for total stroke, 1.52 (0.67–3.41) for hemorrhagic stroke, 2.45 (1.41–4.27) for ischemic stroke, 3.60 (1.64–7.91) for lacunar infarction, 1.53 (0.69–3.41) for nonlacunar cerebral infarction, 2.68 (1.24–5.76) for coronary artery disease, and 2.11 (1.44–3.12) for cardiovascular disease (similar results were found for maximum intima‐media thicknesses of the internal carotid artery). HRs(95% CIs) for heterogeneous plaque versus no plaque were 1.58 (1.09–2.30) for total stroke, 1.25 (0.58–2.70) for hemorrhagic stroke, 1.74 (1.13–2.67) for ischemic stroke, 1.84 (1.03–3.19) for lacunar infarction, 1.58 (0.80–3.11) for nonlacunar cerebral infarction, 2.11 (1.20–3.70) for coronary artery disease, and 1.71 (1.25–2.35) for cardiovascular disease. Conclusions Maximum intima‐media thicknesses of the common carotid artery, maximum intima‐media thicknesses of the internal carotid artery, and heterogeneous plaque were associated with the risks of stroke, lacunar infarction, coronary artery disease, and cardiovascular disease in Asians.

AIM Gait impairment implies subtle cognitive impairment (CI) and is associated with severity of white matter hyperintensities (WMHs). However, cognitive differences in such an association are not yet fully understood. This study examined the association between WMHs and gait performance among three cognitively different older groups. METHODS Gait performance and WMHs were assessed in 150 community-dwelling older adults, comprising 53 with CI (Mini-Mental State Examination [MMSE] score

Aim Using up to 13 years of repeated-measures data, we identified aging trajectories for an index in frailty score among older Japanese undergoing health checkups. In addition, we examined whether these trajectories were associated with all-cause and cause-specific mortality and healthcare costs. Methods In total, 1698 adults aged ≥65 years completed annual assessments during 2002-2014. During follow-up, the average number of follow-up assessments was 3.9, and the total number of observations was 6373. Frailty was defined by using the following criteria from Fried's phenotype: slowness, weakness, exhaustion, low physical activity and weight loss. Results We identified four aging trajectories for frailty. Specifically, 6.5%, 47.3%, 30.3% and 16.0% of participants were in the high, second, third and low trajectory groups, respectively. As compared with the low trajectory group, the high trajectory group had greater risks of cardiovascular disease (adjusted hazard ratios of 3.42) and other-cause death (adjusted hazard ratios of 3.04). The high trajectory group had the highest medical costs until late in the eighth decade of life, costs decreased after age 70 years and were lowest at age 90 years (estimated at $116.7); however, medical and long-term care costs greatly increased after age 80 years in the second and third trajectory groups. Conclusions Higher aging trajectories in frailty score were associated with elevated risks for cardiovascular, other-cause and all-cause death among older Japanese receiving health checkups. Medical and care needs greatly increased for the second and third trajectory groups when their frailty level was progressed in later life. Geriatr Gerontol Int 2020; 20: 1072-1078..

Aim This study aimed to investigate the association between the serum high-sensitivity C-reactive protein (hs-CRP) levels and incident atrial fibrillation risk in the general Japanese population, who have lower hs-CRP levels than the Western population, and assess whether the association is modified by sex, overweight, hypertension, and smoking status. Methods We conducted a prospective study in 6517 Japanese men and women aged 40-79 years without atrial fibrillation at baseline and enrolled in the Circulatory Risk in Communities Study (2002-2008). The hs-CRP levels were measured using the latex particle-enhanced immunonephelometric assay. Atrial fibrillation was identified using standard 12-lead electrocardiograms and information on physician-diagnosed atrial fibrillation history from the follow-up surveys. We used a Cox proportional hazard regression stratified by community. Results During a median follow-up of 11 years, 127 new cases of atrial fibrillation (74 and 53 cases among men and women, respectively) were found. Compared to the lowest quintile of hs-CRP levels, the multivariable hazard ratios (95% confidence intervals) were 2.54 (1.17-5.50), 2.28 (1.06-4.93), 2.92 (1.37-6.23), and 2.77 (1.30-5.91) for the second, third, fourth, and fifth (highest) quintiles, respectively. There was no significant effect modification by sex, overweight, hypertension, and smoking status (P for interaction ＞0.05). Conclusions Elevated hs-CRP levels were significantly associated with increased risk of atrial fibrillation in the Japanese population. The association of hs-CRP levels with incident atrial fibrillation did not vary according to sex, overweight, hypertension status, or smoking status.

Background Diet is a modifiable factor affecting sarcopenia, and accumulating evidence links dietary factors to muscle mass, strength, and function in older adults. However, few studies have examined the association of dietary patterns with sarcopenia. This study examined the association of dietary patterns derived by reduced-rank regression (RRR) with sarcopenia and its components in community-dwelling older Japanese. Methods We conducted a cross-sectional study of 1606 community-dwelling adults aged 65 years or older. Dietary intake was assessed by a validated, self-administered diet history questionnaire. Nutrient-derived dietary patterns were identified by using RRR, with sarcopenia-related nutrients (protein, vitamin D, vitamin C, vitamin E, folate, vitamin K, magnesium, iron, and calcium intakes) as response variables. Sarcopenia was defined by using the algorithm of the Asian Working Group for Sarcopenia 2019. Multivariate regression and logistic regression were used to examine the association of dietary patterns with sarcopenia and its components. Results The first RRR dietary pattern was characterized by high intakes of fish, soybean products, potatoes, most vegetables, mushrooms, seaweeds, and fruit and a low intake of rice and was associated with decreased prevalence of sarcopenia: the multivariable-adjusted odds ratio of sarcopenia was 0.57 (95% confidence interval, 0.34–0.94; p for trend=0.022) in the highest versus the lowest tertile of dietary pattern. This dietary pattern was also significantly positively associated with usual gait speed (β: 0.02, p=0.024). Conclusions A dietary pattern characterized by high intakes of fish, soybean products, potatoes, most vegetables, mushrooms, seaweeds, and fruits and low rice intake was inversely associated with sarcopenia in community-dwelling older Japanese.

Nutritional epidemiology shows that insufficient protein intake is related to senile dementia. The levels of protein intake in aged people are positively associated with memory function, and elderly people with high protein intake have a low risk of mild cognitive impairment. Although the beneficial roles of protein nutrition in maintaining brain function in aged people are well demonstrated, little is known about the mechanism by which dietary intake of protein affects memory and brain conditions. We fed aged mice a low protein diet (LPD) for 2 months, which caused behavioral abnormalities, and examined the nutritional effect of essential amino acid administration under LPD conditions. The passive avoidance test revealed that LPD mice demonstrated learning and memory impairment. Similarly, the LPD mice showed agitation and hyperactive behavior in the elevated plus maze test. Moreover, LPD mice exhibited decreased concentrations of gamma-aminobutyric acid (GABA), glutamate, glycine, dopamine, norepinephrine, serotonin and aspartate in the brain. Interestingly, oral administration of seven essential amino acids (EAAs; valine, leucine, isoleucine, lysine, phenylalanine, histidine, and tryptophan) to LPD mice, which can be a source of neurotransmitters, reversed those behavioral changes. The oral administration of EAAs restored the brain concentration of glutamate, which is involved in learning and memory ability and may be associated with the observed behavioral changes. Although the details of the link between decreased amino acid and neurotransmitter concentrations and behavioral abnormalities must be examined in future studies, these findings suggest the importance of dietary protein and essential amino acids for maintaining brain function.

Highlights • We examined links between medical claims and health check-up data for older adults. • Patients receiving pharmacotherapies were more likely to participate in health checkups. • Patients with intensive disease control were more likely to be aged ≥ 90 years. • Linking these databases can improve evaluations of diseases control in older adults., The Japanese government encourages older adults to participate in annual health checkups designed to detect lifestyle diseases such as hypertension, diabetes, and dyslipidemia. However, individuals who are already being treated for these diseases are unlikely to benefit from health checkup participation. This retrospective cohort study of older adults evaluated the associations of pharmacological treatments for these diseases with health checkup participation and identified the disease control factors among patients receiving treatments. Using medical claims data and health checkup data between September 2013 and August 2014 from 820,215 older adults aged ≥ 75 years residing in Tokyo, Japan, we examined the associations between pharmacological treatments and health checkup participation using binary logistic regression analysis. Next, patients receiving pharmacological treatments were categorized into intensive, moderate, or limited disease control based on their blood pressure, hemoglobin A1c levels, and lipid levels; multinomial logistic regression analyses were used to identify the disease control factors. The results showed that patients receiving pharmacological treatments were more likely (odds ratio: 1.374; P

Sarcopenia is associated with instrumental activities of daily living (IADL) and basic activities of daily living (BADL) disabilities. We developed an index for assessing sarcopenia degree (sarcoscore) and compared it to the Asian Working Group for Sarcopenia (AWGS) criteria. Principal component analyses of walking speed, handgrip strength, and skeletal muscle index were performed to develop a sarcoscore using 3088 Japanese population-based cross-sectional data. During the nine-year follow-up, 278 of 2571 and 88 of 2341 participants developed IADL and BADL disabilities, respectively. Adjusted Cox proportional hazards regression models showed that the sarcoscore criteria, defined as proportional to the sarcopenia prevalence diagnosed by the AWGS criteria, had higher hazard ratios (HRs) and 95% confidence interval (CI) for disability onset than the AWGS criteria (IADL disability: 2.19 (1.64&ndash, 2.93) vs 1.79 (1.32&ndash, 2.43), BADL disability: 4.28 (2.63&ndash, 6.96) vs 3.22 (1.97&ndash, 5.27)). The adjusted HRs for IADL and BADL disabilities were reduced by 4% and 8% per point increase in the sarcoscore, respectively. The sarcoscore assessed the degree of sarcopenia and had a satisfactory performance for predicting functional disabilities in older Japanese adults, suggesting its usefulness as a complementary composite marker for clinical diagnosis.

Although evidence about skeletal muscle mass loss and type 2 diabetes risk has accumulated, little information is available on the combined effect of skeletal muscle mass and abdominal obesity on type 2 diabetes. We examined whether skeletal muscle mass and abdominal obesity were synergistically associated with the prevalence of type 2 diabetes.Skeletal muscle mass and waist circumference (WC) were measured in 1515 Japanese aged 40 to 69 years. Relative muscle mass was calculated as percentage of total skeletal muscle mass in body weight (SMM%). Type 2 diabetes was identified as fasting serum glucose ≥7.0 mmol/L (126 mg/dL), nonfasting serum glucose ≥11.1 mmol/L (200 mg/dL), glycosylated hemoglobin ≥ 6.5%, and/or diabetes medication use.The multivariable-adjusted odds ratio (OR) of prevalent diabetes from the lowest to the third quartile of SMM% compared to the highest quartile gradually increased in both sexes. The association between a high WC and prevalent diabetes was similar. The multivariable-adjusted OR (95% confidence intervals) for the prevalence of type 2 diabetes in the low skeletal muscle mass/high WC group was 3.19 (1.78-5.71) for men and 4.46 (2.09-9.51) for women compared with the high skeletal muscle mass/low WC group. The relative excess risk due to interaction was 2.2 (0.5-3.9) in men and 2.8 (0.2-5.3) in women for an excess burden of type 2 diabetes for low skeletal muscle mass and high WC.Low skeletal muscle mass and abdominal obesity were synergistically associated with presence of type 2 diabetes.背景: 虽然关于骨骼肌肉质量的下降与2型糖尿病风险的证据已有研究, 但关于骨骼肌质量和腹型肥胖对2型糖尿病的联合作用的信息很少。我们研究了骨骼肌质量和腹型肥胖是否与2型糖尿病的患病率协同相关。 方法: 测量1515名40-69岁日本人的骨骼肌质量和腰围。相对肌量以总骨骼肌质量占体重的百分比(SMM%)计算。2型糖尿病被定义为空腹血糖≥7.0 mmol/L(126 mg/dL), 非空腹血糖≥11.1mmol/L(200mg/dL), 糖化血红蛋白≥6 5%, 且或正在使用糖尿病药物。 结果: 相对肌量最低的四分之一与最高四分之一相比, 男性及女性糖尿病患病率的多变量调整优势比(OR)都有所升高。较高腰围和糖尿病发病率之间的联系也是相似的。与高骨骼肌质量/低腰围组相比, 低骨骼肌质量/高腰围组的2型糖尿病患病率多变量调整OR值于男性为3.19(1.78~5.71), 女性为4.46(2.09~9.51)。低骨骼肌质量与高腰围之间的交互作用导致了额外的糖尿病相对风险, 男性为2.2(0.5-3.9), 女性为2.8(0.2-5.3)。 结论: 低骨骼肌质量和腹型肥胖与2型糖尿病发病存在协同关系。.