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.

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.

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>

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.

Concept of and countermeasures against metabolic syndrome / 日本農村医学会雑誌

A cluster of certain metabolic abnormalities has been recognized as metabolic syndrome, which is characterized by resistance to insulin-stimulated glucose uptake, glucose intolerance, hyperinsulinemia, hypertriglyceridemia, hypo- HDL cholesterolemia (HDL-C) and hypertension, with or without hyperglycemia. These multiple metabolic disorders put a person at high risk for cardiovascular disease. With the goal to eliminate all adverse consequences of multiple metabolic disorders, the optimal approach would be through its prevention. Since visceral obesity has been proposed as the most important determinant of multiple metabolic disorders by the International Diabetes Federation and the Japanese Association of Internal Medicine in 2005, health practitioners were thrown into confusion to use any definitions of metabolic syndrome. The Japanese Ministry of Health, Labor and Welfare has decided to introduce a new policy for the prevention of metabolic syndrome and type 2 diabetes mellitus from April 2008. The Ministry of Health, Labor and Welfare conducts to establish a screening system and guidance of the metabolic syndrome. We review the history and concept of metabolic syndrome, insulin resistance and central obesity, pathophysiology and definition, and countermeasures against the metabolic syndrome, to improve the community health care system for the metabolic syndrome and cardiovascular disease.