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.

Influence of rice with different amylose contents on postprandial glycemic response / Journal of Rural Medicine

Objective: Clinical studies suggest that maintaining a lower postprandial glycemic response is important for improvement and prevention of metabolic syndrome and type 2 diabetes mellitus. Amylose, an ingredient in many food grains, is a major factor for the lowering of postprandial glycemic and insulinemic response. The aim of the present study was to determine the influence of rice with different level of amylose on postprandial glycemic and insulinemic response in mice and humans.Materials and Methods: The two types of rice used in the study contained 29 wt% (high amylose rice) or 17 wt% (low amylose rice) amylose. In mice and humans, postprandial glycemic and insulinemic responses were measured and then the area under the response curves of both rice groups were compared.Results: In mice, comparisons of postprandial glycemic response showed high amylose rice was lower than that for low amylose rice in all time points. Notably postprandial glycemic responses for high amylose rice at 15, 30, 45 and 60 min were significantly lower (19%, 31%, 16% and 17% respectively). The area under the glycemic response curve for high amylose rice was a remarkably 16% less than for the low amylose rice. In humans, postprandial glycemic response at 30 min and insulinemic response at 60 min for high amylose rice were significantly lower than for low amylose rice (15% and 40% lower, respectively). Furthermore, general linear measurement multivariate analysis after adjustment for eating time and hemoglobin A1c at baseline showed that postprandial glycemic response at 30 and 60 min and insulinemic response at 60 min, and the area under the glycemic response curve for high amylose rice were significantly lower than for low amylose rice in human.Conclusion: The higher amylose content of the rice lowered the postprandial glycemic and insulinemic response, demonstrating the potential to prevent or improve metabolic syndrome and type 2 diabetes mellitus.

The Evaluation of Community-Based Public Health Education with Reference to Core Concepts in New Public Health / 医学教育

Although great changes have already been made to medical education in Japan, the public health system urgently requires a paradigm change in the educational model. Recently, changes in the concept of public health have been proposed as “New Public Health” based on the World Health Organization's Health Promotion Movement in developed countries. We defined the core concepts and basic theories of New Public Health and have evaluated the validity to New Public Health of the community-based public health education model used since 1978 at Shimane Medical University. We have also established an educational environment that supports the development and dissemination of the model.

Weight Loss and Improvement of Metabolic Syndrome by Interventional Program Based on Health Education / 日本農村医学会雑誌

A cluster of insulin resistance, dyslipidemia and hypertension has been labeled as a metabolic syndrome. Asians have a lower rate of obesity than Caucasians, but have recently become increasingly prone to obesity and the metabolic syndrome, especially in rural communities in Japan. Although weight loss has been considered to be effective for improvement of the metabolic syndrome, most data are based on studies in Western countries with only limited information derived from Japanese populations. We conducted a study of 188 subjects who participated in our interventional program for obesity based on health education and self-determination in 2000-2003. The intervention induced significant decreases in caloric intakes and increases in physical activity in the participants, and then resulted in a significant 1.3kg reduction in weight on the average. Weght-loss was significantly associated with indexes of obesity, values of total cholesterol, triglyceide and HDL cholesterol levels, but was not related with blood pressure and LDL cholesterol, which were significantly decreased by our intervention. Furthermore a simple regression analysis was carried out to verify whether weight loss and metabolic syndrome parameters were related. Weight loss was determinantsexplaining less than a total of 10% of the variance in triglyceride and total cholesterol for the participants. Future studies of weight loss for metabolic syndrome should incorporate Asian ethnic factors, such as dietary habits and genetic influences.

The Occurrence of Bovine Spongiform Encephalopathy (BSE) in Japan from the Viewpoint of Political Science / 日本農村医学会雑誌

The Japanese government's response to the recent discovery of dairy cows suffering from bovine spongiform encephalopathy (BSE) in this country was analyzed from the viewpoint of policy science with reference to the policy in the United Kingdom and other EU countries. The results of investigation into the causative agent (s) androutes of infection of BSE that affected a total of seven cows were reviewed and the points at issue during the course of the epidemiological survey were given. Despite repeated warnings from the UK, EU and WHO, adequate countermeasures were not taken by the government offices concerned-the Ministry of Agriculture, Forestry and Fishery and the Ministry of Health, Welfare and Labor. They failed to prevent the occurrence of BSE and the resultant panic among consumers. The present review brought to lighta lack of a sense of urgency and risk management system in the government, the moral hazard in the food industry and market, the blunder of the government officials and the absence of an adequate food safety surveillance system. At the same time, we presented some proposals as to what the future food safety policy should be.

Healthy Cities and Communities Projects as the Undergraduate Medical Education / 医学教育

We presented here an overview of the international innovation of public health and introduced our community-based educational practice of public health. We also reported it was effective for public health education to let students participate together with teachers in the cooperative movement developing healthy community and let them learn community dynamics, skills of participatory action research and the process of policy making. Today, the under-and post-graduate education of new public health will be effctively performed by participating in the practical healthy community project, which is performed cooperatively by communities, social resources and the university.

The Development of a Community-Based Educational Model in Public Health / 医学教育

Medical education in Japan has undergone dramatic changes, but nothing less than a paradigm change is required for the educational model for social medicine. In the 23 years since 1978, we have developed a community-based public health education program. The curriculum consists of a core of family health practice, student lectures, systematic teachers' lectures, participatory research on community health, and health policy-making. The community-based educational model was effective in developing students' active problem-based learning, abilities in health communication, and understanding of community needs as a biologic-psychologic-cultural-geographic complex; the empowerment of students and the community; and a comprehensive approach to the community care management which integrates health promotion and social welfare. We evaluated the community-based curriculum design, which exposes students to a wide variety of medical, social, and psychological problems in a community as a useful public health educational strategy.

The International Strategy and Methodology of Healthy Communities with Reference to the Policy Science / 日本農村医学会雑誌

Amid the swell of the tide of globarization and decentralization, the building of healthy cities and communities has become an increasingly important task of Japan’s health and welfare policy makers. In this article the international trends, results and problems of the healthy cities projects were reviewed with attention focused on the 3rd period (1998-2002) of the WHO healthy cities programs. The strategy and methodology, and the theory and practice of the development of healthy cities and communities were also proposed with stress placed on the need of the symbiotic collaboration between rural communities and urban communities from the viewpoint of policy science.