Association Between the Appendicular Extracellular-to-Intracellular Water Ratio and All-Cause Mortality: A 10-Year Longitudinal Study.

The appendicular extracellular-to-intracellular water ratio (A-E/I) is a potential marker of skeletal muscle quality, reflecting the balance of water distribution between the extracellular and intracellular compartments of the appendicular limb regions. A-E/I has been increasingly used in recent studies; however, its association with adverse outcomes remains unclear. This study investigated the potential association between A-E/I and all-cause mortality. A prospective cohort study of 8 015 middle-aged and older adults (comprised of 4 755 women, aged 45-74 years) residing in a Japanese community was conducted. The baseline assessment was performed between 2010 and 2012, and the follow-up period lasted until July 2022. A-E/I and skeletal muscle mass were measured using segmental bioelectrical impedance spectroscopy. Handgrip strength (HGS) was measured using a Smedley-type dynamometer. Lifestyle, medical history, and physical activity were assessed by questionnaire and accelerometer. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for each quartile (Q) of A-E/I were estimated using the multivariable Cox regression model. During a 10.5-year median follow-up, the mortality rates were 8.9 and 3.6 per 1 000 person-years for men (292 deaths) and women (174 deaths), respectively. A-E/I quartiles were positively associated with all-cause mortality in both sexes (men: Q1, HR: 1.0 [95% CI: reference], Q4, HR: 1.8 [1.1-2.9], ptrend < .05; women, Q4, HR: 2.2 [1.3-3.8], ptrend < .01). This association remained significant after further adjustment for skeletal muscle mass and HGS (ptrend < .05). Our findings suggest that A-E/I serves as an early predictive marker for mortality in middle-aged and older Japanese adults.

Comparison of Bioelectrical Impedance Indices for Skeletal Muscle Mass and Intracellular Water Measurements of Physically Active Young Men and Athletes.

BACKGROUND: Bioelectrical impedance analysis (BIA) is a minimally invasive, safe, easy, and quick technology used to determine body composition. OBJECTIVES: We compared the relationship among impedance indices obtained using single-frequency BIA, multi-frequency BIA, bioelectrical impedance spectroscopy (BIS), and skeletal muscle mass (SMM) of physically active young men and athletes using the creatine (methyl-d3) dilution method. We also compared the SMM and intracellular water (ICW) of athletes and active young men measured using a reference stable isotope dilution and BIS method, respectively. METHODS: We analyzed data from 28 men (mean age, 20 ± 2 y) who exercised regularly. Single-frequency BIA at 5 kHz and 50 kHz (R5 and R50), multi-frequency BIA (R250-5), and BIS (RICW) methods of determining the SMM were compared. The deuterium and sodium bromide dilution methods of obtaining the total body water, ICW, and extracellular water measurements were also used, and the results were compared to those acquired using bioimpedance methods. RESULTS: The correlation coefficients between SMM and L2/R5, L2/R50, L2/R250-5, and L2/RICW were 0.738, 0.762, 0.790, and 0.790, respectively (P < 0.01). The correlation coefficients between ICW and L2/R5, L2/R50, L2/R250-5, and L2/RICW were 0.660, 0.687, 0.758, and 0.730, respectively (P < 0.001). However, the correlation coefficients of L2/R50, L2/R250-5, and L2/RICW for SMM and ICW were not significantly different. CONCLUSIONS: Our findings suggest that single-frequency BIA at L2/R50, multi-frequency BIA, and BIS are valid for assessing the SMM of athletes and active young men. Additionally, we confirmed that the SMM and ICW were correlated with single-frequency BIA, multi-frequency BIA, and BIS. Bioimpedance technologies may be dependable and practical means for assessing SMM and hydration compartment status of active young adult males; however, cross-validation is needed.

Dose-response relationship between daily step count and prevalence of sarcopenia: A cross-sectional study.

OBJECTIVES: Daily step counts are an easy-to-understand indicator of physical activity; however, there is limited evidence regarding the optimal daily step count to prevent sarcopenia. This study examined the dose-response relationship between daily step count and the prevalence of sarcopenia and explored the optimal dose. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: The study included 7949 community-dwelling middle-aged and older adults (aged 45-74 years) from Japan. MEASUREMENTS: Skeletal muscle mass (SMM) was assessed using bioelectrical impedance spectroscopy, and muscle strength was quantified through handgrip strength (HGS) measurement. Participants who exhibited both low HGS (men: <28 kg, women: <18 kg) and low SMM (lowest quartile in each sex-specific category) were defined as having sarcopenia. Daily step counts were measured for 10 days using a waist-mounted accelerometer. To examine the association between daily step count and sarcopenia, a multivariate logistic regression analysis was performed, adjusting for potential confounding factors such as age, sex, body mass index, smoking status, alcohol consumption, protein intake, and medical history. The odds ratios (ORs) and confidence intervals (CIs) were calculated based on the daily step counts categorized into quartiles (Q1-Q4). Finally, a restricted cubic spline curve was fitted to further investigate the dose-response relationship between daily step count and sarcopenia. RESULTS: The prevalence of sarcopenia in the overall participants was 3.3 % (259/7949 participants), with a mean daily step count of 7292 ± 2966 steps. Expressed in quartiles, the mean daily step counts were 3873 ± 935 steps in Q1, 6025 ± 503 steps in Q2, 7942 ± 624 steps in Q3, and 11,328 ± 1912 steps in Q4. The prevalence of sarcopenia in each quartile of daily step count was 4.7 % (93/1987 participants) in Q1, 3.4 % (68/1987 participants) in Q2, 2.7 % (53/1988 participants) in Q3, and 2.3 % (45/1987 participants) in Q4. The ORs and 95 % CIs adjusted for covariates demonstrated a statistically significant inverse association between daily step count and sarcopenia prevalence (P for trend <0.01), as follows: Q1, reference; Q2, 0.79 (95 % CI: 0.55-1.11); Q3, 0.71 (95 % CI: 0.49-1.03); Q4, 0.61 (95 % CI: 0.41-0.90). The restricted cubic spline curve indicated that the ORs leveled off at approximately 8000 steps per day, and no statistically significant decrease in ORs was observed for daily step counts above this threshold. CONCLUSIONS: The study found a significant inverse association between daily step count and the prevalence of sarcopenia, with the association plateauing when the daily step count exceeded approximately 8000 steps. These findings suggest that 8000 steps per day may be the optimal dose to prevent sarcopenia. Further intervention and longitudinal studies are needed to validate the results.

Association of appendicular extracellular-to-intracellular water ratio with age, muscle strength, and physical activity in 8,018 community-dwelling middle-aged and older adults.

BACKGROUND: The appendicular extracellular-to-intracellular water ratio (Ap ECW/ICW) has recently gained attention as a non-invasive measurable marker of muscle quality. However, there is a lack of basic evidence regarding age-related changes, sex differences, contribution to muscle strength independent of skeletal muscle mass (SMM), and potential improvement through physical activity (PA) in Ap ECW/ICW. METHODS: This cross-sectional study enrolled 8,018 middle-aged and older Japanese individuals (aged 45-75 years). The Ap ECW/ICW and SMM were measured using segmental bioelectrical impedance spectroscopy. Muscle strength was evaluated by measuring the handgrip strength (HGS) with a dynamometer, and the PA level (PAL) was measured with an accelerometer. We performed a linear regression analysis of the associations of the Ap ECW/ICW with age, HGS, and PAL. RESULTS: The Ap ECW/ICW increased by 0.019 for men and 0.014 for women per 5-year increase in age (p < 0.001), and the age-related increase was greater in men than in women (p for interaction <0.001). The Ap ECW/ICW was more strongly associated with the HGS than with the SMM in both men and women (p < 0.001). PAL showed a significant inverse association with the Ap ECW/ICW in both men and women (p < 0.001). CONCLUSIONS: Ap ECW/ICW is higher with age, and it varies by sex. The Ap ECW/ICW may reflect muscle strength more than the SMM, suggesting that the Ap ECW/ICW may be improved by PA. The findings from this study may provide a framework for further Ap ECW/ICW research.

Skeletal muscle mass can be estimated by creatine (methyl-d3) dilution and is correlated with fat-free mass in active young males.

BACKGROUND: Assessing whole-body skeletal muscle mass (SMM) and fat-free mass (FFM) is essential for the adequate nutritional management and training evaluation of athletes and trained individuals. This study aimed to determine the relationship between SMM assessed using the creatine (methyl-d3) dilution (D3-creatine) method and SMM estimated by whole-body magnetic resonance imaging (MRI) in healthy young men undergoing exercise training. Additionally, we examined the association between FFM measured using the four-component (4C) method (FFM4C) and the total body protein value estimated using 4C (TBpro4C). METHODS AND RESULTS: We analyzed the data of 29 males (mean age, 19.9 ± 1.8 years) who exercised regularly. SMM measurements were obtained using the D3-creatine method (SMMD3-creatine) and MRI (SMMMRI). The SMMD3-creatine adjusted to 4.3 g/SMM kg was significantly higher than SMMMRI (p < 0.01). The fit of the creatine pool size compared with SMMMRI was 5.0 g/SMMMRI kg. SMMMRI was significantly correlated with both SMMD3-creatine adjusted to 4.3 g/kg and 5.1 g/kg. TBpro4C was significantly lower than SMMMRI (p < 0.01). Contrastingly, FFM4C was significantly higher than SMMMRI (p < 0.01). CONCLUSIONS: SMMD3-creatine adjusted to 4.3 g/SMM kg-a previously reported value-may differ for athletes and active young males. We believe that a value of 5.0-5.1 g/SMM kg better estimates the total muscle mass in this population. Traditional FFM estimation highly correlates with SMMMRI in well-trained young males, and the relationships appear strong enough for total body protein or SMM to be estimated through the FFM value.

Relationship between Measured Aerobic Capacity and Total Energy Expenditure Obtained by the Doubly Labeled Water Method in Community-Dwelling, Healthy Adults Aged 81-94 Years.

The doubly labeled water method is a gold-standard method for the measurement of total energy expenditure in daily life. We aimed to identify the relationship between measured aerobic capacity and total energy expenditure, activity energy expenditure, or physical activity level using the doubly labeled water method in adults of advanced old age. A total of 12 physically independent older adults (10 men and 2 women), aged 81-94 years, participated in this study. The aerobic capacity was evaluated according to the lactate threshold. Total energy expenditure under free-living conditions was assessed using the doubly labeled water method, and self-reported physical activity was obtained using the Japanese version of the International Physical Activity Questionnaire. The lactate threshold was significantly positively correlated with total energy expenditure, activity energy expenditure, and physical activity level after adjusting for age and sex. We found that the aerobic capacity of the lactate threshold was positively and independently correlated with total energy expenditure, activity energy expenditure, or physical activity level. The present results suggest that maintaining aerobic capacity is an important factor in preventing frailty, although further research is required.

Association between Water and Energy Requirements with Physical Activity and Fat-Free Mass in Preschool Children in Japan.

Water and energy are essential for the human body. The doubly labeled water (DLW) method measures water turnover (WT) and total energy expenditure (TEE), which serves as a benchmark for the adequate intake (AI) of water and estimated energy requirements (EER). The objective of the current study was to examine the association of WT and TEE with physical activity and body composition in Japanese preschool children. We included 41 preschool children (22 girls, 19 boys) aged 3-6 in this study. WT, TEE, and fat-free mass (FFM) were obtained using DLW. Physical activity was measured using a triaxial accelerometer and categorized as light (LPA; 1.5-2.9 Metabolic equivalents, METs) and of moderate-to-vigorous intensity (MVPA; ≥3.0 METs). Exercise duration (Ex) was defined as ≥4.0 METs of physical activity. WT and TEE moderately positively correlated with Ex, but not with LPA. WT moderately positively correlated with BW and FFM while TEE strongly. We established predictive equations for WT and TEE using body weight (BW), FFM, step count, and Ex to guide the AI of water and EER in Japanese preschool children. We found that FFM and step count are the determinants of TEE, and that BW and Ex are the determinants of WT in preschool children.

Association between habitual coffee consumption and skeletal muscle mass in middle-aged and older Japanese people.

AIMS: Coffee consumption has been suggested, in animal studies, to inhibit the progression of sarcopenia, possibly through its anti-inflammatory effects; however, few studies have been carried out in humans. We aimed to examine whether coffee consumption was related to indicators of sarcopenia in a Japanese population, and whether the association was mediated by reduced inflammation. METHODS: This study was a cross-sectional design. Participants were community residents (n = 6369) aged 45-74 years. We measured skeletal muscle mass index (SMI; kg/m2 ) by a bioelectrical impedance method, and grip strength with a Smedley-type dynamometer. Habitual coffee consumption was assessed by a self-administered questionnaire. Serum high-sensitivity C-reactive protein was measured as an inflammatory marker. The association between habitual coffee consumption and SMI or grip strength was analyzed with a linear regression model adjusted for covariates. RESULTS: A significant positive association was found between coffee consumption and SMI (men: ß = 0.023; Ptrend  = 0.004, women: ß = 0.011; Ptrend  = 0.012). Further adjustment for high-sensitivity C-reactive protein did not materially alter the results (men: ß = 0.023; Ptrend  = 0.005, women: ß = 0.009; Ptrend  = 0.024). The relationship between coffee consumption and grip strength did not reach statistical significance; however, a positive trend was observed (men: ß = 0.208; Ptrend  = 0.085, women: ß = 0.092; Ptrend  = 0.167). CONCLUSIONS: We found that coffee consumption was positively associated with SMI independently of inflammation in middle-aged and older Japanese people. Reduced inflammation by coffee does not seem to be an important mediator, and further investigations are required to explore the mechanisms of this association. Geriatr Gerontol Int 2021; 21: 950-958.

Association between the inability to identify particular odors and physical performance, cognitive function, and/or brain atrophy in community-dwelling older adults from the Fukuoka Island City study.

BACKGROUND: Olfactory dysfunction is associated with severe brain atrophy and cognitive impairment in Parkinson's disease. However, it remains unknown whether an inability to identify particular odors is associated with physical performance, cognitive function, and/or brain atrophy in community-dwelling older adults. METHODS: In this cross-sectional study, 44 community-dwelling older adults were included (14 males, 30 females; mean age: 72.4 ± 5.7 years, range: 63-85 years). The Odor Stick Identification Test for Japanese, consisting of 12 odors, was used to examine olfaction. Subjects also completed physical performance (lower limb function, balance, and gait speed) and cognitive function (global cognition, logical memory, and the Trail Making Tests). Additionally, magnetic resonance imaging was used to investigate brain atrophy in the bilateral medial temporal area (MTA) and whole gray matter using the voxel-based specific regional analysis system for Alzheimer's disease. RESULTS: Total olfaction was not significantly associated with physical performance, cognitive function, or brain atrophy. However, MTA atrophy was associated with an inability to identify Japanese orange (B: - 0.293; ß: - 0.347; p < .05) after adjusting for age and sex (R2: 0.328; adjusted R2: 0.277). Subjects who were unable to identify Japanese orange (n = 30) had worse MTA atrophy than those who were able to identify Japanese orange (n = 14), even after adjusting for covariates (p < .05). CONCLUSIONS: Total olfaction was not associated with physical performance, cognitive function, or brain atrophy. However, an inability to identify Japanese orange odor was independently associated with mild MTA atrophy among community-dwelling older adults.

Evaluation of fat-free mass hydration in athletes and non-athletes.

PURPOSE: To evaluate the hydration of fat-free mass (FFM) in athletes and non-athletes. METHODS: We analyzed the data of 128 healthy young adults (athletes: 61 men, 36 women; non-athletes: 19 men, 12 women) using the two-component (2C), 3C and 4C models. Under-water weighing or air-displacement plethysmography and deuterium dilution methods were used for estimating body density and total body water, respectively. The bone mineral content (BMC) was determined using whole-body scans by dual-energy X-ray absorptiometry. RESULTS: There was no significant difference in FFM hydration between the athletes (men, 72.3 ± 1.3%; women, 71.8 ± 1.3%) and non-athletes (men, 72.1 ± 1.2%; women, 72.2% ± 1.0%) in the 3C model. The total mean FFM hydration (72.1% ± 1.3%) was similar to the corresponding value in the literature (~ 73%). The estimation error of the percentage fat by the 2C vs the 4C model was significantly and highly correlated with hydration (r = 0.96), BMC (r = - 0.70), and total body protein (r = - 0.86) in the 4C model FFM. CONCLUSION: Although FFM hydration was similar in athletes and non-athletes, it would be underestimated or overestimated when the 2C model is used for evaluation, and the biological FFM hydration value deviates from the 73% value inter-individually. Despite that this inter-individual variation in FFM hydration is low in terms of between-individual standard deviation (1.3%), the BMC and total body protein differ greatly in athletes, and when it affects FFM hydration, it may also affect the percentage fat measurement in the 2C model. Thus, FFM hydration would not be affected by FFM, percent body fat, or the athletic status.

Physical Activity and/or High Protein Intake Maintains Fat-Free Mass in Older People with Mild Disability; the Fukuoka Island City Study: A Cross-Sectional Study.

Body composition changes with age, with fat mass (FM) increasing and fat-free mass (FFM) decreasing. Higher physical activity and high or adequate protein intake are thought to be beneficial in preventing the loss of skeletal muscle mass in the elderly. We aimed to investigate the relationships between physical activity, protein intake, and FFM in older people with mild disability. Total energy expenditure (TEE) under free-living conditions was assessed using the doubly-labelled water (DLW) method, and physical activity was measured using a triaxial accelerometer. Dietary intake was assessed using a self-recorded food intake diary during the DLW period. Percent FFM was significantly positively correlated with protein intake and physical activity level (PAL) after adjustment for age and sex (protein intake r = 0.652, p < 0.001, PAL r = 0.345, p = 0.011). In multiple linear regression analysis, when PAL, moderate-to-vigorous physical activity (MVPA), or protein intake were included, 31%, 32%, and 55%, respectively, of the variation in %FFM was explained. Moreover, the addition of both PAL/MVPA and protein intake explained 61%/60%, respectively, of the variation in %FFM. Either protein intake above the currently recommended level or higher levels of physical activity would be beneficial for the maintenance of high %FFM.

Habitual Light-intensity Physical Activity and ASC Methylation in a Middle-aged Population.

Apoptosis-associated, speck-like protein containing a caspase recruitment domain (ASC) plays an important role in inflammatory cytokine synthesis in peripheral blood mononuclear cells (PBMCs), and the expression of ASC is suppressed by increased methylation of its CpG sites. The current study investigated the longitudinal association of replacing sedentary time with light-intensity physical activity (LPA) or moderate to vigorous-intensity physical activity (MVPA) on the ASC methylation in middle-aged people. We investigated 1 238 individuals who participated in baseline and 5-year follow-up surveys of a population-based cohort study. Sedentary, LPA and MVPA time were objectively measured using accelerometers. ASC methylation in PBMCs was measured by pyrosequencing. Using a multiple linear regression and employing an isotemporal substitution model, the longitudinal associations of changes in the sedentary time, LPA and MVPA on the changes in the ASC methylation were analyzed after adjusting for potential confounders. Substituting 60 min per day of LPA for sedentary time was associated with 1.17 times (95% confidence interval 1.07, 1.27) higher ASC methylation levels (mean of 7 CpG sites, P<0.001). However, such effects were not seen for MVPA. These results suggest that substituting LPA for sedentary time may be linked with increased (favorable) ASC methylation as a potential biomarker of systemic inflammation.

Total Energy Expenditure, Physical Activity Level, and Water Turnover of Collegiate Dinghy Sailors in a Training Camp.

Prior studies have examined offshore sailing and energy strategies using accurate total energy expenditure (TEE) measurement in free-living conditions. However, no research has studied energy and water requirement during dinghy class sailing such as an Olympic event with concentrated training. This study aimed to investigate the TEE, physical activity level (PAL), and water turnover (rH2O) of collegiate dinghy sailors in a training camp using the doubly labeled water (DLW) method. Eleven dinghy sailing collegiate athletes (9 males and 2 females) participated. The DLW method was used to determine the participants' TEE and PAL over 8 days (6 training, 2 non-training days). Participants trained approximately 7 h/day on water. Body fat was measured using a stable-isotope dilution method. The rH2O was estimated using deuterium turnover. The mean TEE, PAL, and rH2O were 17.30 ± 4.22 MJ/day (4133 ± 1009 kcal/day), 2.8 ± 0.3 (range, 2.1 to 4.1), and 3.3±0.7 (range, 2.6 to 4.5) L/day, respectively. To our knowledge, this was the first study to use the DLW method to determine TEE, PAL, and rH2O as references for competitive dinghy sailors in a spring training camp. Our results may serve as a reference to assist competitive dinghy sailors in determining their required nutritional support.

Total energy expenditure in elite open-water swimmers.

This study aimed to examine the total energy expenditure (TEE) and physical activity level (PAL) of elite open-water swimmers. Our study group included 5 world-class competitive open-water swimmers. TEE was measured using the doubly labeled water method for 1 week. The TEE was 4549 ± 1185 kcal/day. The PAL was 3.22 ± 0.46. Our results may provide a reference to optimize energy requirement support.

Coping strategy and social support modify the association between perceived stress and C-reactive protein: a longitudinal study of healthy men and women.

Inconsistent associations have been reported between perceived stress and C-reactive protein (CRP), a marker of systemic inflammation. We previously observed a male-specific inverse relationship between perceived stress and CRP in a cross-sectional study. In the present study, we examined the longitudinal association between changes in perceived stress and CRP, and further analyzed whether changes in coping strategies and social support modify this association. This study included 8454 participants in both a baseline survey and a follow-up survey 5 years later. Psychosocial measures (i.e. perceived stress, coping strategies, and social support) and CRP concentrations were measured by identical means in both surveys. Consistent with our previous findings, increased perceived stress was significantly associated with lower CRP in men (ptrend = .037), but not in women. Increased "emotional expression," a coping strategy, was also associated with lower CRP in women (ptrend = .024). Furthermore, interactions between perceived stress and a coping strategy (positive reappraisal) or social support on CRP were found in men (pinteraction = .007 and .038, respectively); the above inverse association between stress and CRP was not detected for participants with diminished positive reappraisal or social support. In conclusion, increases in perceived stress during a 5-year period were associated with decreases in CRP among healthy men, and the observed association was possibly modified by coping strategy or social support.

Intensity-specific effect of physical activity on urinary levels of 8-hydroxydeoxyguanosine in middle-aged Japanese.

Physical activity (PA) is recommended to both promote and maintain health and prevent cancer by improving the body's DNA repair system, which is considered a mechanism of cancer prevention. However, associations between PA and urinary levels of 8-hydroxydeoxyguanosine (8-OH-dG), which reflects DNA damage, are unclear. This cross-sectional study included 2370 men and 4052 women aged 45-74 years enrolled between 2010 and 2012. Habitual PA was assessed by single-axis accelerometer and urinary 8-OH-dG levels by automated HPLC. Multiple linear regression analysis was used to examine the relationship between log-transformed urinary 8-OH-dG and total PA (TPA) and PA of moderate/vigorous intensity (MVPA; ≥3 metabolic equivalents), with adjustment for age, body mass index, energy intake, alcohol consumption, smoking status, daily coffee drinking, menopause status (in women), and TPA (for MVPA). On multivariate adjustment, urinary 8-OH-dG levels were inversely correlated with TPA (ß = -0.020, P < 0.01) in women, and this correlation was not changed by PA intensity. Conversely, urinary 8-OH-dG levels were inversely correlated with MVPA (ß = -0.022, P < 0.05) in men, although the correlation with TPA was non-significant. This inverse correlation was clearer in current smokers than in never or former smokers, although the interaction between smoking status and MVPA on urinary 8-OH-dG levels was non-significant. In conclusion, greater TPA in women and greater MVPA in men were correlated with reduction in urinary 8-OH-dG, suggesting sex-specific effects of MVPA and TPA on protection from oxidative DNA damage. Increasing PA may mediate reduction in oxidative stress.

Factors associated with non-participation in a face-to-face second survey conducted 5 years after the baseline survey.

BACKGROUND: Non-participation in second surveys is reported to be associated with certain baseline characteristics; however, such data are unavailable for Japanese populations. Although disease incidence during follow-up might influence participation, few reports have addressed this possibility. This study sought to identify factors associated with non-participation in a second survey of a population-based cohort, and to evaluate the influence of self-reported disease incidence on non-participation. METHODS: After excluding participants who left the area (n = 423), died (n = 163), and withdrew from the study (n = 9) among 12 078 participants in a baseline survey for the Japan Multi-Institutional Collaborative Cohort Study in the Saga region between 2005 and 2007, 11 483 people were invited by mail to participate in a face-to-face second survey between 2010 and 2012. The 5-year clinical health history of non-participants was assessed by mail or telephone. Baseline characteristics and self-reported clinical outcomes of non-participants were compared with those of participants. RESULTS: Among 11 483 people, 8454 (73.6%) participated in the second survey, and 2608 out of 3029 non-participants answered mail or telephone health surveys. Female sex, youngest and oldest ages, lower education, lower occupational class, current smoking, lower physical activity level, shorter sleep time, obesity, and constipation were associated with non-participation. Light drinking (0.1-22.9 g ethanol/day) was associated with participation. Non-participants reported a significantly higher incidence of cancer and a significantly lower proportion of hypertension compared with participants. CONCLUSIONS: Both baseline characteristics and disease incidence during the follow-up period had significant associations with non-participation in the face-to-face second survey.