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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。

Aim: The purpose of the present study is to assess the relationships of muscle strength and power with recent leisure-time physical activity and exercise during adolescence in middle-aged and elderly Japanese women. Methods: The subjects consisted of 1128 community-dwelling women aged 40–79 years. They were interviewed about their physical activity habits during leisure time in the past 12 months and exercise they engaged in during adolescence. Muscle function was measured as grip strength, knee extension strength and leg extension power. Subjects were grouped into three intensity levels for leisure-time physical activity and as to whether or not they engaged in adolescent exercise. The relationships of muscle strength and power with leisure-time physical activity and adolescent exercise were assessed using analysis of covariance controlled for age, smoking status, annual income and education level. Results: The proportion of subjects that participated in leisure-time physical activity was 67.1% (light, 33.7%; moderate or heavy, 33.4%). The subjects that engaged in adolescent exercise represented 41.9% of the total. There was a significant relationship between leisure-time physical activity and adolescent exercise. In the analysis of covariance controlled for age, smoking status, annual income and education level, leisure-time physical activity and adolescent exercise had significant main effects on all muscle strength and power measurements. However, there was no interaction effect between leisure-time physical activity and adolescent exercise. Conclusion: The results suggest that current leisure-time physical activity and adolescent exercise benefit muscle function in middle-aged and elderly women.

To study the effect of aging on astigmatism in adult Japanese. Measurements of refractive errors and keratometry were performed on 2161 randomly selected subjects (aged 40–79 years). The relation between age and the net value in diopters (D) of astigmatism was evaluated with a trend test. The relation between age and the polar value was also examined by linear regression analysis. The mean (±SD) value of total and corneal astigmatism was −0.97 ± 0.72 D and −0.86 ± 0.63 D, respectively, and the net value of both increased with age (P trend < 0.001). The prevalence of either type of astigmatism also increased with age, according to the Cochran-Mantel-Haenzel test (P < 0.0001 for total and P < 0.01 for corneal astigmatism). The prevalence of against-the-rule astigmatism increased with age for either type of astigmatism (P < 0.0001 for total, P < 0.0001 for corneal). According to the analysis of polar values by age, the regression coefficient (±SE) for total and corneal astigmatism was −0.024 ± 0.002 (P < 0.0001) and −0.028 ± 0.002 (P < 0.0001), respectively. There was no statistical difference between these two regression coefficients. The prevalence of astigmatism increases and the axis turns to against-the-rule with age. The result of the linear regression analysis indicates that the age-related change in astigmatism is mainly associated with changes in the cornea.

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.

This study examined associations between physical activity and depressive symptoms in 1,151 community-dwelling adults in Japan. Physical activity was measured using a pedometer, whereas depressive symptoms were assessed with the Center for Epidemiological Studies-Depression Scale. A structural equation modeling with a cross-lagged panel design revealed that for the older adults (65-79 years of age), daily walking at baseline predicted fewer depressive symptoms at the 2-year follow-up, even after adjusting for confounders. In contrast, the association was not confirmed for the middle-aged adults (40-64 years of age). Findings suggest that age should be considered when estimating the effect of physical activity on psychological well-being.

The aim of this study was to describe the distribution of visual acuity and investigate the predictors of visual impairment in a Japanese population. Best-corrected visual acuity was measured in 2263 subjects aged 40–79 years randomly selected from a local community. Relations between visual impairment and possible risk factors were investigated. Among these subjects, 41 individuals (1.8%) were identified as visually impaired (best-corrected visual acuity in the better eye ≪0.5). Both sexes in the older age groups had a higher frequency of visual impairment (Mantel-Haenszel chi-square test: P ≪ 0.001). A multiple logistic regression indicated that an increase in age of 10 years [odds ratio (OR) 3.9; 95% confidence interval (CI) 2.3–6.7] and myopia (OR 2.9; 95%CI 1.4–6.0) were independent risk factors for visual impairment. Individuals with the highest level of education (college or higher) had a lower risk of visual impairment (OR 0.1; 95%CI 0–0.7) compared to individuals with the lowest level of education. As expected, visual impairment increased with advancing age, although the prevalence of visual impairment in our population was lower than in other surveys. Racial and regional differences and differences in study design may be responsible for discrepancies between surveys. It is noteworthy that myopia was a significant risk factor for visual impairment, although the reasons for this association are uncertain and need further investigation. Jpn J Ophthalmol 2004;48:37–43 © Japanese Ophthalmological Society 2004

Aim: Depression is a common psychiatric problem in late life. The purpose of the present study was to assess the prevalence of depressive symptoms among community-dwelling elderly, both cross-sectionally and longitudinally. Methods: This study was a part of the community study in a large cohort of elderly people aged 65 and over in Nangai Village, Japan. Data on depressive symptoms from the fifth survey in 2000 were analyzed cross-sectionally and also combined with data from the first survey in 1992 to assess aging and cohort effects. Depressive symptoms were measured by the short form of Geriatric Depression Scale. Results: Among 1195 respondents at the fifth survey, the prevalence of depressive symptoms was 22.3%. In 457 subjects who responded at both surveys, mean depression score or prevalence of depressive symptoms tended to be higher at the fifth survey than at the first survey. The difference in prevalence between the first survey and the fifth survey among individuals of the same age groups was significant only in the oldest group (77 years and over). Conclusion: Among Japanese community-dwelling elderly people, aging effects on depressive symptoms were found, though marked cohort effects were not confirmed.

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.

Given that osteoprotegerin plays an important role in bone remodeling, the osteoprotegerin gene may be a candidate locus for susceptibility to osteoporosis. The relation of polymorphisms in the promoter of the osteoprotegerin gene to bone mineral density (BMD) was examined in a Japanese population-based prospective cohort study with randomly recruited subjects (1095 women and 1125 men for the 950T --> C polymorphism, 1094 women and 1127 men for the 245T --> G polymorphism). 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. Genotypes were determined with a fluorescence-based allele-specific DNA primer assay system. Among 950T --> C genotypes, BMD for the proximal radius was lower in premenopausal women with the CC genotype than in those with the TT or TC genotype; the difference in BMD between the two groups was 3.9% (P=0.0075). Among 245T --> G genotypes, BMD for the radius, total body, femoral neck, trochanter, and Ward's triangle was lower in postmenopausal women with the GG genotype than in those with the TT or TG genotype, the TT genotype, or the TG genotype; the differences in BMD between the GG genotype and the TT or TG genotype were 19.8% for the distal radius (P=0.0015), 13.1% for the proximal radius (P=0.0095), 11.2% for the total body (P=0.0013), 12.9% for the femoral neck (P=0.0067), 18.7% for the trochanter (P=0.0008), and 27.1% for Ward's triangle (P=0.0038). BMD was not associated with the 950T --> C or 245T --> G genotypes in men. The present results implicate the osteoprotegerin gene as a susceptibility locus for reduced BMD in Japanese women.

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.

Purpose: To evaluate the age-related change in contrast sensitivity seen in a middle-aged to elderly Japanese population. Methods: Contrast sensitivity and visual acuity were measured in subjects aged 40 to 79 years randomly recruited from a community in Aichi prefecture near Nagoya, Japan. Contrast sensitivity tests were performed using the Vistech contrast sensitivity test chart (VCTS 6500). The results were statistically analyzed relative to age. Results: A statistically significant decrease in contrast sensitivity was seen with advancing age at each spatial frequency (Cochran-Mantel-Haenszel: P

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: To investigate the refractive status and factors associated with myopia by a population-based survey of Japanese adults. Methods: A total of 2168 subjects aged 40 to 79 years, randomly selected from a local community, were assessed in a cross-sectional study. The spherical equivalent of the refractive error was calculated and used in a multiple logistic regression analysis to evaluate the relationships between myopia and possible related factors. Results: The mean (± SD) of the spherical equivalent was −0.70 ± 1.40 diopters (D) in men, and −0.50 ± 1.44 D in women. Based on ± 0.5 D cutoff points, the prevalence of myopia, emmetropia, and hypermetropia were 45.7%, 40.8%, and 13.5% in men, and 38.3%, 43.1%, and 18.6% in women, respectively. A 10-year increase in age was associated with reduced risk of myopia [men: odds ratio (OR) = 0.53, 95% confidence interval (CI): 0.44–0.62; women: OR = 0.65, 95% CI: 0.54–0.78]. In men, myopia was significantly associated with higher education (high school: OR = 1.6, 95% CI: 1.1–2.3; college: OR = 2.0, 95% CI: 1.3–3.1) and management occupations (OR = 1.6, 95% CI: 1.0–2.4). For women, high income (OR = 1.5, 95% CI: 1.1–2.2), and clerical (OR = 1.5, 95% CI: 1.0–2.4) and sales/service occupations (OR = 1.7, 95% CI: 1.1–2.6) were also associated with myopia. Conclusions: The prevalence of myopia in a Japanese population was similar to that in other Asian surveys but higher than in black or white populations. Our study confirmed a higher prevalence of myopia among younger vs. older populations, and a significant association with education levels and socioeconomic factors.

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 objective of the present study is to describe the circumstances of injurious falls leading to medical care among the elderly living in a rural community, which have never been reported comprehensively. From 1992 to 1993, an interview survey on falls was carried out every 3 months. Of the 1349 subjects aged 65 or more of Nakazato village in Japan, 1317 persons responded to the survey by a door-by-door interview. Two-hundred-and-fifty-six elderly people experienced a fall at least once during the 1-year period. One-hundred-and-twenty-four falls were recorded by 94 men and 215 falls were experienced by 162 women. In men, 16 (31.31/1000 person-year) injurious falls leading to medical care were documented. In women, 58 (75.74/1000 person-year) falls were found to be injurious. The difference in the rate of injurious falls between the sexes was statistically significant (P < 0.01). In each sex, there was no increased rate of injurious falls with advancing age. Most of the injurious falls occurred in the daytime. As for the location of injurious falls, outdoor falls were more frequent than indoor falls in the case of men. Half of the injurious falls in women occurred indoors. Extrinsic factors largely contributed to the occurrence of injurious falls compared with intrinsic ones. Women tended to be injured in the buttocks and hip in a greater proportion than men. This study reveals the circumstances of injurious falls leading to medical care and provides useful information on preventing injurious falls among the elderly living in the community.

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.

The authors examined the association of the alcohol dehydrogenase 2 (ADH2) genotype with vascular events in community-dwelling Japanese (1,102 men/1,093 women). The allele ADH2*2 encodes an isozyme with a higher level of activity than ADH2*1. Here, the authors show that the ADH2*1 carriage is associated with high prevalence of cerebral infarction and lacunae in men. Multiple regression analyses confirmed that the risk of lacunae and cerebral infarction was increased by the ADH2*1 allele.

Fear of falling and the post-fall syndrome (fear-related activity restriction) are serious psychological symptoms associated with falls. This paper reported the definition and prevalence of fear of falling. Prevalence has yielded highly varying estimates due to the various definitions and instruments used to measure fear. Correlates of fear of falling by a longitudinal study were also described. As most of the research on fear of falling has been cross-sectional, more longitudinal studies are needed. As to the post-fall syndrome, definition and prevalence among community-dwelling elderly was discussed. It is difficult to measure general prevalence due to the lack of solid criteria of this syndrome.

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.

A fall prevention exercise programme, which elderly persons could undertake in their home alone to maintain and improve leg muscle strength, body balance ability and flexibility, was developed. The programme consisted of number of movements from which the best were selected on the basis of participant evaluation. The purpose of this report is to document the actual contents and an examination of the effects of this exercise programme in elderly people.A total of 551 elderly persons, aged 75 years and over, not needing the support of elderly care insurance in S town, Miyagi Japan, were the subjects of this study. An intervention area and a non-intervention area were set in the study region. In the intervention area, 85 elderly people of high-risk for falls were selected to perform a longitudinal intervention study for one year. The selection criteria were as follows: 1) Maximum walking speed slower than median value, 2) Falls had been experienced in the past year. Forty elderly persons (15 men and 25 women) participated in the class. Thirty movements designed to improve flexibility, leg muscle strength, and body balance, and to prevent tripping were executed and evaluated. Effects of this intervention on participants in the fall prevention class were examined using a follow-up survey one year after the baseline survey. The outcome of the fall prevention exercise programme was measured in terms of incidence of falls.A final fall prevention exercise programme consisting of ten movements was produced by the intervention. In addition, seven movements using a chair were part of the exercise programme. METS of the exercise programme for students, leaders, and elderly persons were 3.41 +/- 0.37, 3.16 +/- 0.47, and 3.08 +/- 0.4, respectively. The incidence of falls over one year of the participants in the class significantly decreased from 48.4% at baseline survey to 25.8% at follow-up survey, but that of non-participants did not change. One-leg standing times with eyes open of the female participants significantly extended from the baseline survey to the follow-up survey, but not that of non-participants.This result of intervention suggested that incidence of falls was decreased by the execution of the exercise programme in twelve sessions of fall prevention class and at home.

Objective Otoacoustic emissions (OAEs) are useful clinical tools that can be used as a test to reflect hearing, especially cochlear function. When OAEs are recorded, the sound energy is conducted inwards and outwards through the middle ear system, but the degree to which the middle ear condition affects the OAEs level remains obscure. The objectives of the present study were to estimate the effect of the condition of the middle ear expressed by multifrequency tympanometry on the distortion product otoacoustic emissions (DPOAEs) adjusting for age and the corresponding pure-tone thresholds. Subjects and methods The evaluation was conducted using 1043 subjects without a history of ear disease or occupational noise exposure out of a population-based sample of 2259 adults aged 40–82 years. Multifrequency tympanometry, DPOAEs, and pure-tone audiometry were administered. The resonance frequency (RF), static admittance (SA) and tympanometric peak pressure (PP) were taken as variables representing middle ear function. Subjects were categorized into three groups of variables ≤5th percentile, between 5th and 95th percentile, and ≥95th percentile. The signal-to-noise ratio in DPOAE levels were compared among three groups adjusting for age and the pure-tone threshold level. Results Both abnormally high and low RF exerted a negative effect on DPOAEs. Smaller RF values were related to smaller DPOAEs for the frequency around 1000 Hz, and greater RF values were related to smaller DPOAEs for the frequency around 4000 Hz. The tendency was similar between genders. Abnormally high SA had a negative influence on DPOAEs, while abnormally low SA had no significant effect on either gender. Smaller PP values were significantly related to smaller DPOAEs. Conclusions We interpreted the findings of the present study as verification of the effect of the condition of the middle ear on DPOAEs after adjustment for age and the pure-tone threshold level, although ears out of normal range in tympanometric variables might conceivably include not only middle ear dysfunction but also inner ear abnormality. Tympanometric assessment must always be taken into account when OAEs are analyzed for an estimation of the cochlea function.

This study was conducted to assess characteristics of elderly leaders volunteering to participate in a fall prevention programme.We surveyed 1,503 individuals (75 elderly leaders volunteering to participate in a fall prevention programme and 1,428 non-leader elderly) among the elderly population living in a rural community, Miyagi Prefecture. Subjects were aged 70-84 years. The questionnaire covered socio-demographic factors, as well as physical, psychology and social variables. To analyze the characteristics of the elderly leaders volunteering to participate in this programme, the relationships of socio-demographic, physical, psychology and social factors to whether the elderly were leaders in the programme were analyzed using logistic regression.As a result of multiple logistic regression analysis, the characteristics of elderly leaders volunteering to participate in the fall prevention programme were as follows; 1) being male (OR = 0.25, 95%CI 0.14-0.44); 2) young age (OR=0.43, 95%CI 0.25-0.73); 3) having a high intellectual activity (OR = 2.72, 95%CI 1.65-4.48); 4) being well satisfied with their health (OR = 1.45, 95%CI 1.02-2.07), and 5) having a high IKIGAI (OR = 1.06, 95%CI 1.01-1.13).Only elderly individuals capable of high-level intellectual activities can fill the roles of elderly volunteer group leaders discussed in this study.

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.

The objectives of the present study were to evaluate both the respective and combined effects of occupational noise exposure and smoking on hearing, taking age into consideration. The evaluation was conducted using 1478 subjects without a history of ear disease out of a population-based sample of 2267 adults, aged 40 79 years. Pure-tone audiometry and a questionnaire were administered. A deleterious effect of noise exposure on hearing was significantly observed in both genders at many frequencies after adjustment for age, income, and education. The smoking habit alone significantly affected hearing deterioration at 4000 Hz in noise-unexposed males. The combined effect of noise and smoking was not interactive but additive. A dose-response effect of smoking on hearing loss was observed in middle-aged males without noise exposure. Smoking and noise exposure were associated with hearing loss respectively.. This result is noteworthy for the preservation of good hearing especially at the beginning of aging.

This study examined whether cognitive impairment, falls, and urinary incontinence (UI) were independent predictors of functional decline using a 2-year observation of a non-disabled older Japanese cohort living in a community from 1999 to 2001. A total of 139 men and 214 women aged 70-94 years at the baseline who were independent in both activities of daily living (ADL) and instrumental activities of daily living (IADL) were analyzed in this study. Independent variables, such as cognitive impairment, falls, UI, and other possible factors associated with functional decline were obtained from an interview survey at the baseline. A dependent variable was functional status in ADL and IADL obtained at the time of the 2-year follow-up. During the 2-year follow-up, cognitive function was a significant predictor for both IADL dependence and ADL and/or IADL dependence. Using a group of subjects with Mini Mental State Examination (MMSE) scores of 30-27 points as a reference group, a significant correlation was identified between lower MMSE scores and an increased odds ratio for functional decline. Lower cognitive function was a significant predictor of functional decline, even among those older Japanese whose cognitive function was deemed to be within the normal range.

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.

Purpose To study the association between Cholecystokinin A receptor (CCKAR) genotypes and intelligence in community-living men and women. Method Subjects were 2251 community-dwelling Japanese men and women aged 40 to 79 years. The CCKAR gene promoter polymorphisms A -81 G and G -128 T were determined. Intelligence was assessed by Japanese Wechsler Adult Intelligence Scales – Revised Short Forms (JWAIS-R SF). The difference in intelligence between wild type and mutation was tested. Results There were no subjects with AA / GT , AA / TT , or AG / TT genotypic combinations. Both A -81 G and G -128 T genotypes were related to intelligence quotient (IQ) estimated by JWAIS-R SF. The mean and SE of IQ levels of subjects with the wild-type allele and the mutation allele at nucleotide -128 were 103.4 ± 0.3 and 101.6 ± 0.6, respectively. There was a significant difference in IQ for G -128 T (p = 0.008). The difference in IQ for A -81 G was also significant (p = 0.011). The IQ level was 103.6 ± 0.4 in the subjects with the wild-type allele and 102.0 ± 0.5 in the subjects with the mutation. Differences in IQ levels by haplotypes for combinations of A -81 G / G -128 T were examined. IQ significantly decreased with an increasing number of mutation alleles (p = 0.018). Conclusion There were statistically significant differences in IQ for CCKAR gene promoter polymorphisms A -81 G and G -128 T in community-living Japanese.

The aim of the present study was to survey the interest of Japanese orthopedists in preventing fractures in the elderly, and investigate their awareness with regard to main prevention strategies such as medications and hip protectors. From the list of 20,899 members of the Japanese Orthopedic Association, we randomly selected a sample of 2035 people. Each orthopedist was sent an anonymous survey consisting of 12 questions during July to August 2001. At that time, risedronate, raloxifene, and parathyroid hormone had not been approved for clinical use in Japan, and even alendronate had just been approved. Of the survey forms sent, 1011 responses were received, for a response rate of 50%. Analysis of these responses showed a very high interest in osteoporosis, fractures in the elderly from falls, and the prevention of such fractures. This interest was associated with physician age, with those above the age of 50 years being 2.3 times more likely to have an interest in each of these than physicians below that age. The respondents considered the most promising measure for the prevention of fractures in the elderly from falls to be fall prevention, followed by exercise and osteoporosis medications. The medication considered to be effective as a monotherapy by the overwhelming number of respondents was bisphosphonates, followed by vitamin D3 and calcitonin. Combination agents cited were vitamin D3, bisphosphonates, and calcitonin, in that order. Forty-two percent of respondents had some knowledge of hip protectors, but confidence in them as a means to prevent fractures was still low. The practical information from our survey should serve as a starting point for comparison to periods when new bisphosphonates or hip protectors become commonly available to Japanese orthopedists. The overall results indicate that Japanese orthopedists are very positive toward fracture prevention.