Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study / Journal of Rural Medicine

Objective: Falls in older adults are a major public health issue, and it is unclear whether the neighborhood environment is associated with falls among this group. This cross-sectional study investigated whether hilly neighborhood environmental factors were associated with fall status (falls or fear of falling) in rural Japanese older adults.Materials and Methods: Data obtained from 965 participants aged 65 years and older living in Unnan City, Shimane Prefecture, Japan, in 2017 were analyzed. Fall status was assessed based on the 1-year fall incidence (yes/no) for the past year and fear of falling (yes/no) using a self-report questionnaire. For hilly neighborhood environmental factors, the mean elevation and land slope were assessed using a geographic information system. The logistic regression model examined the odds ratios (OR) and 95% confidence intervals (CIs) of fall status in quartiles for elevation and land slope, respectively, and was adjusted for confounders.Results: Falls and fear of falling were observed in 16.8% and 43.2% of participants, respectively. Falls were associated with elevation (OR 1.99, 95% CI 1.17–3.37 for Q2 vs. Q1; OR 2.02, 95% CI 1.19–3.44 for Q3 vs. Q1) and land slope (OR 1.74, 95% CI 1.04–2.93 for Q3 vs. Q1; OR 1.74, 95% CI 1.04–2.93 for Q4 vs. Q1). Fear of falling was associated with elevation (OR 1.78, 95% CI 1.19–2.65 for Q3 vs. Q1) and land slope (OR 1.51, 95% CI 1.01–2.25 for Q4 vs. Q1).Conclusion: Our study found that elevation and land slope as hilly neighborhood environment factors were positively associated with falls or fear of falling among older adults living in rural Japan. Prospective observational studies that investigate the effects of region-specific environmental factors on falls among older adults should be conducted.

Prevalence of lifestyle-related chronic diseases among agricultural and non-agricultural workers in ruralareas of Japan: the Shimane CoHRE study / Journal of Rural Medicine

Objective: Engaging in agriculture greatly affects workers’ lifestyles, particularly related to physical activity. This study aimed to clarify the prevalence of lifestyle-related chronic diseases among workers engaging and not engaging in agriculture in rural areas of Japan.Methods: A total of 4,666 consecutive participants aged ≥40 years (1,929 men and 2,737 women) were recruited during health examinations conducted from 2006 to 2014. For analysis, the participants were divided by sex and age into those engaging in agriculture and those not engaging in agriculture.Results: Engaging in agriculture may be contributing with a low prevalence of dyslipidemia, a constitutive factor of metabolic syndrome, in both sexes between the ages of 40 and 64 years. In the elderly aged ≥65 years, engaging in agriculture may influence the low prevalence of hypertension in men. Hypertension, a strong risk factor for stroke and cardiovascular disease, is very frequent among the Japanese elderly and, therefore, engaging in agriculture may have a significant impact on its prevention and control.Conclusion: In rural areas of Japan, engaging in agriculture may contribute to the control of lipid metabolism in middle-aged individuals and blood pressure in the elderly.

The interaction of Apolipoprotein A5 gene promoter region T-1131C polymorphism (rs12286037) and lifestyle modification on plasma triglyceride levels in Japanese

BACKGROUND/OBJECTIVE: Apolipoprotein A5 gene promoter region T-1131C polymorphism (APOA5 T-1131C) is known to be associated with elevated plasma TG levels, although little is known of the influence of the interaction between APOA5 T-1131C and lifestyle modification on TG levels. To investigate this matter, we studied APOA5 T-1131C and plasma TG levels of subjects participating in a three-month lifestyle modification program. SUBJECTS/METHODS: A three-month lifestyle modification program was conducted with 297 participants (Age: 57 +/- 8 years) in Izumo City, Japan, from 2001-2007. Changes in energy balance (the difference between energy intake and energy expenditure) and BMI were used to evaluate the participants' responses to the lifestyle modification. RESULTS: Even after adjusting for confounding factors, plasma TG levels were significantly different at baseline among three genotype subgroups: TT, 126 +/- 68 mg/dl; TC, 134 +/- 74 mg/dl; and CC, 172 +/- 101 mg/dl. Lifestyle modification resulted in significant reductions in plasma TG levels in the TT, TC, and CC genotype subgroups: -21.9 +/- 61.0 mg/dl, -20.9 +/- 51.0 mg/dl, and -42.6 +/- 78.5 mg/dl, respectively, with no significant differences between them. In a stepwise regression analysis, age, APOA5 T-1131C, body mass index (BMI), homeostasis model assessment-insulin resistance (HOMA-IR), and the 18:1/18:0 ratio showed independent association with plasma TG levels at baseline. In a general linear model analysis, APOA5 T-1131C C-allele carriers showed significantly greater TG reduction with decreased energy balance than wild type carriers after adjustment for age, gender, and baseline plasma TG levels. CONCLUSIONS: The genetic effects of APOA5 T-1131C independently affected plasma TG levels. However, lifestyle modification was effective in significantly reducing plasma TG levels despite the APOA5 T-1131C genotype background.

Effects of quercetin derivatives from mulberry leaves: Improved gene expression related hepatic lipid and glucose metabolism in short-term high-fat fed mice

BACKGROUND/OBJECTIVES: Mulberry leaves contain quercetin derivatives, which have the effects of reducing obesity and improving lipid and glucose metabolism in mice with obesity. It is not clear whether or not mulberry leaves can directly affect metabolic disorders, in the presence of obesity, because of the interaction between obesity and metabolic disorders. The aim of the current study was to assess the direct action of quercetin derivatives on metabolic disorders in non-obese conditions in short-term high-fat diet fed mice. MATERIALS/METHODS: C57BL/6N mice were fed a high-fat diet, supplemented with either 0% (control), 1%, or 3% mulberry leaf powder (Mul) or 1% catechin powder for five days. Anthropometric parameters and blood biochemistry were determined, and hepatic gene expression associated with lipid and glucose metabolism was analyzed. RESULTS: Body and white fat weights did not differ among the four groups. Plasma triglycerides, total cholesterol, and free fatty acids in the 1%, 3% Mul and catechin groups did not differ significantly from those of the controls, however, plasma glucose and 8-isoprostane levels were significantly reduced. Liver gene expression of gp91phox, a main component of NADPH oxidase, was significantly down-regulated, and PPAR-alpha, related to beta-oxidation, was significantly up-regulated. FAS and GPAT, involved in lipid metabolism, were significantly down-regulated, and Ehhadh was significantly up-regulated. Glucose-metabolism related genes, L-PK and G6Pase, were significantly down-regulated, while GK was significantly up-regulated in the two Mul groups compared to the control group. CONCLUSIONS: Our results suggest that the Mul quercetin derivatives can directly improve lipid and glucose metabolism by reducing oxidative stress and enhancing beta-oxidation. The 1% Mul and 1% catechin groups had similar levels of polyphenol compound intake (0.4 x 10(-5) vs 0.4 x 10(-5) mole/5 days) and exhibited similar effects, but neither showed dose-dependent effects on lipid and glucose metabolism or oxidative stress.

Effects of quercetin derivatives from mulberry leaves: Improved gene expression related hepatic lipid and glucose metabolism in short-term high-fat fed mice

BACKGROUND/OBJECTIVES: Mulberry leaves contain quercetin derivatives, which have the effects of reducing obesity and improving lipid and glucose metabolism in mice with obesity. It is not clear whether or not mulberry leaves can directly affect metabolic disorders, in the presence of obesity, because of the interaction between obesity and metabolic disorders. The aim of the current study was to assess the direct action of quercetin derivatives on metabolic disorders in non-obese conditions in short-term high-fat diet fed mice. MATERIALS/METHODS: C57BL/6N mice were fed a high-fat diet, supplemented with either 0% (control), 1%, or 3% mulberry leaf powder (Mul) or 1% catechin powder for five days. Anthropometric parameters and blood biochemistry were determined, and hepatic gene expression associated with lipid and glucose metabolism was analyzed. RESULTS: Body and white fat weights did not differ among the four groups. Plasma triglycerides, total cholesterol, and free fatty acids in the 1%, 3% Mul and catechin groups did not differ significantly from those of the controls, however, plasma glucose and 8-isoprostane levels were significantly reduced. Liver gene expression of gp91phox, a main component of NADPH oxidase, was significantly down-regulated, and PPAR-alpha, related to beta-oxidation, was significantly up-regulated. FAS and GPAT, involved in lipid metabolism, were significantly down-regulated, and Ehhadh was significantly up-regulated. Glucose-metabolism related genes, L-PK and G6Pase, were significantly down-regulated, while GK was significantly up-regulated in the two Mul groups compared to the control group. CONCLUSIONS: Our results suggest that the Mul quercetin derivatives can directly improve lipid and glucose metabolism by reducing oxidative stress and enhancing beta-oxidation. The 1% Mul and 1% catechin groups had similar levels of polyphenol compound intake (0.4 x 10(-5) vs 0.4 x 10(-5) mole/5 days) and exhibited similar effects, but neither showed dose-dependent effects on lipid and glucose metabolism or oxidative stress.

Cognitive Function Improvement Effect of Old People by Complex-type Dementia Prevention Program / 日本農村医学会雑誌

　　This study aimed at clarifying the effects of intervention with the composite Dementia Prevention Program. Subjects were 46 elderly people who had participated in the program. The study method included intervention trials to test the effects on the changes in BMI, physical function, and cognitive function of the program participants before and after the trial. Those aged 75 and up (old-old participants) had significantly stronger grip strength before the intervention than those below the age of 75 (young-old participants), but there was no difference in cognitive and physical functions between old-old and young-old participants. The average number of steps taken in the young-old group had significantly increased from approximately 4,000 steps before intervention to approximately 7,000 steps after intervention. When it comes to physical functions, the time taken for the 5-m walking exercise was significantly shortened from 3.8±0.8s to 3.5±0.5s in the young-old subjects; a change from 3.5±0.8s to 3.7±1.0s was observed for TUG in the young-old subjects and from 4.1±1.0s to 3.6±1.0s in old-old subjects. As regards cognitive function, episodic memory of the young-old subjects improved significantly, from 47.9±7.5 points before intervention to 56.5±8.8 points after intervention. The improvement in the old-old subjects was gradual. Episodic memory was improved without bearing on the changes shown in the 5-m walking tests (β＝-0.751, p＝0.020). The physical functions and episodic memory in cognitive function had both improved. This study suggested early intervention could increase the dementia prevention effect.

Factors Relating Utilization of Health Care Facilities in Rural Mountainous Region / 日本農村医学会雑誌

　　Health care plan has been established in each secondary medical area. Although health care plan should be focused on needs of people live in such units, studies with a view from residents’ perspective have not always been considered adequately. The aim of this study was to examine the factors that effect on utilization of health care facilities located outside of the secondary medical area in a rural region. The data included 515 patients with hypertension, 253 patients with hyperlipidemia, and 104 patients with diabetes. Factors relating utilization of health care facilities were assessed by age, sex, employment, number of diseases, body mass index (BMI), carotid plaque score, HbA1c, distance to the nearest clinic, and distance to the nearest bus stop. We conducted a logistic regression analyses of that data divided into two groups; car use and non car use. The result showed that sex, BMI, carotid plaque score and distance to the nearest bus stop were statistically significantly associated with the utilization of health care facilities located outside of the secondary medical area in patients with car use. Whereas, there were no statistically significantly associations in patients with non car use. Our findings suggested that it is important to consider health utilization of patients with lifestyle related diseases for making sustainable health care plan.

Anti-obesity effects of hot water extract from Wasabi (Wasabia japonica Matsum.) leaves in mice fed high-fat diets

The anti-obesity effects of a hot water extract from wasabi (Wasabia japonica Matsum.) leaves (WLE), without its specific pungent constituents, such as allyl-isothiocyanate, were investigated in high fat-diet induced mice. C57J/BL mice were fed a high-fat diet (control group) or a high-fat diet supplemented with 5% WLE (WLE group). Physical parameters and blood profiles were determined. Gene expression associated with lipid metabolism in liver and white adipose tissue were analyzed. After 120 days of feeding, significantly lower body weight gain, liver weight and epididymal white adipose tissue weight was observed in the WLE group compared to the control group. In liver gene expression within the WLE group, PPARalpha was significantly enhanced and SREBP-1c was significantly suppressed. Subsequent downstream genes controlled by these regulators were significantly suppressed. In epididymal white adipose tissue of the WLE group, expression of leptin, PPARgamma, and C/EBPalpha were significantly suppressed and adiponectin was significantly enhanced. Acox, related to fatty acid oxidization in adipocytes, was also enhanced. Our results demonstrate that the WLE dietary supplement induces mild suppression of obesity in a high-fat diet induced mice, possibly due to suppression of lipid accumulation in liver and white adipose tissue.

A Review of Literature Analyzing Healthcare Utilization by Use of Geographic Information Systems / 日本農村医学会雑誌

　　The establishment of a sustainable healthcare system based on residents’ needs is an urgent issue in a rural region. For this purpose, considering the structure of a healthcare system, such as the numbers of beds, doctors, and nurses is important. In addition, the study of healthcare utilization using the date gathered through geographic information systems (GIS) would be very helpful in building such a healthcare system. In Japan, however, there are few published studies available on how health services are utilized. The aim of this paper was to review articles of GIS research on healthcare utilization. We conducted a systematic search of published peer-reviewed literature on PubMed. We found 38 articles that satisfied our inclusions criteria for review. Of them, 12 articles had a map for understanding health needs or demands, 23 articles carried analyses of distance and time for health utilizations, and seven articles had a buffer or database for analyses of healthcare utilization. Most of these articles have dealt with pediatric care and emergency care. Given the aging population in a rural region, we concluded that a more evidence-based approach should be taken to rural health focussing on lifestyle-related diseases.

The Effect of Utilization of In-home Services and the Changes in Levels of Care Needs of Frail Persons(2002-2004): Results of a Two-year Follow-up Study / Journal of Rural Medicine

<b>Objectives</b>: Despite the increasing utilization of in-home services, the assessment of in-home services used by those that have certified levels of care needs has been limited to the actual changes in individual outcomes. The purpose of the present study was to determine factors affecting how the utilization of in-home services could have sustained and/or improved or deteriorated the care needs levels of frail persons. We also examined the effect of in-home services used in the lower level of care needs subgroup and the higher level of care needs subgroup during a two-year period.<br><b>Subjects and Methods:</b> We used longitudinal data from Izumo City of those individuals with certified levels of care needs to analyze the changes in care need levels in Izumo City between 2002 to 2004. In 2002, 2,651 persons had certified levels of care needs. All permanent residents of care facilities, at care needs level 5 in 2002, those who died since 2002 and people who could not be traced during the two-year follow-up period were excluded. The remaining data from 1,788 frail persons were ultimately analyzed. We arbitrarily divided the changes in care needs levels into two categories: sustained/improved and deteriorated. The care needs levels were also stratified into a lower level of care needs subgroup and a higher level of care needs subgroup at the baseline. Simple statistical analysis and binary logistic regression analysis were used to analyze factors that were thought to be related to in-home service utilization data to predict changes in care needs levels.<br><b>Results:</b> Approximately 63.3% of the respondents had a sustained or improved care needs level, and 36.7% of the respondents showed deteriorated of care needs levels. In the lower level of care needs subgroup, utilization of home help/bathing (OR=2.59) was associated with significant sustained/improved care needs levels. In the higher level of care needs subgroup, day care service (OR=0.90) and short stay services (OR=0.87) were significantly related to deteriorated care needs levels, respectively.<br><b>Conclusions:</b> This study shows that home help/bathing care in the lower level of care needs subgroup was a significant predictor of sustained/improved levels of care needs for frail persons but that short stay services and day care services in the higher level of care needs subgroup have a negative impact on sustained/improved levels of care needs. Our results suggest that utilization of home help services can prevent deterioration of these levels of care needs in frail persons.

Behavioral Intervention in the Overweight and ObeseEmployee: The Challenge of Promoting Weight Lossand Physical Activity / Journal of Rural Medicine

Effects of gender and employment situation on weight loss and lifestyle modification were assessed in a 3-month intervention study done for overweight and obesity. A total of 384 individuals in Izumo City Japan, participated from 2000 to 2006. Lifestyle modifications were quantitatively evaluated by calculating calories of energy intake and expenditure. Eleven men and 15 women failed to complete the intervention; they were significantly younger in both genders, and the women had a higher rate of employment than the completing group (91 men and 267 women). Intervention induced a weight loss of 1.9 kg for men and 1.6 kg for women, with no significant differences by gender. Significant differences were found in changes in energy intake and expenditure in both genders, but these disappeared after adjusting for weight. There were significant decreases in weight (1.6 kg in unemployed, 2.5 kg in employed) in men. Increases in walking and exercise for the employed were smaller than those for the unemployed. The relationship between changes in weight and energy balance by employment status was independently significant using multiple regression analysis. Employment is associated with difficulty in losing weight due to limited exercise time in behavioral intervention.

Intervention by Milk Ingestion and Physical Activities for the Frail Elderly in Community / 日本農村医学会雑誌

  As the abilitiesof physical and daily life tend to fall by aging, and nutrition improvementis importantin elderly. Effects of nutrition improvement for elderly has verified on the seriously malnutrition elderly in a hospital, but there is little evidencefor elderly in community. We conducted the intervention by milk ingestion based on physical activities program for the frail elderly in community. Subjects were 45 elderly people (73.7±5.7 years old) who participated in the preventive program for three months in Izumo City, and were divided into two groups of 22 milk intervention subjects and 23 controlsubjects. The milk intervention group was provided with milk (180 ml/day) by door-to-door delivery, and the parameters of nutrition and anthropometricwere investigated before and after intervention. BMI, HDL-cholesterol and hemoglobinwere significantly improved in the milk intervention group, but no significant effects in the control. The intervention group had significant health-effects of BMI, albumin, HDL-cholesterol, hemoglobin, HbA1c and essential amino acids/nonessential-amino-acid ratio, compared with the control group. Asphysical activities in the control groupbefore intervention was poorer than the intervention group, the control group improvedsignificantlyby the physical activities program.In conclusion, daily milk ingestion based on physical activities program makes an improvement of nutrient state in frail elderly in community.

Prospective Study of the Effects of Lifestyle and Frailty on Elderly Mortality / 日本農村医学会雑誌

  Lifestyle-related diseases among the elderly have been brought to light by many investigaters. However, it remains unclear whether age-related frailty in the basic activities of daily living (ADLs) affects mortality independently of lifestyle. To clarify the relationship of lifestyle and frailty to elderly mortality, we conducted a three-year prospective study on 66 elderly people with reduced vital functions newly certified as requiring nursing care (frail elderly) and 72 elderly people living on their own (independent elderly) in Unnan City, Shimane Prefecture. The mortality rate for the frail elderly tended to be higher than for the independent elderly. However, this difference was not statistically significant. Gender was the only factor related to mortality in the frail elderly, who had advanced frailty. Furthermore, mortality rates were significantly higher for men than women. No relationship was observed between lifestyle and frailty. In the independent elderly, smoking and unstable gait, respectively, were significantly related to mortality. The present findings indicate that lifestyle and frailty are independently related to elderly mortality.

Use of Geographic Information System to Measure Access to Health Care Facilities in Rural Communities in Mountainous Region / 日本農村医学会雑誌

  As is often the case with rural communities in Japan, a dearth of health resources poses a serious problem in a mountainous region of Shimane Prefecture. Although a medical care plan focusing on needs of people should be devised with a view to building up a sustainable health care system, studies have not always adequately been pursued. The aim of this study was to assess the data on the patients with lifestyle-related health problems to and from health care facilities. A Geographic Information System was used for measuring the travel time and road distance. The data for 255 patients with hypertension, 114 patients with hyperlipidemia, and 42 patients with diabetes were amassed. The results showed that the average travel time and distance were much longer in patients with diabetes than those with hypertension. Statistically no significant difference was observed in severity of diabetes (HbA1c, BMI and LDL-c) and blood pressure levels between patients who received regular treatment at clinics in the two towns and those who went all the way to clinics outside of the towns. In addition, compared with the patients with diabetes aged 75 years or over, the average travel time and road distance for aged of 74 years or younger were much longer. Similarly, compared with the patients with hypertension aged 75 years or over, the average travel time and road distance for aged of 74 yeras or younger were also much longer. These results indicated that the diabetics and the elderly age 74 or younger tended to go to health facilities beyond the secondary-medical care zone. These findings also suggested that a closer cooperation between facilities in the neighboring secondary-medical care zones to improve the quality of medical services and support general practitioners to review the existing disease management program would make it possible to cope with the present situation.

Evaluation of Coverage for Emergence Medical Services in Shimane Prefecture Using Geographic Information System / 日本農村医学会雑誌

  Recently, the deficiency of emergency care system has become a social issue by the decline in the number of emergency hospitals due to the shortage of doctors in Japanese rural communities. Although the number and distribution of doctors were taken into account when secondary-medical care areas were designated, real transportation time required to reach the emergency hospitals has not been considered enough. The main objective of this study was to clarify the characteristics of accessibilities to emergency hospitals by secondary-medical care sectors in Shimane Prefecture, excluding islands, using a Geographical Information System. We categorized areas within 3 min., 10 min., and 30 min. transportation time to evaluate the accessibility to emergency hospitals by calculating the population of each area. The western areas of Shimane such as Ooda, Masuda and Hamada had a higher proportion of residents with over 30 minutes of transportation time than the eastern parts. This result indicated that there was a disparity in terms of accessibility to emergency hospitals between the eastern and western parts of Shimane Prefecture. Furthermore, we estimated that residents in the Ooda area were forced to take longer transportation time after the closure of the Ooda City Hospital emergency unit. Our study suggested that not only the discussion of healthcare resources but also the consideration of accessibilities to emergency hospitals in a region was important for the planning of health and medical service.

Changes of Care Levels of Frail Elderly Individuals After Introduction of Long-Term Nursing Care Insurance System / 日本農村医学会雑誌

  A long-term care insurance law was enacted in 2000 for the purpose of socializing elderly care. Since then, the Japanese government has come to shoulder an unexpected financial burden because of a large increase in the number of the slightly frail elderly. Based on the need of frail elderly individuals, five care levels were established by the insurance law. Predictive factors for changes of the care level of such individuals are not yet clear. We conducted an analysis of the relationship between changes of care levels of frail elderly people residing in Izumo City, Shimane, and such factors as gender, age, activity of daily life (ADL) and care services utilization, in a cohort study of 1,965 certified elderly individuals in 2000, and of 2,547 such individuals in 2002. We arbitrarily set the care levels into three categories:maintenance/improvement, deterioration, and death; we then tracked the care levels of each cohort over a two-year period. At the end of 2-year tracking, 39.9% of the 2000 cohort were in the maintenance/improvement level, 37.7% in deterioration and 22.4% had died; for the 2002 cohort, the results were 51.8%, 25.8% and 22.5%, respectively. The elderly in all care levels in the 2002 cohort, especially those with the higher ADL (support necessary and care level 1), improved their ADL but showed no significant differences in death rate, compared with the 2000 cohort. The certification method of care level for long-term care did not substantially change between 2000 and 2004. The improvement of care level change in the 2002 cohort was not related to either level of care or dementia, or to utilization rates of services at home. Therefore, the attitude of the users of services and the quality of home care may have contributed to the improvement of care levels from 2000 to 2002.

Psychosocial Factors That Have an Influence on the Effects of Obesity Improvement Programs / Journal of Rural Medicine

<b>Objective:</b> The objective of the present study was to clarify the relationship between factors having an influence on obesity improvement programs and psychosocial factors from a more comprehensive point of view.<br> <b>Methods:</b> We studied a total of 43 subjects with a body mass index (BMI) of 25 kg/m2 or higher who wished to take part in an obesity improvement program and agreed to participate in the study. We conducted an obesity improvement program based on behavior change theories for three months and evaluated physical composition, mental health, social support, stress-coping and the like before intervention and immediately after completion of the program.<br> <b>Results:</b> The average weight showed a significant decrease from 69.0 } 8.8 kg to 65.7 } 8.7 kg before and after intervention (p<0.001), respectively. It was also shown that the presence or absence of chronic diseases, social support from a spouse and the decrease of avoidance stress coping were related to weight loss.<br> <b>Conclusion:</b> The findings suggest that it will be further necessary to continue working on the need to enhance awareness about stress with a view to preventing occurrence of rebound after the end of weight loss programs and acquisition coping techniques, apart from the cooperation of attending doctors, strengthening of social support from family and friends and managing stress for the duration of the program.<br>

Ten-year Follow-up of Obesity and Obesity-related Metabolic Disorders in Male Rural Japanese Workers / Journal of Rural Medicine

Objectives: Prevention of obesity is a high priority of health management at workplaces. We conducted a follow-up study of obesity and obesity-related metabolic disorders in Japanese male workers. Subjects and Methods: Ninety-eight male workers engaged in the operation of a nuclear power plant in Shimane Prefecture, aged 41 ± 8 years in 2006, were subjected to regular health check-ups in 1996 and 2006. Results: The changes in their body weights and metabolic parameters (blood pressure, AST, ALT, γ-GTP, LDL-cholesterol, HDL-cholesterol, triglycerides, glucose and uric acid) were compared by BMI class and age group. Twenty-three percent of the subjects fell within the 23.0 to 24.9 BMI range, and 23% were over 25.0 BMI. Body weight increased significantly, by 3.6 ± 5.3 kg in all subjects, but there was no significant difference in weight gain over the 10 years by age or BMI group. Weight gain was positively associated with metabolic parameters, such as the values of systolic blood pressure, ALT, triglycerides and uric acid, and negatively associated with the value of HDL-C. Conclusions: Japanese male workers, regardless of age and BMI at baseline, experienced an increase of body weight and obesity-related metabolic disorders. Therefore, health professionals in the workplace should consider educating workers about stress-coping methods to reduce job stress, promote a health-supportive environment, such as healthy menus in employee cafeterias and fitness clubs, and be cognizant of high-risk factors in the individual employee.

Predictive Values of Anthropometric Measurements for Visceral Obesity and Metabolic Syndrome in Educational Intervention / 日本農村医学会雑誌

Obesity is an important public health problem in Japan and many other countries. There is a need for simple and reliable anthropometric measurement tools for visceral obesity to facilitate the prevention of metabolic syndrome (MS). Although studies have so far suggested waist circumference (WC) is the best indicator of visceral obesity, there is no reportof predictive value for improvement of MS. We conducted to analyze the relationship between anthropometric measurements and metabolic disorders in an interventional study of 358 subjects who participated in our program for visceral obesity based on health education and self-determination from 2000 to 2006. The intervention induced significant decreases in calorie intake and increases in physical activity of the participants, and resulted in significant decreases of 1.7 kg (3% of body weight at the baseline) of weight and 2.4 cm (3%) of WC, but body fat percent using bioelectrical impedance analysis found their body fat percentage increased 0.5% at the baseline. Weight-loss was significantly associated with improvement of metabolic measurements by our intervention. Weight and body mass index (BMI) showed the highest correlation coefficient for improvement of metabolic measurements, while WC and body fatpercentage showed lower values for improvement of metabolic measurements. In conclusion, weight-loss is the suitable indicator for the evaluation of the educational program, and 3-7% weight-loss for three months is recommended to improve visceral obesity and MS.

Prevalence of Metabolic Syndrome in Rural Community as Defined by the Japanese Association of Internal Medicine and the Ministry of Health, Labor and Welfare / 日本農村医学会雑誌

Recently, people are interested in visceral obesity and metabolic syndrome (MS). The Japanese Ministry of Health, Labor and Welfare has decided to introduce a new MS screening system and health promotion guidance on the prevention of type 2 diabetes mellitus (diabetes) and cardiovascular disease from 2008. We analyzed the prevalence of MS and estimated the number of candidates for MS in a rural community based on the new criteria provided by the Japanese Association of Internal Medicine and the Ministry of Health, Labor and Welfare. Data obtained from 393 males and 526 females aged over 20 years were studied for the prevalence of MS and diabetes. The prevalence of MS was 14% for males and 6% for females. It was a remarkable lower prevalence than the reported prevalence in urban communities. We calculated again the prevalence of MS with the exclusion of diabetes, because diabetes was usually preceded by MS. The prevalence of diabetes and MS was 10% and 10% for males and 8% and 6% for females, respectively. Diabetes increased with age, but MS prevailed among younger people aged 20-59 years. We think that countermeasures against MS should be taken targeted on younger people, and those against diabetes on elder people. We also estimated the member of people with MS using the Ministry of Health, Labor and Welfare criteria. In 2012, the health organizations, both public and private, will be providing service to 3,470 thousand adults with MS and encouragement to 3,950 thousand adults to have a motivation for healthy lifestyle.