Real-world survey of eating attitudes and spending behaviors related to healthy foods/supplements in women seeking to become pregnant.

BACKGROUND & AIMS: Since 2022, fertility treatments have been partially covered by insurance in Japan. Women who wish to become pregnant may explore various means of conception as fertility treatments have shown low success rates. Therefore, we aimed to clarify the state of knowledge, behavior, and attitudes toward health foods among women who are actively trying to become pregnant. METHODS: A web-based research company surveyed the eating attitudes and behaviors towards healthy foods of 900 women seeking to become pregnant. Regression analysis for the total amount spent on pregnancy was conducted, with "amount spent on actions undertaken to conceive" as the dependent variable. Multiple regression analysis on actions undertaken to conceive was performed using age, family income, body mass index, duration of hospital visits, duration of actions undertaken to conceive, cumulative amount incurred to conceive, awareness of dietary guidelines, adherence to dietary practices, number of types of health foods and supplements, whether participants considered consumption of nutritious foods and supplements to be important, and cumulative amount spent on healthy foods and supplements. The effect size for the Chi-square test was determined with Cramer's coefficient of association. RESULTS: Increasing age was associated with a longer time to conceive, longer hospital visits, higher conception costs (including fertility treatment), and a higher intake of healthy food products. The number of healthy food types had the greatest impact on the cost incurred to conceive. Folic acid was the most commonly consumed healthy food, followed by iron and calcium. CONCLUSIONS: This study clarified the real-world situation regarding healthy foods for women seeking pregnancy in Japan. The information necessary for pregnant women to select safe healthy foods was clarified, which may lead to the establishment of risk-communication measures to ensure safety.

[Current Status and Issues on the Foods with Function Claims System in Japan: Evidence of Functionality of the Foods].

The purpose of this narrative review was to clarify the current status and issues of scientific evidence for functionality in the Foods with Function Claims system based on previous research. From the introduction of the system in April 2015 to January 1, 2023, there were 6606 notifications, of which 6297 (95.3) were systematic reviews (SRs) and 309 (4.7%) were clinical trials (CTs). SRs were identified the following problems: i) inadequate description based on the first version of PRISMA checklist, and ii) very low levels of quality assessment in the first version of AMSTAR checklist and AMSTAR 2. CT was reported to have the following problems: i) inconsistencies between the protocol and the content in the paper (non-compliance), ii) high risk of bias, and iii) not described based on the CONSORT 2010 checklist. Since SRs and randomized controlled trials (RCTs) often have low-quality notifications, it is necessary to correctly communicate this information to consumers in order to make appropriate purchasing decisions.

A Cross-Sectional Study Based on Forty Systematic Reviews of Foods with Function Claims (FFC) in Japan: Quality Assessment Using AMSTAR 2.

BACKGROUND: The Foods with Function Claims (FFC) was introduced in Japan in April 2015 to make more products available that are labeled with health functions. The products' functionality of function claims must be explained by scientific evidence presented in systematic reviews (SRs), but the quality of recent SRs is unclear. This study assessed the quality of SRs in the FFC registered on the Consumer Affairs Agency (CAA) website in Japan. METHODS: We searched the database from 1 April to 31 October 2022. Confidence in the methodological quality of each SR was evaluated by the AMSTAR 2 checklist. RESULTS: Forty SRs were randomly extracted on the basis of the eligibility criteria and recruitment procedures. Overall confidence was rated as "high" (N = 0, 0%), "moderate" (N = 0, 0%), "low" (N = 2, 5%), or "critically low" (N = 38, 95%). The mean AMSTAR 2 score was 51.1% (SD 12.1%; range 19-73%). Among the 40 SRs, the number of critical domain deficiencies was 4 in 7.5% of SRs, 3 in 52.5% of SRs, 2 in 35% of SRs, and 1 in 5% of SRs. Registering the review's protocol and comprehensive search strategies were particularly common deficiencies. Additionally, the risk of bias (RoB) was insufficiently considered. CONCLUSION: Overall, the methodological quality of the SRs based on the FFC, introduced eight years earlier, was very poor. This was especially true in the interpretation and discussion of critical domains, which had many deficiencies in terms of protocol registration, a comprehensive literature search strategy, and accounting for the RoB.

Exploratory Systematic Review and Meta-Analysis of Panax Genus Plant Ingestion Evaluation in Exercise Endurance.

BACKGROUND: Many studies that use food containing Panax genus plants (PGPs) have been conducted but most of them have not mentioned the effective compounds ginsenosides and their composition. Therefore, we conducted a systematic review and meta-analysis of time to exhaustion as an index of exercise endurance with ingestion of PGPs or ginsenosides to reveal their effects. METHODS: We performed a systematic review with a comprehensive and structured literature search using seven literature databases, four clinical trial databases, and three general web search engines during 15-22 March 2021. A random-effects model was applied to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) as the difference between the mean in the treatment and placebo groups. We evaluated the risk of bias of individual studies along with the risk of bias tool in the Cochrane handbook. This study was funded by Maruzen Pharmaceuticals Co., Ltd. (Hiroshima, Japan). The protocol for this study was registered with the UMIN-CTR (No. UMIN000043341). RESULTS: Five studies met the inclusion criteria. The number of total participants was 90, with 59 in the ingestion-PGPs group and 64 in the control group, because three studies were crossover-design trials. We found that ingestion of PGPs or ginsenosides significantly improved exercise endurance (SMD [95% CI]: 0.58 [0.22-0.95], I2 = 0%). It was suggested that ginsenoside Rg1 (Rg1) and PGPs extract containing Rg1 were significantly effective in improving exercise endurance (SMD [95% CI]: 0.70 [0.14-1.27], I2 = 30%) by additional analysis. CONCLUSIONS: This systematic review suggests that the ingestion of PGPs or ginsenosides, especially Rg1, is effective in improving exercise endurance in healthy adults. However, further high-quality randomized controlled trials are required because imprecision and publication bias cannot be ignored in this systematic review.

Effect of non-surgical interventions on pain relief and symptom improvement in farmers with diseases of the musculoskeletal system or connective tissue: an exploratory systematic review based on randomized controlled trials.

Objective: There are many observational and clinical studies on pain treatment in farmers; however, little is known about the effects of interventions based only on randomized controlled trials (RCTs) on diseases of the musculoskeletal system or connective tissue (D-MSCT). This review aimed to summarize evidence on the effects of non-surgical interventions for pain relief and symptom improvement in farmers with D-MSCT. Materials and Methods: We searched seven databases, including MEDLINE, and three clinical trial registries, including the International Clinical Trials Registry Platform, from inception up to February 15, 2021, to identify studies that included at least one treatment group wherein nonsurgical interventions were applied. We focused on 1) pain relief and symptom improvement and 2) quality of life and improvement in physical fitness. Results: Four studies (three on low back pain and one on knee osteoarthritis) met all the inclusion criteria. Overall, the risk of bias was high, and meta-analysis could not be performed due to heterogeneity. However, a participatory ergonomic approach, exercise centered on strength training with a transtheoretical model, and/or a combination of both could be included in effective educational programs, at least in the short term, to prevent and/or reduce exacerbation of D-MSCT in farmers. Based on internal and external validity, we could postulate a future research agenda and a conceptual education model to prevent D-MSCT in farmers. Conclusion: Participatory ergonomic intervention, exercise centered on strength training, and/or a combination of both could be included for effective educational programs to prevent and reduce exacerbation of D-MSCT in farmers. High-quality RCTs with a less risk of bias will be implemented for many agricultural work types in various parts worldwide (especially developing countries and regions) during the COVID-19 pandemic.

Relationship Between Neighborhood Food Environment and Diet Variety in Japanese Rural Community-dwelling Elderly: A Cross-sectional Study.

BACKGROUND: Food access is an important aspect of health promotion for the elderly. The aim of this study was to investigate the relationship between distance to the nearest food store and diet variety in rural community-dwelling elderly Japanese. METHODS: This cross-sectional study analyzed data from 1,103 elderly participants surveyed by mail in rural areas of Japan. Diversity of food intake was assessed using the diet variety score (DVS). Street network distance from home to food store was calculated and categorized by quartile using a geographic information system and analyzed in relation to diet using multivariable regression with the primary outcome as low DVS. Sub-analysis of the association with DVS was conducted for each food store category (convenience store, supermarket, and small food store). The association between intake frequency of each food group and distance was also analyzed. RESULTS: Participants in the fourth quartile of distance to food store had significantly higher prevalence ratio (1.15; 95% CI, 1.01-1.32) for low DVS than those in the first quartile. There was a significant tendency between greater distance to food store and lower DVS (P for trend = 0.033). Supermarkets and convenience stores, in particular, showed significant associations. Greater distance was significantly associated with lower frequency of meat and fruit intake. CONCLUSION: There was significant association between distance to nearest food store and diet variety in rural Japanese elderly. These findings suggest the importance of interventions for areas at high risk of low diet variety, such as places far away from food stores.

Effect of Lycopene Intake on the Fasting Blood Glucose Level: A Systematic Review with Meta-Analysis.

Lycopene is a lipophilic unsaturated carotenoid exhibiting a strong singlet oxygen-quenching ability. Herein, we investigated the effect of lycopene intake on the fasting blood glucose (FBG) level by conducting a systematic review and meta-analyses. We searched 15 databases (from the earliest date to June 2022 for PubMed or to August or September 2018 for the other databases) and included human interventional studies that assessed the effects of oral lycopene intake on FBG levels of participants ≥ 18 years of age. Three authors independently selected applicable studies and then assessed the study quality. Data were pooled as standardized mean difference (SMD) and analyzed by the random-effects model. Heterogeneity was assessed by I2 statistics. A meta-analysis including 11 trial arms (n = 750) revealed a tendency towards a significant decrease in FBG level with not-important heterogeneity [SMD = -0.15 (95% CI: -0.31, 0.00), p = 0.05, I2 = 9%]. Subgroup meta-analysis including two studies (n = 152) in type 2 diabetes patients revealed significantly decreased FBG levels with not-important heterogeneity [SMD = -0.37 (95% CI: -0.69, -0.05), p = 0.02, I2 = 0%]. Most studies meeting the eligibility criteria had a moderate risk of bias. The funnel plot for FBG suggested an absence of publication bias. In conclusion, this systematic review and meta-analyses suggested that lycopene intake exerted an FBG-decreasing effect.

Effects of lycopene intake on HDL-cholesterol and triglyceride levels: A systematic review with meta-analysis.

Lycopene is a lipophilic unsaturated carotenoid and has a very strong singlet oxygen-quenching ability. Increased serum or plasma lycopene levels have been reported to be associated with a lower risk of metabolic syndrome. We aimed to investigate the effects of lycopene intake on blood HDL-cholesterol (HCL-c) and triglyceride (TG) levels, which are metabolic syndrome biomarkers, by systematic review and meta-analyses of human interventional trials. We searched 15 databases and included studies that assessed the effects of oral lycopene intake on blood HDL-c and TG levels of participants ≥18 years of age. Three reviewers independently selected applicable studies, then assessed study qualities. Data were pooled as standardized mean difference (SMD) and analyzed by random-effects model. Heterogeneity was assessed by I2 statistics. Meta-analysis including 12 trial arms (n = 781) revealed a significantly increased HDL-c level in the lycopene group compared with that in the control group (SMD = 0.33 [95% CI: 0.12, 0.54], p = 0.002) and moderate heterogeneity (I2  = 45%). Most subgroup meta-analyses (restricted to study design, test food type, intake period, and participants' characteristics) showed similar results for HDL-c level. On the other hand, meta-analysis including 11 studies (n = 854) revealed no significant difference in TG level between the lycopene and control groups. Most studies which met eligibility criteria had moderate risk of bias. Funnel plots for HDL-c and TG suggested an absence of publication bias. In conclusion, this systematic review and meta-analyses suggested that lycopene intake significantly improved blood HDL-c levels but not TG levels.

Italian and Japanese public attention toward balneotherapy in the COVID-19 era.

Italian and Japanese public widely use balneotherapy. The population interest in balneotherapy in coronavirus disease-2019 (COVID-19) era should be investigated. Therefore, we aimed to exploit Google Trends analysis, as a measure of peoples' interest in balneotherapy, in two countries, Italy and Japan. In this infodemiology study, Google Trends was queried for the lay terms widely used by the Italian population to refer to the balneotherapy setting (terme + termale) and by the Japanese to refer to the bathing place and balneotherapy facilities ( + スパ). The internet searches in 2020 were compared to overlapping time spans in 2016-2019 and were correlated with new confirmed cases/deaths. This study demonstrated that from February 23 to June 20, 2020, and from October 4 to December 26, 2020, the internet searches of the Italian words corresponding to balneotherapy were statistically significantly decreased; however, the internet searches were not significantly different in June 21 to October 3, 2020, compared to overlapping time spans in 2016-2019 in Italy. The study also showed that from March 15 to September 5, 2020, and from November 29 to December 26, 2020, the internet searches of the Japanese words corresponding to balneotherapy were statistically significantly decreased; however, the internet searches were significantly increased in September 13 to November 7, 2020, and were not significantly different in November 8 to 28, 2020, compared to overlapping time spans in 2016-2019 in Japan. There were significant negative correlations between the relative search volume and number of new cases (rho=-0.634; p<0.001)/deaths (rho=-0.856; p<0.001) in Italy and the number of new deaths (rho=-0.348; p=0.012) in Japan. Population interest in balneotherapy has changed in the COVID-19 era both in Italy and Japan. During the early stage of pandemic (March to June), the interest was lower. After this early stage, the interest showed a recovery in both countries. In Italy, the population interest reached to its prior levels in late June through early October, with a peak in August. In Japan, the recovery exceeded the prior 4-year levels in mid-September through early November. Then, both countries demonstrated a decline in interest: began in early October in Italy and late November in Japan. This information would allow us to understand/address the population response in the pandemic in respect of the balneotherapy and would guide the preparedness of healthcare providers and planners both in this pandemic and future similar situations.

Compliance of Clinical Trial Protocols for Foods with Function Claims (FFC) in Japan: Consistency between Clinical Trial Registrations and Published Reports.

BACKGROUND: A new type of foods with a health claims notification system, the Foods with Function Claims (FFC), was introduced in Japan in April 2015. This cross-sectional study sought to clarify compliance of clinical trial protocols reported as the scientific basis of efficacy in the FFC system. METHODS: All articles based on clinical trials published on the Consumer Affairs Agency website from 1 July 2018 to 30 June 2021 were reviewed. Items assessed included first author characteristics (for-profit or academia), journal name, year published, journal impact factor in 2020, article language, name of clinical trial registration (CTR), and seven compliance items (Title: T, Participant: P, Intervention: I, Comparison: C, Outcome: O, Study design: S, and Institutional Review Board, IRB). Among studies that conducted CTR, consistency with these seven compliance items was evaluated. RESULTS: Out of 136 studies that met all inclusion criteria, 103 (76%) performed CTR, and CTR was either not performed or not specified for 33 (24%). Compliance between the protocol and the text was high (≥96%) for items P and S, but considerably lower for items T, I, C, O, and IRB (52%, 15%, 13%, 69%, and 27%, respectively). Furthermore, 43% of protocols did not include functional ingredients or food names in items T or I. The total score was 3.7 ± 1.1 pts (out of 7). CONCLUSIONS: Some CTs had no protocol registration, and even registered protocols were suboptimal in transparency. In addition to selective reporting, a new problem identified was that the content of the intervention (test food) was intentionally concealed.

Association of Daily Home-Based Hot Water Bathing and Glycemic Control in Ambulatory Japanese Patients with Type 2 Diabetes Mellitus During the COVID-19 Pandemic: A Multicenter Cross-Sectional Study.

PURPOSE: To clarify the relationship between daily hot water bathing (HWB) at home and glycemic control in middle-aged and elderly ambulatory patients with type 2 diabetes mellitus (T2DM). METHODS: We defined hemoglobin A1c (HbA1c) as the main outcome. We set 7.0% based on the mean value of the dependent variable as the cut-off point for analysis. Frequency of HWB was an explanatory variable. A two-sample t-test was used to compare between groups with continuous variables. Multiple logistic regression analysis was performed for frequency, adjusted age, sex, BMI, T2DM duration (Model 1), and other confounding factors (Model 2). Odds ratio (OR) and 95% confidence interval (95% CI) were calculated. RESULTS: Among 838 patients, there was a significant difference (p<0.001) in age between males (n=528, 62.8±8.7 years) and females (n=310, 65.0±8.1 years). In Model 1, compared with participants who used HWB more than seven times a week, those with poorly controlled HbA1c were significantly associated with low frequency of HWB: four to six times a week (OR 1.32, 95% CI 0.87-1.99) and less than three times a week (OR 1.43, 95% CI 0.98-2.10); p-value for overall trend was 0.041. In Model 2, p-value for overall trend was 0.138. CONCLUSION: A higher frequency of HWB was moderately associated with a decreased risk of poor glycemic control in middle-aged and elderly ambulatory patients with T2DM.

Overview of Systematic Reviews with Meta-Analysis Based on Randomized Controlled Trials of Balneotherapy and Spa Therapy from 2000 to 2019.

BACKGROUND: The objectives of this review were to summarize systematic reviews with meta-analysis of balneotherapy (BT) and spa therapy (ST) based on randomized controlled trials, and to provide a perspective for future research. METHODS: Eligible studies were systematic reviews based on randomized controlled trials with meta-analysis that included at least one group treated with BT or ST. We searched the following databases for articles published in English from the year 2000 to 20 November 2019: Cochrane Database Systematic Review, MEDLINE, CINAHL, Web of Science, and Ichushi-Web. RESULTS: Eighteen studies met all inclusion criteria. Based on the International Classification of Diseases (ICD)-11, among these 18 studies, 8 (44%) were about "#15 Diseases of the musculoskeletal system or connective tissue", 5 (28%) were about "#21 Symptoms, signs or clinical findings, not elsewhere classified", 4 (22%) were about "#11 Diseases of the circulatory system", and 1 study (6%) was about "#8 Diseases of the nervous system". Both BT and ST provided significant pain relief and improved quality of life in chronic diseases of the musculoskeletal system and connective tissues. Additionally, BT and ST with exercise under water improved physical fitness and function in patients across diseases. CONCLUSION: Researchers need to conduct studies on the treatment of many kinds of potential diseases using the keywords of pain relief and QoL. In addition, depending on patients' symptoms, physical fitness, and disabilities, performing exercise under water may improve treatment effects on physical function and fitness.

Quality of Systematic Reviews of the Foods with Function Claims in Japan: Comparative Before- and After-Evaluation of Verification Reports by the Consumer Affairs Agency.

Background: In Japan, a new type of foods with health claims, called Foods with Function Claims (FFC), was introduced in April 2015 in order to make more products available that are clearly labeled with certain health functions. Regarding substantiating product effectiveness, scientific evidence for the proposed function claims must be explained by systematic reviews (SRs), but the quality of SRs was not clear. The objectives of this review were to assess the quality of SRs based on the FFC registered on the Consumer Affairs Agency (CAA) website in Japan, and to determine whether the CAA's verification report in 2016 was associated with improvement in the quality of SRs. Methods: We evaluated the reporting quality of each SR by the AMSTAR checklist on methodological quality. We searched the database from 1 April to 31 October 2015 as the before-SR and from 1 July 2017 to 31 January 2018 as the after-SR. Results: Among the 104 SRs reviewed, 96 final products were included: 51 (53.1%) were supplements, 42 (43.8%) were processed foods without supplements, and 3 (3.1%) were fresh foods. Of the 104 SRs, 92 (88.5%) were qualitative reviews (i.e., without meta-analysis) and 12 (11.5%) performed a meta-analysis. The average quality score of before-SRs and after-SRs was 6.2 ± 1.8 and 5.0 ± 1.9, respectively, a statistically significant decrease (p < 0.001). Conclusion: Overall, the methodology and reporting quality of after-SRs based on the FFC were poorer than those of before-SRs. In particular, there were very poor descriptions and/or implementations of study selection and data extraction, search strategy, evaluation methods for risk of bias, assessment of publication bias, and formulating conclusions based on methodological rigor and scientific quality of the included studies.

Relationship of daily hot water bathing at home and hot water spa bathing with underlying diseases in middle-aged and elderly ambulatory patients: A Japanese multicenter cross-sectional study.

The purpose of this study was to clarify the relationship of daily hot water bathing at home (DHW) and hot water spa bathing (HSPA) with the number of underlying diseases in middle-aged and elderly ambulatory patients. We defined the number of underlying diseases as the main outcome and dependent (criterion) variable. The frequency and time of DHW and the frequency of HSPA were set as explanatory variables. Multiple logistic regression analysis was performed for each frequency and time, adjusted age and sex. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated. Among the 1261 patients who participated, there was no significant difference in age between males (n = 508, 72.8 ± 6.8 years) and females (n = 753, 73.5 ± 6.9 years). There was also no significant age difference between males (number of diseases: 2.7 ± 2.0 pts.) and females (number of diseases: 2.7 ± 2.1 pts.) in the occurrence of underlying diseases. Frequency and time of DHW were not associated with the occurrence of underlying diseases. However, compared with participants who utilized hot water spa at least once a week, the occurrence of underlying diseases was significantly associated with bathing frequency: one to three times per month (OR 2.72, 95% CI 1.63-4.52); twice or five times a year (OR 1.92, 95% CI 1.25-2.94). In conclusion, lower frequency of HSPA was significantly associated with increased risk of the occurrence of underlying diseases in middle-aged and elderly ambulatory patients. However, the relationship between proactive use of hot water spa and patients' mental and physical support should be clarified by well-designed cohort studies. The present study was registered as UMIN000033018 by the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) in Japan (refer: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000037643).

Quality of systematic reviews of the Foods with Function Claims registered at the Consumer Affairs Agency Web site in Japan: a prospective systematic review.

The objective of this review was to assess the quality of systematic reviews (SRs) based on the Foods with Function Claims (FFC) registered at the Consumer Affairs Agency (CAA) Web site in Japan by AMSTAR checklist. Study design was a prospective SR of SRs based on the FFC registered at the CAA Web site in Japan. We searched the database from 1 April 2015 (starting date) through 27 October 2015 on the CAA Web site. A full quality appraisal of identified articles was made using the combined tool based on the AMSTAR checklist developed to assess the methodological quality of SRs. Each item was scored as "present" (yes), "absent" (no), "unclear or inadequately described" (cannot answer), or "not applicable" (N/A). Forty-nine SRs met inclusion criteria. The quality of the articles was in the poor description category (mean±SD; 6.2±1.8 points, range; 2-11 points). Especially, there were very poor descriptions and/or implementations regarding the registration (2%), evaluation of publication bias (12%), and appropriate conclusions based on scientific quality of the included studies (27%). As a whole, the quality of SRs based on the FFC was poor in methodology and reporting. To develop SRs of the FFC and healthy foods, it will be important for future research to introduce and use (1) the AMSTAR checklist (ie, a tool to assess the methodological quality of SRs), (2) the PRISMA (ie, a checklist in the general description of SRs) and PRISMA-NMA checklists (ie, a checklist in the specific description of SRs with meta-analysis), (3) many English databases, (4) development of the original checklist for the FFC and healthy foods, and (5) notification documents (including SR) of the FFC in English.

Association of low back and knee pain with falls in Japanese community-dwelling older adults: A 3-year prospective cohort study.

AIM: To examine whether the chronicity and intensity of low back pain (LBP) or knee pain (KP) was associated with the occurrence of falls among a community-dwelling older population. METHODS: This was a community-based 3-year prospective cohort study. In 2009, baseline questionnaires were mailed to 3080 randomly selected residents aged 60-79 years; 2534 residents (82.3%) responded to the baseline survey, and 1- and 3-year follow-up surveys were subsequently mailed to them. The data for 1890 respondents who had no falls in the past year at baseline were analyzed. Associations between pain status (chronicity, intensity and persistence) and the occurrence of falls were analyzed by multivariable-adjusted logistic regression. RESULTS: A total of 197 (13.6%) participants had at least one fall during 12 months at 3-year follow up; of those, 68 (4.8%) had multiple falls, and 65 (4.5%) resulted in an injury. Chronicity and intensity of LBP were associated with injurious falls (P for trend = 0.033 and P for linearity = 0.041, respectively), and KP was associated with at least one fall (P for trend = 0.021 and P for linearity = 0.040, respectively). In addition, participants who had chronic pain persistently at both baseline and 1-year follow up had a higher risk of falls (LBP for injurious falls; adjusted odd ratio 2.46, 95% confidence interval 1.08-5.63, KP for at least one fall; adjusted odd ratio 2.39, 95% confidence interval 1.29-4.44), compared with those who had no pain at both time-points. CONCLUSIONS: LBP and KP chronicity, intensity and persistence of chronic pain were associated with a greater risk of falls in older adults. Geriatr Gerontol Int 2017; 17: 875-884.

Effectiveness of Pilates exercise: A quality evaluation and summary of systematic reviews based on randomized controlled trials.

OBJECTIVE: The objective of this review were to summarize evidence for the effectiveness of Pilates exercise (PE) and to assess the quality of systematic review (SRs) based on randomized controlled trials (RCTs). STUDY DESIGN: A systematic review of SRs based on RCTs. METHODS: Studies were eligible if they were RCTs. Studies included those with one treatment group in which PE was applied. We searched the following databases from 1995 up to August 20, 2014: MEDLINE via PubMed, CINAHL, Web of Science, Global Health Library, and Ichushi-Web. We also searched All Cochrane Database and Campbell Systematic Reviews up to August 20, 2014. Based on the International Classification of Diseases-10 (ICD-10), we identified a disease targeted for each article. RESULTS: Nine studies met all inclusion criteria. As a whole, the quality of the articles was good. Seven studies were about "Musculoskeletal system and connective tissue (M5456)". There were two studies in "Factors influencing health status and contact with health services (Z723)". The traits of participants were for females and the comparatively young- and middle-aged. Five SRs for chronic low back pain (CLBP) concluded that there was pain-relief and functional improvement of the intervention in the short term, but two SRs were inconclusive about the effectiveness of PE. There were no adverse events described in any of the studies. CONCLUSION: Although no SR reported any adverse effect or harm by PE, there was pain-relief and functional improvement attributed to PE in the short term in participants with CLBP. There was also evidence of improved flexibility and dynamic balance, and of enhanced muscular endurance in healthy people in the short term. In addition, there may have been an effect on body composition in the short term.

Association between knee pain and gait speed decline in rural Japanese community-dwelling older adults: 1-year prospective cohort study.

AIM: The present study examined whether knee pain was associated with decline in maximum gait speed (MGS) in a rural mountainous region. METHODS: This was a population-based 1-year prospective cohort study. A total of 658 men and women aged 60 years and older participated in the baseline survey in 2006, and 400 individuals participated in the follow-up survey in 2007. We compared the incidence of meaningful decline in gait speed (≥0.1 m/s) in older adults with different knee pain levels (none, mild, severe), estimating incidence rate ratio (IRR) by multivariable-adjusted Poisson regression model. RESULTS: Meaningful decline in MGS presented in 24.3% of participants, especially in men (30.3%). Baseline knee pain level was significantly related to meaningful decline in MGS after adjustment of potential confounders (IRR 1.79 for mild pain, 1.84 for severe pain; P for trend <0.01). In sensitivity analyses with change in MGS as the continuous variable, the association was not significant, but a similar negative association with knee pain was confirmed (mild pain ß = -0.040, severe pain ß = -0.088; P for trend = 0.104). In addition, older adults with knee pain at both baseline and follow up had a higher risk of meaningful decline in MGS (IRR 2.33, 95% CI 1.59-3.40) compared with those who had no pain at baseline or follow up. CONCLUSIONS: Knee pain was associated with a decline in gait speed at 1-year follow up. Prevention and treatment of knee pain might be important for suppression of decline in physical function in older adults.

Effect of Polydextrose Intake on Constipation in Japanese Dialysis Patients: A Triple-Blind, Randomized, Controlled Trial.

The objective of the present study was to evaluate bowel habits induced by ingestion of 10 g polydextrose (PDX) fed to Japanese hemodialysis (HD) patients. This was a randomized, placebo-controlled, triple-blind, parallel-group controlled, 8-wk study. A total of 50 HD outpatients capable of self-management (51-79 y of age) were recruited at H Clinic, Japan. Inclusion criteria for participation in the study were ingestion of one or more laxative tablets for more than 3 mo and having received HD for more than 6 mo. The participants were randomly assigned to 2 groups: A (0 g polydextrose/d; control), B (10 g polydextrose/d; PDX). The primary outcome measure was stool frequency. Secondary outcomes were stool consistency, abdominal pain, intestinal bloating and clinical biochemistry indexes. PDX had no significant effect on blood biochemistry indexes. The PDX group showed significant improvements in bowel function (stool frequency increased from 3.0 times per week to 7.5 times per week) and reported no laxation problems (abdominal distention, cramps, and diarrhea) (p<0.01). Regular consumption of the PDX products increased dietary fiber intake to recommended levels and improved bowel habits.

Association between musculoskeletal pain and trips or falls in rural Japanese community-dwelling older adults: a cross-sectional study.

AIM: The present study examined whether low back pain (LBP) and knee pain (KP) are associated with trips and falls in rural Japanese community-dwelling older adults. METHODS: A population-based cross-sectional survey of community-dwelling older adults was carried out in Unnan City, Shimane Prefecture, in Japan. A total of 499 men and women aged 60 years and older living in the community were recruited from 2008 to 2010. The main outcome measures were self-rated recent trip frequency and self-reported experience of falls in the past year. RESULTS: Trips and falls presented in 44.0% and 15.9% of participants, respectively. LBP was not associated with trips, but was significantly associated with falls: severe pain versus single fall (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.04-6.03); and severe pain versus multiple falls (OR 11.09, 95% CI 2.41-51.10). KP was significantly associated with trips: mild pain versus trips (OR 1.81, 95% CI 1.20-2.72); mild pain versus multiple falls (OR 4.47, 95% CI 1.21-16.50); severe pain versus trips (OR 3.83, 95% CI 1.82-8.04); and severe pain versus multiple falls (OR 7.26, 95% CI 1.51-34.86). Participants with both pain sites were associated with trips (OR 2.44, 95% CI 1.45-4.12) and multiple falls (OR 10.79, 95% CI 1.33-87.19). CONCLUSIONS: Severe LBP was associated with single and multiple falls, whereas KP was associated with trips and multiple falls, irrespective of severity of pain. In addition, participants with both pain types were associated with trips and multiple falls.