岡本 尚子

BACKGROUND: Second-hand smoke exposure has been associated with poor mental health. However, among Japanese adults, little is known about the association between second-hand smoking and depressive symptoms. We examined this association in a cross-sectional study among a Japanese general adult population sample. METHODS: Japanese adults were recruited from the Japan Multi-Institutional Collaborative Cohort Study in the Okazaki area between 2012 and 2017. Second-hand smoke exposure and smoking status were assessed using a self-administered questionnaire. Based on their frequency of exposure to second-hand smoke, non-smokers and smokers were categorized as "almost never," "sometimes," and "almost every day". Depressive symptoms were defined by a Kessler 6 score ≥5 points. We performed a multivariable Poisson regression analysis to obtain adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for depressive symptoms. RESULTS: Overall, 5,121 participants (4,547 non-smokers and 574 smokers) were included whose mean age was 63.6 (standard deviation [SD], 10.3) years for non-smokers and 59.33 (SD, 10.2) years for smokers. The association between second-hand smoking and depressive symptoms was significant among non-smokers, but not among smokers. Among non-smokers, PRs compared with "almost never" were 1.25 (95% CI, 1.09-1.42) for "sometimes" and 1.41 (95% CI, 1.09-1.84) for "almost every day" (P for trend <0.001); among smokers, PRs compared with "almost never" were 1.30 (95% CI, 0.82-2.06) for "sometimes" and 1.44 (95% CI, 0.90-2.33) for "almost every day" (P for trend = 0.144). CONCLUSIONS: Second-hand smoking and depressive symptoms were associated among non-smokers. Our findings indicate the importance of tobacco smoke control for mental health.

Objectives: Family caregiver burden is associated with higher psychological distress. However, little is known about the impact of neighbourhood relationships on caregivers’ psychological distress. We examined whether neighbourhood relationships of caregivers moderate the association between family caregiver burden and psychological distress. Study design: This was a cross-sectional study. Methods: We recruited 5321 Japanese adults who participated in the Japan Multi-Institutional Collaborative Cohort Study in the Okazaki area between 2013 and 2017. Participants completed self-reported questionnaires to measure psychological distress (Kessler 6: K6), subjective caregiver burden, and neighbourhood relationships. We performed a multivariable linear regression analysis in which caregiver burden was designated as an independent variable and the K6 score as a dependent variable, adjusting for demographics. The interaction term between caregiver burden and neighbourhood relationships was also included in the analysis. Results: Data from a total of 5069 participants were included (mean age [standard deviation]: 63.1 years [10.3 years]; 2226 [43.9%] female). Caregiver burden was significantly and positively associated with psychological distress (compared with no burden, mild burden: β = 0.24, P = 0.197; severe burden: β = 0.60, P < 0.01; P for trend < 0.01). There was a significant negative interaction effect of caregiver burden × neighbourhood relationship on psychological distress (severe burden × good neighbourhood relationship: β = −3.29, P < 0.01). Conclusions: A higher caregiver burden was associated with higher psychological distress, and neighbourhood relationships moderated this association. Our findings suggest that good neighbourhood relationships can buffer caregiving-associated psychological distress.

We examined the association between family caregiver burden and subjective well-being with social participation's moderating effect among Japanese adults. Data were obtained from a cross-sectional survey by the Japan Multi-Institutional Collaborative Cohort Study in the Okazaki area between 2013 and 2017. Study participants included 5321 adults who visited the Public Health Center for annual health check-ups and answered a questionnaire regarding health status and lifestyle. Subjective well-being was assessed by a single item, out of 10 points, and analyzed with multivariable linear regression analysis models by subjective family caregiver burden ("none", "mild", "severe"), stratified by gender. Ultimately, 2857 men and 2223 women were included. Mean participant age (standard deviation) in years was 64.7 (10.4) for men and 61.3 (10.0) for women. Multivariable analysis revealed that, among women, higher caregiver burden was inversely associated with subjective well-being (p for trend < 0.001), and the interaction of severe caregiver burden and social participation on subjective well-being was positive and significant (p for interaction < 0.05). High family caregiver burden was inversely associated with subjective well-being among Japanese women, but moderated by the caregiver's social participation, suggesting the importance of community development that enables family caregivers' social participation to protect their subjective well-being.

OBJECTIVE: We aimed to examine missing data in FFQ and to assess the effects on estimating dietary intake by comparing between multiple imputation and zero imputation. DESIGN: We used data from the Okazaki Japan Multi-Institutional Collaborative Cohort (J-MICC) study. A self-administered questionnaire including an FFQ was implemented at baseline (FFQ1) and 5-year follow-up (FFQ2). Missing values in FFQ2 were replaced by corresponding FFQ1 values, multiple imputation and zero imputation. SETTING: A methodological sub-study of the Okazaki J-MICC study.ParticipantsOf a total of 7585 men and women aged 35-79 years at baseline, we analysed data for 5120 participants who answered all items in FFQ1 and at least 50% of items in FFQ2. RESULTS: Among 5120 participants, the proportion of missing data was 3·7%. The increasing number of missing food items in FFQ2 varied with personal characteristics. Missing food items not eaten often in FFQ2 were likely to represent zero intake in FFQ1. Most food items showed that the observed proportion of zero intake was likely to be similar to the probability that the missing value is zero intake. Compared with FFQ1 values, multiple imputation had smaller differences of total energy and nutrient estimates, except for alcohol, than zero imputation. CONCLUSIONS: Our results indicate that missing values due to zero intake, namely missing not at random, in FFQ can be predicted reasonably well from observed data. Multiple imputation performed better than zero imputation for most nutrients and may be applied to FFQ data when missing is low.

BACKGROUND: It is known that physical activity affects glucose metabolism. However, there have been no reports on the influence of physical activity earlier in life on subsequent glucose metabolism. Therefore, we analyzed the influence of physical activity in earlier decades of life on insulin resistance in middle aged and older residents in Japan. METHODS: The subjects were 6,883 residents of Okazaki City between the ages of 40 and 79 years who underwent physical examinations at the Okazaki City Medical Association Public Health Center from April 2007 through August 2011. They gave informed consent for participation in the study. Data on individual characteristics were collected via a questionnaire and from the health examination records. Fasting blood glucose and insulin levels were used to calculate the homeostatic model assessment of insulin resistance (HOMA-IR). HOMA-IR >1.6 was considered to indicate insulin resistance for the purpose of logistic regression models. RESULTS: The study sample included 3,683 men and 3,200 women for whom complete information was available. For those who exercised regularly throughout their teens to their 30s-40s, the odds ratio for having insulin resistance was 0.75 (95% confidence interval [CI], 0.58-0.96) for men and 0.76 (95% CI, 0.58-0.99) for women after adjusting for other variables, including age, body mass index, and present physical activity. A linear trend was also observed in both men and women. CONCLUSIONS: Subjects who have exercised regularly in the early decades of life are less likely to have insulin resistance later in life.

<p>目的：身体活動は糖代謝に影響を及ぼすことが知られており，生活習慣病の予防と密接な関係をもつ。我々は過去の身体活動について若年期の身体活動量に着目し，壮年期以降の糖代謝との関係について調査した。</p><p>方法：対象者は，40歳から79歳までの愛知県岡崎市の住民で，2007年4月から2011年8月までの間に岡崎市医師会公衆衛生センターで健康診断を受け，研究への参加に同意が得られた者とした。過去の身体活動量とインスリン抵抗性との関連を検討するために，質問紙から得られた年齢，BMI，飲酒および喫煙習慣，現在の運動習慣を調整した多変量線形回帰分析を行った。</p><p>結果：最終的に男女合計2,378名から得られたデータを分析した。インスリン抵抗性を目的変数とした多変量線形回帰分析の結果，インスリン抵抗性と年齢，BMIには有意に正の関連を認め，飲酒習慣，現在の運動習慣，若年期の身体活動には有意に負の関連を認めた。20代の「やりすぎ」群を除いては，インスリン抵抗性の正常範囲内の数値であった。</p><p>結論：若年期に定期的な身体活動がある場合，壮年期以降のインスリン抵抗性をもつ割合は低く，身体活動量が多くなるにつれてインスリン抵抗性が低くなる傾向がみられた。</p>

<p>目的 出生体重と，その後の成人期以降に生じ得る生活習慣病との関連を明らかにすることで，生活習慣病対策に寄与できるかを検討した。</p><p>方法 人間ドックを受診した34歳～79歳の地域住民のうち，研究参加に同意が得られた7,575人から，自記式調査票で，「出生体重はどのくらいでしたか」という質問に対し「非常に大きかった」「大きかった」「普通」「小さかった」「未熟児」の5群いずれかを回答した5,812人（男性3,046人，女性2,766人）を対象とした。このうち出生体重が「非常に大きかった・大きかった」「普通」「小さかった」「未熟児」に当てはまる4群の，生活習慣病関連の検査値について，出生時の体重を「普通」と回答した者をリファレンスとしたロジスティック回帰分析を行い，年齢，Body Mass Index(BMI)，喫煙歴，アルコール歴，家族歴を補正したオッズ比(95％信頼区間(CI))を算出した。</p><p>結果 出生体重を「普通」と回答した者に比べ，男性では，出生体重「非常に大きかった・大きかった」回答群で，インスリン抵抗性高値のオッズ比が0.59(95%CI:0.44-0.79),肥満のオッズ比が1.32(95%CI:1.05-1.68)と有意であった。また，出生体重「小さかった」回答群で，拡張期血圧高値のオッズ比が1.33(95%CI：1.01-1.76)，ヘモグロビンA1c高値のオッズ比が1.54(95%CI:1.15-2.06)であった。女性では，出生体重「非常に大きかった・大きかった」回答群で，肥満のオッズ比が1.39(95%CI:1.02-1.89)，出生体重「小さかった」回答群で中性脂肪高値のオッズ比が1.49(95%CI:1.01-2.20), 出生体重「未熟児」回答群で，収縮期血圧高値のオッズ比が1.78(95%CI:1.11-2.87)，肥満のオッズ比が2.24(95%CI:1.44-3.50)であった。</p><p>結論 将来の生活習慣病発症の予防のためには，出生体重をリスクの一つとして捉え，出生直後から切れ目のない支援を続けることが重要となる可能性が示唆された。</p>

Home cooking has been suggested as a key to healthy dietary intakes. However, little is known about the association between cooking behaviour and nutrient intake among young-to-middle-aged women. We aimed to investigate the association between home cooking frequency and nutrient intake adequacy among married Japanese women. Self-administered questionnaires were used to assess the weekly frequency of cooking dinner at home and habitual nutrient intake during the preceding month. We evaluated nutrient intake adequacy by comparing the self-reported intake with two indices of the dietary reference intakes for Japanese (2015): the estimated average requirement (EAR) of fourteen nutrients, and the 'tentative dietary goal for preventing lifestyle-related diseases' (DG) of seven nutrients. A total of 143 participants (25-44 years old) completed the questionnaires, with 32·9 % of participants reporting a weekly home cooking frequency of seven times/week. Women with a higher home cooking frequency (seven times/week) were more likely to have children (P = 0·001) than those with a lower home cooking frequency (0-6 times/week). Of the nutrients evaluated, there was no significant difference between the two groups in meeting EAR and DG. Our findings suggest that daily home cooking may not be necessary to achieve adequate nutrient intake, specifically among married, young-to-middle-aged Japanese women.

子宮内発育不全に起因する低出生体重児は、生活習慣病のリスクが高いことが知られている。本研究では、日本の地域住民の出生時体重と2型糖尿病との関連性について検討した。

BMIのデータが存在する時、腹囲が肥満情報の追加にどれぐらい有用かについて検討した。

A growing body of evidence from Western countries shows that the presence of children in households is associated with the dietary intake of adults, but little is known about this relationship in non-Western countries with different food cultures. Our aim was to examine whether dietary intake was different with respect to the presence of young children in the home among Japanese married women. Subjects were Japanese married women (aged 23-44 years) living with children aged less than 5 years (n 73) and married women who did not have children (n 85). Data regarding habitual dietary intake were obtained using a validated, self-administered diet history questionnaire. A cross-sectional comparison between women with young children and women without children was conducted using ANCOVA adjusted for potential confounding factors. Women with young children had a significantly greater intake of protein, carbohydrates, Na, Zn and Cu than did women without children. Intake of cereals, pulses and sugar was significantly higher among mothers than among non-mothers. Intake of both alcoholic and non-alcoholic beverages was significantly higher among non-mothers than among mothers. Thus, the presence of young children at home might influence women's intake of macronutrients and some minerals, especially Na, and beverages among Japanese married women. Our findings suggest that effective dietary interventions among Japanese mothers with young children may differ from those of married women without children.

Objective: Inconsistent results have been found in prior studies investigating the accuracy of self-reported waist circumference, and no study has investigated the validity of self-reported waist circumference among Japanese individuals. This study used the diagnostic standard of metabolic syndrome to assess the accuracy of individual's self-reported height, weight and waist circumference in a Japanese sample. Methods: Study participants included 7,443 Japanese men and women aged 35-79 years. They participated in a cohort study's baseline survey between 2007 and 2011. Participants' height, weight and waist circumference were measured, and their body mass index was calculated. Self-reported values were collected through a questionnaire before the examination. Results: Strong correlations between measured and self-reported values for height, weight and body mass index were detected. The correlation was lowest for waist circumference (men, 0.87; women, 0.73). Men significantly overestimated their waist circumference (mean difference, 0.8 cm), whereas women significantly underestimated theirs (mean difference, 5.1 cm). The sensitivity of self-reported waist circumference using the cut-off value of metabolic syndrome was 0.83 for men and 0.57 for women. Conclusions: Due to systematic and random errors, the accuracy of self-reported waist circumference was low. Therefore, waist circumference should be measured without relying on self-reported values, particularly in the case of women.

日本人を対象に身長、体重、BMI、腹囲の測定値と自己申告値とを比較し、自己申告値の正確性を確認した。

BACKGROUND: Although open-ended dietary assessment methods, such as weighed food records (WFRs), are generally considered to be comparable, differences between procedures may influence outcome when WFRs are conducted independently. In this paper, we assess the procedures of WFRs in two studies to describe their dietary assessment procedures and compare the subsequent outcomes. METHODS: WFRs of 12 days (3 days for four seasons) were conducted as reference methods for intake data, in accordance with the study protocol, among a subsample of participants of two large cohort studies. We compared the WFR procedures descriptively. We also compared some dietary intake variables, such as the frequency of foods and dishes and contributing foods, to determine whether there were differences in the portion size distribution and intra- and inter-individual variation in nutrient intakes caused by the difference in procedures. RESULTS: General procedures of the dietary records were conducted in accordance with the National Health and Nutrition Survey and were the same for both studies. Differences were seen in 1) selection of multiple days (non-consecutive days versus consecutive days); and 2) survey sheet recording method (individual versus family participation). However, the foods contributing to intake of energy and selected nutrients, the portion size distribution, and intra- and inter-individual variation in nutrient intakes were similar between the two studies. CONCLUSION: Our comparison of WFR procedures in two independent studies revealed several differences. Notwithstanding these procedural differences, however, the subsequent outcomes were similar.

健診受診者から選択した7526名(男4136名、女3390名、35〜79歳)を対象として、血清硫酸デヒドロエピアンドロステロンサルフェイト(DHEAS)濃度と年齢、性、一般的健康指標(身長、体重、腹囲、血圧、呼吸機能、音響的骨評価指数)および血液・尿試験成績との関連について横断研究を行った。その結果、血清DHEASは男女の年齢と中程度の相関を示し、男女両性で年齢は他のほぼ全評価項目と中程度の相関を示した。女性では血清アルブミン(Alb)と年齢との相関が非常に弱かったが、ほぼ全評価項目が年齢と中程度から強い相関を示した。年齢と相関する評価項目を除外すると女性群の血清Albのみが残るが、年齢や性ほどの影響はなかった。血清DHEASに及ぼす年齢の効果は男女両性で大きく、他の評価項目との相関は非常に弱かった。以上より、血清DHEASは年齢・性以外の評価項目とは独立した要因であり、年齢・性は血清DHEAS濃度の主要指標になりうると考えられた。

<p>目的：敷地内全面禁煙は，非喫煙者を受動喫煙による健康被害から守り，喫煙者の禁煙を促すのに有効な方法と考えられる．名古屋市立大学では2006年6月よりキャンパス敷地内全面禁煙となり，6年が経過した．そこで，キャンパス敷地内全面禁煙化後の医学生の喫煙率や，喫煙に関する意識の変化を調べた．</p><p>方法：喫煙に関する意識調査として2007年12月に全学職員・学生を対象に実施したものと，2012年4月に医学部学生を対象として実施したものについて，医学部1～5年生の集計結果を比較検討した．</p><p>結果：回収率は2007年調査では57.0%，2012年調査では92.6%であった．男子喫煙率は全学年で9.94%から5.39%，女子喫煙率は2.37%から1.65%といずれも減少しており，2012年調査では1年生の喫煙者は男女ともに0名だった．キャンパス敷地内全面禁煙については「知っていた」と回答した割合は84.9%から66.2%と有意に減少し，喫煙環境に無関心な非喫煙者が増えている状況がうかがえた．また喫煙者の平均年齢は，2007年調査時は22.3±4.2歳であったが，2012年調査では25.9±4.2歳と有意に高かった．</p><p>結論：キャンパス敷地内全面禁煙化から6年経ち，喫煙率は低下した一方，敷地内全面禁煙の認知度が低下していたことから，今後の防煙教育や禁煙対策に向けた新たな課題が明らかになった．</p>

OBJECTIVE: To evaluate the effect of diet versus exercise intervention on weight reduction. METHODS: Participants were randomly divided by gender, age, and living area into four groups: group DE (diet and exercise, n = 16), group D (diet only, n = 15), group E (exercise only, n = 15), and group C (control, n = 16). This study ultimately aimed to help participants reduce their body mass index (BMI) by 7% of baseline value. Subjects were 62 residents (men and women ranging in age from 40 to 69 years) of two residential areas in Nara Prefecture, Japan, who participated in annual health checkups in 2006. BMI of the participants was ≥24 and <28 kg/m² at baseline examination. All participants agreed to undergo a 6-month intervention between January 2007 and September 2007. RESULTS: In our intention-to-treat analysis, mean change in BMI from baseline to final examination was as follows: group DE mean BMI decreased 6.6%, group D mean BMI decreased 5.3%, group E mean BMI decreased 2.3%, and group C mean BMI decreased 2.2%. The reduction in BMI from baseline to final examination was significant in all groups (DE, p < 0.001; D, p < 0.001; E, p = 0.009; C, p = 0.019). Further, mean abdominal circumference was significantly reduced in all groups. Blood glucose levels were significantly reduced only in group DE (p = 0.047). CONCLUSION: Combined intervention with diet and exercise proved to be effective in weight reduction, whereas exercise intervention alone was not found to be effective.

BACKGROUND: A previous study reported the development a 75-item food frequency questionnaire for Japanese children (CFFQ). The first aim was to examine the reproducibility and validity of the CFFQ in order to assess dietary intake among two groups; 3-11 year old children (YC group) and 12-16 year old children (AD group). The second aim was to use the CFFQ and the FFQ for adults (AFFQ), and to determine which was better suited for assessing the intake of children in each group. METHODS: A total of the 103 children participated in this study. The interval between the first CFFQ and AFFQ and the second CFFQ and AFFQ was one month. Four weighted dietary records (WDRs) were conducted once a week. Pearson's correlation coefficients between the first and second FFQs were calculated to test the reproducibility of each FFQ. Pearson's correlation coefficients between WDRs and the second FFQ were calculated for the unadjusted value and sex-, age-, and energy-adjusted values to determine the validity of each FFQ. RESULTS: The final number of subjects participating in the analysis was 89. The median correlation coefficients between the first and second CFFQs and AFFQs were 0.76 and 0.73, respectively. There was some over/underestimation of nutrients in the CFFQ of the YC group and in the AFFQ of the AD group. The medians of the sex-, age-, and energy-adjusted correlation coefficients were not different between the YC and AD groups for each FFQ. The correlation coefficient in sex-, age-, and energy-adjusted value revealed that the largest number of subject with high (0.50 or more) value was obtained by the CFFQ in the YC group. CONCLUSIONS: This study indicated that the CFFQ might be a useful tool for assessing habitual dietary intake of children in the YC group. Although the CFFQ agreed moderately with habitual intake, it was found to underestimate intake in theAD group. However, for the AFFQ, the ability to rank habitual intake was low. Therefore, it is necessary to develop a new FFQ or modify an existing FFQ to accurately assess the habitual diet of children in the AD group.

BACKGROUND: Food frequency questionnaires (FFQ) are used for epidemiological studies. Because of the wide variations in dietary habits within different populations, a FFQ must be developed to suit the specific group. To date, no FFQ has been developed for Japanese children. In this study, we developed a FFQ to assess the regular dietary intake of Japanese children. The FFQ included questions regarding both individual food items and mixed dishes. METHODS: Children (3-11 years of age, n = 621) were recruited as subjects. Their parents or guardians completed a weighed dietary record (WDR) for each subject in one day. We defined FOOD to be not only as a single food item but also as a mixed dish. The dieticians conceptually grouped similar FOODs as FOOD types. We used a contribution analysis and a multiple regression analysis to select FOOD types. RESULTS: We obtained a total of 586 children's dietary data (297 boys and 289 girls). In addition, we obtained 1,043 FOODs. Dieticians grouped into similar FOODs, yielding 275 FOOD types. A total of 115 FOOD types were chosen using a contribution analysis and a multiple regression analysis, then we excluded overlapping items. FOOD types that were eaten by fewer than 15 subjects were excluded; 74 FOOD types remained. We also added liver-based dishes that provided a high amount of retinol. A total of 75 FOOD types were finally determined for the FFQ. The frequency response formats were classified into four type categories: seven, eight, nine and eleven, according to the general intake frequency of each FOOD type. Information on portion size was obtained from the photographs of each listed FOOD type in real scale size, which was the average amount of the children's portion sizes. CONCLUSIONS: Using both a contribution analysis and a multiple regression analysis, we developed a 75-food item questionnaire from the study involving 586 children. The next step will involve the verification of FFQ reproducibility and validity.