The prevalence of glomerular hyperfiltration increased with increasing stages of prediabetes and prehypertension. Therefore, kidney function should be monitored in subjects with prediabetes or prehypertension. In subjects with hyperfiltration, earlier treatment of hyperglycemia and high BP may be necessary to prevent the development of kidney damage.

Aim: All health insurers in Japan are mandated to provide Specific Health Checkups and Specific Health Guidance (SHG) focusing on metabolic syndrome (MetS) in middle-aged adults, beginning in 2008; intensive HG for individuals who have abdominal obesity and two or more additional MetS risk factors, and motivational HG for individuals with one risk factor. The aim of this study is to describe medium-term changes in health indexes for intensive and motivational HG groups using the National Database.Methods: We compared changes of risk factors and initiation of pharmacological therapy over 3 yr between participants (n = 31,790) and nonparticipants (n = 189,726) who were eligible for SHG in 2008.Results: Body weight reduction in intensive HG was 1.98 kg (participants) vs 0.42 kg (nonparticipants) in men (p < 0.01) and 2.25 vs 0.68 kg in women (p < 0.01) after 1 yr. In motivational HG, the respective reduction was 1.40 vs 0.30 kg in men (p < 0.01) and 1.53 vs 0.42 kg in women (p < 0.01). Waist circumference reduction was also greatest among participants in intensive HG (2.34 cm in men and 2.98 cm in women). These reductions were fairly unchanged over 3 yr and accompanied greater improvements in MetS risk factors in participants. We also detected significantly smaller percentages of SHG participants who initiated pharmacological therapy compared with nonparticipants.Conclusion: Participants in SHG showed greater improvements in MetS profiles with proportionally smaller pharmacological treatment initiations than did nonparticipants for 3 yr. Although selection bias may be present, this study suggests SHG would be a feasible strategy to prevent MetS and its sequelae.

This large epidemiological survey of older people examined oral hypofunction and the relationship between oral hypofunction and frailty. Methods: Participants were community-dwelling adults aged 65-85 years in Japan. The oral function evaluation included seven items (oral hygiene, oral dryness, occlusal force, tonguelip motor function, tongue pressure, masticatory function and swallowing function), and oral hypofunction was defined as having abnormalities in at least three of these items. The frailty status was classified into three categories (robust, pre-frail and frail) according to the total Kihon Checklist score. We analyzed 978 subjects with complete data. The relationship between oral function and frailty status was analyzed using multivariate multinomial logistic regression analyses. Results: Approximately 60% of the older adults had oral hypofunction. The multivariate odds ratios (ORs) for a pre-frail or frail status were significantly higher for older people with reduced occlusal force, reduced tongue-lip motor function and deteriorated swallowing function than in those without deterioration of those items. Of the oral function items, swallowing function was most strongly associated with the frailty status, and the ORs (95% confidence interval [CI]) for deteriorated swallowing function in pre-frail and frail patients were 6.4 (3.9-10.8) and 10.2 (5.4-19.1), respectively. Those with oral hypofunction had significantly higher adjusted ORs for pre-frail (OR 1.4, 95% CI 1.1-2.0) and frail (OR 2.1, 95% CI 1.2-3.5) statuses. Conclusion: Many community-dwelling older people have reduced oral function or oral hypofunction, which is significantly associated with frailty in older people. Geriatr Gerontol Int 2020; 20: 917-926.

BackgroundA randomized control trial was performed to test whether a lifestyle intervention program, carried out in a primary healthcare setting using existing resources, can reduce the incidence of type 2 diabetes in Japanese with impaired glucose tolerance (IGT). The results of 3 years' intervention are summarized.MethodsThrough health checkups in communities and workplaces, 304 middle-aged IGT subjects with a mean body mass index (BMI) of 24.5 kg/m2 were recruited and randomized to the intervention group or control group. The lifestyle intervention was carried out for 3 years by public health nurses using the curriculum and educational materials provided by the study group.ResultsAfter 1 year, the intervention had significantly improved body weight (-1.5 ± 0.7 vs. -0.7 ± 2.5 kg in the control; p = 0.023) and daily non-exercise leisure time energy expenditure (25 ± 113 vs. -3 ± 98 kcal; p = 0.045). Insulin sensitivity assessed by the Matsuda index was improved by the intervention during the 3 years. The 3-year cumulative incidence tended to be lower in the intervention group (14.8% vs.8.2%, log-rank test: p = 0.097). In a sub-analysis for the subjects with a BMI > 22.5 kg/m2, a significant reduction in the cumulative incidence was found (p = 0.027).ConclusionsThe present lifestyle intervention program using existing healthcare resources is beneficial in preventing diabetes in Japanese with IGT. This has important implications for primary healthcare-based diabetes prevention.Trial registration numberUMIN000003136

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